iPATH 2014 Best Practices

Required steps for Attending Providers It is important that medication history is updated before Admission Medication Reconciliation occurs. Completing Admission Med Rec before the medication history is updated may result in meds that the patient is no longer taking being ordered inappropriately. The green checkmark indicates completion. The following items must be completed before the Hospital Summary is Final/Distributed: The Problem and Diagnosis list (Consolidated Problems) Follow up Discharge Medication Reconciliation Discharge PowerPlan Utilize the “Home Meds Stopped” form to indicate medications stopped during this admission. ClickClick here for a 2 minute demo of the DC MPage. Click

Required steps for Attending Providers The Hospital Course must be completed as a part of the Hospital Summary utilizing contents of defined templates. Click here to view the templates.Click here to view the templates must If any change is made to Problems and Diagnoses, Follow up, Discharge Medication Reconciliation, or Discharge PowerPlan after the Hospital Summary has been Final/Distributed, the Hospital Summary must be Final/Distributed again to update the content.  Clicking Final/Distribute updates the document to reflect the most current information for distribution and the medical record. For discharges to Skilled Nursing Facilities, the Hospital Summary must be completed and signed prior to the patient leaving the hospital. ClickClick for a 2 minute demo on the Depart window. Click

Required steps for Attending Providers The Discharge(specify) order must not be entered until all of the above items are completed.  Nursing looks for the Discharge Order as the indicator that your work for discharge is complete and the patient may depart. This process applies only to patients who are discharged from an inpatient unit. Ultimate responsibility for and completion of medication reconciliation and the medication list sent home with the patient belongs to the attending provider. Consulting providers are responsible to reconcile those medications related to the consultation.

Consulting Providers Required steps for Consulting Providers The following items must be completed before the Hospital Summary is Final/Distributed by the attending provider: The Problems and Diagnosis related to the consultation Follow up appointments related to the consultation Discharge medication recommendations or prescriptions Discharge Instructions entered via the Discharge PowerPlan (or specific consultant orderable, i.e. Infectious Disease) must If any change is made to any element listed above after the Hospital Summary has been signed, the Hospital Summary must be Final/Distributed again to update. Therefore, Consultant work must be completed prior to the Attending Final/Distributing the Hospital Summary. Communication must occur between consulting and attending providers. This process applies only to patients who are discharged from an inpatient unit.

Hospital Course Content The Hospital Course narrative should contain the following elements at a minimum: Simple Med/Surg patientComplex Med/Surg patient Date of Discharge Attending/Discharging provider Non-physician provider completing summary (if applicable) Description of hospital course and condition at discharge Core Measure requirements Date of Discharge Attending/Discharging provider Non-physician provider completing summary (if applicable) Description of hospital course and condition at discharge Pertinent procedures/diagnostic testing Core Measure requirements Discharge disposition Requirements for Attending Providers Click here to return to Requirements for Attending Providers templates Click here for a pocket sized printable version of the templates. Auto Text Click here for printable instructions on creating Auto Text.

Efficiency Tips Work your way down the yellow section. Completion of required elements is most efficiently accomplished through the use of the Discharge MPage. Work your way down the yellow section. Problems and Diagnoses Problems and Diagnoses. Use the MPage component called Consolidated Problems to search for specific terms, drag and drop to prioritize, and multi select to cancel. Utilize to access documents without navigating away from the MPage. Utilize Dragon templates or auto text templates for required Hospital Course elements for simple and complex patients. The myPatient Views PMP Med Reconciliation is a printable tool which will be helpful when completing both admission and discharge medication reconciliation. ClickClick for a 2 minute demo on the PMP Med Reconciliation tool. Click Click for a 2 minute demo on Problems and Diagnoses. Click

Efficiency Tips Utilize the Estimated Discharge Date form to communicate the estimated discharge date for the patient. This gives other disciplines, such as case management, HealthLink, and Pharmacy information to help them complete their work in a timely manner. Complete Estimated Discharge Date information then sign by clicking the green checkmark. ClickClick for a 1 minute demo on Estimated Discharge Date. Click

Utilizing HealthLink scheduling Munson HealthLink can be utilized to schedule post-discharge follow up appointments for inpatients. Both primary care offices and MMC are incentivized to ensure medical-inpatients are seen by their primary care provider within 7 days of their discharge. Many offices are enthusiastically collaborating with Munson HealthLink to deliver on this objective – while additionally, decreasing avoidable readmissions through ensuring a smooth transition of care.

Utilizing HealthLink scheduling HealthLink can schedule primary care and specialist follow up appointments when you request. Appointments able to be scheduled include: Primary Care appointments – establishing a new patient who didn’t previously have an established PCP Primary Care appointments - already established relationship between PCP and patient Specialist appointments, most-feasible (yet not limited to) already-established relationships or when specialist consulted with in-patient Due to tests/labs needing to be ordered prior to specific specialist appointments, should HealthLink be unable to schedule a specific specialist appointment, they will update the MPage to read appropriately for the printing of the patient’s DC instructions. ClickClick for a 1 minute demo on Estimated Discharge Date. Click

Utilizing HealthLink scheduling 1.Complete Estimated Discharge Date form. This information allows HealthLink to schedule the appointment in a timely manner. 2.Enter provider info; name, timeframe, address. 3.Double click to select “HealthLink to Schedule” in comments. 4.HealthLink will schedule and update appointment info. The orderable to “Schedule Primary Care Follow up” will be removed from the system on October 14, Double click “HealthLink to Schedule” on the Follow Up tab within the MPage and provide an Estimated Discharge Date as early in the patients stay as possible. ClickClick for a 1 minute demo on Estimated Discharge Date. Click

Future Enhancements Effective October 14, 2014 PowerChart will allow partial Admission and Discharge Medication Reconciliation. This will allow attending and consulting providers to work together to complete medication reconciliation. Utilize the PMP Med Reconciliation as a source of truth so see what home medications may have been discontinued by either the consultant or the attending provider. Do Not Continue At discharge, active inpatient meds default to Do Not Continue. Home medications must each be addressed. Inpatient medications default to discontinue. Inpatient medications default to discontinue. Home medications have no default and must each be addressed. Home medications have no default and must each be addressed. ClickClick for a 2 minute demo on partial Medication Reconciliation. Click

Future Enhancements To improve the value of the Hospital Summary information to ambulatory and follow-up providers, effective October 14, 2014, changes will be made to the Hospital Summary. Medications to Stop Taking will be moved above the medication list on both Hospital Summary and Patient Instructions. The discharge medication list for the Hospital Summary will no longer display in grid format. However, Patient Instructions will continue to display in the more patient friendly grid format. Prescription routing and quantity dispensed will be listed on both Hospital Summary and Patient Instructions.

Core Measures and Quality Measures At this time, completion of core measures requirements remains unchanged from pre- iPATH. Continue to include in the Hospital Course (clinical narrative). Core Measure templates are available in Dragon. Core Measure templates can also be built into autotext for the Clinical Course. Munson reports on 3 Quality Measures at this time: ED Throughput VTE Stroke VTE and Stroke Quality Measures documentation is located on the Discharge MPage and require a provider signature prior to patient discharge. Munson Clinical Quality nurses complete the form when indicated. The provider must co- sign the form prior to patient discharge. ClickClick for a 2 minute demo on Quality Measures. Click

Two minute demonstrations ClickClick for a 2 minute demo on entering Follow Up. Click Click for a 2 minute demo on Problems and Diagnoses. Click Click for a 2 minute demo on the Discharge PowerPlan. Click Please view the 2 minute demonstrations below for areas you want more information about. When you are done, please continue through this program. Please view the 2 minute demonstrations below for areas you want more information about. When you are done, please continue through this program. ClickClick for a 2 minute demo on the Depart window. Click Click here for a 2 minute demo of the DC MPage. Click Click for a 2 minute demo on the PMP Med Reconciliation tool. Click Click for a 2 minute demo on Partial Medication Reconciliation. Click Click for a 2 minute demo on Quality Measures. Click Click for a 1 minute demo on Estimated Discharge Date. Click

Thank you. To receive credit for completion of this program, please complete the post-test and return it to the Clinical EHR Education department at Munson Medical Center. Click to access the post-test. Click to access the post-test.