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KEYWORDS
Questions
Answer
33
Core
measures
Joint
Commission
CMS
Standardizati
on
Alerts about
core measure
patients
Problem list
How are core
measure
patients
identified in the
system? How
are appropriate
people alerted?
Dependent on system functionality
Proposed Rule requires problembased list.
Each system must have a problembased list that can be extracted
electronically to permit/encourage
clinical decision support and
research on aggregate patients.
Reviewed by
(Taskforce Member)
Julie Luengas
Melissa Barthold
Lisa Bove
Brenda Kulhanek
Data or Evidence?
Certification Commission
for Health Information
Technology
http://www.cchit.org/
https://www.cms.gov/EH
RIncentivePrograms/Dow
nloads/Hosp_CAH_MUTOC.pdf
Vendors can assist with
standardization of these measures in
their system by designing
automated solutions based on
Snomed or ICD-9 codes and creating
mini-applications to permit easy
identification of core measure
patients.
CMS-Electronic
Specifications
http://www.cms.gov/Qual
ityMeasures/03_Electroni
cSpecifications.asp#TopO
fPage
Federal Register, January
13, 2010. Medicare and
Medicaid Programs;
Electronic Health Record
Incentive Program,
Proposed Rule.
http://edocket.access.gpo
.gov/2010/pdf/E931217.pdf
34
Robert
How is the flow
of
information/co
mmunication
managed
between
Page 1 of 9
Reference/Source
Date
9-9-2011
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35
36
Clinical alerts
Isolation
Alerts
Decision
support
inpatient units,
the
Perioperative
area and back including
pharmacy. How
are the different
systems
involved?
Is best of breed
better - or
integrated
system better?
How is the
clinical staff
notified of a
patient's need
for isolation,
based on lab
results from a
prior admission?
Clinical alerts can be based on:
Prior lab results - few staff members
have the time to review labs from
previous admissions. Some results
would continue to require isolation
(e.g. MDRO, VRE) while others (CDIFF) may not require on the
admission.
Clinical staff should be alerted about
patients in the first category so that
appropriate action should be taken.
The alert should be generated as
soon as the patient is admitted,
hopefully prior to the patient's
admission to the nursing unit.
If isolation is based on hospital
policy, an automatic order set could
be created that would be activated
on the patient's admission (after
approval by MEC and Infection
Control Department.)
Jane McNeive
Julie Luengas
Melissa Barthold
Lisa Bove
Brenda Kulhanek
Larson, E, Cohen, B, Ross, B
& Behta, M. “Isolation
Precautions for MethcillinResistant Staphylococcus
Aureus: Electronic
Surveillance to Monitor
Adherence. American
Journal of Critical Care 13.1
(2010): 16-26
Magnus, M. Herwehe, J.,
Andrews, L, Gibson, L, et al.
“Evaluating Health
Information Technology:
Provider Satisfaction with an
HIV-Specfic, Electronic
Clinical Management and
Reporting System.. ADS
Patient Care & STD’s 23.2
(2009): 85-91.
Robeznieks, A. “Doctors are
beginning to accept e-alerts:
study”. Modern Healthcare
36.3 (2006)
Juster, I. “Technology-
Page 2 of 9
9-9-2011
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driven Interactive Care
Management Identifies and
Resolves More Clinical
Issues than a Claims-Based
Alerting System. Disease
Management 8.3 (2005)
188-197
37
New orders
CPOE
Notification
to RN
Flags
New order
alerts
Communicati
on
How are nurses
notified of new
orders in a CPOE
environment?
System dependent.
One system's process:
After order is entered - it appears as
a red flag in 'New Orders'. This 'New
Orders' column appears on several
different screens that are frequently
used by nurses. The actual order
appears on the Task List. Once
order is acknowledged, it removes
the flag for that nurse. (This is core
function of a system.)
Melissa Barthold
Jim Cato
Brenda Kulhanek
Lisa Bove
Julie Luegnas
9-9-2011
Another system uses the clerk to
send a text message of the
copied/pasted order to the nurse's
VoIP phone.
Some systems use an electronic
status board - tv screen hung on the
wall in different parts of the unit to
display the census with an indicator
of a new order.
38
Is current
practice
documenting at
the bedside or
Older means of communication - i.e.
verbal, phone calls - should be
employed in the case of stat/urgent
orders. Face to face communication
can not be ignored.
Best practice is not to transcribe
from paper into the electronic
system, where practical.
In most instances, there is no point
Mark Sugrue
Melissa Barthold
Julie Luengas
Julie Kliewer
Page 3 of 9
Courtney,, KL, Demiiris, G,
Alexander, GL
Information technology:
changing nursing processes
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away from the
bedside?
of care documentation. Only bar
code medication administration was
done at the patient’s bedside. The
computers on wheels are in the
hallways and nurses are charting
there.
Interesting transformation, since
most nurses had no issue charting
on the paper chart in the patient’s
room.
There is a cultural issue – most
nurses will sit at the station to chart
at a area that is ‘theirs’ for the shift.
VS documentation that is transcribed
has 25% errors.
at the point-of-care”.
Nursing Administration
Quarterly 29.4 (2005) 315322.
POC documentation may also be
dependent to some degree on the
hardware in use.
39
Best Methods
for end-user
training?
40
(continue
of a
question
created.
What is an
electronic
signature?
Shrager, F. E. (2010).
Revamping end-user
training. CIN: Computers,
Informatics, Nursing, 28(1),
5-7.
Elements of performance for
rc.01.02.01
1. Only authorized staff make
entries in the medical record
2. The organization defines the
types of entries in the medical
record made by nonindependent practitioners that
require countersigning, in
accordance with law and
regulation.
3. The author of each medical
record entry is identified in the
medical record.
4. Entries in the medical record
are authenticated by the
Melissa Barthold
Jim Cato
Brenda Kulhanek
Joint Commission: Manual
on Healthcare Accrediation,
2009
Digital signatures at heart of
health care reform debate
(2007, October 27).
http://healthcare.zdnet.com
/?p=397
Digital Signatures Tutorial.
Explains the criteria for a
legal signature, then
explains how digital
signature technology works,
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provides information about
public key certificates and
closes with a discussion of
challenges and
opportunities.
http://www.abanet.org/scite
ch/ec/isc/dsg-tutorial.html
author. Information introduced
into the medical record
through transcription or
dictation is authenticated by
the author.
Note 1: Authentication can be
verified through electronic
signatures, written signatures or
initials, rubber-stamp signatures,
or computer key.
Youd, David. What is a
Digital Signature? A very
simplified description of a
digital signature.
http://www.youdzone.com/s
ignature.html
Note 2: For paperbased records, signatures entered
for purposes of authentication
after transcription or for verbal
orders are dated when required
by law or regulation or
organization policy. For electronic
records, electronic signatures will
be date-stamped.
1. The individual identified by the
signature stamp or method of
electronic authentication is the
only individual who uses it.
2. The organization credentials all
staff before they are given
access to enter orders.
41
What is
appropriate
email etiquette
for healthcare
organizations?
101 Email Etiquette. 2010
101 Email Information Tips
http://www.101emailetiquet
tetips.com/
Email Etiquette. 2010.
Emailreplies.com
http://www.emailreplies.co
m/
IEmail Etiquette. About.com
2010
http://careerplanning.about.
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com/od/communication/a/e
mail_etiquette.htm
42
How are RN’s as
well as ancillary
care providers
notified of an
order being
discontinued?
(electronic
system – CPOE)
This will be system
dependent. With
functionality of ‘nurse
review’, an icon will
appear on the patient
locator, indicating a new
order (this can be any new
order, including
discontinuation). The ‘big
four’ systems indicate new
orders with an icon.
Mark Sugrue
Melissa Barthold
Julie Luengas
Julie Kliewer
Brenda Kulhanek
Some sites are using paper
printouts for orders, in
addition to signing orders
electronically.
There is a hierarchy that
will define priority of
orders, especially of
orders that need to be
discontinued very soon.
When the nurse is using the
computer, the process needs
to be checking the orders
prior to a
treatment/medication
administration. Orders
must be checked prior – and
this can eliminate the 24
hr chart check.
Melissa will
How should
It is still important to
verbally communicate
between the provider and
the nurse.
Normal is a healthy human
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get info from
caring list.
Within defined
limits be used?
being. Based on the
patient’s condition/status
the patient’s ‘normal’ may,
in reality, be abnormal.
The system must, if ‘within
normal limits’ is selected,
clearly state what those
normal/defined limits are.
Organizations that are
interested in nursing
research are more
interested in discrete data
fields. Hospitals that
aren’t research-based may
not be as interested.
Some of the vendors
products were not built to
handle ‘charting by
exception’ well. May
require reworking of the
software.
‘Within normal limits’ is
not as appropriate as
‘within defined limits’.
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43
How do we
address the lack
of nursing’s
voice in ARRA?
Sensmeier, J. “Achieving
ARRA without nurses?> Not
Likely”. HIMSS blog. Date
of access: 8-10-2010
http://blog.himss.org/2010/
08/13/achieving-arraoutcomes%c2%a0without%
c2%a0nurses%c2%a0not%
c2%a0likely/
Education to basic nurse on
the importance of NI to
their practice.
Include NI
concepts/theories/applicati
ons in basic courses.
Emmions, N. “Higher
Purpose: What Meaningful
Use Means to Nurses”.
Nurse.com Date of Access:
8-06-10
http://news.nurse.com/articl
e/20100809/NATIONAL01/1
08090064/-1/frontpage
44
CPOE
With CPOE
implementation,
do you need a
separate order
for each
different
indication for a
medication?
(Example: if
Tylenol is
ordered for pain
and fever, do
you need two
different orders?
How does the
nurse document
the Tylenol?)
No answer yet – may be a
particular mock surveyor’s
preference.
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45
Countinued
Charting by
Exception
Lisa Bove
Mark Sugrue
Brenda Kulhanek
Melissa Barthold
Page 9 of 9