Milwaukee, Wisconsin April 30 – May 2, 2007 Welcome to the RUG n’ Roll Midwest & Great Lakes Regional User Group for Cerner Clients Milwaukee, Wisconsin April 30 – May 2, 2007

Interdisciplinary Teaching Records using PowerPlan Functionality Lynn Germanson, RN, BSN Senior Business Application Analyst Clinical Documentation Team Aurora Health Care, Milwaukee, WI Lori Zareczny, RN, BSN Business Application Analyst Clinical Documentation Team Aurora Health Care, Milwaukee, WI

Objectives Describe the challenges of standardizing Teaching Record content across multiple disciplines and multiple facilities. Describe how Interdisciplinary Teaching Records have been interpreted by Aurora Health Care using Cerner PowerPlan functionality. Describe how Teaching Records have been built in the electronic medical record for Aurora Health Care facilities.

Who is Aurora Health Care? Integrated Delivery Network 14 Hospitals (40-600 beds) 120+ Outpatient Clinics 140+ Retail Pharmacies Long Term Care Home Health Services Hospice Services Laboratory Services One of the nation’s “Most Wired” hospitals in 2004, 2005 & 2006 Private, non-profit, teaching organization: 684 employed physicians 3,200 physicians on staff 25,000 employees $2.6 billion annual revenue 0.5 million IP days/year 2.3 million OP visits/year 0.25 million ED visits/year 0.3 million Home Care visits/ year 5.6 million retail Rx/year

Where is Aurora?

Diverse Hospital Mix 14 Hospitals Range from 40-600 beds Include rural community hospitals and metropolitan acute care hospitals Teaching facilities Newly constructed and acquired facilities Various levels of “Computerization”

Cerner Applications at Aurora Hospital “Core” systems implemented from 2000-2004 Patient Access (Registration & Scheduling) PowerChart Orders, Results, Charges Radiology, Surgery, Emergency Dept Interfaces: Lab, Transcription, Dietary, Digital Imaging “Advanced” product implementations under way PowerChart Office in Clinics (>75% done) Pharmacy (100% done) Multidisciplinary Clinical Documentation & eMAR (90% done) PowerPlans & INet (14% done) Teaching Records (1st site Go-Live Sept. 2007) Barcode Medication Administration (new) CPOE (7% done)

Teaching Record History . . .first there was paper, then there were. . . Online FORMS

Form Mimics Paper STOP! Ambulatory Surgery Teaching Record: First area to capture teaching in Cerner Form developed to capture their specialized teaching Physical Therapy/Occupational Therapy: Developed short list of common teaching topics Speech, Nutrition, Nursing . . . Other Disciplines. . . Requested their “Own” teaching topics STOP!

Ambulatory Surgery

Ambulatory Surgery

PT Teaching Record

Form Format? PROs Interdisciplinary Pulls LCV, so can see what was taught previously Customized to list specific teaching materials given CONs Each Topic requires 7 DTAs Complex Event Set Hierarchy Required teaching not identifiable Unable to individualize General Topics - Comment/note at bottom of page to be more specific Maintenance nightmare Teaching Records needed (>150)

The PowerGrid?

Prenatal Care Coordination Home Visit Teaching

PowerGrid Format PROs Useful for areas seeing patient over extended period of time (several months) with focused topics Can select multiple topics in one entry Allows individualization (comments) LCV pulls previous teaching, allowing review in form CONs LCV pulls previous teaching, so resign others’ data each time Several topics identified in each visit Confusing to new care provider One packed row vs. several rows in order to provide details about response to each topic Inpatient build would be several forms with multiple sections because of variety of teaching topic groupers Unable to identify Required Components

The Challenge

. . . Incorporate >150 paper teaching records x 14 site variations using different formats into something that will be. . . Interdisciplinary Individualized Address Barriers to Learning for each learning session Address components identified through evidence / regulatory standards Allow easy review of previous charting Standardized across a multi-hospital system

Teaching Records using PowerPlan Design System Interdisciplinary Groups met several times to decide: Diagnosis-based plans (CMS/Premier standards) Subcategories in each Diagnosis Teaching Plan Required components to meet set standards Grouper Headers for other topic categories Topic detail level What is recorded about each topic – readiness, who, what, how, when, result

Diagnosis-Based Teaching Plans

Diagnosis-Based Teaching Plans Congestive Heart Failure / CHF Community Acquired Pneumonia / CAP Total Joint Replacement / TJR Cardiac Surgery Acute Coronary Syndrome /AMI Cerebral Perfusion Alteration / CVA etc. . .

Conceptual Design - Subcategories in Diagnosis Teaching Plans

Subcategories in Diagnosis Teaching Plans Disease Condition Tests / Procedures Treatments Therapy / Equipment Treatment Medication Management Functional Skills Safety Skills Assistive Devices Nutrition Guidelines Diet Wellness Advance Directives Smoking Discharge Review Instructions Home Monitoring Community Resources / Home Care

Building Blocks Diagnosis-based Teaching Records Plans Composed of Subcategory “Building Blocks” Includes “Groupers” which exist independently for use without Diagnosis Teaching Plans Diagnosis-based Plans Subcategory Groupers Diagnosis Disease Condition Tests / Procedures Nutrition Guidelines Diet Treatments Therapy / Equipment Treatment Wellness Advance Directives Smoking Medication Management Discharge Review Instructions Home Monitoring Community Resources/ Home Care Functional Skills Safety Skills Assistive Devices

Using Cerner Functionality to Drive Teaching Record Format Plans Teaching Record category – “lives” after Discipline Plans TEACH prefix helps in Plan Search window Document In Plan Interventions not Goals Ready to Learn Initial or Reinforcement Who taught Method of instruction Evaluation of patient progress Progress to Teaching Completion

Search and Select Teaching Plan

The Plan of Care “Homepage”

CHF Diagnosis Specific

CHF Treatments

CHF Medication Management

CHF Functional Skills and Nutrition

CHF Wellness

CHF Discharge

CHF Discharge cont.

Customize the Plan and Initiate

Only Selected Interventions Show

Document in Plan

Quick Chart

Linking to Form

Note/Variance Details

Teaching Documentation Ready to Learn? Initial vs. Reinforcement? Who Taught? Format Info Presented Evaluation of Learning

Teaching Documentation

Any Questions ?