Welcome to the RUG n’ RollMidwest & Great Lakes Regional User Group for Cerner Clients
Milwaukee, WisconsinApril 30 – May 2, 2007
Interdisciplinary Teaching Records using PowerPlan
Functionality
Lynn Germanson, RN, BSNSenior Business Application Analyst Clinical Documentation TeamAurora Health Care, Milwaukee, WI
Lori Zareczny, RN, BSNBusiness Application AnalystClinical Documentation TeamAurora Health Care, Milwaukee, WI
Objectives• Describe the challenges of standardizing
Teaching Record content across multiple disciplines and multiple facilities.
• Describe how Interdisciplinary Teaching Records have been interpreted by Aurora Health Care using Cerner PowerPlan functionality.• Describe how Teaching Records have been built in the electronic medical record for Aurora Health Care facilities.
Who is Aurora Health Care?
• Private, non-profit, teaching organization:• 684 employed physicians• 3,200 physicians on staff• 25,000 employees• $2.6 billion annual revenue• 0.5 million IP days/year• 2.3 million OP visits/year• 0.25 million ED visits/year• 0.3 million Home Care visits/ year• 5.6 million retail Rx/year
• Integrated Delivery Network • 14 Hospitals (40-600 beds)• 120+ Outpatient Clinics• 140+ Retail Pharmacies• Long Term Care• Home Health Services• Hospice Services• Laboratory Services• One of the nation’s “Most
Wired” hospitals in 2004, 2005 & 2006
Where is Aurora?
Diverse Hospital Mix
• 14 Hospitals – Range from 40-600 beds– Include rural community
hospitals and metropolitan acute care hospitals
– Teaching facilities– Newly constructed and
acquired facilities– Various levels of
“Computerization”
Cerner Applications at Aurora
• Hospital “Core” systems implemented from 2000-2004 Patient Access (Registration & Scheduling) PowerChart Orders, Results, Charges Radiology, Surgery, Emergency Dept Interfaces: Lab, Transcription, Dietary, Digital Imaging
• “Advanced” product implementations under way PowerChart Office in Clinics (>75% done) Pharmacy (100% done) Multidisciplinary Clinical Documentation & eMAR (90% done)
• PowerPlans & INet (14% done)• Teaching Records (1st site Go-Live Sept. 2007)
Barcode Medication Administration (new) CPOE (7% done)
Teaching Record History
. . .first there was paper, then there were. . .
Online FORMS
Form Mimics Paper
Physical Therapy/Occupational Therapy: Developed short list of common teaching topics
Ambulatory Surgery Teaching Record: First area to capture teaching in Cerner Form developed to capture their specialized teaching
Speech, Nutrition, Nursing . . . Other Disciplines. . . Requested their “Own” teaching topics
STOP!
Ambulatory Surgery
Ambulatory Surgery
PT Teaching Record
Form Format? PROs• Interdisciplinar
y• Pulls LCV, so
can see what was taught previously
• Customized to list specific teaching materials given
CONs• Each Topic requires 7 DTAs • Complex Event Set Hierarchy• Required teaching not
identifiable• Unable to individualize• General Topics - Comment/note
at bottom of page to be more specific
• Maintenance nightmare• Teaching Records needed
(>150)
The PowerGrid?
Prenatal Care Coordination Home Visit Teaching
PowerGrid FormatPROs• Useful for areas seeing
patient over extended period of time (several months) with focused topics
• Can select multiple topics in one entry
• Allows individualization (comments)
• LCV pulls previous teaching, allowing review in form
CONs• LCV pulls previous teaching, so
resign others’ data each time• Several topics identified in
each visit• Confusing to new care provider• One packed row vs. several
rows in order to provide details about response to each topic
• Inpatient build would be several forms with multiple sections because of variety of teaching topic groupers
• Unable to identify Required Components
The Challenge
. . . Incorporate >150 paper teaching records x 14 site variations
using different formats into something that will be. . .
• Interdisciplinary• Individualized• Address Barriers to Learning for each learning
session• Address components identified through
evidence / regulatory standards• Allow easy review of previous charting• Standardized across a multi-hospital system
Teaching Records using PowerPlan Design
System Interdisciplinary Groups met several times to decide:Diagnosis-based plans (CMS/Premier
standards)Subcategories in each Diagnosis Teaching Plan Required components to meet set standardsGrouper Headers for other topic categoriesTopic detail levelWhat is recorded about each topic – readiness,
who, what, how, when, result
Diagnosis-Based Teaching Plans
Diagnosis-Based Teaching Plans
• Congestive Heart Failure / CHF• Community Acquired Pneumonia / CAP• Total Joint Replacement / TJR• Cardiac Surgery • Acute Coronary Syndrome /AMI• Cerebral Perfusion Alteration / CVA• etc. . .
Conceptual Design - Subcategories in Diagnosis
Teaching Plans
Building BlocksDiagnosis-based
Teaching Records• Plans Composed
of Subcategory “Building Blocks”
• Includes “Groupers” which exist independently for use without Diagnosis Teaching Plans
Diagnosis-based Plans Subcategory Groupers
Diagnosis• Disease Condition• Tests / Procedures
Nutrition• Guidelines• Diet
Discharge• Review Instructions• Home Monitoring• Community Resources/ Home Care
Medication Management
Treatments• Therapy / Equipment• Treatment
Wellness•Advance Directives•Smoking
Functional Skills• Safety• Skills• Assistive Devices
Using Cerner Functionality to Drive Teaching Record
Format• Plans• Teaching Record
category – “lives” after Discipline Plans
• TEACH prefix helps in Plan Search window
• Document In Plan• Interventions not
Goals• Ready to Learn• Initial or
Reinforcement• Who taught• Method of
instruction• Evaluation of patient
progress• Progress to Teaching
Completion
Search and Select Teaching Plan
The Plan of Care “Homepage”
CHF Diagnosis Specific
CHF Treatments
CHF Medication Management
CHF Functional Skills and Nutrition
CHF Wellness
CHF Discharge
CHF Discharge cont.
Customize the Plan and Initiate
Only Selected Interventions Show
Document in Plan
Quick Chart
Linking to Form
Note/Variance Details
Teaching Documentation
• Ready to Learn?• Initial vs. Reinforcement?• Who Taught?• Format Info Presented• Evaluation of Learning
Teaching Documentation
Any Questions ?