PACS System Update
During the past several weeks, it has been our experience that imaging data migration for the new PACS system will take longer than expected. Because we want to launch and utilize a fully functional and optimized system, the go-live has been pushed back to Tuesday, November 3rd.
Education for all users will be communicated closer to the new launch date. If you or your staff have been through training, additional training will be provided.
If you have any questions, please contact Judy Raishart, System Director of Imaging Services, at 724-830-8537, or email@example.com. Thank you for your patience as we continue to develop the system to its fullest potential.
HERO Mobile App/Site Now Available
The HERO Mobile App/Site is functional again with respect to patient lists. We apologize for the prolonged outage.
In addition to return of the patient list functionality, you may also notice the following:
-improved performance and load times
-ability to add diagnoses from within the app
-better display for labs, medications, and documents
Please take a moment to try this from your smart phone or tablet.
If you encounter any new issues, or have any questions about use of the site, please contact the Support Center.
The ePortal access issues have been resolved. You should now be able to access from external locations. Please contact the Help Desk (724-689-0090) with additional issues.
HERO Provider Update - July 2015
Please take a moment to review the following updates for use of HERO. As always, if you have specific questions or support needs, please contact HERO Provider Support at 724-832-4376.
STAT Orders for ED Patients
If you need care executed promptly on a patient that is in the ED, please discuss that care directly with the ED attending. The ED staff do not routinely look at the orders in HERO and unfortunately cannot immediately predict which patients will be held in the ED for an extended timeframe. For those who are wondering, we do hope to implement Cerner/HERO in the ED within the next 18-24 months.
Selection of Printers for Prescriptions
Please make sure you select the correct printer when generating printed prescriptions from HERO. You must print to a printer/drawer with tamperproof paper. Outpatient pharmacies are not legally permitted to fill prescriptions that are printed on basic paper and should call you for a valid prescription. Printers that have the tamperproof paper are designated with “rx” at the end of the name. Call HERO Provider Support if you would like assistance with creating favorites for prescription printers. You may also consider transmission to a pharmacy via e-prescription for non-controlled prescriptions.
Many have asked if there is an easy way to find IV fluids with potassium or bicarbonate additives. We have enhanced the EH common orders folders to be more inclusive of IV fluid options. If you are looking for a particular fluid and cannot find it using general search terms “dextrose,” “sodium,” “kcl,” “bicarb,” click on the Folders icon, click EH Core Content, then click IV Fluids/Blood Products/TPN folder. Within that folder there are subfolders for fluids with potassium and those with bicarbonate. If you use any of these fluids regularly, you can save them as personal favorites. If you have any questions about how to find or use these, please call HERO Provider Support.
New Excela Health Network Password Policy
NOTICE: New Excela Health Network Password Policy
If your Excela Health network password is older than 90 days, you will be prompted to change it to meet the policy below upon your next login to HERO.
This will affect your password for the following applications:
· Citrix MyApps/HERO
· DR PACs
· VPN access
· computer/Internet access at Excela facilities
· Single SignOn authentication at Excela facilities
· Excela Health email **(if you have an Excela Health email account, you will need to update your password on your smartphone/tablet device after you change your network password)
Excela Health Password Policy:
· Expires every 90 days
· Your password must contain at least 3 of the following criteria: uppercase, lowercase, numbers, non-alphabetic/special characters
· Password must be at least 6 characters long
· Password CANNOT contain your username, first name or last name
· Password history – remembers your last 5 passwords, which cannot be reused
· Account will be disabled after 5 invalid attempts
HERO MOBILE SITE NOT AVAILABLE
The HERO Mobile website is not available at this time due to issues related to the system upgrade early this morning. The team is working to re-establish access. We will post an update when the system is available. Please use the standard HERO link for remote access on a laptop of desktop computer if you need to access patient information in HERO. We apologize for the inconvenience.
We are almost 6 months into the transition to our new dictation system and seeing great results in terms of document turnaround times and overall accuracy. Thank you for your patience and cooperation with the transition. On behalf of the Medical Information Management department, I wanted to share a few tips for use of the Nuance Dictation system.
How to move to a new dictation without hanging up
At the completion of your dictation, press 5 to start a new dictation. You will be prompted for location and work type, but you will not need to re-enter your provider number. We are working on the creation of a keystroke combination that will cue up a new dictation for the same location and work type (i.e. a series of operative notes).
How to pause and resume
The system is set to timeout after 1 minute of silence. This timeframe is as long as we can make it. To pause a dictation, press 4. To resume a dictation, press 2.
Preliminary Discharge Summaries
Providers may dictate preliminary discharge summaries prior to a weekend and/or when handing off to a colleague. Until this week, those preliminary summaries were not immediately available in the electronic record. We have made a change to the system so those documents will be available immediately after transcription. If you dictate a preliminary discharge summary when the date of discharge is still uncertain, you will need to manually modify that document with the actual discharge date when known.
If you have questions regarding the process for using the dictation system, please contact Medical Information Management at 724-832-4065.
If you have questions regarding how to addend or modify an existing dictation in HERO, please contact HERO Provider Support at 724-832-4376.
HERO System Available
The HERO Electronic Medical Record is now available for use (1:14 PM 4/20/2015). Please resume normal processes for order entry and documentation. Please note that some results may be delayed in posting over the next hour as system interfaces resume to normal activity. We apologize again for the inconvenience.
EH WOUND AND INCISION CARE
EH WOUND AND INCISION CARE
A group of inter-professional staff recently held a LEAN event to standardize the patient education material given to a patient upon discharge related to Wound and Incision Care. The members of the team engaged patients, staff, and providers to develop a finished product. Any patient discharged with a wound or incision should receive this education material in addition to any provider specific or disease specific education. You will see this new and revised material in Patient Education in Cerner and Allscripts soon.
Reporting of Suspected Transfusion-Associated Infections
Reporting of Suspected Transfusion-Associated Infections
The safety of the voluntarily donated blood supply has been steadily improving during the last fifteen years. This improved safety of the blood supply, including the decreased risk of transfusion transmitted infections such as HIV and viral hepatitis, has been accomplished by improvements in donor selection and testing procedures.
The risk for Hepatitis C transmission through a blood transfusion has been decreased to an estimated 1 in 1,000,000 transfusions, The improved testing (NAT) closes the window period for not detecting an infected donor to an approximate period of one week.
The risk for Hepatitis B transmission to has been reduced to between 1 in 800,000 to 1,000,000. The improved NAT testing has closed the window period for not detecting an infected donor to an approximate period of 3 to 4 weeks.
The risk for HIV-1/2 transmissions through a blood transfusion is about 1 in 1 to 1,5 million per transfused unit. NAT testing has closed the window period for not detecting an infected donor to an approximate period of 7 to 10 days.
Despite the rarity of transfusion-associated Hepatitis and HIV infections (along with HTLV I and II, CMV, West Nile Virus, T.cruzi (Chagas disease) and parvovirus infections), sporadic cases can occur. Physicians are reminded to still consider the possibility of post-transfusion-related infections in the follow-up examinations of recently transfused patients. Suspected cases must be reported by the physician to either an Excela Health Blood Bank or Infection Control Department so that involved donors can be investigated
Click here for a powerpoint presentation regarding Ebola.
Click Here for an Ebola Resource Guide and Fact Sheet.
HERO provider update for September 2014
The provider update is available by Clicking Here
Pending Cultures from the ED
Discharge Medication Reconciliation
Initiation of Powerplans
Consent for Transfusion
Correctional Insulin for Discharge Medication List
HERO provider update for July 2014
The provider update is available by Clicking Here
Summary of the changes:New
Fluid Analysis PowerplanNew
Thoracentesis and Paracentesis powerplans to include orders for the procedure and the corresponding fluid analysisReminder
about the Quality Measures ToolNew
Diabetes Management Outpatient section in the Discharge Orders powerplanReminder
about DME and Face to Face Requirements
HERO provider update for May 2014
The provider update is available by Clicking Here
If you provide care in the inpatient setting, please take a moment to read the attached update regarding a series of changes to HERO. These changes will be implemented starting next Tuesday, May 27. These changes are driven by protocol and policy changes and/or with intent to improve patient care.
Some of the changes will impact powerplans and will thus require those users with personal powerplan favorites to re-save their favorite powerplans if impacted. Because of the impact on favorites, we try to make changes to powerplans infrequently, but do need to keep them current with best practice and policy.
Summary of the changes:New
Activity Order to Accommodate the Mobility ProtocolNew
Bed Placement Orders - Increased Care Needs, Telemetry, and Critical Care BedsNew
GI Prophylaxis Powerplan for Stress Ulcer PreventionNew
DME Powerplan and “Face to Face” Documentation RequirementsNew
Diabetes Management PowerplanNew
BMI in Patient Banner BarChanges
to Urinary Catheter Insertion and Continuation Orders to Reflect the New Urinary Catheter Removal ProtocolChanges
to Code Status Order to Reflect Policy Changes – Removal of Comfort Care Option and Comments and Special InstructionsChanges
to MRI Orders to Guide Appropriate UtilizationUpdates
to Outpatient Prescriptions Powerplan
New Policy for plasma transfusion
To: All Excela Health Practitioners ordering blood products
From: Charles Choi MD, Tissue and Transfusion Committee Chairperson
Subject: New Policy for plasma transfusion.
The Excela Health blood bank will be following new AABB guidelines and American Red Cross recommendations, necessitated by anticipated reduced inventories of group AB plasma. Recent best practice is to generally exclude plasma donated from females who have been pregnant, to mitigate risk of transfusion related acute lung injury (TRALI). As a result, the following change is implemented beginning April 1, 2014:
1. Group A plasma will be provided for emergency release to adult patients when the patient's blood group is unknown or group AB plasma is unavailable.
2. Patients should be ABO typed as soon as possible to allow transfusion of group-specific plasma
3. Pediatric, cardiac surgery, and transplant patients, and patients with TTP requiring exchange transfusion will continue to receive group-specific plasma only.
Please contact Charles Choi MD, transfusion committee chair, with any medical questions at 724-537-1853.
Patti Schildkamp, Blood Bank system supervisor, can be contacted with nursing/technical questions at 724-537-1573.
HERO Office Staff Training Sessions – Being Offered NOW!!!!
Webchart/Homecare Portal Announcement
On Monday night, May 6 we will be implementing the new Webchart/Homecare Portal application (eliminating the Homecare tab in ePortal). The link can be found on the navigation area to the left.
New Venous Thromboembolism Prophylaxis Recommendations and Order Sets
From: William A Jenkins, MD, FACEP / Venous Thromboembolism Prophylaxis Team
As I am sure that you are all aware, the American College of Chest Physicians (ACCP) released new guidelines this year regarding the prevention of venous thromboembolism (VTE) and the use of antithrombotic therapy for VTE prevention. These guidelines can be reviewed in their entirety in CHEST for those of you who wish to review the entire guideline.
Excela Health has been working for several years to improve the VTE protection provided to our patients. In conjunction with nursing and as a project in partnership with Highmark and now CMS, Excela has taken great strides to support a nursing risk assessment program for VTE beginning hospital day one providing mechanical compression stockings to nonambulatory patients pending the physician’s assessment of VTE risk and the implementation of pharmacologic VTE prevention where indicated. The use of pre-printed order sets and the use of a comprehensive power plan in Cerner has aided the physicians in following the most evidence based guidelines for VTE prophylaxis for our inpatients.
As the guidelines have recently been modified, this monograph will highlight the newest changes and recommendations and provide examples of changes to the pre-printed order sets and the Cerner power plan.
The clinical recommendations are designed to consider the balance of benefit and harm that result in the decision to provide VTE prophylaxis to our inpatients. The guidelines acknowledge that not all patients require VTE prophylaxis and suggest a risk stratification methodology (The Padua Prediction Risk Score) to determine those patients at highest risk.
The Padua Prediction Risk Score
Risk Factor Score
· Active cancer 3
· Previous VTE 3
· Reduced mobility 3
· Known thrombophilic condition 3
· Recent (≤ 1 month) trauma/surgery 2
· Elderly (≥ 70) 1
· Heart/respiratory failure 1
· AMI/ischemic stroke 1
· Acute infection/Rheumatologic disorder 1
· Obesity (BMI≥30) 1
· Ongoing hormonal therapy 1
Patients are deemed high risk if their Padua Risk Score is ≥ 4 or they are admitted to a critical care unit and considered clinically critically ill. (The guidelines address the critically ill however they are not necessarily part of the formal Padua Scoring System. We have modified our score to assure those in critical care areas automatically fall into the high risk category for efficiency and ease in ordering prophylaxis).
Patients are considered low risk for VTE if their risk stratification score is 3 or less.
For acutely hospitalized patients considered low risk for VTE the guidelines recommend AGAINST the use of either pharmacologic or mechanical VTE prophylaxis. It should be stressed that the patient’s risk level may change throughout the course of their hospitalization and thus risk determination is a dynamic process that should be re-evaluated with each change in patient condition or transition of care. The physician must document “low risk/no prophylaxis indicated” – this is easily accomplished on the order sheet or order set.
As stated above, regardless of risk score, critically ill patients (those in the ICU or deemed critically ill clinically) should receive prophylaxis. Low molecular weight heparin (LMWH) or low dose unfractionated heparin (LDUH) is recommended. For critically ill patients who are bleeding, or at high risk for major bleeding mechanical thromboprophylaxis is recommended until a time when pharmacologic agents can be safely initiated.
For acutely hospitalized patients considered high risk for VTE the guidelines recommend anticoagulant thromboprophylaxis with LMWH, LDUH bid, LDUH tid, or fondaparinux (arixtra). For high risk patients who are bleeding, or at high risk for major bleeding mechanical thromboprophylaxis is recommended until a time when pharmacologic agents can be safely initiated.
Attached you will find a copy of the Excela pre-printed order sheets designed to take you through the risk stratification process for VTE and provide you with the ordering choices for appropriate evidence based VTE prophylaxis. In addition, you will find copies of the screens in Cerner dedicated to VTE prophylaxis. VTE Prophylaxis Power Plan
screen shotsVTE Prophylaxis Order Set
New Transitional Orders PowerPlans – Monday November 12
In an effort to assist with timely entry of common “tuck-in” orders for patients admitted after hours, the HERO team has developed 4 transitional orders PowerPlans to cover the most common evening admissions at Latrobe and Frick, and ultimately Westmoreland Hospital.
Transitional Orders General Surgery
Transitional Orders Medicine
Transitional Orders Orthopedics
Transitional Orders Urology
These PowerPlans contain the admission/observation order, code status, common nursing tasks, basic diet/NPO options, common IV fluids, common medications, and common diagnostic testing ordered by each of these disciplines. While the common items for other subspecialties may not be represented in this content, we can add additional options in the future if the content is available.
The nursing staff will begin to use these on Monday, November 12. When calling to obtain orders for an after hours admission, a nurse may utilize one of the transitional orders PowerPlans to quickly capture these “tuck-in” orders given by the admitting provider.
We hope that use of these PowerPlans will assist with timeliness of order entry and with accuracy of entry as most of the options in these sets are pre-configured to minimize manual data entry.
-The provider will stay on the phone with the nurse while the nurse makes selections in order to make sure true “read back” is performed as part of standard policy for telephone orders.
-The provider or covering partner is expected to cosign these orders the following morning.
-The provider will complete admission medication reconciliation the following morning.
-The provider will complete the VTE risk assessment order the following morning if not otherwise completed as part of the initial orders.
-The provider will order all other non-urgent orders the following morning as part of routine rounds.
Providers are certainly free to use these PowerPlans for direct order entry as well and/or to use the standard admission PowerPlans available in the system. Direct entry by the provider has advantages in minimizing the risk of transcription error and in getting all orders complete with one step.
Thank you for your support of this new initiative. Please feel free to contact me with any questions.
David Rich, MD, FAAP
Chief Medical Information Officer
HERO (CERNER) EMR Training Sessions
Time Out - Joint Commission Finding
Performing a TIME OUT prior to all operative and invasive procedures is the policy of Excela Health and has proven to prevent wrong site, side, and patient procedures nationally. TIME OUT is required immediately prior to all non-emergent operative and invasive procedures done in any location (including at the bedside). TIME OUT is a pause immediately prior to the invasive procedure during which ALL activity stops and the team (at a minimum the physician and an RN or technician) :
· Identifies the patient
· Reviews the informed consent and ensures appropriate completion
· Confirms the planned procedure
· Confirms that the surgical / procedural site is appropriately marked
· Ensures that all anticipated equipment and medications are readily available
· Reviews anticipated post-procedure needs of the patient.
Performance of the TIME OUT will be documented by a member of the nursing staff.
During a recent Joint Commission Survey at Frick Hospital, it was identified by the survey team that a bedside thoracentesis was performed by a physician without the required TIME OUT (including site marking) being performed. This is an unacceptable and risky practice.
As a result of this observation, a very rigorous and extensive audit will be conducted over the next four months to assure 100% compliance with this policy in all locations.
If you have any questions, please contact Denise Addis, Director Accreditation and Regulation at 724-832-5163 or firstname.lastname@example.org . Thank you for your continued support and commitment to patient safety.
Professional Practice Evaluation Process
As discussed at the General Staff meeting, Excela Health has initiated the development of a Professional Practice Evaluation process.
The work of the Patient Care Evaluation Committees will be transitioned beginning July 1, 2012 to the Professional Practice Evaluation Committee, referred to as PPEC. The PPEC is a new multi-specialty committee and the foundation of the new process. The PPEC's sole function is to use its expertise to help colleagues on the Medical Staff improve their clinical practice. When concerns are identified in a practitioner's clinical practice, the PPEC may develop an individual performance improvement plan to address those concerns.
Below is a link to an information sheet and detailed process flow chart. The policies can be found under the intranet at the Medical Affairs
link then "Policies"Professional Peer Evaluation Information Sheet PPE Flow Chart