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 ?