1. Process for Auto Linking Surgical and Cardiac Cath Implants/Devices to the Prosthetics Package to meet Performance Measure In Surgical OR – Nurse completes Nurse IntraOperative Report during the case and records all prostheses that are installed. Documentation of case is completed by the nurse. Provider – Immediately after surgery writes a brief Operative Note per Medical Center Bylaws (a) – using JCAHO format (b) (a)6.5.2.2 All operations performed shall be briefly described in the progress notes of the patient's chart immediately after the procedure and, in addition, fully described in an operative report dictated as soon as possible after completion of the procedure. (b)Name of primary surgeon and assistants, findings, procedure(s) performed, description of procedure(s), estimated blood loss, as indicated, specimen removed and post operative diagnosis.

2. All surgeons will use a generic reminder template to capture: a)The post operative note b)And automatically populate a prosthetic consult with all prostheses implanted as recorded in the Surgical Intraoperative Report. Provider must designate in the consult the “Implant Site” (right, left, neck, etc.) Provider must click on Lexicon and select correct diagnosis. The steps above must be completed within 24 hrs. of surgery in order to auto populate the consult using the VISN supplied routine/objects. Provider exits the chart, signing both a note and the consult order. Consult prints automatically to Prosthetics. Prosthetics processes as needed and orders replacements.

3. What Makes this Work? Behind the scenes, IRM/CAC’s are using a routine created and used at the Richmond VAMC. That routine is now supported by our VISN 6 Programmer should future patches to CPRS, Surgery or Prosthetics package alter this process. We are also using four (4) objects as created at Richmond VAMC and now supported by our VISN 6 Programmer. The objects are: Date of Operation Post – Op Principal Diagnosis Attending Surgeon Prosthesis Installed

4. This is the provider’s progress note that has been converted to a dialog. Many surgical providers already use a similar template. White bars = free text entry. This is the reminder dialog component that MUST be completed and pulls in the consult if answered YES.

5. This data is auto populated by the VISN routines/objects from nurse entries in the OR. Every recorded implant will be brought forward. All the provider must do at this point is insert the site, and click OK.

6. This is the consult order and as noted the provider must click on the Lexicon to enter a diagnosis. At this point we are directly linked to the National Prosthetic consult and we cannot override this step. 1

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9. 5 Provider should verify the data is correct and accepts the order.

10. The order awaiting signature

11. Once the order is signed -Prosthetics receives an electronic consult for closure in their suspense file. It is linked to meet the Performance Monitor vs. their current manual entry.