Provider Cerner Education Session #6

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Presentation transcript:

Provider Cerner Education Session #6 Blue Hill Hospital Provider Cerner Education Session #6 03.21.2019 Dr. Michael Ross / Edited Dr Charles Zelnick June 2019

Blue Hill Training Web Page: http://ci.emhs.org/MIO_BlueHill Provider Cerner Education Session 2 01.17.2019

Curriculum Outline Week Topics Navigation, Personalization, Note Creation Overview Problems (Intro); Revenge of the Message Center, Centricity CCD Orders and Favorites Medications, Basic Mmodal Autotext, Smart Templates, Patient Letters Recommendations, Patient Care Advisor, Worklists Family & Soc History, Advanced Mmodal, Q&A Modify with Insert > Header & Footer mm.dd.yyyy

Overview: Todays class Autotext: Advanced Smart Templates Provider and Patient Letters: Recommendations M-page component Patient Care Advisor Dynamic Worklist Provider Cerner Education Session 3 01.31.2019

Test Patients for use: Go to Ambulatory organizer/Home Be sure to use MAY 1st Go to Ambulatory organizer/Home Search for me in calendar; you will see my calendar filled with test patients. Pick a test patient from the schedule for use today. We will use this as a source of Test patient’s with Ambulatory encounters for future sessions as well. Dr Z’s -> Modify with Insert > Header & Footer mm.dd.yyyy

Advanced Autotext uses: Autotext has no limit: Can add multiple pages of content Letters Community resources Patient Instructions Locations of care Dropdowns/configuration/defaults Smart Templates Provider-facing content Patient facing content Use the Centricity Autotext as a base (Included in email) Provider Cerner Education Session 3 01.31.2019

Using Autotext Dropdowns: Provider Cerner Education Session 3 01.31.2019

Autotext example: Provider Cerner Education Session 3 01.31.2019

Best Method for Sharing Autotext: Utilize Message Center: Least amount of clicks Doesn’t require the user to go into the Autotext tool each time: Video link: Provider Cerner Education Session 3 01.31.2019

Autotext Building Session: (Copy/paste from Centricity Autotexts to supplement) Provider Cerner Education Session 3 01.31.2019

Mmodal and Autotext pairing: Provider Cerner Education Session 3 01.31.2019

Patient Letter Provider Cerner Education Session 3 01.31.2019

Patient Letter: Used to produce letter for patient Letter templates exist within the system using /let autotext. Create your own templates as you see fit to supplement. Provider Cerner Education Session 3 01.31.2019

Patient Letter Can add orders (including prescriptions) and labs Change type of letter Multiselect labs to include Print, or send to office staff on your behalf. Provider Cerner Education Session 3 01.31.2019

Provider Letter/Provider-to-provider communication Provider Cerner Education Session 3 01.31.2019

Provider Letter Preferred method of sharing clinical content with colleagues Suggest using this instead of just forwarding notes Allows delegation to office staff Draws attention to the most pertinent clinical area Provider Cerner Education Session 3 01.31.2019

Example of Provider-to-provider communication: Provider Cerner Education Session 3 01.31.2019

Provider Letter: External Providers- Fax your letters Provider Cerner Education Session 3 01.31.2019

Recommendations and PCA: Recommendations helps manage patient preventive and condition care. It allows for real-time notification of health screening, prevention, and management of diseases for patients based on various elements such as age, risk factors, gender, documented conditions, and documented procedures. Preventive Care Advisor allows clinicians to see a Medicare patient's eligible Preventive Services according to CMS records. The view displays both eligible and future eligible Preventive Services. All services are checked again within Millennium to ensure no current orders or charges could affect eligibility. Both of these Items work together within the Recommendations component to provide guidance on preventative care. The Vision:

About Recommendations: Preferred workflow for addressing patient care recommendations Fully loaded visits preventative services Supporting highest level of quality care delivery Localized and Owned by us (Northern Light Build) Have specific actions that can/cannot be taken (and associated limitations) Current build is an amalgamation of metrics from Centricity, Allscripts, Old Cerner newer Cerner build. Continued cleanup by System recommendations workgroup; new metrics from the System Primary Care Improvement Group. Provider Cerner Education Session 3 01.31.2019

Workflow: Active Recommendations Laboratory Request Changes 03.14.2019

Workflow: Recommendations Review: Laboratory Request Changes 03.14.2019

Wellness visit Recommendations: Provides both follow-up and this visit options: Full satisfier for visit billing; partial satisfier for next scheduled appointment. 03.14.2019 Laboratory Request Changes

Colon Cancer Screening… Yes. We Know. Right now, our incoming colonoscopies do not satisfy the screening automatically. Right now, you cannot order a colonoscopy from the recommendation. Provider Cerner Education Session 3 01.31.2019

Everyone is working on it. We promise. 01.31.2019 Provider Cerner Education Session 3

BUT: Help is on the Way… Updates this week: Lipid Screening (IDEA0002854) routine Currently state: males >35 and females >45. Needs to be changes to all adults 40-75 years of age to reflect current guidelines. HPV Screening (IDEA0002858) Currently this is only HPV and PAP; needs to be HPV or PAP. We need to update our recommendation to reflect the current guidelines. Shutting down the Medicare wellness appointment made reminders (INC00559476) We wanted to change this to 14 days pending. This is included in the next group of changes to be made.  Smoking Cessation Education reminder (INC0612475) Name to be changed to Tobacco Cessation Counseling.  Need to add the following 2 orders as satisfiers with a duration of 365 days: Tobacco Use Cessation Intensive >10 Minutes 99407 and Tobacco Use Cessation Intermediate 3-10 Minutes 99406 Breast Cancer Screening and Family Hx Breast Cancer Screening Recommendations (INC0612589) Corrected to satisfy based on the 'mammography' note type.  This note type was originally approved but 'mammogram' was accidentally added instead.  This error has made it so the Recommendations are not working as intended. “Done Elsewhere” to “Done” (DMND0018104) (New) Passed by Clinical Stakeholder group 5/14 Provider Cerner Education Session 3 01.31.2019

BUT: Help is on the Way… Updates this week: Diabetes Maintenance - Eye Exam (RITM0152563) (New) Change satisfier duration from 730 days to 365 days. Diabetes Maintenance – Microalbumin (RITM0152632) (New) Add Urine Microalbumin/Creatinine POC 82043 order with a temporary satisfier of 14 days and Urine Microalbumin/Creatinine - POC result with a satisfier of 365 days. Diabetes Screening (RITM0152635) (New) Change population to individuals ages 40-70 with BMI greater than or equal to 25. Todd will verify the Diabetes reports sent to Beacon are in line with this. Recommendation to remove Family History of Breast Cancer and Colon Cancer (INC0627954) Remove the Family History of Breast Cancer recommendation for ages 40-74. Remove the Family History of Colorectal Cancer recommendation for ages 40-75. Provider Cerner Education Session 3 01.31.2019

BUT: Help is on the Way… Updates this week: Add “Done Elsewhere” to Influenza Recommendation (DMND0018105) Influenza recommendation only: add an Action for “Done Elsewhere.”  When “Done Elsewhere” is chosen end user will be able to record the date and add comments.   For all other recommendations change the Action from “Done Elsewhere” to “Done.”  When the “Done” option is chosen, it allows the end user to then choose the Reason – done elsewhere, done in system, or done in office. Asthma Management (INC0626168) Component is not satisfying the recommendation.   Aaron to address. Change colonoscopy default to one year (INC0627938) Primary Care group voted to change all colonoscopy screening recommendations to yearly as a safety mechanism. Proposed workflow: results to be reviewed and determine clinically what the follow up should be. The provider would then modify the recommendation (push out the date) as appropriate. Provider Cerner Education Session 3 01.31.2019

Modifying a time interval between recommendations: Can be done at anytime (not just during a visit) Best to do during results review Indicate within the recommendation: Next screening due Reason Comment (finding) Provider Cerner Education Session 3 01.31.2019

Recommendations: Adult Reminder Population Included Frequency AAA (Abdominal Aortic Aneurysm) Screening Male tobacco users between 65 and 75 years of age ONCE Adult Wellness Individuals at least 18 years of age Annually AMB Joint Practice Protocol All patients Blood Pressure Management Individuals at least 18 years of age with condition of high BP (last result for SBP 140 or greater) BMI Management Individuals at least 18 years of age with last BMI result greater than/equal to 25 OR less than 18.5 Annually* Healthy Adult - Bone Density Screening Females at least 65 years of age Every 2 years* Breast Cancer Family Hx Screening Females age 40-74 with family hx of breast cancer Healthy Adult - Breast Cancer Screening Females age 50-74 without family hx of breast cancer Every 2 years CAD Maintenance - Lipid Lowering Therapy Evaluation Individuals with a condition of CAD CAD Maintenance - ACE Inhibitor Prescribed n/a CAD Maintenance - Antiplatelet Agent Prescribed Modify with Insert > Header & Footer mm.dd.yyyy

Recommendations: Adult Reminder Population Included Frequency Healthy Adult - Cervical Cancer Screening Age 21-29 Females age 21-29 Every 3 Years Healthy Adult - Cervical Cancer Screening Age 30-65 Females age 30-65 PAP Every 3 Years HPV +/- PAP Every 5 Years Colon Cancer Family Hx Screening Individuals age 40-75 with family hx of colon cancer Fecal Occult Blood Every Year Flexible Sigmoidoscopy Every 5 Years Colonoscopy Every 5 Years Healthy Adult - Colorectal Screening Individuals age 50-75 without family hx of colon cancer Fecal Occult Blood Every Year Flexible Sigmoidoscopy Every 5 Years Colonoscopy Every 10 Years Condition Specific Immunizations - Meningococcal Individuals at least 18 years of age with hx of splenectomy or cochlear implant ONCE Condition Specific Immunizations - Pneumococcal Individuals at least 18 years of age with hx of any of the following: asthma DM splenectomy chronic lung disease chronic liver disease chronic kidney disease HF cochlear implant Modify with Insert > Header & Footer mm.dd.yyyy

Recommendations: Adult Reminder Population Included Frequency Condition Specific Immunizations - Hepatitis B Individuals at least 18 years of age with hx of any of the following: DM chronic liver disease chronic kidney disease substance use/opioid dependence ONCE Depression Management Individuals with a condition of depression Annually Depression Screening Individuals at least 18 years of age Diabetes Maintenance - HgbA1c Individuals with condition of diabetes Every 6 Months Diabetes Maintenance - Eye Exam Diabetes Maintenance - Foot Exam Diabetes Maintenance - Microalbumin Diabetes Maintenance - Statin Medication Prescribed Individuals with condition of diabetes without statin medication on chart Diabetes Screening Individuals at least 45 years of age Every 3 Years Modify with Insert > Header & Footer mm.dd.yyyy

Recommendations: Adult Reminder Population Included Frequency Fall Risk Screening Individuals at least 65 years of age Annually Fluoride Screening Individuals age 6-60 months Hepatitis C Screening Individuals born 1945 through 1965 ONCE Hypothyroidism Management Individuals with a condition of hypothyroidism Healthy Adult - Lipid Screening Males at least 35 years of age Females at least 45 years of age Every 5 Years Lung Cancer Screening Individuals age 55-77 years who are tobacco users or have a hx of tobacco use PPD Skin Test Individuals who were Acadia inpatients within the past 6 months, without PPD skin test ordered or completed in the past 6 months and without a positive result on the PPD Reading Form Every 6 Months Smoking Cessation Education Individuals with condition of tobacco user Spirometry Individuals with condition of asthma Modify with Insert > Header & Footer mm.dd.yyyy

Recommendations: Pediatrics Reminder Population Included Frequency Autism Screening 18+ months Individuals age 17-22 months ONCE Autism Screening 24+ months Individuals age 23-26 months Chlamydia Screening Females age 15-24 Annually Depression Management (ACO) Individuals at least 12 years of age with initial depression screen score or detailed depression screen score greater than 9 Depression Screening Adolescent- MUST BE FULL Tool; the “2-items” does NOT satisfy this one. Individuals age 12-17 Developmental Screening 9+ months Individuals age 9-14 months Developmental Screening 15+ months Individuals age 15-29 months Developmental Screening 30+ months Individuals age 30-74 months Fluoride Screening Individuals age 6-60 months Influenza Vaccine Individuals at least 6 months of age Lead Screening Individuals age 8-72 months Modify with Insert > Header & Footer mm.dd.yyyy

Recommendations: Pediatrics Reminder Population Included Frequency Well Child Visit Individuals age 2-17 months of age Between 2 and 11 months of age - every 2 months Between 12 and 17 months of age - every 3 months Well Child Visit. Individuals age 18 months-18 years of age Between 18 and 35 months of age - every 6 months Between 3 and 18 years of age - annually Modify with Insert > Header & Footer mm.dd.yyyy

About the Preventative Care Advisor: Real-time query to CMS database validates Medicare eligibility for preventive services; displays eligible and future services for a charge within the last 6 months. Services are checked again within Millennium to ensure no current orders or charges could affect eligibility. Typical lag time: 5 days Clinician can order directly from workflow view Summary of screenings due are included on all patient visit Summary. Consistent workflow with Recommendations allow other recommendations to be incorporated into the same workflow. BUG: refresh issue Provider Cerner Education Session 3 01.31.2019

Provider Cerner Education Session 3 01.31.2019

PCA-Specific Recommendations: Always indicated by Same actions as standard recommendations Expandable to yield prior history of screenings Provider Cerner Education Session 3 01.31.2019

Preventative-Care-Advisor Specific Recommendations Preventive Care Service Annual Wellness Visit (AWV) Bone Mass Measurements Colorectal Cancer Screening Depression Screening Diabetes Screening Glaucoma Screening Pneumococcal Vaccine and Administration Screening Mammography Screening Pap Test AAA screening Preventative-Care-Advisor Specific Recommendations 01.31.2019 Provider Cerner Education Session 3

Think of Dynamic worklists like a “Mini-Registry” Dynamic Worklist is a user-level query tool designed to query patients with multiple different criteria: Conditions Results Orders Appointment types Age Sex Clinicians use the Dynamic Worklist to identify subsets of patients in PowerChart, gather relevant information about them, and act upon those findings. Think of Dynamic worklists like a “Mini-Registry”

Limited, specific problems/conditions:

Queries return:

Links to the Chart:

Dynamic Worklist: Creating Patient Communication