Connection to Clinical Connect Regional Health Information Exchange
Excela Health is now connected to the Clinical Connect Regional Health Information Exchange (HIE). This exchange contains patient information related to prior health care encounters with UPMC, Butler, Heritage Valley, St. Clair, Washington, the Veterans Administration, and other organizations in the region. This information can be useful to supplement the patient history and possibly prevent duplicate testing.
On January 4, we will be adding a new link to Clinical Connect on the HERO menu for all providers and staff. When you click on this link, a window will open to the right of the link. If the patient has consented (this process occurs at registration), a summary page will open with details regarding that patient. Various tabs will be enabled if information exists. The user interface should be rather straightforward. Please reference the HERO Provider Information site for more details if needed.
The team is working to add a link for Clinical Connect within Allscripts as well. We anticipate this work will take a few months to complete. EHMG/Allscripts users can access through HERO when needed.
Other key points:
-Allegheny Health Network is NOT contributing information to the exchange at this time.
-Excela Health is only contributing registration data at this time. You will not see clinical information (allergies, medications, immunizations, problems, documents, and results) from Excela in the HIE at this time. We are working to send clinical information from the hospital setting and ultimately EHMG practices, but the timeline for such has not yet been finalized.
We hope you find this functionality useful for providing the best care to your patients.
Changes to HERO Radiology Orders Monday, July 11
As part of our implementation of Cerner’s radiology information system, you will notice changes to all radiology orders in HERO next week.
Effective Monday July 11, all radiology orders in HERO will have a dropdown Reason For Exam list. The purpose of these lists is to guarantee capture of information relevant to the study. The list will be specific to the particular exam. Selection from this list will be required.
If you do not see an applicable reason on the list, there is an “other” option. If you select the other option, please enter details in the second Reason for Exam field which will allow text entry. You can also use this field to add other supporting details or relevant history that you would like to convey to the radiology team.
Users with personal favorites, please read:
Users who have personal favorites for radiology orders saved with default reasons for exam will find that you are now prompted to choose from the new dropdown list. You can re-save your favorites (and any powerplan favorites containing these items) with the new format including a pre-selected reason from the dropdown list. Our HERO Provider Support Team can assist with this if needed. Any standard items with default content (powerplans, common order folders, quick orders) will be updated by the HERO team.
Thank you for your patience with this transition.
For additional materials with images, please check the HERO Provider Information Page.
HERO Provider Updates
On Monday June 20, we will add a diagnosis and problem entry section to the physician discharge instructions powerform to assist with capture of those key items prior to discharge. Please review the HERO Provider Update emails for additional details.
On Monday July 5, we will change the default mode of transmission for prescriptions to e-prescribe. This change will NOT apply to prescriptions for controlled substances. Please review the HERO Provider Update emails for additional details.
E-prescription default for new prescriptions from HERO - July 5, 2016
On July 5, we will be changing HERO system settings such that the default mode for transmission of new prescriptions will be via e-prescription to the preferred pharmacy on record for the patient in HERO.
This will NOT apply to controlled substances as they cannot be transmitted electronically without additional security measures.
Benefits to the Patient:
-Safety in elimination of transcription of a printed prescription into another system
-More prompt transmission
-Elimination of lost paper prescriptions
Benefits to the Provider:
-Less searching for prescription printers
-Less searching for paper prescriptions
Benefits to the Health System:
-Ensure that the e-prescribing rates for allowable prescriptions exceed thresholds for Meaningful Use
-Decreased cost for tamperproof prescription paper
We have been working with nursing staff to make sure capture and review of patient pharmacy preference is completed for every encounter (hospital, outpatient surgery, outpatient procedures). This will insure that the medications are transmitted to the desired location for that patient for that specific encounter.
Most outpatient practices use e-prescription almost exclusively with patients seeing this as a huge benefit. Early concerns of delayed transmissions have not been realized.
For those patients at Westmoreland Hospital, you may not know that Westmoreland Hospital has an outpatient pharmacy that can receive prescriptions electronically. Please consider using this as an added benefit for patients who may find the hardship of travelling to another location after discharge challenging.
We will be sending and posting (on the DR Web Page) a frequently asked questions document soon. Additionally, we will re-post information on selection of preferred pharmacy and prescription printers for your reference.
Thank you for your attention to this information.
New VTE and Sepsis Advisor Tools for HERO - May 3rd
This is a reminder that beginning tomorrow, May 3rd, you will notice a new required VTE Advisor order within most medical admission powerplans. This order replaces the old VTE Risk Assessment order and the related VTE prophylaxis powerplan/subphase. The new VTE advisor order will walk you through risk assessment and related orders for VTE prophylaxis when indicated. To open the advisor, you must “right click” on the order to modify the details.
Additionally, you may see alerts and/or be called by nursing staff regarding a new Sepsis Advisor. This tool looks at trends in patient data and triggers alerts regarding possible indications of sepsis which then guide the provider through selection of management options when indicated.
Printable Tri-folds for each “Advisor” tool will be added to the HERO Provider Information Page including a more detailed announcement from last week.
Our support team will be rounding at all 3 campuses this week to address questions you may have regarding the new functionality. Also, we have established a special command center number for this implementation: 724-689-1927. After hours, please use the HERO Provider Support number: 724-832-HERO.
Thank you for your attention to this important information.Physician Announcement - April 28VTE TrifoldSepsis Trifold
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