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Update on iSparrow EMR
- Mike Zaroukian, MD, PhD; VP & CMIO
Connecting to Purpose iSparrow EMR and the Sparrow Way
The Sparrow Way
Adhering to patient-centered, evidence-based best practices
Reduce unnecessary
variation
Deliver national benchmark-level
outcomes
iSparrow EMR as essential enabling technology, yet only a tool
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Update on iSparrow EMR iSparrow Guiding Principles iSparrow EMR Implementation Timeline
- Mike Zaroukian, MD, PhD; VP & CMIO
Patient and family needs will drive system design
We own our implementation and
outcomes
Get live quick…then focus on optimization
We will use Epic applications to
develop an integrated system
We will standardize our work and
workflows
iSparrow users will be trained and demonstrate proficiency
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Update on iSparrow EMR Selected Key Scoping Decisions Affecting Physicians Approved by IPAG and MSEC
Scope Question Decision
How will you go live? “Big Bang” or phased?
Big Bang — All 4 Sparrow facilities will go-live with clinical documentation & CPOE on 12/1/2012
What will your training requirements be for all physicians who use Epic?
8+ hours of required classroom training + proficiency test
What types of training will you require?
Classroom training + e-learning modules
Will you mandate computerized physician order entry (CPOE)?
YES: Go-Live with CPOE at same time as Go-Live for Phase II hospitals
Will you allow physicians to dictate after Epic is live?
YES: IPAG to determine policies & procedures for structured data entry vs. partial/full dictation vs. Voice Recognition.
What will your source(s) be for clinical content?
Selected ProVation (powered by UpToDate) for Order Sets and Care Plans.
How will Sparrow validate, maintain and update clinical content?
Create clinical content governance structure for physician order sets, nursing care plans, and clinical documentation.
- Mike Zaroukian, MD, PhD; VP & CMIO
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Update on iSparrow EMR Selected Key Scoping Decisions Affecting Physicians Approved by IPAG and MSEC
Scope Question Decision
To what extent will you standardize workflows and content across hospitals and departments?
Strive to standardize workflows and across all sites.
Will you replace niche systems that departments use with Epic?
Implement “all” Epic modules (including OB & OR) to meet quality & safety goals, work closely with departments to address concerns.
Who ‘owns’ the Problem List?
Physicians, PAs, NPs will own the Problem List.
Does your organization have a clearly defined policy on protocols and standing orders?
IPAG will lead and work with ICAC regarding validation of current policies, with final approval by MSEC.
Will you send prescriptions electronically?
YES (as in the ambulatory environment)
Where will clinicians authenticate transcriptions?
Authentication will be completed in Epic.
- Mike Zaroukian, MD, PhD; VP & CMIO
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Update on iSparrow EMR
iSparrow EMR Physician Training Requirements
Physician Training and EMR Satisfaction: Key Findings of a Recent Survey* EHR satisfaction highly correlated with - Involvement in EHR selection - Med staff overwhelming chose Epic in 2008) - Amount of training (more is better) Usability ratings for Meaningful Use tasks and advanced features… - Higher among those with more training
All end users, including physicians, require training
Many “wish they had gotten more out of training”
Success factors
• General computer literacy
• Classroom training
• E-Learning
• Practice in realistic “playground” environment
• Super users to facilitate, reinforce learning, provide support
• Post go-live training
• The Correlation of Training Duration with EHR Usability and Satisfaction:
• Implications for Meaningful Use. AmericanEHR Partners, 2011
- Mike Zaroukian, MD, PhD; VP & CMIO
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Update on iSparrow EMR
iSparrow EMR Physician Training Requirements
Approved requirements for receiving an iSparrow ID/password (live system) - 8(+) hours of mandatory classroom training - Successful score on proficiency test(s) Other training highly recommended
What the Medical Staff Bylaws, Policies and Procedures Manual Say About Training
EMR training/proficiency requirement supported (P&P Manual, p. 88)
Successful completion of required iSparrow EMR training and proficiency assessments will be mandatory for all physicians admitting or caring for patients at Sparrow and is required… - To have a User ID and password to access the live EMR - To avoid temporary suspension of privileges
Training Requirement and Registration: Watch Your Mailbox
Mailing to offices the week of April 16 - MSEC and IPAG have repeatedly affirmed that classroom training and demonstrated proficiency will be mandatory for maintenance of provider privileges in any Sparrow Hospital after Nov. 30, 2012.” - If you will care for patients at a Sparrow ED, inpatient or outpatient department after Dec 1, 2012, you need to complete Hospital-based iSparrow EMR training and pass proficiency assessments >
- Mike Zaroukian, MD, PhD; VP & CMIO
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Update on iSparrow EMR
Physician Training Schedule
Building Order Sets and Care Plans PROVATION
Evidence-based medicine order sets use best current evidence available to justify the decisions for the care of a patient with certain conditions.
Super-user training 9/17 - 10/12
End-user training 10/8 - 11/16
Classes occur in 4-hour blocks:
7:30 am - 11:30 am
12:30 pm - 4:30 pm
5:30 pm - 9:30 pm
Training available at SCH, SIH
Weekend classes also available
Physician Training Tracks
– Physician • Physician OB
• Physician Cardiologist
• Physician Invasive Procedures
– Surgeon • Surgeon OB
• Surgeon Cardiologist
– ED Physician
– Radiologist, Radiologist Interventional
– Anesthesiologist
– Physician Assistant, Nurse Practitioners [Mid-Level]
Physician
Registration Hotline
1-800-Sparrow
SPARROW ORDER SETS Paper Based
(~400)
ProVation Evidence-based Order Set Content
Admission Allergy Anesthesiology Breast Cardiovascular Endocrine / Metabolic ENT Gastrointestinal Genitourinary Genitourinary Female Genitourinary Male Health Maintenance Hematologic / Oncologic
Infectious Disease Musculoskeletal Neurologic Obstetric Ophthalmologic Psychiatric / Social Renal Respiratory / Pulmonary Skin Surgical Toxic Trauma
iSparrow – Epic EBM Order Set
- Mike Zaroukian, MD, PhD; VP & CMIO
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Update on iSparrow EMR
What’s in ProVation? 1. Order set template library 2. Autho2ring and review software 3. Links to clinical content as incorporated into the templates (i.e., UpToDate topics) 4. A clinical content library - UpToDate full content - Other resources (e.g., Ovid MEDLINE, Cochrane) Order Set Creation, Review, Approval
- Mike Zaroukian, MD, PhD; VP & CMIO
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Update on iSparrow EMR
Order Set Development Schedule Goal: - 250 order sets in iSparrow at go-live - 50/month from May-September First 100 Order Sets
1. General Medical Admission
2. General Discharge
3. Labor and Delivery Admission
4. Pregnancy; Postpartum
5. Postpartum - Discharge
6. Pregnancy Group B Strep Prophylaxis
7. ICU Admission
8. General Pediatric Admission
9. Newborn Nursery
10. Newborn Nursery; HIV (+) Mother
11. Surgical Admission - Preoperative
12. MI, ST-Segment Elevation (STEMI) - Admission
13. MI, ST-Segment Elevation (STEMI) - Discharge
14. Heart Failure - Admission
15. Heart Failure - Discharge
16. Pneumonia; Community Acquired, Medicine
17. Behavioral Health Admission
18. Cesarean Section; Preoperative
19. Bacteremia and Sepsis
20. Hip Replacement; Postop Day 1
21. Hip Replacement; Postop Day 2
22. Hip Replacement; Postoperative
23. Hip Replacement; Preoperative
24. NICU Admission
25. NICU Admission; Level 2
Red = First 20 to be built in Epic / iSparrow
- Mike Zaroukian, MD, PhD; VP & CMIO
10
Update on iSparrow EMR
First 100 Order Sets
Red = First 20 to be built in Epic / iSparrow
26. Alcohol Withdrawal
27. Chest pain
28. Rehabilitation Admission
29. Atrial Fibrillation
30. Atrial Fibrillation; Maintenance of Sinus Rhythm
31. Major Gynecological Surgery; Preoperative
32. Major Gynecological Surgery; Postoperative
33. Cellulitis, Non-Diabetic
34. Asthma
35. Asthma (Pediatric)
36. Bronchitis
37. Bronchiolitis (Pediatric)
38. Syncope
39. Generalized Seizures
40. DVT Prophylaxis - Medical
41. DVT Prophylaxis - Surgical
42. Smoking Cessation
43. Patient Controlled Analgesia
44. Immunizations, Influenza and Pneumococcal
45. Central Line Infection Prevention
46. Percutaneous Coronary Intervention; Postoperative
47. Percutaneous Coronary Intervention; Preoperative
48. Preeclampsia
49. Restraint Justification and Order Form
50. Back & Neck Proc Exc Spinal Fusion
51. Organ Procurement
52. Blood Products
53. ED Abdominal Pain
54. Major General Surgery: Preoperative
55. Major General Surgery: Postoperative
56. Diabetic Ketoacidosis (Pediatric)
57. ICU Admission (Pediatric)
58. Discharge (Pediatric)
59. Cardiopulmonary Resuscitation Order
60. Diabetic Ketoacidosis
61. Diabetic Ketoacidosis; ICU
62. Magnesium Replacement
63. Potassium Replacement; Oral Route Avail
64. Potassium Replacement; Oral Route N/A
65. Calcium Replacement
66. Phosphate Replacement
67. PICC/Central Line Placement
68. Nasogastric Tube Feeding
69. Post Fall Protocol
70. Central Line Infection Prevention
71. Bowel Program Module
72. Warfarin Reversal
73. Venous Thromboembolism
74. Ventilator Management
75. Anesthesia, Postoperative
76. Anesthesia, Preoperative
64.
- Mike Zaroukian, MD, PhD; VP & CMIO
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Update on iSparrow EMR
First 100 Order Sets UpToDate is Now Available!
Red = First 20 to be built in Epic / iSparrow
64.
- Mike Zaroukian, MD, PhD; VP & CMIO
77. Colonoscopy; Preoperative
78. Comfort Measures / Hospice
79. Bronchiolitis (Pediatric)
80. Procedural/Conscious Sedation (Pediatric)
81. Hip Fracture: Preoperative
82. Hip Fracture: Postoperative
83. Routine ECT Orders
84. Surgery - Trauma
85. Open Heart Surgery - Preoperative
86. Open Heart Surgery - Postoperative: ICU
87. Open Heart Surgery - Postoperative: Step-Down
88. Cardiac Surgery - Discharge
89. Fever: 0-28 days (Pediatric)
90. Fever: 29-90 days (Pediatric)
91. Newborn Discharge (Pediatric)
92. NICU Discharge (Pediatric)
93. Pressure Ulcer Prevention
94. Pressure Ulcer Treatment
95. Spine Surgery; Preoperative
96. Spine Surgery, AM Admit; Preoperative
97. Spine Surgery, Complex; Preoperative
98. Spine Surgery, Simple Cervical; Postoperative
99. Spine Surgery, Simple Lumbar; Postoperative
100. Spine Surgery, Simple Thoracic; Postoperative
Today: On-site universal access (no login needed)
Coming: Remote password authentication access (CME)
http://www.uptodate.com/
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Update on iSparrow EMR
64.
Help Wanted … Physicians for Order Set Development
Physician roles
- Owners
- Authors
- Reviewers
- Subject Matter Experts
If you are interested, please contact:
1. Physicians will NOT be required to enter the expected discharge date at the time of admission, encouraged during course of hospitalization
2. Use New Result Flag (not In Basket) to notify caregivers of new inpatient results
3. Residents, NPs, PAs can order Imaging Exams without requiring an attending physician co-signature.
4. Attending physicians must enter a CMS-compliant teaching physician attestation for resident notes.
5. Ordering providers will be required to associate problems/diagnoses with consultation orders
6. New consultation requests/orders will be routed to the In Basket of the consultant physician/group
7. Patient information from one Sparrow facility will be visible to authorized users at all Sparrow facilities
8. Scribes and iSparrow EMR - Scribes will be able to document but not enter orders
- Mike Zaroukian, MD, PhD; VP & CMIO
Other Recent IPAG/MSEC Decisions
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Update on iSparrow EMR
Other Recent IPAG/MSEC Decisions 64.
- Mike Zaroukian, MD, PhD; VP & CMIO
9. Dictation: Full vs. Partial at Go-live - Full and partial dictation are both in scope - Structured data entry also expected (orders, problems, etc.)
10. Voice Recognition - Out of scope as enterprise offering at go-live - Will be prioritized as part of optimization - Physicians who already have VR tools (e.g., Dragon) on their own notebook devices will be supported
11. Approved enterprise standard elements, sequence for H&P, Progress Note, Discharge Summary; Initial Consultation Note - Specialty-specific modifications available
12. Approved list of first 100 order sets to be reviewed
13. Pended (“incomplete”) notes will be visible to other users
14. Physician-specific Key Performance Indicators recommended - CPOE, Med Reconciliation, Problem List entries, documentation timeliness, preoperative antibiotics, readmissions
15. Student Documentation in iSparrow EMR - Support current student documentation, supervisor/signature rules - Students can access same tools as their fully trained colleagues (with supervision) - IPAG endorses system-wide approach to student documentation in the legal medical record to standardize both policies and procedures.
