UPDATES since presentation:

Apple Watch Support in Haiku v3.6.3 & Server S/Us needed.

Some 2015 new Features will now come out in subsequent IUs/SUs. :^(

Gordon Tait

EMR Group Architect

May 8, 2015 INFORMATION SERVICES

Expanding Mobile Use Including Clinical Images

& 2015 Droolings: Get off your butt!

ABOUT PENN MEDICINE

The University of Pennsylvania Health System was created in 1993 and consists of three hospitals (Hospital of the University of Pennsylvania, Presbyterian Medical Center, Pennsylvania Hospital), a faculty practice plan, a primary care provider network, two multi-specialty satellite facilities, home care, hospice and a nursing home.

Licensed Beds 1,893

Total Employees 24,293*

IT Employees 419

IT Operating Budget $112, 396, 932

Operating Revenue $4.9 Billion

Adult Admissions 83,994

Outpatient Visits 2,837,864~

Physicians 2,846~

Total Figures as of FY14 *Includes CCA, CORP, CPUP, HCHS

+ Includes CCA/CHCA + Includes CHOP

~ Includes physicians with privileges at more than one hospital.

Henry A. Jordan, M ’62

Medical Education Center

Fall 2014

$38 million

Pavilion for Advanced Care

at Penn Presbyterian

Winter 2015

$127 million

*Figures & Statistics as of FY13 (http://www.uphs.upenn.edu/news/facts.htm)

Penn Medicine University City

Summer 2014

$38 million

RESEARCH Penn Medicine is an internationally recognized leader in discoveries that advance science and pave the way for new therapies and procedures to improve human health. Sixty-eight Penn Medicine researchers are elected Members of the Institute of Medicine, one of the highest honors in medicine. The basic and clinical research findings emerging from Penn Medicine's laboratories and hospitals improve the treatment of a wide range of medical conditions and provide the foundation of knowledge on which many of medicine's next generation of cures will be developed.

NEW BUILDINGS The combined cost of the capital projects over the next

two years is expected to total more than $200 million.

continued… ABOUT PENN MEDICINE

The Perelman Center for Advanced Medicine is a state-of-the-art, outpatient facility containing 321 exam rooms (including the new south-tower expansion in 2013), with diagnostic and treatment facilities designed to be in close proximity for patient-focused care.

The Chester County Hospital and Health System, which became part of Penn Medicine in fall 2013, includes a 245-bed hospital complex in West Chester and satellite locations in Exton, West Goshen, New Garden, Jennersville, and Kennett Square.

Pennsylvania Hospital is the nation's first hospital (cofounded by Benjamin Franklin in 1751), with many expert clinical programs, including the Women's Cardiovascular Center, the Center for Bloodless Medicine and Surgery, orthopaedics, and maternity.

Penn Presbyterian Medical Center is consistently recognized for delivering superior patient safety and high-quality care and as a center of excellence for cardiac surgery, cardiac care, orthopaedics, and ophthalmology.

The Hospital of the University of Pennsylvania is annually recognized as one of the nation's best hospitals by the US & World Report in its Honor Roll of best hospitals.

continued… ABOUT PENN MEDICINE

Past Mobile Use @Penn: View-Only

• When on a Patient:

– Summary.

– Encounters.

– Lab Results.

– Care Team.

• W/o being on a Patient yet:

– Patient Lists – yours, shared, or system-defined.

– Schedule – yours.

– In-Basket – Result Messages & Staff Messages.

– Search – manually only.

– More – Change Department & Logoff

• Providers ONLY!

• Okay, but far from a primary device for any workflow.

2010 Version & Before Gradually increasing as people want to do things Mobile, but no real “spark”.

Logins

Users

Request Process Streamlining While we did NOT use device ID security, our process was: 1) User is interested in Haiku.

2) User opens a Service Desk ticket.

3) Security analyst gives user some instructions on how to setup.

4) User has to email analyst the device’s unique App ID.

5) Analyst plugs in that ID, grants access, & emails user.

This was turned into: All providers were given the access.

1) User is interested in Haiku.

2) User sees peer use it, downloads it, & copies settings.

This led to slight up-curve in first half of 2014 users/logins.

New Users Per Month Not yet on Inpatient or E/D.

New Users per month were boring except for a somewhat interesting spike as each new “class” was on-boarded in June/July especially for Haiku.

Due to the upgrade to 2014, audit logs were split and a new report had to be setup which led to an impatient period for me.

Double Upgrade: 2012/2014 Before being on a patient:

Upgrade Enhancements Turned On: In-Basket: Enter Result Note

In-Basket: Release to MyChart

In-Basket: Co-Sign Clinic Orders

In-Basket: Medical Advice Requests

Recent Patients in Search

Other Enhancements: Multi Provider Schedule! (default to self)

Double Upgrade: 2012/2014 Once on a patient:

Upgrade Enhancements Turned On: Care Everywhere Activity: view info already pulled into Chart.

Notes Review Activity: view all specified Notes across ALL mobile Encounters.

Custom Reports Activity: simple “Rounding” & “Handoff” reports.

More User Roles Given Mobile: Transplant Coordinators

Biobank Researchers

Practice Managers & Directors

Impact of Upgrade? Additional functionality may have drawn in more users & use.

Communication about the upgrade & features may have contributed just by itself.

Logins

Poor iPads!

Users

Did the New Class Follow Suit? OH YEAH! There was a tremendous spike in new users around the time of new staff for the “school” year.

The self-service ability may have been a contributor.

Since Upgrade ASAP, Phoenix, & Radiant implemented: Transplant DEPs had UNOS/Transplant view added to Summary view.

Dermatology Pilot of mobile Clinical Images: Derm had wanted mobile photos for more than a year due to the volume of photos being taken and manually imported into charts.

2010 photo feature was cumbersome compared to 2014 method.

Dermatology Photo Pilot 4 Practice locations were targeted for the Pilot.

2 were included, do not assume adequate WiFi coverage!

Medical Assistant Take the photos

Attending Pull photos into Progress Note

Smartlink was used to pull only Encounter-level images.

Samsung Tablet, Apple mini iPad, & Apple iPod “touch” were each piloted and swapped between the sites for trial.

Derm Devices Chosen The tablets were found to be more awkward to use.

An M/A & Attending from the Pilot demo’d the process at a department-wide meeting and answered questions.

(IT sat back quietly, letting the users answer the other users)

Even with a small group Piloting, mobile use went up further.

An existing “Derm Photo” document type was the ONLY type offered in mobile and it was set to be the default for all the Profiles used by the Derm departments.

Photo Pilot Downsides While there was no longer a backlog of waiting to get images loaded into the charts & the staff was happier than ever…

…it was not all rainbows and kittens

Prior to Haiku, “photos” were just an Attachment in the Progress Note.

Literally embedding the photos into the Progress Notes means that the Progress Note will PULL each photo into the note upon opening.

And since our Encounter Summary report includes that encounter’s P/N…

Some Encounters were taking 6-10 seconds to Load/Open in Hyperspace.

Non-Derm Photo Pilot A few Family Medicine physicians were also trying to use this.

News came in that they would not see the photo until hours later.

This was a roadblock in expanding Derm further.

Since this was NOT Derm, their default Document Type in mobile was “Haiku/Canto Image”.

As it turned out, some Shared Security Classes were missing appropriate settings for the Haiku/Canto Image document type.

Specifically: ECL I 20682, I 20684, & I 20688

Derm Expansion ~80 iPod Touches were purchased & configured.

Locking cabinets were purchased & installed at each location.

WiFi was installed/improved where needed.

Staff was educated.

Photo Impact “Derm Photo” images by month. Mobile Pilot started.

* ~36 hr Mobile outage

*

Did the convenience of the new process encourage more photos?.

Photo Expansion • Having a solid use case seems to significantly ramp up

mobile use of Haiku (just after the annual on-board spike).

• Other areas trying it as well: Wound Care Center, Family Medicine, OTO, Urology, etc.

Others Features To Keep Pace Up • E-Prescribing Pilot since Discrete Sigs live.

– Full roll out should significantly increase users & usage.

• Voice Recognition – no one interested yet. :^(

• Links to other Native & Web Apps

• Patient Face Photos

• Canto Dashboard (Chad!)

• Possibly Radiant Work List

• Possibly Charge Capture

• More User Types!

2014 & Earlier • What are your BEST used workflows for Epic Mobile?

– 1)

– 2)

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Coming Soon Feature-Wise (/drool) • 2015 will be released soon! (June)

• Along with it will be v4.0 Mobile (June)

• Big Question: WHICH 2015 features in v4.0 will be rolled back to 2014 and potentially 2012?

– I ask my Mobile TS this every other week!

– So far DVLP has not committed anything.

/drool: Telemedicine • Video Visits will let the Provider also use mobile

(which the patient can already do in MyChart Mobile)

• Telemedicine on a desktop has its Citrix challenges!

• Referring Providers will ALSO be able to in EpicLink!

/drool: Notifications, Touch ID, IB Defer Notification support which “user” can control on his/her device.

Touch ID for logging in.

Swipe & “Defer” involved IB Msgs to work on later.

/drool: In-Basket - Patient Calls • Finally!

• (it’s so groovy it does not need a screenshot!)

(and I do not have a screenshot of it)

/drool: In-Basket – More Stuff

In Basket - Chart Completion

– Let your clinical users work on chart completion while on a train, etc. (hopefully NOT while driving!)

– Maybe they will gain back more of their outside life.

(or they might become more of a work-a-holic!)

In Basket – CC Charts

– Clinicians process informational messages about patient charts, including chart notifications, patient reports, and Chart Review reports.

/drool: Dictate Later & Chart Search

• Tag parts of the Note in Hyperspace to be finished in Haiku using Haiku as the microphone when it is more convenient to finish it.

• Chart Search in Mobile!

/drool: Mark As Reviewed • Allergies, Problems, & Medications

/drool: Canto - Order Entry • Especially designed for ASAP E/D.

/drool: Canto - SmartForms • ROS, HPI, Subjective, & Objective

• Take photos directly while in Progress Note

• Annotate on Image

• SmartPhrase/etc. support?

/drool: Canto – “Jot” • Throw away your Etch-A-Sketch!

• Writing can also then be view in sidebar of Hyperspace.

/drool: Canto – Anesthesia • View Status Board

• Document Attestations

• Note Timing of Several Key Events

• Ready-for-Procedure Information

/drool: Canto – ASAP E/D • See Triage Info

• Sign Up for Any Unassigned Patient Through Track Board

/drool: Canto – Inpatient Completely new view/widget & ability to build your own.

/drool: Canto – Inpatient, Handoff While reviewing, providers can easily make changes to handoff information by clicking Edit (pencil).

/drool: Canto – Hyperspace • Launch “Certain” Hyperspace Activities right from

Canto through third-party integration using Citrix Receiver – provide Hyperspace in a pinch.

Android Face Life • Adding (already in iOS): Cosign Clinic Orders, Results

Release, Result Notes, Rx Request.

• Adding: Patient Calls, Chart Completion

Android Face Life, more • Adding (already in iOS): E-Prescribing (already?) &

Free Text Notes w/Voice Recognition.

Rover (Inpatient Encounter)

Background: iOS or Windows Mobile (phasing out).

For use with “Sled” (Code, Honeywell, etc.).

Features: Barcode Med Admin, eMAR charting, Barcode specimens collected, take Clinical Images, Update Pharmacy Balances, Task List, Enter Flowsheet Data, Chart Blood Admin, Can login by barcoding your staff ID. Beaker/Phleb!

• Rover for Android coming in 2015.

Rover, more

• Flowsheet Development is a HIGH priority for Epic since some types are not (yet) supported.

Rover, yet more

Nurses or Resp Therapists can add meds to their Cart or do one at a time. Can configure which tabs show.

Rover, yet more again

Can send preconfigured pharmacy msgs from App.

Can also force recommend/require flowsheet data to be filled in when administering a medication.

Beyond 2015 Version • Real-time Secure texting on Epic’s plan.

– Likely at LEAST a year out, if not 2 or more.

– No specifics given (Haiku vs. other App, $$$, etc.)

Credits & Questions Dermatology for diving into the Photo workflow!

Epic for spending some serious development time on 2015 mobile.

How can we all make mobile Epic better?

Submit Your Ideas & LIKE others in UserWeb!

Have a question?

taitg@uphs.upenn.edu