CMIO News
Rabindra Tambyraja, CMIO
Linda Madsen, Associate CMIO
August 2016
From the desk of:
Rabindra Tambyraja, CMIO
“The screen is not the patient.”
When a patient is in my office, every moment I
spend staring at the screen instead of my
patient is a waste of both our time. Patients and
families often come to us in a time of pain or
fear, and for them to watch us silently clicking
and tapping is absurd. In my view, the ‘Perfect
EMR’ is the one that requires neither clinician
nor patient to interact with a computer, unless
it enhances rather than detracts from the visit.
EMRs are at an early stage, and thus not
perfect. But the technology affords us the
opportunity to gather, analyze, and take action
upon an endless stream of data about our
patients. The right decisions become clearer,
and wrong decisions more easily avoided. This
requires a careful and ongoing alignment
between our software builders and our clinical
teams, and this alignment is one of my most
important goals as CMIO. In every instance I’ve
seen, when IT understands the clinical scenario,
and the clinicians have a leading role in finding
ways to integrate the technology into patient
care, the results are much better than without
those critical pieces.
I look forward to hearing from all of you what’s
been working well, and where we need to
continue improving. I’m excited to be joining a
team of skillful and dedicated technologists,
and humbled to be joining such a sterling
clinical practice.
Contents
Journey to Zero
Allergy Alert Rule
Transfusion Electronic Requisition
Type & Screen for Red Blood Cell Antibody
Bronchiolitis Guideline Alerts
Iron Dextran Ordering
Improving the EMR Experience
AIMS Scores
Workflow Summary: Neonatal Information
Hourly I & O
Improving Communication
Documenting PIV
Updates to Birth History Powerform
DNAR/POLST Update
U of MN Cytogenetic Report Status
Ambulatory Update
Discharge Med Rec Data
Journey to Zero
Milk/Egg Allergy Alert
An alert has been designed to indicate when a
food allergy, such as milk or egg, could result in
an allergic reaction when a specifc medication is
administered or a new IV bag is hung.
Please feel free to seek me out and offer any
feedback, ideas, wishes, anything at all that
you think will help us take better care of our
patients. Thank you for reading, and I look
forward to working with you!
CMIO News
Page 1 of 6
July 2016
CMIO NEWS
Journey to Zero Cont’d.
Transfusion Electronic Requisition
Beginning August 16th, the paper slips for
requesting blood product release will be
replaced by an electronic release process for
routine transfusions in order to:
Provide alerts prior to administration if:
o A patient requiring premedication
has not received them.
o The product was ordered for a
Hematology/Oncology outpatient
on an inpatient encounter.
 Remove extra steps to create a paper
requisition and send via tube.
 Eliminate the possibility of transcription
error.
Read more, including the new RN process.

To facilitate this process Blood bank will add to the
problem list “Red Blood Cell Antibody positive,
compatible pRBC difficult to obtain” once the
antibody is identified.
Bronchiolitis Guideline Alerts
The Bronchiolitis clinical working group convened
to create alerts that integrate best practice into
care according to the AAP. Children’s own
Bronchiolitis Guidelines are imbedded and the
alert makes it easy to modify or cancel orders that
are not recommended including:


If an Albuterol trial did not show
improvement in the patient’s WARM score
or if the patient is admitted for Bronchiolitis,
an alert will discourage ordering Albuterol.
To discourage unnecessary radiation
exposure, an alert will present if a CXR is
ordered on a patient with a diagnosis of
Bronchiolitis.
Click to view the complete guidelines.
Iron Dextran Ordering
To advance safety and efficiency and eliminate a
paper process, which required transcription of data, a
calculator has been added, using the patients Hgb
and measurements to calculate the Iron Dextran dose.
Type and Screen for Red Blood Cell Antibody
To minimize the need to redraw if an
inadequate amount of blood was drawn, and
to get blood ready for the patient as quickly as
possible, a new type and screen is being added
for patients with a significant red blood cell
antibody.
A calculator will appear when the order for the
dose/test dose is selected and will automatically
recommend the dose.
This rule, which can help to ensure enough
blood is drawn in the first poke, has been added
to alert the Provider to order a specific type and
screen- Known Antibody Type and Screen- that
instructs to draw the correct amount of extra
blood.
CMIO News
Page 2 of 6
August 2016
CMIO NEWS
Improving the EMR Experience
Additions to the Other section will include (Last 3
values will display when present):
AIMS scores have been recently added to the
Devices Settings and Screening section in order
to display and track these results over time.
•
•
•
Modified Finnegan Neo Abstinence
Score
Pain Agitation Scale
C.R.I.E.S Scale
Discharge Activity status and more detail will be
added including:


The Neonatal Info section of the Workflow
Summary is improving with the guidance of the
Neonatal MD and NPs.
Date of results
When one of these items is ready for
discharge it will be indicated by a green
checkmark:
o Circumcision if desired/male and
complete
o Car Seat passed
o ABR and OAE screens passed
o Hepatitis B given
o Newborn metabolic screen(s) will
show all ordering statuses with
dates (ordered, in process or
complete).
It will now consolidate key data and/or display
information that was previously difficult to find
including:

Removing the measurement graph. The
team felt the Growth Chart Component
together with the feeding summary and
weight sections will be used.

Adding the formula and diet orders to the
Feeding Summary.

Adjusting the bili & phototherapy graphs
to display only for babies 35 weeks
gestation or greater. The graphs will only
appear for 14 days from date of birth.
CMIO News
Hourly I & O has been improved based on
Clinical feedback from Critical Care Clinicians
including:



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Page 3 of 6
Reverse Chronological Order Display.
Individual bottle volumes/breastfeeding
attempts
Feeding % including oral and Enteral
Hourly Urine Output. Calculation is
UOP=mL/kg/hr. with rolling 12 hrs look
back for the volume.
August 2016
CMIO NEWS
Improving Communication
DNAR & POLST Update
Documenting Periperal IV for NNP Group
The following fields have been added in the
Dynamic Vascular Access NNP Iview Band to
facilitate documentation:
A review of national approach, MN standards
and Children’s experience was undertaken to
improve care for families with “approaching the
end of life” issues. To incorporate the results of
this review, the DNAR process will improve the
process based on feedback to reflect best
practice, improve experience and
communication.
Venapuncture and arterial line
puncture to support billing
 PIV Insertions
 PICC line dressing changes NNPs do for
patients
Anything that is documented in the NNP Band
will display in the regular Dynamic Vascular
Access Band.

Birth Hx PowerForm
Updates are being done to standardize entry
of items shared on other Powerforms to benefit
all and make one shared source of truth
which:



Standardize and share entry of
Gestational age between Dietician,
Nursing and Provider Powerforms to
eliminate multiple varying entries of the
same information
Include the source of the Gestational
age whether by assessment or
estimated date of conception for use
when relevant.
Include Discharge Head
Circumference for use when relevant
A second section called “Infant Care at Birth”
is in development for use by the Neonatal
teams to record data for research and begins
their journey to minimizing time-consuming
duplicate documentation for the Neonatal NP
group.
GroupWise Signature include
gibberish at times?
Click this link to learn how to
fix this common issue.
CMIO News
University of Minnesota
Cytogenetic Report Status
Due to ongoing technical problems with the
reporting interface, Cytogenetic results from the
University of Minnesota will be reported
differently as of August 1, 2016. Click for more
information.
Ambulatory Update
Nephrology’s EMR design is in progress. They are
targeting a September Go-Live for their clinic.
Sleep, MCRC and Psychology are the only three
remaining clinics on the EMR master rollout plan.
They will begin with a current state assessment
(target Fall) in these clinics to determine what will
be included and timeline. In August, Informatics
is focusing their efforts on helping clinics meet
their meaningful use requirements.
What’s new with Patient Education?
We have continued to add Children’s customdeveloped content (or Patient Family Education
Materials) into Patient Education Aftercare
Instructions within Cerner. The following titles
have been added in August.
If you'd like to view all the custom titles which
we've added to Cerner, you can search in the
"Custom" folder within the patient education
tool.
Page 4 of 6
August 2016
CMIO NEWS
Discharge Med Rec Data
Discharge Medication Reconciliation
Data tables for January through June are
available on the next two pages.
Group summary reports are available to
Medical Directors and Managers upon
request.
CMIO News
Page 5 of 6
August 2016
CMIO NEWS
WE ARE LISTENING AND PUTTING YOUR IDEAS INTO ACTION!
We are looking for ways to incorporate your suggestions and ideas into future EMR
enhancements. A new field has been added to EMR requests that asks for documentation
regarding the benefit, goals, needs and concerns the request is aimed at addressing to further
help us understand your requests.
We also want your input related to safety, patient care issues, cost or efficiency concerns using
the EMR. Email: [email protected] or [email protected]
CMIO News
Page 6 of 6
August 2016