Problem List and Comorbidity Notices Webex Justine Carr John Unterborn Karen Hughes January 2013

1. Problem List and Comorbidity Notices Webex Justine Carr John Unterborn Karen Hughes January 2013

2. Problem List as Efficient New Source of Patient Information • The problem list is now a required part of the medical record. • Efficient abstract at discharge • Shared among caregivers for continuity • Physicians/LIPs must update and maintain this list. • Enter problems as they appear • Edit status at discharge • If you are going (or have gone) off service, you should still add the problem, if it is accurate • Problems should appear in 3 places • On the list AND in the daily note AND in the d/c summary

3. Why is the Problem List important?

4. When to Add Problems to Problem List?

5. What Problems Should Be Added? • Diagnoses • Reason for admission • E.g. diabetic ketoacidosis • Chronic problems • E.g. atrial fibrillation; hypertension; COPD • Comorbid Conditions • Present on admission • E.g. urinary tract infection; hypernatremia • Acquired during hospital stay • E.g. acute renal failure

6. Who adds problems to the problem list? • Last year, Nurses added problems to the problem list. • This year, Licensed Independent Practitioners (MD, DO, NP, PA, Midwife) need to add problems to the problem list and manage the problem list to insure completeness as part of the discharge information for the next care giver. • Next year, we are asking Meditech to improve information flow between problem list and nurse care plan

7. Automated Problem List assistance • Lab-driven alerts for selected diagnoses Comorbidity Notice • This is a developing pilot • Initial prompts: renal failure, respiratory failure, DKA • New prompts (1/31/13): acidosis, alkalosis, hypernatremia, hyponatremia, pancytopenia • Electronic “Page one” at discharge to review and update the problem list

8. Ensuring Documentation Completeness

9. Automated assistance for Problem List

10. Comorbidity Alerts: Dec 10, 2012

11. Comorbidity Alerts: Jan 31, 2013

12. Comorbidity Notices for Multiple Patients > Click on notice to review

13. pH <7.35 triggers Acidosis

14. Acidosis w/comment detail > Save

15. Acidosis now appears on Problem List

16. Reconciliation of Problems at Discharge • Problems pull into the Electronic Page 1 • Edit/update the problem list at discharge • Benefits • Up to date current list is shared with patient and next provider of care as required by Meaningful Use • Problem list is current if the patient is re-admitted at a later time

17. Click Document to Begin the E-Page 1

18. Click New in the footer

19. Click Discharge Referral

20. Referral Opens, Problems pull into E-Page 1 Problems from summary panel pull in and the display will say “Entered”

21. Click Problem field to view/edit/update

22. To Update the List, Click Edit in Footer If a problem is no longer active, click on EDIT.

23. Click on Status to change ARF to Resolved > Save This notice was automatically generated from a pre-set lab threshold and requires clinical correlation. This patient has a creatinine greater than 1.5 or an increase of greater than 0.5 mg/dl since last test

24. Problem List Updated E-page 1 Click OK to return to the E-page 1 and enter additional information

25. View of completed page 1 prior to entering your PIN to Sign/Save

26. Questions or Suggestions • Contact: • VPMA at your hospital • Justine Carr, MD justine.carr@steward.org • Karen Hughes karen.hughes@steward.org