Technically Speaking: The Distributed Antenna System

Have you ever wondered how you can get a great LTE signal in the Radiology core… or Pharmacy… or in the 5th Floor pediatric resident work room when the outside world is hundreds of feet, a few walls, and a lot of steel and concrete away? What? You’ve NEVER thought about that? Ok, well, I guess I really am a geek. The answer, if I’ve piqued your curiosity, lies in our Distributed Antenna System (DAS). I recently asked Tony Adams, manager of IT Technical Services, for an explanation of how a DAS works and what we’re doing to make ours better. 

Here’s how that conversation went:

Stephen:    Hi, Tony.

Tony:         Hi, Stephen.

Stephen:    Thanks for being here!  I’d like to ask you a few questions about our DAS if you don’t mind.

Tony:         Sure. Fire away!

Stephen:    Can you start by telling me what a DAS is and what it does?

Tony:         Sure! A DAS (or distributed antenna system) is an in-building system that boosts the cellular signal for popular wireless carriers like AT&T, Verizon, T-Mobile and US Cellular. Each carrier must provide a signal source either by fiber, ethernet backhaul or antenna and then connect their hardware to the DAS. 

Stephen:    Uh…I have no idea what that even means…but do we receive these signals from all those carriers?

Tony:         <laughs> No—not all carriers have brought in a signal source or installed equipment onsite at Children’s. We currently only receive signals from AT&T and Verizon.

Stephen:    So, is that why my Verizon phone works fine and someone else’s T-Mobile doesn’t, even though we’re standing right next to each other?

Tony:         Precisely. Phones on carriers’ networks whose signals we don’t receive must get their cell signal from external towers, which results in average to low/no signal quality depending on the device’s location.

Stephen:    Are we doing anything to fix that?

Tony:         Absolutely! We’ve contracted with Pierson Wireless to improve the existing DAS by upgrading infrastructure, coordinating the installation of carrier hardware and tuning the signal source configuration to ensure the best possible signal throughout each building. 

Stephen:    And I assume T-Mobile and US Cellular are a part of that plan.

Tony:         Yep.

Stephen:    Nice!  What’s the timeline look like?

Tony:         <slides a piece of paper across the table> It looks just like this!

(Click here to see the DAS install/upgrade status per building.)

Stephen:    Awesome! I’m sure everyone will appreciate your team’s hard work as their cellular signals continue to improve. Thanks so much for being here – is there anything else you’d like everyone to know?

Tony:         We really do care a lot about how our networks’ performance impacts staff at Children’s, and we are always pushing to make things better. Once the DAS has been upgraded in the Specialty Pediatric Center and Pavilion in May, the cellular signal for AT&T and Verizon should drastically improve, and as we receive new hardware and signal sources, everyone with a T-Mobile or US Cellular device should see much better performance. As always, if you’re having network issues of any kind, please alert the Helpdesk. We can’t fix what we don’t know is wrong!

Stephen Dolter, M.D. | CMIO

Technically Speaking: Operative Reports

First things first: I’m sorry.

I’m sorry for changing your dictated operative report template without letting you know. There was supposed to be some testing and a scheduled go-live date, but that plan must have gotten lost in our communication with our vendor, and the new template dropped without anyone knowing about it. I quickly found out when all of you started sending me negative feedback. I’ll try to make sure changes are better communicated in the future.

So why did we want to change the template in the first place? One word—compliance. Drs. Maegen Wallace, chair of the Department of Surgery from 2020-2021, and Paul Esposito, surgeon-in-chief, have been keeping their eyes on operative report compliance. According to them, the organization needs to do a better job of documenting the “required elements” in our reports. This is obviously a source of potential trouble with The Joint Commission (JCAHO); incomplete documentation can also compromise patient care. By adding section headings and wild cards that would require providers to address each element before signing the report, we thought we could drive more complete documentation and increase our compliance.

We immediately received feedback about the order of the elements in the template, as well as about the necessity of each of the sections—one surgeon pointed out that JCAHO does not actually require all the elements in the template in operative reports. We based the template on an existing note template in Epic that has been around since 2012, which, in turn, was based on our medical records policy (MS059). Upon more careful research, here’s what I found regarding who requires what in an operative report (I even threw in the Centers for Medicare and Medicaid Services (CMS) for the LOLs):

ElementCMS RequirementJCAHO RequirementChildren’s Policy
Date and time of procedure  
Name(s) of surgeon(s) 
Names of assistants (if any)  
Pre-operative diagnosis  
Post-operative diagnosis 
Name of procedure performed 
Type of anesthesia administered  
Complications (if any)  
Findings 
Estimated blood loss 
Detailed description of the procedure
Tissues or specimens removed or altered
Surgeons or practitioners name(s) and a description of the specific significant surgical tasks that were conducted by practitioners other than the primary surgeon/practitioner  
Prosthetic devices, grafts, tissue, transplants, or devices implanted (if any)  

As Mr. Spock would say, “fascinating.”  As you can see, Children’s policy is the most rigorous of the three. In response, we are removing the Patient Name, Consent and Disposition sections of the dictation template. That’s the good news. The bad news is that also based on Children’s policy, we are adding Assistants and Complications. And there’s more. JCAHO openly states they were very careful in adding the words if any to the Estimated Blood Loss requirement. This means (their words, not mine) that if there wasn’t any blood loss, it doesn’t need to be documented. However, Children’s policy doesn’t account for this.

So, we’ll make some changes to the headings and re-order them so that the report makes a little more sense, and the wild cards are there to stay so that we can ensure dictated operative reports comply with our documentation policy. I understand your frustration, and at the same time, we are bound by what the policy writers thought was important. If you disagree with the policy, I strongly encourage you to get together with your peers, draft a revision and propose it to the Medical Executive Committee. I joke a lot in these columns, but this isn’t one of those times. We shouldn’t limit ourselves to venting about our frustrations—we should invent ways out of them.

All that said, if portions of your reports aren’t being transcribed into the right sections, let me know, and I’ll relay that feedback to our service provider.

Thanks for understanding and for all you do!

Stephen Dolter, M.D. | CMIO

Technically Speaking: Getting IT to Work for YOU

True or false—getting help from IT is as simple as asking. False. I wish it were true, but just the process of asking for help can be quite confusing at times. Let’s talk about how to get the help you need—specifically, how to open tickets and request projects.

First, there’s the Helpdesk ticket. I’m pretty sure most of you are acquainted with that one. To open one on your own, just click on the My Service Center icon on your desktop.

You can then enter your own requests into the Cherwell service management system by clicking through My Helpdesk, ensuring that the exact issue is brought to light. Helpdesk tickets are good for quick fixes and small changes.  Here’s what My Service Center looks like:

But what if you need something big? Something that’s going to require a lot of time and resources? Then, we ask that you submit a project request. To do so, click on IT Project Request from within My Helpdesk. This will take you to the instruction page, which will walk you through the process. There’s even a video! 

At first blush, this seems like a ton of work just to request help, but the information you enter on the form assists with research that the IT project management team performs on every request. This research, combined with their knowledge and experience, helps them decide how much time and how many resources your request will require. If your request is, in fact, deemed to be a true IT project, you’ll be asked to present it at the monthly Opportunities Management meeting. There, the committee will hear your request and have a chance to ask questions about it. Offline, your request will either be approved or denied based upon established criteria, and if approved, prioritized with appropriate resource allocation. You’ll be kept in the loop the whole way.

Now, we need to talk about the elephant in the room—what’s the difference between a ticket and a project? On the IT side, it’s all about time, money and resources. Isn’t it always? But how the heck do you know how much something is going to cost or how long it’ll take? We don’t expect you to. Here are some general features of an IT project:

  • It involves multiple service lines, clinics, hospital units or patient care areas.
  • It involves adding any of the above.
  • It integrates software applications or involves more than one Epic module.
  • It involves significant changes to a workflow or will require user education and/or training.
  • It requires working with third party vendors.
  • It requires interfacing new computer hardware or medical devices with existing systems.
  • It involves adding a new software platform or Epic module.
  • It involves billing and/or scheduling.

Helpdesk tickets are usually easier requests like adding or changing a medication, procedure, order set, flowsheet row, questionnaire, note type or note template. If you’re in doubt, I’ll advise you to submit a ticket. If it needs to be a project request, we’ll just say so. If the ticket will suffice, you just saved yourself 10 minutes.

If you have questions or need assistance, now you know what to do! Keep being awesome!

Stephen Dolter, M.D. | CMIO

Technically Speaking: Private Appointments

In 2022, our lives are less private than they’ve ever been. Our personal information circulates widely.  Advertisers can track our location. We can see if someone is busy at work by looking at their shared Outlook calendar. Wait—what?! You can do that? Yeah, you can do that. So, if you want to hold onto at least a little privacy, you should make sure your calendar is secure. And if you like to add surgical cases with protected health information (PHI) to your Outlook calendar, you darn well better be sure you’re doing it.

To do it well, we need to revisit a topic from about a year ago. Outlook features four separate and distinct calendar permissions that restrict the level of detail that colleagues can view on your calendar:

The Children’s default setting is Titles & Locations. Users who’d like their calendar to remain more private or become more transparent will need to change their permission settings by navigating to the File menu, then selecting Options à Calendar à Calendar Options à Change the permissions. This change will only apply to new events; old events will not be affected.

If you have any PHI (or other personal information) on your calendar, please do one of two things: either set your permissions to Free/Busy or make all those appointments Private.  When creating a new event, you can click the Private box to prevent anyone else from seeing any information about that appointment on your calendar. Here’s an example:

You can also right-click on an existing appointment and mark it as Private in the pop-up menu.

Thanks for keeping PHI secure and for all you do!

Correction: In the Jan. 27 edition of TechSpeak, I stated that one could access UNMC email using the Outlook app on their mobile device(s). This is not possible for most people—UNMC email cannot be accessed on any device that does not have UNMC mobile device management (MDM) installed. Those who have a device with UNMC MDM must download Outlook from the UNMC App Store once Intelligent Hub is installed on their device. I apologize for any confusion this may have caused.

Stephen Dolter, M.D. , CMIO

Technically Speaking: A Year of TechSpeak

Believe it or not, you’ve just started reading the 52nd Technically Speaking column! I hope it’s not the first one you’ve ever read. I hope you’ve been a faithful reader from the start and that you’ve learned a bunch of stuff along the way!

2021 brought quite a few changes to Children’s and to IT. The biggest was the opening of the Hubbard Center for Children last August. That monumental project consumed a majority of IT resources for the first two-thirds of the year. Its success was a testament to the tireless efforts and steadfast dedication of every member of our team. We hope that the systems and tools we installed in the Hubbard Center are meeting your needs and helping you provide exceptional care for our patients.

Wiebe Tower, we’re coming for you next…

Elsewhere, we rolled out Office 365, introduced Teams and OneDrive, replaced the infuriating RSA fobs with DUO for controlled substance prescribing, moved from 4- to 10-digit dialing, eliminated about half the pagers from our environment, put monitor data and a dictation microphone on your mobile phones and taught you how to spot a phishing scheme.

In Epic alone, we updated our build to the February 2021 version of the EHR software, integrated Zoom into telehealth visit workflows, assigned problem list entries expiration dates, gave you the ability to provide best practice advisory feedback and revised the darn formula order at least seven times.

And that’s just the stuff I wrote about! 

This year, you can expect continued evolution—we’re going to adopt a new surgical case request process, potentially switch provider scheduling platforms, start biannual Epic updates, make clinical pathways easier to find and use, further optimize the Voalte platform, digitize procedural consents, measure the effectiveness of our remote patient monitoring programs, continue streamlining EHR functionality and keep transforming data into useable information.

And with every change, you can expect to see another column right here, telling you what you need to know when you need to know it.

Thanks for reading and for all you do!

Stephen Dolter, M.D., CMIO

Technically Speaking: UNMC Email at Children’s

You’re probably tired of hearing me talk about communication. It’s discussed often because it’s really a cornerstone of everything we do at work. If we’re not able to share ideas, opinions, updates and requests, then everyone’s going to suffer. But you might be bored with communication talk. If that’s the case, just move on to the next article. I won’t even know. But if you want to learn the Four Best Ways to Read Your UNMC Email When You’re at Children’s, keep reading.

  1. Add your UNMC account to Outlook on your office computer. This is by far the best way.  It’s easy, gives you the most flexibility and keeps you from having to log in every time you want to access your UNMC account. To add it, open Outlook and go to the File menu. Then click Add Account. Navigate through the prompts, supply your UNMC information, authenticate with DUO and you should have access established in about 60 seconds. Once you’ve added the account, you can bounce back and forth between both in-boxes. I strongly encourage you to leave them separate (the default).
  2. Use a web browser. This one works just as easily at work as it does anywhere else in the world. If you have an internet connection, you can point your browser to O365.com and click Sign In in the upper right. Enter your UNMC credentials, and you’ll have access in seconds. If you choose to access both your UNMC and Children’s accounts this way, be prepared for your browser to get confused and take you to the wrong inbox. You may have to clear your cache to get things to work right. This method can be wonky, but it will still work.
  3. Add your UNMC account to the Outlook app on your mobile device. If you don’t have it already, you can download the app from the App Store (iOS) or Google Play (Android).  Once installed, you can add as many accounts as you like, including both Children’s and UNMC. Again, I’d advise you to keep your inboxes separate. Children’s IT is proud to offer support for the Outlook app; we do not support native email applications on any mobile device. If you’re using one of those and it’s working, great! But if it stops working, we won’t be able to help—we have to draw the line somewhere.
  4. You can log into the UNMC network directly on a hardwired workstation. Legend has it there are several computers at Children’s that are physically connected (via lots of network wizardry) to the UNMC network. When you use these computers, it’s as if you’re on campus at the U. You can not only access email directly using the Outlook app, but you can also access tools like payroll direct deposit that are normally restricted to the UNMC campus.

If you’ve figured out any other ways to get to your UNMC email from Children’s, leave a comment by clicking the link at the top of the article. Stay warm, and thanks for all you do!

Stephen Dolter, M.D., CMIO

Technically Speaking: Sensitive Notes

We all know what protected health information (PHI) is. And we all know and accept that accessing patients’ medical records is allowable only for those clinicians who are providing care at that time. But what about a circumstance in which a provider wants to add an extra layer of security to a note? What if a patient divulges information that could be embarrassing? What if a history includes a narrative that could foster resentment between parents? What if a consult note documents an opinion that could be used by an abuser to change their story? How can we keep those notes away from people who don’t need to see the information while still allowing caregivers who could be impacted proper access? We can use sensitive notes.

Clinicians can mark notes in Epic as sensitive, meaning the note contains patient information that should be treated with additional care. Examples include, but are not limited to, behavioral health documentation, adolescent social history, results of sexually transmitted infection testing, and any information that should reasonably be kept out of the hands of parents and families (non-accidental trauma documentation, etc.). Sensitive notes cannot be opened unless a user has specific Epic security clearance. Sensitive notes are also not pushed to any electronic patient portals such as Children’s Connect. They are, however, still available if a parent requests a copy of the medical record from Health Information Management (HIM).

Currently, the following user classes have access to sensitive notes: providers, inpatient nurses, emergency nurses, social workers and nurse case managers.

Access to sensitive notes must strike a balance between the interests of patients (and families) and health care professionals. Patients and families have legal rights to confidentiality; the contents of medical records are protected information that can only be accessed on a “need-to-know” basis. In addition, it is reasonable for them to expect that “sensitive” information be treated with even more discretion. Health care professionals do have a duty to keep such information confidential; however, those same individuals also have a duty to provide safe, compassionate and comprehensive care. If the contents of a note could impact care in such a way, clinicians will have the ability to access the note. 

It must also be said that it is impossible to know the specific circumstances when a particular user in a single role would need to access sensitive content. We must think broadly, assume positive intent and grant access to entire classes of clinical users when a reasonable use case is brought forth. Decisions to grant access to sensitive notes are not taken lightly; a compelling case must be made to the Employee Health Records (EHR) Governance Committee when requesting access to sensitive notes and the request must be approved by a majority of the committee.

Clinicians are also encouraged to use other EHR tools (e.g., problem list, medical history, FYI flags) to communicate diagnostic and safety-related information, as this may obviate the need to read sensitive documentation altogether. 

Thanks for keeping patient information secure and for all you do!

Stephen Dolter, M.D., CMIO

Technically Speaking: The Daily Safety Briefing Dashboard

Safety. We talk about it all the time. It kicks off our meetings, mandates checklists to slow us down when errors are more likely to occur and generally guides our practice. Every morning, we gather on the Daily Safety Brief (DSB) WebEx to discuss…<record scratch>…the hospital census?! Not anymore.

Chanda Chacón, Children’s president & CEO, and Chris Maloney, M.D., Ph.D., executive vice president, chief clinical officer and physician-in-chief, recently called for a refreshed DSB format that returns to the original spirit of the call – safety – while still allowing attendees to see how patients are moving through the system. To replace the current unit roll call, they asked IT to compose an Epic dashboard that contains relevant inpatient census, COVID-19 data, Emergency Department visits and Operating Room utilization data. 

So, we did. The data was already there—we just needed to format it, validate it and pull it all together. Nearly all Epic users now have access to this DSB Dashboard and can review real-time patient numbers at any point throughout the day. The DSB is free to evolve into a true safety discussion as leaders see fit.

Here’s how to access the dashboard:

  1. Open Epic Hyperspace.
  2. Click on the menu bar option that says, “My Dashboards.” If it isn’t in your top menu, you’ll have to add it by clicking the wrench icon in the upper left.
  • In My Dashboards, search for “Daily Safety Brief (DSB)” or some approximation of it. If you want to be efficient, “dsb” will get the job done.
  • Select the Daily Safety Brief (DSB) dashboard.
  • You’ll now see the dashboard. Click the Play icons in each section of interest to run the embedded reports and retrieve the corresponding data.

Again, this is real-time data that changes as patients move and OR cases are booked and canceled. Look for the format of the DSB to evolve as users get used to consuming this information in Epic rather than as unit report-outs on the call. Chanda and Chris, take it away!

Keep dodging Omicron, and thanks for all you do!

Stephen Dolter, M.D., CMIO

Technically Speaking: File Sharing with OneDrive and Teams

Welcome back for the third of three installments in the OneDrive saga. In Part 1, we talked about all that OneDrive allows you to do with file storage and access. Part 2 told you how to find OneDrive on your computer and start using it for personal file storage. Now, let’s talk about how you can leverage OneDrive (and other Office applications) to share your files with other users.

The first way is something you’re probably already familiar with—email attachments. Just like with files on your computer’s hard drive or a shared network drive, you can attach files stored on OneDrive to emails. Just click on Attach File in the email you’re composing, browse to your OneDrive and select a file to attach.  But look—there’s more you can do now! Instead of just attaching a copy of the file, you now have the option to share a link. Like the description implies, sharing a link to the file on your OneDrive lets recipients make changes to the file and see any revisions you or anyone else makes to it!

This eliminates version control, the process by which a user tracks and manages changes to a document. No longer will you have to merge changes made by multiple users into one document.  No longer will you have to keep track of four copies of the same file that all have bizarre names like this:

Is that the final copy? Or the final final copy? Who has time for that? Now, everyone can just make changes to the file on your OneDrive. Oh, and those changes? They’re saved automatically. 

What’s more, like we talked about in Part 1, multiple users can work with the same file simultaneously. This not only lets everyone see the most recent changes in real time, but also prevents the dreaded:

Ugh—I HATE that message! Now there are going to be two versions! Merge changes later sounds harder than taking the One Ring up Mt. Doom; and I don’t want to do this later! But you know what? You and I might never have to see it again if we play our cards right.

When sharing links by email, the default security setting is that anyone who is a Children’s user (or member of another approved domain such as unmc.edu, nebraskamed.com, or catholichealth.net) and recipient of the email can make changes to the shared file. Clicking on the arrow on the right side of the file tile opens a menu that allows you to change permissions.

Whew! Still with me? Good. Because there’s more. So far, we’ve just covered file sharing in Outlook, but you can do something similar in Teams as well! Let’s jump into the time machine and head back to May of 2021 when we talked about file sharing in Teams. Here’s a screen shot of my Technology Leadership Team Teams site:

As you can see, I’m currently in the Files tab. If I click Upload, I can share files with my team, either from my computer or (you guessed it) my OneDrive space. You can also share files in Teams chat, but if you do, please remember that they will not be visible there for longer than 30 days! As a reminder, if you’d like us to create a Team for your group, you can submit a request through the MyServiceCenter portal (snowflake icon on your desktop or Quick Link on the myChildren’s intranet home page).

Last, we now have a more definitive rollout schedule:

  • A – C – Jan. 17
  • D – H – Jan. 18
  • I – M – Jan. 19
  • N – R – Jan. 20
  • S – Z – Jan. 21

That’s really all there is to it. I hope you enjoy using OneDrive as much as I do. Granted, I’m a huge nerd, but I really think it eliminates lots of document management headaches. If you have problems getting OneDrive set up or using it, or if you’d like to request approval for another email domain for file sharing, please submit a support ticket (see above MyServiceCenter process) or call the Helpdesk at 402-955-6700.

Happy New Year, and thanks for all you do!

Stephen Dolter, M.D., CMIO

Technically Speaking: Windows 10 Upgrade Reminder

Always hopeful, yet discontent
He knows changes aren’t permanent
But change is

Those are lines from the 1976 Rush hit, Tom Sawyer. I think they nicely describe the ever-evolving health care IT landscape, even decades after they were written. We always want something better. There will always be something new. We need to abandon the status quo and keep moving toward a better state. 

Okay, so it’s not quite as “modern-day rebel” as Tom, but on the heels of the Epic update, we did begin upgrading all main campus Children’s computers running Windows 10 to the most recent version, 20H2 last week. Our current version will no longer be supported as of May 2022. Prior to this, we performed a thorough pilot involving more than 300 computers in the IT department. There were no issues with the upgrade on any of those machines.

The upgrade will be pushed out to the computers automatically and installed between 1 and 5 a.m. Users will not have to do anything, but after the upgrade is installed, the computer will need to be restarted. Thus, it is imperative that you save all your open work before leaving for the day! Honestly, you should be doing this anyway, but it’s really important right now! We plan to work with departments and divisions that provide 24/7 patient care to minimize disruptions. Below is a schedule:

StartEnd 
11/1/202111/26/2021Pilot with IT Extension Group
11/29/20211/7/2022Main Campus (Excludes laptops and Executive Team)
11/29/20211/7/2022Pilot with CP Embassy Park
1/10/20221/14/2022Executive Team
1/17/20223/4/2022Clinics & Remote Sites
3/7/20224/1/2022Laptops

If you experience problems following the upgrade, please reach out to the Helpdesk.  I’ll be sure to let you know when our next upgrade rolls out. Thanks for your flexibility, adaptability and for all you do!

Stephen Dolter, M.D., CMIO

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