1. Mark Lepore, MD November 18, 2014 THE PHYSICIAN HANDOFF FINALLY WORKS!!!!!!!!!!!

2. Primary Contact This new field, “Primary Contact”, took the place of the “Physician Contact” in Cerner on Wednesday 11/12/14.

3. Primary Contact When either updated from the “Physician Handoff” or from the “Admitting Physician” from the admission order, the “Primary Contact” now appears on the Banner Bar, in the former place of the “Resident” field:

4. Primary Contact

5. Assigning the Primary Contact In order to assign the “Primary Contact”, THE PROVIDER MUST BE ASSOCIATED WITH A CARE TEAM. Therefore, if you cannot find yourself or a provider who is to be the “Primary Contact’, then do the following:

6. Assigning the Primary Contact Open “Physician Handoff”:

7. Assigning the Primary Contact Open the drop down menu:

8. Assigning the Primary Contact Select “Manage Care Team Providers”

9. Assigning the Primary Contact Select a Medical Service list and select a Team from the drop- down menus, then search for the provider to assign

10. Assigning the Primary Contact Note: There are some Medical Services (i.e. Hematology/Oncology, Hospitalist (for Santa Paula Hospital)) that will have no teams associated with them, but others (i.e. Internal Medicine, OB/GYN/Newborn, Surgery Orthopedics, etc.) that will have a number of teams associated with them (i.e. VCMC Inpatient Medicine Teams A, B, C, D and E; VCMC OB/GYN/Newborn and SPH OB/GYN/Newborn; VCMC Surgery and SPH Surgery; VCMC Orthopedics and SPH Orthopedics, etc.).

12. Initial Population of the “Primary Contact” Field The “Primary Contact” will be initially assigned from the “Admitting Physician” field on the “Admit to Hospital” and “Assign to Observation” orders. This will likely become a mandatory field on those orders, and SHOULD BE FILLED IN BY THE ADMITTING RESIDENT. (any objections?) “Resident Physician” field will likely be removed from those orders in subsequent weeks.

13. Changing the Primary Contact Once a provider is able to be assigned to the “Primary Contact” field (because they are associated with a “Care Team”), that field can be updated in the same way the “Physician Contact” has been modified:

14. Changing the Primary Contact Open the drop down menu:

15. Changing the Primary Contact Click the Primary Contact button

16. Changing the Primary Contact Assign yourself (1) or someone else (2) 1 2

18. Printing the Physician Handoff Printing either an abbreviated patient list or an expanded "Handoff" list will both be very easily and successfully performed from the Physician Handoff page drop down menu (FINALLYYYYY!!!!!!!!).

19. Printing the Physician Handoff Open the drop down menu:

20. Printing the Physician Handoff Click the “Print” button

21. Printing the Physician Handoff Can print “Simplified” or “Detailed”

23. I-PASS and Physician Handoff To access the “Physician Handoff” and I-PASS, click the right arrow next to the patient name:

24. I-PASS and Physician Handoff I-PASS should pop up and can be populated with handoff data

25. I-PASS and Physician Handoff I-PASS should pop up and can be populated with handoff data

26. I-PASS Illness Severity Code Status Patient Summary Actions Situational Awareness Synthesis by Receiver (Diagnoses)

28. Clinical Data Tab Clinical Data tab gives labs over last 24 or 48 hours

29. Care Team Tab

31. Care Team Lists Click the “Care Team Lists” button

32. Care Team Lists

34. Patient Assignments To add patients to “Patient Lists”: Go to the patient’s chart Click “Patient”, then “Add Patient to Patient List”, then choose the list to which to add the patient

35. Patient Assignments To add patients to a “Care Team List” – MUCH more irritating and complicated Long and the short, you have to find the list to which to add the patient, then click on the TITLE OF THE TEAM LIST (destination), and THEN it allows you to add the patient to that list (example would violate HIPAA since CERT is down)

36. Patient Assignments

38. “Patient Lists” vs. “Care Teams” The "Care Team" concept is something new that Cerner has introduced that nearly completely changes the way in which teams are thought about in the hospital. The fundamental difference between a “Team” on Patient Lists and a “Team” with the new Care Team concept is as follows

39. “Patient Lists” vs. “Care Teams” -"TEAMS" in the current patient lists (seen on Physician Handoff) are exclusive for patients -- you can only belong to one team (i.e. VCMC Inpatient Medicine Team A, and NOT VCMC Inpatient Medicine Team B or C or D (there are exceptions which I'll ignore for simplicity)).

40. “Patient Lists” vs. “Care Teams” "TEAMS" in the sense of Care Teams are more about the PROVIDERS and the groups that they belong to -- and then those teams associate with individual patients. So, as a patient, you can now belong to "VCMC Inpatient Team A" care team, along with the "Hematology/ Oncology" care team and probably a whole bunch of other care teams. Providers will need to associate themselves with a Care Team, and then the Care Team will be associated with the patient.

41. “Patient Lists” vs. “Care Teams” It is nearly impossible to remove oneself from a “Care Team”, so you’ll end up on a bunch. This is quite irritating. Something I want to work on with Cerner

42. Thanks to Sanjiv Ekbote, Sabrina Clemore, Aimee Brecht- Doscher, Carrie Holt, Terry Theobald, and all of the others who worked on finally making this work!!!