Preparation for the RPMS EHR 2014 August 19, 2014

Transcription

1 Preparatin fr the RPMS EHR 2014 Pre-deplyment Task List Meet with Area and Lcal Infrmatin Technlgy Specialist(s) t review technical requirements/specificatins checklist and plan fr cmpletin f checklist Ensure all prviders/eligible hspital demnstrate MU within 2014 prir t installatin f the 2014 CEHR Medicare: must be by quarter (Jan-Mar, April-June, July-Sept) Medicaid: can be any cntinuus 90 day perid within 2014 Cmmunicatin and Outreach Plan and educate ALL staff fr the 2014 EHR upgrade. All RPMS/EHR users Sites shuld re-enfrce EHR/MU teams and meet n a rutine basis t prep fr RPMS EHR 2014 upgrade. Identify Super-users that will assist during pre-deplyment, pst-deplyment and nging deplyment t meet measures and maximize functinality Infrm Leadership abut magnitude f upcming RPMS EHR 2014 EHR Utilize the fllwing resurces t maintain educatin EHR Nuggets Handut RPMS Trainings & Office hurs Recrded Trainings Office Hurs T be psted t EHR Training website r hsted by yur area EHR staff Dn t frget t check with yur lcal/area training crdinatr fr additinal trainings Develp a plan fr pst-installatin deplyment including (but nt limited t) the fllwing: Run prvider prductivity reprts pre-deplyment Cnsider extending prviders scheduled appintment time t accmmdate additinal time needed t cnvert prblem list Determine what functinality t deply and when Develp r review cntingency plan Ensure all users understand the prcess during dwntime Map ut a plan fr training f end users Blck ut resurces (trainers, space, time) Cnduct wrkflw assessments t identify which areas will be affected by the new functinality Plicy and Prcedures Page 1

2 Preparatin fr the RPMS EHR 2014 Review and mdify existing plicy and prcedures t align with new functinality Create new plicy and prcedures as needed fr new functinality/services Package Optimizatin: Install, deply and ptimize utilizatin f required systems Clinical Applicatins Crdinatrs and Package Owners Practice Management Applicatin Suite (PMAS) aka BMW Vista Imaging Referred Care Infrmatin Management GUI Cmpnents icare Clinical Reminder Radilgy Emergency Rm System Plus any ther package nt currently ptimized Please cntact Area Pint f Cntact fr that package Attend training specific t the package yu are ptimizing fr additinal infrmatin. See RPMS Curse Materials: ftp://ftp.ihs.gv/pubs/rpms-training See RPMS Applicatins Manuals: Prblem List Clean-up Encurage Prviders t clean up existing patient prblem list Prviders Cding Prfessinals T assist sites in the transitin t the Integrated Prblem List (IPL) using SNOMED terminlgy. IMPORTANT: Sites wh d nt clean their existing prblem list can expect a significant impact t dcumentatin wrkflws fr ALL staff required t dcument in RPMS/EHR (i.e. prviders, nursing, pharmacist, labratry, etc.) Please see the EHR Nuggets Handut fr best practices n cleaning up the prblem list. User Reprts Obtain a list f active users and identify which keys, menus, and mail grups they will need with 2014 EHR Page 2

3 Preparatin fr the RPMS EHR 2014 Obtain active list f prviders and ensure that their persnal/wrk infrmatin is crrectly ppulated in RPMS. Target Clinical Applicatins Crdinatr (CAC) Infrmatin Technlgy Specialist/Site Manager Additinal Guidance /Instructin/Resurces: Sites will need t update the list f users that are registered in RPMS. This is the pprtune time t ensure that users wh are n lnger at the site have been deactivated while thse that are still emplyed have accurate RPMS prfiles. Once yu btain a list f active users yu can plan ut the allcatin f new keys, secndary menus, and mail grup assignments assciated with the 2014 EHR. Run the fllwing reprts t identify active users. Optin A: See Identifies Users with Active New Persn Accunts that hld Prvider Keys Optin B: Cnsult w/ HR and credentialing staff fr list f active staff Crdinate with ther departments (pharmacy, cntract health) Once reprts are ran determine which users shuld be deactivated See Cleaning up Prvider File Steps Re-run user reprts s yu can use the final list (i.e. active list) t determine wh gets new keys, secndary menus, and needs t be added t mail grups. OIT is develping final list Ensure that Area and/r Lcal Infrmatin Technlgist staff receives a cpy f users and what each user needs assigned pst-installatin f patches. Prvider Reprt New service applicatins will utilize infrmatin such as phne number, address, etc. frm New Persn/Prvider files. The lcal site needs t verify that wrk infrmatin vs hme infrmatin has been ppulated crrectly in the users RPMS prfile. Use the abve reprt t identify all active prviders Using the reprt abve t verify that the clinic infrmatin (nt persnal) is ppulated crrectly in the New Persn file fr each prvider fr the CCDA dcumentatin: CCDA Field New Persn (#200) File Recmmended changes Care Team Street Address fields Verify Clinic address (# ) ppulated NOT prvider Telecm- Phne Office Phne field (#.132) persnal address Verify Clinic phne number NOT prvider persnal phne Page 3

4 Preparatin fr the RPMS EHR 2014 CCDA Field Institutin (#4) File Recmmended changes Street Address Pulls frm Clinic and Hspital Lcatin pinters Verify that the crrect clinic address is ppulated. Pharmacy Optimize pharmacy quick rders in effrt t prepare fr SNOMED transitin. Prepare pharmacy fr wrkflw changes assciated with the implementatin f the 2014 EHR. Pharmacy Staff Cding Staff Wrkflws pertaining t the dcumentatin f a POV during a pharmacy refill visit AND a cunseling nly visit will change with the implementatin f the 2014 RPMS EHR. Staff will need t be infrmed abut the changes s they can mdify wrkflws apprpriately. Sites need t ensure pre-ppulated ICD-9 clinical indicatin in medicatin quick rders have been remved befre upgrading t the 2014 EHR. Pre-ppulated ICD-9 cdes in the quick rder will cause unnecessary errrs t ccur when rdering medicatins in the 2014 EHR. Identify any quick rders with pre-ppulated clinical indicatin and remve See Medicatin+QO+Clinical+Indicatin+SearchOutline prcess fr capturing POV fr pharmacy refills Site activity based n existing wrkflws Develp prcess fr capturing POV fr cunseling nly visits Site activity based n existing wrkflws Adverse Reactin Tracking Optimize the ART Package prir t the install f the RPMS EHR 2014 sftware Pharmacy Staff/Infrmaticists assigned t the ptimizatin and maintenance f the ART Package at the lcal level **Reminder: The user interface and prcess f allergy dcumentatin have nt changed with this release. Mst f the changes in the ART package were dne behind the scenes. Causative Agents (Ingredients) are mapped t RxNrm cdes and/r UNII cdes. Signs/symptms are mapped t SNOMED CT cdes. The details f these mappings can be viewed in the EHR GUI when lking at the Adverse Reactin detail windw frm the ART cmpnent n the cver sheet. Review Plicies and Prcedures fr Adverse Reactin Tracking Review Package Settings Page 4

5 Preparatin fr the RPMS EHR 2014 Divisins Tp 10 signs/symptms Aut-verify settings Run Prblem List Allergy List Reprt (PLAL) and remve allergies frm prblem list and add t the adverse reactin tracking package where apprpriate Reprt lcated in the PCC package PWA List All Patients w/allergies/nka n Prblem List Free Text Allergy Clean-up Lcated in the ART Menu ptins Enter/Edit Site Cnfigurable Files Allergy Clean Up Utility Free Text (PRIORITY) Ingredient Drug Class In depth training materials fr the Adverse Reactin Tracking package are available here: ftp://ftp.ihs.gv/pubs/ehr/training/manuals/ehr%20adverse%20reactin%20tracking/ Package manuals are available here: Cnsults Plan fr additinal cnfiguratin required nce the 2014 RPMS EHR has been installed. Clinical Applicatin Crdinatrs Cnsult Package Owners/Cnsult Teams Review existing list f cnsults and inactivate thse n lnger in service. The wrksheet listed belw will help sites prepare fr the changes assciated with the 2014 upgrade. Cmplete the wrksheet prir t upgrading and then use it t quickly guide yu thrugh the changes that will need t be made nce yur 2014 EHR is nline. Overall clean-up recmmendatin: Run reprts fr each cnsult service, assess deficiencies and crrect Use RPMS Cnsult Tracking Reprts Cmpletin Time Statistics Service Cnsults Pending Reslutin Using the reprt abve identify defunct cnsults and inactivate Use Cnsult Tracking excel wrksheet Re-Run yur cnsult reprt s that nly active cnsults are listed. Identify apprpriate SNOMED cde fr each f the active cnsults listed n yur reprt Use Cnsult Tracking excel wrksheet Decide in cnjunctin with cnsult team whether the cnsult shuld require a clinical indicatin Page 5

6 Preparatin fr the RPMS EHR 2014 Use Cnsult Tracking excel wrksheet Text Integrated Utility (TIU) T prepare fr nte title standardizatin changes that will be implemented with the 2014 EHR upgrade. T prepare fr TIU nte bjects that will change with the implementatin f the 2014 EHR. Clinical Applicatins Crdinatrs HIM prfessinals Run reprt fr nte titles Instructins: TIU_ _Ntes fr mre infrmatin VHA Enterprise Standard Title Objective: Review and inactive (as apprpriate) nte titles that are used infrequently Run reprt t identify templates that cntain V POV and V POV Multi-line Instructins: 2014_VPOVSEARCH fr reprt instructins Objective: Once yu upgrade site will use this reprt t assist them in replacing V Prb w/ dates Run reprt t identify templates that cntain Active Prblems Will display all active prblems, including episdic and may clutter ntes Will need t be replaced pre-installatin with Active Prblems w/ dates (display chrnic prblems) Clinical Reminders: Plan fr reminders 2.0 Clinical Applicatins crdinatr Install any new clinical reminders that sites want t deply Remve any ICD POV fields frm reminder dialgs if they will be used in the 2014 EHR Review released Clinical Reminders (PXRM) dcumentatin fr further instructins EHR GUI Template changes Plan fr the EHR GUI changes. Page 6

7 Preparatin fr the RPMS EHR 2014 Sites will need t determine if they will utilize existing GUI template(s) r cnvert t standard template Target Clinical Applicatins Crdinatr Additinal Guidance /Instructin/Resurces: Review current EHR GUI layut Wrk with area crdinatrs abut standard GUI templates Create 2014 EHR GUI standard using the area training database befre upgrade. ICD Picklists Plan fr the transitin t SNOMED terminlgy HIM Prfessinals Clinical Applicatins Crdinatr ALL Clinical Staff wh ppulate purpse f visits (POV) in the electrnic health recrd Once the 2014 EHR has been implemented sites will n lnger use ICD-9 cdes t dcument patient encunters. Sites will need t review existing ICD picklist and cmpare it t the Natinal SNOMED picklist Sites will need t prepare a deplyment prcess fr educating staff n hw t use the Integrated Prblem List (IPL) & new SNOMED terminlgy picklist. Exprt site ICD POV picklist and imprt int excel See ExprtingPOV_Picklist fr directins Review natinally released SNOMED Picklists Cmpare and cntrast t site s existing picklist t identify deficiencies Use excel dcument called SNOMED ALL Use the existing pick lists as a guide in selecting SNOMED terms. Sme f yur pick lists may grw due t increased granularity f SNOMED. Include sme mre generic terms as well. Fcus n the best cncepts t describe clinical prblems nt the specific ICD cdes Outline remaining SNOMED terms yu wish t use and define new picklist fr creatin Specialty Services Prvider-specific CPT Superbills Review existing picklist and identify superbill assciatins that cntain POVs. HIM Prfessinals Clinical Applicatins Crdinatr ALL Clinical Staff wh dcument POVs assciated with CPT prcedures Page 7

8 Preparatin fr the RPMS EHR 2014 The ICD POV assciatins will return in a future versin f EHR but they will nt be available after the initial EHR upgrade. Sites will need t remve the POVs after they upgrade t the 2014 EHR and establish a training prcess t educate staff n hw t dcument the missing POV. Run CPT Fileman reprt and identify ICD POVs that will need t be remved pst upgrade See VA+FileMan+reprt+fr++BGO+CPT+PREFERENCES ID Plan fr dcumenting CPT prcedures that utilize ICD POV assciatins in Superbills Immunizatins Identify plan t dcument immunizatins, etc. that are currently dcumented using Superbill assciatins Clinical Applicatin Crdinatr Nursing HIM Prfessinals Optins t cnsider while planning: Manual capture Strngly cnsider dcumenting the single Prblem/POV Immunizatin advised alng with any ther medical justificatin when needed (Hep C r DM fr Hep B in an adult patient fr example) and having Cders add the vaccine specific ICD cdes in the cding queue: 1. There are nt mapped SNOMEDs fr every vaccine s cders will have t edit anyway 2. This will add clutter t the prblem list 3. ICD10 there is nly 1 vaccine cde instead f ne fr each vaccine type Patient Registratin Optimize package Patient Registratin Supervisrs and Staff Cllect patient specific infrmatin n Page 10 address Generic health permissin Preferred methd Health Infrmatin Management Page 8

9 Preparatin fr the RPMS EHR 2014 Ensure cding queue is caught up t the extent pssible Run HIM mnitring reprts, identify deficiencies and crrect Discuss plan t mitigate lack f Visit missing POV ntificatin Target HIM Prfessinals Additinal Guidance /Instructin/Resurces: PLAL Fix uncded prblem file diagnsis Fix uncded POV diagnsis PCC errr reprts (mnitr with increased frequency) Radilgy Optimize latest release f the radilgy package Establish plan t deply radilgy CPOE specifically fr sites that d nt have inhuse radilgy department. Radilgy Package Owners Clinical Applicatins Crdinatr Clinical staff credentialed t rder radilgy exams OIT Radilgy Leads Area Radilgy Lead Radilgy Manuals: D=0 Lab Plan fr change in clinical indicatin Plan fr rphan visits If using the GIS interface site shuld install the GIS interface befre upgrade Lab Prfessinals Clinical Applicatins Crdinatr Clinical Staff OIT Labratry Leads Area Labratry Lead EHR Visits T ensure site has prperly cnfigured telephne and chart review visits. Clinical Applicatins Crdinatr Page 9

10 Preparatin fr the RPMS EHR 2014 Check t ensure these parameters are set: 29 BGO POV DEFAULT CHART Select default POV fr chart reviews 30 BGO POV DEFAULT TELEPHONE Select default POV fr telephne visits Other Wrk with apprpriate IT staff t ensure all last minute task are cmplete (i.e. patches are updated, PXRM indexing has been scheduled, SSL certificates have been btained, and full back-ups) Back-up all GUI templates, TIU templates, ICD9, CPT and educatin picklists Page 10