ELECTRONIC HEALTH RECORD (EHR) ENHANCEMENTS FOR MARCH 15, 2016 SUMMARY

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Dale Phelps
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1 ELECTRONIC HEALTH RECORD (EHR) ENHANCEMENTS FOR MARCH 15, 2016 SUMMARY Problem Opening PACS Images on ipads or ibooks has Been Fixed Changes have been made in PROD to enable user credentials to be passed through from PowerChart to Centricity seamlessly. Providers who are currently logging into Centricity on their devices will no longer have to when viewing their patient s images. This will also allow providers who use MACs/Androids to access their patients PACS images on their devices. Related Results in PowerPlans Currently related lab results can be found using Related Results when ordering selected single medication orders. For example, Warfarin will pull in INR results if the results are in the patient profile. We are going to carry this functionality forward to PowerPlans as well. Starting with the following blood transfusion PowerPlans for adults/paediatrics/neonates, related results will be linked to the plans. Blood transfusion - Packed Red Blood Cells = Hemoglobin Blood transfusion - Prothrombin Complex Concentrate INR based = INR Blood transfusion Plasma = INR Blood transfusion Platelets = THR (platelet count) Blood transfusion Cryoprecipitate = FIB (Fibrinogen level) Blood transfusion Factor VIIa recombinant = THR, INR/PTT, FIB P a g e 1

2 The number of related lab results to view will be indicated in ( ). Click Related Results to view results. P a g e 2

3 Paediatric Cardiology Studies at VH Only When the following orderables are ordered electronically you are no longer required to also send a paper requisition VH Cardiology. Area ECG Order ECG 12 Lead Pediatric ECG Pediatric Research ECG Research Resulted Pediatric ECG Signal Average Pediatric Echo Echo Fetal Echo Pediatric Holter Holter hrs Pediatric Holter hrs Pediatric Holter 60 hrs - 13 days Pediatric Holter Peds Research Loop Loop Recording 14+Days Pediatric Loop Recording 24-35hr Pediatric Loop Recording 36-59hr Pediatric Loop Recording 60hr-13 day Pediatric Stress Testing Stress Testing Pediatric Stress Testing Pediatric Metabolic Stress Testing Pediatric Research Stress Research Resulted Pediatric Stress Test Ped Metabolic Research LHSC Chargeable Items On March 30 th, 2016 Finance and ITS will complete the implementation of electronic ordering of chargeable items at LHSC. This electronic process replaces the current paper process in which the healthcare professional completes a paper invoice, has the patient sign it, and then sends the copies to the appropriate departments. P a g e 3

What Are Chargeable Items? Chargeable items are those governed by Corporate Policy FIN001- Charging of Uninsured Service, Supplies and Devices. Currently this policy is under review.

4 What Are Chargeable Items? Chargeable items are those governed by Corporate Policy FIN001- Charging of Uninsured Service, Supplies and Devices. Currently this policy is under review. Chargeable items are products and equipment, not included in OHIP coverage, which patients take home when discharged from the hospital. These include; crutches, splints, braces, abdominal binders, breast pumps, etc. Units and departments purchase these items, Finance then charges the patient after discharge and reimburses the unit/department. These charges may originate from any patient care area in the hospital, i.e., inpatient, outpatient, emergency, day surgery. How Are Chargeable Items Ordered and Invoiced Electronically? An electronic order and invoice process is used when the invoice will be $10 or greater. A regulated health professional assesses a patient and determines their product needs. They confirm the assessment with the patient, discuss the item cost, and confirm consent for the product. The consent is documented in the patient chart and an order is placed in Cerner on the patient s current encounter. Chargeable item orders can be found by: In Add Orders type charge in the Search field. In Add Order open the Patient Accounts order folder and look in the appropriate sub-folder(s). Setting up your own favorites of items you frequently provide. P a g e 4

5 *Important Orders that are used for chargeable items all have (charge) at the end of their name. ONLY use these orders when the product has been given to the patient. Once the order is placed, a message automatically goes to the Finance system identifying the item, quantity, and department/unit from which the item came. When the patient is discharged a bill is automatically generated and sent to the patient s current address. Once the bill is paid, the department/unit is reimbursed. Electronic Order Details All of the orderables have a similar layout. The Ordering Department is automatically set to the patient s registration location when ordered as blank. If the product originated from another unit or department, that location is selected from the field s drop-down menu. Communicating Costs to Patients To help encourage accurate communication of product costs, reference text is available for each of the items identifying the current cost charged by the hospital. This information can be accessed by clicking the paper icon on the orderable. P a g e 5

6 Opening the reference text will show the cost. What if the Item is NOT Needed When the Patient is Discharged? If the product is no longer needed, the healthcare professional will cancel the order in the Cerner system before the patient has been discharged. This will automatically send a message to Finance that the patient should no longer be charged. What if the Invoice is Less Than $10? When the invoice is less than $10 we do not charge electronically. In this scenario the patient can be charged directly. Documentation of these invoices needs to be completed and submitted to Finance through a paper process. Consult your leader regarding the paper process is for your area. What if the Item Does Not Appear in the Cerner System, but Should be Charged? Items for which a patient should pay, but are not available in the Cerner system, should be managed using the paper process. This means completing the paper charge slip and sending it to the Business Office. Finance will then follow-up with the patient. Processes for having new or replacement items added to the system are under development by the Finance Department. Cerner Downtime In a Cerner downtime situation the paper charge slip ( ) should be completed and sent to the Business Office. Back entry of these orders into Cerner should NOT occur as duplicate charges may be sent to the patient. P a g e 6

PowerForm Added to EMG Order (St. Joseph s Health Care Only) This change will affect the EMG referral for St. Joseph s Hospital and Parkwood Institute Main Building.

7 PowerForm Added to EMG Order (St. Joseph s Health Care Only) This change will affect the EMG referral for St. Joseph s Hospital and Parkwood Institute Main Building. The electromyography (EMG) order will now require a PowerForm to be completed that will improve the ordering process. Complete the PowerForm 1. You must complete all yellow fields as they are required to complete/sign the PowerForm. 2. Click the Sign icon (green check mark) in the upper left corner. 3. Complete any additional order details in the order window. 4. Click the Sign button to sign the order. Precaution Orders at St. Joseph s Precaution orders will be implemented starting March 1, for all inpatients and one-day stays. Precaution orders will allow us to electronically track, document and monitor the implementation and discontinuation of additional precautions in the organization in a consistent and timely manner. Any health care professional can initiate precaution orders. P a g e 7

Precaution Orders will: Identify patients requiring precautions electronically in PowerChart; Provide consistent communication of the need for precautions during patient stay and during transfer;

8 Precaution Orders will: Identify patients requiring precautions electronically in PowerChart; Provide consistent communication of the need for precautions during patient stay and during transfer; Facilitate the tracking and monitoring of precautions of admitted patients; and Facilitate the tracking and monitoring of staff exposures to infections. Intermittent Medication Orders in PowerPlans You may encounter an error message when attempting to save PowerPlans containing Intermittent IV Medication Orders as favourites. We are aware of this issue and have been told that this issue will be resolved with our next code upgrade in September. Please check all favorite PowerPlans before signing to ensure your intermittent IV medication orders are ordered correctly. Please review the following list of medications for which this system error is seen. The following medications are currently flagged as intermittent in the Cerner system: BCG BCG 1.6 x 10*8 units-interferon alfa-2b 10,000,000 units BCG 1.6 x 10*8 units-interferon alfa-2b 20,000,000 units BCG 1.6 x 10*8 units-interferon alfa-2b 25,000,000 units BCG 2.67 x 10*8 units-interferon alfa-2b 10,000,000 units BCG 3.2 x 10*8 units-interferon alfa-2b 10,000,000 units BCG 4 x 10*8 units-interferon alfa-2b 10,000,000 units BCG 8 x 10*8 units-interferon alfa-2b 10,000,000 units CARBOplatin (onc) CARBOplatin (paeds) CISplatin (onc) CISplatin (paeds) CISplatin-cycloPHOSPHAMIDE-etoposide P a g e 8

9 CISplatin-mannitol DACTINomycin (onc) DACTINomycin (paeds) DAPTOmycin DAUNOrubicin (onc) DAUNOrubicin (paeds) DOCEtaxel (onc) DOCEtaxel (paeds) DOXOrubicin (onc) DOXOrubicin (paeds) DOXOrubicin liposomal (onc) EPIrubicin (onc) IDArubicin (onc) IDArubicin (paeds) Kadcyla trastuzumab emtansine (onc) PACLitaxel (onc) PANitumumab (onc) PEMEtrexed (onc) PERTuzumab (onc) Remicade TIGE50I acetazolamide acetylcysteine acyclovir aldesleukin (onc) aldesleukin (paeds) alemtuzumab alemtuzumab (onc) alemtuzumab (paeds) alteplase (tpa) amphotericin B ampicillin ampicillin injection amsacrine (onc) anti-thymocyte globulin (rabbit) arsenic trioxide arsenic trioxide (onc) arsenic trioxide (paeds) asparaginase Erwinia (onc) asparaginase Erwinia (paeds) asparaginase Escherichia coli (onc) asparaginase Escherichia coli (paeds) azacitidine (onc) P a g e 9

10 azacitidine (paeds) azithromycin basiliximab bendamustine (onc) bevacizumab (onc) bevacizumab (paeds) bleomycin (onc) bleomycin (paeds) blinatumomab (onc) blinatumomab (paeds) bortezomib (onc) bortezomib (paeds) brentuximab vedotin (onc) brentuximab vedotin (paeds) busulfan injection cabazitaxel (onc) calcium 1000 mg-magnesium 1000 mg calcium chloride calcium gluconate carfilzomib study carmustine (onc) carmustine (paeds) caspofungin cefazolin cefazolin -additive cefazolin 1 g-metronidazole 500 mg cefoxitin ceftazidime ceftriaxone cefuroxime injection cetuximab (onc) chloramphenicol cladribine (onc) cladribine (paeds) clindamycin clofarabine clofarabine (onc) clofarabine (paeds) cloxacillin cyclophosphamide (onc) cyclophosphamide (paeds) cyclophosphamide-mesna cytarabine (onc) P a g e 10

11 cytarabine (paeds) cytarabine-hydrocortisone 1 to less than 2 yrs cytarabine-hydrocortisone 2 to less than 3 yrs cytarabine-hydrocortisone 3 to less than 9 yrs cytarabine-hydrocortisone greater than 9 yrs cytarabine-hydrocortisone less than 1 yr dacarbazine (onc) dacarbazine (paeds) denosumab (onc) desmopressin dexamethasone dexamethasone (paeds) dexamethasone - additive dexamethasone 10 mg-granisetron 1 mg dexamethasone 10 mg-ondansetron 8 mg dexamethasone 20 mg-ondansetron 16 mg dexamethasone 20 mg-ondansetron 8 mg dexrazoxane (onc) dexrazoxane (paeds) dextrose 10% in water (D10W) bolus dextrose 5% in water (D5W) bolus dextrose 5% in water (int) dextrose 5%-sodium chloride 0.45% (int) dextrose 5%-sodium chloride 0.9% dextrose 5%-sodium chloride 0.9% (int) digoxin diluent dimenhydrinate injection dinutuximab (paeds) diphenhydramine enalaprilat eribulin (onc) erythromycin lactobionate etoposide etoposide (onc) etoposide (paeds) etoposide phosphate (onc) etoposide phosphate (paeds) filgrastim (paeds) fludarabine (onc) fludarabine (paeds) fluorouracil (onc) folic acid P a g e 11

12 fosaprepitant foscarnet furosemide (paeds) furosemide injection ganciclovir gemcitabine (onc) gemcitabine (paeds) gentamicin glycopyrrolate granisetron granisetron (paeds) hydralazine hydrocortisone hydrocortisone - additive hyoscine butylbromide ifosfamide (onc) ifosfamide (paeds) ifosfamide-mesna ifosfamide-mesna in 1000 ml dextrose 5%-sodium chloride 0.45% (int) ifosfamide-mesna in 1000 ml dextrose 5%-sodium chloride 0.9% (int) ifosfamide-mesna in 1000 ml sodium chloride 0.9% (int) ifosfamide-mesna in 50 ml dextrose 5%-sodium chloride 0.45% (int) infliximab interferon alfa-2b interferon alfa-2b (onc) ipilimumab (onc) irinotecan (onc) iron dextran iron sucrose ketorolac lactated ringers bolus leucovorin (onc) leucovorin (paeds) levofloxacin magnesium in 1000 ml dextrose 5%-sodium chloride 0.45% (int) magnesium sulfate (paeds) magnesium sulfate - additive magnesium sulfate 1 g-potassium chloride 20 mmol magnesium-mannitol-kcl in 1000 ml dextrose 5%-sodium chloride 0.45% (int) magnesium-mannitol-kcl in 1000 ml dextrose 5%-sodium chloride 0.9% (int) magnesium-mannitol-kcl in 1000 ml sodium chloride 0.9% (int) magnesium-potassium chloride in 1000 ml dextrose 5%-sodium chloride 0.9% (int) magnesium-potassium chloride in 1000 ml sodium chloride 0.9% (int) P a g e 12

13 magnesium-potassium chloride in 500 ml sodium chloride 0.9% (int) mannitol mannitol - additive mannitol in 1000 ml dextrose 5%-sodium chloride 0.45% (int) mannitol-potassium chloride in 1000 ml dextrose 5%-sodium chloride 0.45% (int) mannitol-potassium chloride in 1000 ml sodium chloride 0.9% (int) melphalan (onc) mesna (onc) mesna (paeds) methotrexate (onc) methotrexate (paeds) methotrexate-hydrocortisone 1 to less than 2 yrs methotrexate-hydrocortisone 2 to less than 3 yrs methotrexate-hydrocortisone 3 to less than 9 yrs methotrexate-hydrocortisone greater than 9 yrs methotrexate-hydrocortisone less than 1 yr methylprednisolone methylprednisolone sodium succinate metoclopramide injection metronidazole metronidazole mitoxantrone (onc) mitoxantrone (paeds) mitomycin (onc) nab-paclitaxel protein-bound Abraxane (onc) nelarabine (onc) nelarabine (paeds) obinutuzumab (onc) ondansetron ondansetron (paeds) oxaliplatin (onc) pamidronate (onc) pegaspargase (onc) penicillin G sodium phytonadione piperacillin-tazobactam plerixafor (onc) potassium chloride potassium chloride -additive potassium chloride 20 mmol in sodium chloride 0.9% 50 ml catheter syringe potassium chloride 40 mmol in sodium chloride 0.9% 50 ml catheter syringe potassium phosphate potassium phosphate (paeds) P a g e 13

14 potassium phosphate bolus in sodium chloride 0.9% (paed) potassium phosphate bolus in sodium chloride 0.9% central (paed, based on potassium content) potassium phosphate bolus in sodium chloride 0.9% peripheral (paed, based on potassium content) prednisone (paeds) raltitrexed (onc) rituximab rituximab (onc) rituximab (paeds) rifampin injection romidepsin (onc) sodium bicarbonate (onc) sodium bicarbonate (paeds) sodium chloride sodium chloride 0.45% (half normal saline) bolus sodium chloride 0.9% (int) sodium chloride 0.9% (normal saline) bolus sodium chloride 0.9% (normal saline) bolus (paeds) sodium chloride 0.9% syringe sodium phosphate streptozocin (onc) temsirolimus (onc) temsirolimus (paeds) teniposide (onc) ticarcillin-clavulanate tobramycin topotecan (onc) topotecan (paeds) trabectedin (onc) tranexamic acid trastuzumab (onc) triple intrathecal therapy (int) triple intrathecal therapy 1 to less than 2 yrs triple intrathecal therapy 2 to less than 3 yrs triple intrathecal therapy 3 to less than 9 yrs triple intrathecal therapy greater than 3 yrs triple intrathecal therapy greater than 9 yrs valproic acid vancomycin vinblastine (onc) vinblastine (paeds) vincristine (onc) vincristine (paeds) P a g e 14

15 vinorelbine (onc) vinorelbine (paeds) voriconazole P a g e 15

MEDICAL NECESSITY GUIDELINE

MEDICAL NECESSITY GUIDELINE PAGE: 1 of 10 IMPORTANT REMINDER This Clinical Policy has been developed by appropriately experienced and licensed health care professionals based on a thorough review and consideration of generally accepted