Toolbox

Questions – Answers - References

ReF # / KEYWORDS / Questions / Answer / Reviewed by
(Taskforce Member) / Data or Evidence? / Reference/Source / Date
5 / What type of format should be used to indicate errors or changed documentation?
Should the older data be displayed?
How is the completed history of data configured? (audit trail)
“Error explanations– changes – how much should be in strikethrough format? Or should it be in that format?” / It is vendor-specific, but strike-through is common.
Some systems display it with strikethrough, some have the erroneous data display removed from view.( This is often configurable.)
Since clinical decisions are based on data, it is important to at least be able to see what the prior data was. The clinician needs to know that the data was changed.
Can it be configured to one standard?
CHIT standard is Show the original, the date/time of the error - and provided the ability to maintain it.
AHIMA - Especially refers to physician documentation. Most physicians have addendums, rather than strikethrough, even on paper. / Lisa Bove
Melissa Barthold
Jim Cato
Brenda Kulhanek
Julie Luengas

CHIT

24 / What policies should be addressed prior to electronic documentation design/implementation?
8 / What is the best practice for maintaining the power supply on mobile devices?
9 / How is the appropriate number of documentation devices determined?
11 / Default
Design
Copy forward
Pre-checked
Documentation
Policy
Access
Charting
Clinical documentation
Efficiency
Optimization
Point of care documentation
Choice lists / Are ‘default’ answers in forms permitted? / Default answers allow for quicker data entry, but should be used judiciously so that users don’t miss the need to change from the default to the correct option.
When making this decision, the following should be considered:
Have you allowed defaults on paper forms or in other applications? If so, then these defaults should be reviewed to determine if they are still appropriate for an electronic form.
Consider one of the ways to determine that a question can have a defaulted answer is if the default option ‘correct’ at least 80% of the time.
Ensure that the end-user can easily change the default answer.
Consider where the option is located or how easy it is to view the other options.
Review with Compliance Officer/Risk Management.
Can your electronic system ‘remember’ previous responses that are patient specific?
Can your system identify items that were defaults (as opposed to selected from a choice)?
(If you've elected to use the 'copy forward' function, the default option should not be used in conjunction with 'copy forward'.) / Lisa Bove
Melissa Barthold
Jim Cato
Brenda Kulhanek
Julie Luengas
17 / Julie / What is current practice for enhancement request prioritization?
How are clinical enhancement requests reviewed? Does the review of clinical enhancement requests include an assessment of the clinical impact of the changes?
What is current practice for communication of system-related changes, enhancements?
20 / How is the future state included in the planning and execution of current implementations or enhancements? How are technology decisions analyzed that may negatively impact future enhancements/building? How are decisions made when an urgent need is addressed in a future enhancement that is not an organizational priority? What is the current best practice window for future technology planning?
21 / Brenda / What is current practice for training staff. What is the current practice for training and utilizing SuperUsers? How are SuperUsers best utilized as a resource?
22 / What QA is necessary for electronic systems?
Who should do QA?
23 / Lisa / How is standardization of practice documentation analyzed, implemented and measured?
24 / What is the current state of EHR use in mental health?
25 / How are ancillary departments trained to use the EHR?
26 / What is the best practice for use of computer protective equipment such as keyboard covers, and computer cleaning for computers used in patient care areas
29 / Jim / How you manage sound on computers in your hospital setting. We are having discussions about enabling sound on select devices where possible for nursing and patient education (products like Elsevier, etc). How do your hospitals handle staff and patient education? Do you have sound-enabled devices at certain locations? If so, how is your patient education material approved? Do you have sound at devices in nursing stations / CARING list / 8-18-09
31 / CPOE
Nursing
Process / How are telephone or verbal orders handled in a CPOE environment?
Protocols - how are drug, diagnostic and imaging orders placed by nurses under a protocol when no physician doesn't sign them directly. In the paper world, there was a signed protocol in the Administration office that validated that order. Does the system require choosing a doctor or is a protocol ok? Especially applies to ED and newborn nursery. / No policy for telephone orders, the mandatory use of CPOE is
in the orientation for the medical staff as well as the nursing staff.
Our workflow for this is as follows:
1. All orders are in CPOE - no exceptions
2. No verbal orders are taken for CPOE unless in an emergent situation
with all hands needed on patient
3. no phone orders except in following case:
a. RN calls with abnormal test result or patient care need and
patient needs treatment related to this
b. MD is in transit from one place to another and cannot access
computer - no more than 6 orders is our guideline on this, just enough
to get patient care initiated. Note that MD MUST remain on phone
while RN is entering the orders so that they can reply to any alerts the RN
encounters when entering orders
c. if verbal orders are requested, we ask that pathway orders or order sets be accessed as orders are prechecked and RN can read the orders off to MD with rare/few changes.
______/ Connie Whittington / Oct 13-09
33 / How are core measure patients identified in the system? How are appropriate people alerted?
34 / How is the flow of information/communication managed between inpatient units, the Perioperative area and back - including pharmacy. How are the different systems involved?
35 / Is best of breed better - or integrated system better?

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