Aspirus Medical Staff

In This Issue

IT "Go Future" Updates

H&P Audit a Success at 96.1%

Suggested Empiric Antimicrobial Agents of Choice 9th Edition

Four Wisconsin Pediatric Dentists Recognized

IT "Go Future" Updates

For the past several months, the Medical Executive Committee (MEC) has invested a great deal of time and leadership in our CPOM/eDOC preparations and the restoration of our IT department ("Go Future"). Below are a few of the updates discussed at the MEC meeting on 6/12:

• Chief Information Officer (CIO) recruitment has reached first round interviews. Al Sinisi, continues to serve in an interim role devoting attention to rebuilding this important service.           
• We have, and continue to, utilize third parties to conduct risk assessments of our IT infrastructure.
• The secondary data center is operational. This includes immediate access to a read only copy of Epic, redundant phones (with the exception of switchboard functions scheduled for August), and redundant Microsoft exchange (includes email). We are now reassessing all downtime procedures to update them to reflect these new capabilities. Additional systems are scheduled to be duplicated in the secondary data center by the end of the calendar year.
• An IT Rounder role has been implemented in the hospital to troubleshoot hardware issues on a daily basis (Monday-Friday), interacting with caregivers for feedback. The Help Desk has been re-engineered to reduce wait times.
• 5 FTEs were added to IT earlier this year and are nearly filled. An additional 5 will be added effective 7/1. While these new team members orient and acclimate, additional expertise has been contracted including two "builders" and a testing manager who will help us test our Epic CPOM/eDOC Go Live build this summer.
• An experienced training manager has been contracted and has been on site for the past few months to help us successfully prepare for CPOM/eDOC Go Live on 9/23 and to help us build this competency at Aspirus. A training manager position has been posted and will be hired as quickly as we find excellent candidates.  
• We are combining the ambulatory trainers and the inpatient trainers into one team who will be led by the new Training Manager. This is a step forward toward integrating "clinical informatics" at Aspirus and is designed to:

- Support ongoing training and optimization needs.

- Ensure consistent answers and solutions/best practices.

- Redeploy trainers by specialty, so that solutions are sought and created across the continuum of care and not specific to clinic versus hospital.

- Evolve to trainers who can train clinicians on all systems, not just Epic.

- Build a larger team that can offer greater support.

Questions about any of the above should be directed to AskAWHCPOM@aspirus.org.

H&P Audit a Success at 96.1%

H&Ps obtained within 30 days prior to admission must have an Update within 24 hours of inpatient admission, but always prior to a surgery or procedure requiring sedation or Anesthesia services. 

Last fall, prior to our Joint Commission survey, CMS (aka Medicare) became more prescriptive as to what the Update must include in its documentation.  Specifically the Update documentation must indicate:

1.     The H&P was reviewed; and

2.     The patient was examined for any changes that might be significant to the planned course of treatment; and

3.     Any pertinent changes or the absence of changes

At the time of survey in many cases our current documentation stated #3 but only inferred #1 and #2.  Following rigorous discussion with our very reasonable physician surveyor, it was clear that we must comply with CMS' specificity. Cath Lab and Pain Clinic were already largely in compliance; however for Surgery, where the Anesthesia Record was relied upon as evidence of the H&P Update, change was necessary.

While Anesthesiologists regularly assess patients, their assessment is specific to the provision of anesthesia -- specifically heart, lungs, and airway.  They are not assessing the patient for changes specific to the surgical site.  In many instances it may be inappropriate to expect an Anesthesiologist to evaluate all changes that could impact the patient's fitness for the specific procedure being performed or the impact of any changes on the planned course of treatment developed by the surgeon.  Surgeons and Interventionalists are already doing this assessment, but just not documenting it.   

We created a quick way for Surgeons and Interventionalists to document the H&P Update:

I have reviewed the History and Physical and examined the patient.

(Check one of the following)

___  There are no changes that are relevant to the planned course of treatment; OR

___  There have been interval changes* as listed below:

*Changes:__________________________________________

Sign/Date/Time

This was implemented in late January 2012 and audited per the Joint Commission prescribed four (4) months, which concluded at the end of May. We have successfully passed our audit having averaged over a 90% completion rate (96.1%).

Going Forward

H&P Updates have been a confusing subject in all hospitals. The good news: We are not nearly as confused as other hospitals, in part thanks to the benevolence and clarity of our physician surveyor. Many other hospitals were so confused about what had to be in the Update, they were requiring physicians to simply complete a new H&P if the current one was over 24 hours old!

The bad news: While all seem to be in consensus that concept is a good one, following the documentation requirement is inefficient for those who swing rooms in particular.

The most common confusion we hear is "who has to do this update?" and "Isn't this Anesthesia's responsibility?" The answer to the latter is "No". Anesthesia clears the patient for general anesthesia, not for the specific procedure being performed.

CMS (aka Medicare) is looking for a responsible provider to attest that nothing in the patient's condition has changed that would warrant not performing the planned procedure (eg: knee replacement planned, but on the morning of surgery the knee is red and swollen). The specific language in the regulation is "The patient was examined for any changes that might be significant to the planned course of treatment". The extent of the examination is up to the individual physician, and of course can take into account the assessment that Anesthesia has performed for their role in the care.

So, our current stance is: If you can prescribe the procedure (including dentists and podiatrists), you can consider whether or not the patient still needs the procedure on the day of surgery and document the Update.

Lastly we received one request to have our legal counsel review the language in Update documentation to ensure it does not create any additional legal liability. As CMS essentially creates a national standard by their regulation and we are following it, it does not create legal liability.

Suggested Empiric Antimicrobial Agents of Choice (aka Blue Card) - 9th Edition

William Bowler, MD recently completed updates to the "Blue Card". Updated cards were mailed to Medical Staff and Allied Health Staff the week of June 11th.  It is also available as a PDF on the Medical Library website at

http://aspiruslibrary.org/drug_information/DrBowler2012_2014.pdf. If you did not receive a card, or would like additional copies, please contact pss@aspirus.org.

Four Wisconsin Pediatric Dentists Recognized as Outstanding Entrepreneurs at Small Business Administration National Conference

First Impressions pediatric dentists, Drs. Thomas Turner, Corey Brimacombe, Carl Hash, and Joshua Spiegl were presented the "Wisconsin Small Business Persons of the Year" award in a gala event held May 23, in Washington D.C by the U.S. Small Business Administration.

Criteria for award selection included showing employee growth, financial performance, and innovativeness, response to adversity and contributions to the community. "We are honoring their achievements and spirit of entrepreneurship, innovation and determination," says SBA Administrator Karen Mills. "It is this spirit that continues to drive economic recovery, economic growth and job creation."

First Impressions used their SBA loan to expand its services to underserved children in central and northern rural communities. They have offices in Weston, Stevens Point, Rhinelander, Medford and Shawano and are the state's largest provider of pediatric dentistry services to Medicaid recipients.