Technically Speaking: OneDrive Setup and Access

Last week, we talked about the upcoming rollout of Microsoft OneDrive and the features of the cloud storage platform that should make your work lives a lot easier once you start using it. Some things we didn’t discuss, however, are how you get started with OneDrive in the first place and how you can access your stored files.

First thing’s first: how does OneDrive get on your computer? Easy. We put it there. There’s literally nothing you have to do. One morning, you’ll just have it (if you don’t already). So, first, let’s talk about how to get to it.

OneDrive can be accessed in a variety of ways. The easiest way on your office computer is by clicking on the OneDrive app in the Windows Start Menu (bottom left corner of your screen).

Don’t want to go digging for it all the time?  Just right-click on it and select Pin to Start. A tile will appear alongside the alphabetized list. You can rearrange these app tiles and change their sizes, but they’ll always be right there for easy access. Here’s a screenshot of mine for reference:

Once you get familiar with OneDrive, you’ll see that the organizational structure looks just like the Windows File Explorer. This is intentional—you’re already used to browsing for files in this format, so OneDrive doesn’t need to be any different. I hear what you’re asking yourself right about now:

“I wonder if I can see OneDrive if I click on This PC (My Computer for us old dogs) on the desktop…” Yup.  It’s there, too. And is it in your Quick Access folder next to the Start Menu icon? Of course it is. And on the office.com website that you can access from home without having to remotely access your office computer? You bet. It’s everywhere.

So, let’s do it. Click on OneDrive for the first time. You’ll immediately receive a large shock through the mouse be prompted for your e-mail address. Enter it and click Sign In. Click through the tutorial (if there is one), then click Open my OneDrive Folder. If this step isn’t accompanied by heavenly sounds, let me know, and I’ll submit a ticket. Once your folder opens, you’re finished setting it up and ready to get to work.  Here’s a tip sheet with step-by-step instructions and some screen shots.

Next, you’ll want to start moving all your files from wherever they’re currently stored to OneDrive. If it’s a shared network drive, that should be straightforward—just copy (Ctrl+C) and paste (Ctrl+V) into their new home and organize to your heart’s content. Moving files from Box is only slightly harder. Here’s another tip sheet that walks you through that process.

Alright. OK. Done? Great!  Exhale. You did it! Now you can easily access your files from work or home. For extra credit, you can download the OneDrive mobile apps so you can really work from anywhere, but I won’t blame you if you don’t.

Believe it or not, there’s still more to the OneDrive story.  Next week, in an unprecedented Part 3, we’ll talk about how you can share your files with other users and control who can access them. And remember—all the above only applies once we’ve installed OneDrive on your computer.  Look for it soon!

Thanks for all you do!

Stephen Dolter, M.D., CMIO

Technically Speaking: Here Comes OneDrive

In the ‘80s, we had 5.25” floppy disks. Good times. In the ‘90s, floppies shrank to 3.5” and we got Zip disks and rewritable CDs. The early 2000s brought us flash memory (USB drives), portable HDDs and solid-state drives (SSDs). Media was constantly getting smaller, more durable and less expensive. These days, most of these portable storage solutions are obsolete. Instead, we store everything in the cloud.

What is “the cloud,” you ask?  Simple—it’s just someone else’s computer.

With a network connection, we can access our rented partitions of cloud storage whether we’re at work, at home or sitting on the beach. Cloud storage is secure, reliable and easy to use.  Children’s will soon be bringing personal cloud storage to you in the form of Microsoft OneDrive. Going forward, OneDrive will be the best way for you to securely store your work-related files, whether they’re currently in Box or on a shared network drive like P:/ or Q:/.  If you’re a Box user, guess what—this transition will be easy because you already have experience with cloud storage. If you keep your paper journals in a cardboard box, don’t worry—we’ll still get you into the cloud with minimal effort.

Once you start using OneDrive, you’ll wonder how you ever lived without it. Here are just some of the aspects of the experience that you’re going to love:

  • Users can access files anywhere they have an Internet connection — even on mobile devices — and without having to log in to their office computer remotely.
  • Users can view and modify files within desktop applications (Word, Excel, etc.) on their device or from within a web browser.
  • OneDrive is integrated into the Windows File Explorer.
  • Files are automatically saved when any changes are made.
  • Multiple users can modify the same file simultaneously.
  • Files can be shared as copies or as links to the original file (to eliminate different versions).
  • File sharing can be restricted, so only specified users can access shared content.

So when do you get to experience all that OneDrive has to offer? Good question. Here’s our rollout plan:

User GroupDate
MeNovember, 2020
Anesthesiology (pilot user group)June, 2021
Box UsersDecember, 2021
Non-Box-Using ProvidersQ1, 2022

Now the really important question—how do you access OneDrive in the first place? As with most things IT, you’ve got options. Meet me here next week for Part 2, and I’ll show you how!

Until then, stay warm, and thanks for all you do!

Stephen Dolter, M.D., CMIO

Technically Speaking: Epic Update This Weekend

As you may have already heard, we will be installing an Epic update this weekend, which will bring our production environment onto the February 2021 version of the software. Our plan is to install the update early Sunday morning on Dec. 5, during which time downtime procedures will be in place. All other electronic systems should function appropriately.

Providers should see only minor changes when Epic comes back online. Here’s a quick summary of notable additions:

  • If a provider chooses not to share a note with a family, they will be prompted to enter a reason for not doing so. This is not punitive—I promise!
  • Users will be able to enter ambulatory orders from a new tab in the inpatient Manage Orders activity. Use of the discharge navigator will no longer be required.
  • Lab components will be searchable in Chart Search. This will allow users to search for specific lab components rather than the lab order.
  • Best practice advisories will have feedback buttons and offer users a chance to comment on their utility.
  • Outside lab results imported via Care Everywhere will appear in Chart Review in line with Children’s results.
  • More “hover-to-discover” bubbles will be available in a multitude of locations.

Beginning Sunday morning, we will have an active update command center in operation and will have increased resources available for provider support. If you’re having problems, reach out to the Helpdesk (402-955-6700) or let me know. Following this installation, we will move to a twice-per-year update cadence to make sure we are providing you with the most up-to-date patient care tools possible.

Thanks for your flexibility, adaptability and for all you do!

Stephen Dolter, M.D., CMIO

Technically Speaking: We Did a Thing

Good problem-list management is a critical aspect of our mission to become a data-driven organization. Back in August, I shared some information about a new Epic feature—we now have the ability to set “expiration dates” for problem list entries. In the words of Epic, “to help keep an accurate and up-to-date problem list, you can configure a batch job to automatically change the status of problems for a specific diagnosis a number of days after the problem was added to the problem list.” So that’s exactly what we did.

Representatives from inpatient, ambulatory specialty and Children’s Physicians areas met and sifted through a list of diagnoses that had been added to all our patients’ Epic problem lists five or more times in 2021. We stopped at problems with five additions because less prevalent diagnoses aren’t worth actively managing. Besides, we were over 1,000 problems into the list when we got to the ones with four or fewer additions. 

For conditions that are self-limited, would be adequately treated, would be replaced with a more precise diagnosis in a reliable timeframe or would no longer apply due to changing age, we assigned a reasonable expiration time. Whenever possible, we erred on the side of keeping a problem on the list too long. When the time comes, the problem will be automatically resolved (it can still be viewed by clicking to show past problems in the problem list activity.) 

Here’s a sampling of some of the most common problems and the auto-resolve times we set:

  • 7 days: dehydration, encounter for consultation, encounter for immunization, person under investigation for COVID-19, encounter to discuss test results
  • 14 days:  fever
  • 30 days:  decreased oral intake, jaundice of newborn, rhinovirus infection, need for observation and evaluation of newborn for sepsis, respiratory distress, acute respiratory failure, elevated CRP, otitis media
  • 90 days:  bronchiolitis, RSV, tachypnea, rash, viral gastroenteritis, acute constipation, acute sinusitis, viral illness, acute post-operative pain, respiratory distress syndrome in newborn, pharyngitis
  • 180 days:  COVID-19, appendicitis, normal newborn, concussion with no loss of consciousness, swallowed foreign body, colic, postoperative examination
  • 365 days:  health care maintenance, wheezing, cough, vomiting, s/p myringotomy with insertion of tube, redundant prepuce, failed newborn hearing screen, observation for suspected genetic condition

If you have suggestions for changes or additions to this list, please don’t hesitate to reach out!  Thanks for all you do!

Stephen Dolter, M.D., CMIO

Technically Speaking: Wait—Boys Town Moved Where?

No matter what you think of Epic, it’s hard to argue that importing medical records from other facilities isn’t great. Epic’s Care Everywhere allows users at Children’s to query other health care organizations running Epic for records on their patients, then import them into Children’s electronic health record (EHR). Each year, the information we import becomes more detailed, and the way in which it’s displayed along with our own data becomes more integrated.

Recently, Boys Town National Research Hospital went live with Epic. Instead of installing and customizing the Epic Foundation (out-of-the-box Epic) system like we have in the past, they partnered with Mercy Health in St. Louis, Mo., to bring a pre-configured Epic build to their organization. This strategy, called Epic Community Connect, allows them to leverage off-site IT resources and streamline their operations.

I know what you’re thinking, “Why do I care?”

Here’s why this is relevant: because when we query Boys Town for patient records using Care Everywhere, the data we import will be tagged with Mercy Health’s information. This isn’t a mistake! It’s still from Boys Town.

Fortunately, querying Boys Town for patient records can still be done by searching for “Boys Town” in the Care Everywhere activity. It’s only the records after import that carry the Mercy Health label.

If any of you are experiencing difficulties using Care Everywhere, please reach out—we’re here to help! Thanks for all you do!

Stephen Dolter, M.D., CMIO

Technically Speaking: Streaming Services

This week, I’m reaching into the mailbag. 

Dr. David Soffer, Children’s Neonatology, writes, “Any chance I could be allowed to download Spotify so I could jam it up in my office in times of need?”

Dr. Soffer, I’m glad you asked; you’re not the first, and you probably won’t be the last. IT leadership has discussed this very issue, and what you’re about to read is our official stance.

We want to help.  Really—we do. Satisfaction is one of our top priorities. But we just can’t spare the bandwidth right now. A few years ago, a network utilization audit found that as much as 50 percent of our internet bandwidth was being used for personal streaming media. This was causing network slowdowns and compromising the functionality of critical applications. So to maintain network integrity, we blocked most streaming services. YouTube was a notable exception. We couldn’t block YouTube because it’s used for training, public relations and staff announcements. We also didn’t restrict streaming access on the guest Wi-Fi network used by patients and families because this access is a patient/family satisfier. Before you bring up provider satisfaction, though, know that the bandwidth used by the guest network is capped, so it can’t interfere with critical applications. Plus, we all have access to it.

In the next 18 months, we plan to increase our internet bandwidth by about a factor of 5. Once this expansion occurs, we should have plenty of extra throughput with which to use streaming services. As we are going through the upgrade, we would like to partner with a small user group to track utilization and see if it would indeed be feasible to open up streaming services to everyone. That group would be the first to be granted access. 

Until then, we are all free to continue listening to music using the guest Wi-Fi network and a connected device of our choosing. And not to be flippant, but you can get reasonably good, low-cost Bluetooth speakers that you can connect to your cell phone on Amazon. I know because I have one!

Let me know if you’d like to help with our pilot and get early access. Thanks for all you do!

Stephen Dolter, M.D., CMIO

Technically Speaking: Avoid Telehealth Documentation Mistakes

Few would argue that digital health innovations have changed the way we practice medicine. Perhaps chief among the innovations are telehealth and telemedicine, which now allow providers to see patients remotely. Since the beginning of the COVID-19 pandemic in 2020, Children’s providers have conducted almost 100,000 virtual visits (wow!). This has not only saved patients and families time, but also allowed them to remain out of health care facilities where they could possibly contract communicable diseases.

New visit types, however, don’t mesh well with old documentation templates. Last month, a small, random Health Information Management (HIM) audit of telehealth documentation found that five out of the 30 physician claims billed had physical examination documentation that would not be plausible in a remote setting using audio/video technology.

While I’m not at liberty to discuss detailed findings of the audit, this should prompt us all to look carefully at what we are documenting in our notes. Recording any parts of a physical examination that are not performed, regardless of where the patient is, constitutes fraud and could spell trouble for both the provider and hospital if it were ever discovered by a regulatory agency or payor.

For the record, I do not believe that any of these transgressions were intentional. I’m guessing that they were simply the product of a note template that had not been adapted for a virtual visit, an inappropriate Smart Phrase that was utilized out of habit or a note that was copied forward (although we do still need to be careful with this feature). 

Regardless, I’m asking us all to pay particular attention to what we are documenting in our notes and make sure that nothing appears in the exam if it wasn’t done. If you would like assistance modifying any of your existing documentation tools for virtual care use, please enter a support request in MyHelpDesk or reach out to the Digital Health team (or me, of course)!

I also wanted to respond to several concerned providers who messaged IT regarding Tuesday’s announcement about securing personal Zoom accounts to keep them in line with our current security parameters for video/meeting platforms.  This change will not impact Zoom accounts used for virtual care—those are Pro accounts.

Thanks for all you do!

Stephen Dolter, M.D., CMIO

Technically Speaking: File Sharing

  • 1860:  Write another one and deliver it to me on horseback.
  • 1950:  Duplicate the document with a photocopier and mail it to me.
  • 1990:  Print another copy and mail it to me.
  • 2000:  Email me a copy of the file.
  • 2020:  Put the file in the cloud and share it with me.

File sharing has come a long way since the days of the Pony Express. As we have become more digitally connected, we have more options than ever to share and collaborate our documents at work. Microsoft’s latest technology allows us to collaborate like never before—we can all make changes to the same document at once! Those changes appear in real time — and they’re saved automatically.

As of today, the only organization-wide platform approved for cloud-based file sharing is Microsoft Teams. Teams is a collaboration application that consolidates messaging, file sharing and bulletin boards into one package. Soon, we will widely release OneDrive, which will enable users to share files and collaborate without being part of an official MS Teams team. For now, though, it’s Teams or bust.

Inside Teams, click on Teams in the top left, then on your team, then Files in the menu bar near the top of the window. You are now in the Teams Team Channel Tab (confused yet?) and will now be able to upload files to your team’s space, and everyone in your team will be able to see and edit them. If any changes are made, they are automatically saved to the file in Teams. No need to hit Ctrl-S… and did I mention that multiple users can edit the same file at the same time? No more read-only files and multiple versions that need to be painstakingly merged later. 

Clicking the three dots next to your uploaded file opens a menu of actions you can take, including editing the file either within the browser with limited functionality or in the app with full functionality. I always open in the app when I can, in order to have all the program’s features at my disposal. Working on the file from within a browser offers a great deal of agility.

This image has an empty alt attribute; its file name is image.png

Is that not enough? You can also share files with any Teams user, even if they aren’t on your team, in the Chat Tab (also in the upper left). There are important caveats, though. Messages and files are automatically deleted from Chat conversations after 30 days. Files shared with your team in the Teams Team Channel tab are retained for 90 days.

OneDrive, once it’s fully implemented, will expand this capability beyond groups of users to every individual in the organization with e-mail access. In addition to attaching copies of a file, users will be able to send a link (with appropriate permissions) via e-mail. Recipients could use the link to review the file or make automatically saved changes just like Teams. And file retention? If a file is shared from OneDrive, you won’t have to worry about them expiring.

Of course, all of this begs the question, “So how do I get on a team?” Submit a Helpdesk request or send me an email with everyone’s names and what you’d like your team to be called. We’ll do the rest.

If you have an idea for a future column, please reach out. Thanks for all you do!

Special thanks to Melissa Rappl, chief Information Security officer, Tony Adams, IT manager of Technical Services and Robert Pelzer, IT systems engineer, for their contributions to this week’s piece.

Stephen Dolter, M.D., CMIO

Technically Speaking: Securing Your Personal Zoom Accounts

As health care providers, it is our duty to safeguard our patients’ protected information. And as professionals, it is our duty to keep private matters private. Last spring, our security team learned of multiple instances when uninvited users joined a meeting, were confronted and left the meeting without saying a word. While these incidents may have been accidents, they were suspicious enough to warrant widespread conversations regarding masking meeting details in Outlook calendar settings. Now another similar vulnerability has been brought to the fore.

This time the risk lies within Zoom. Zoom, if by some odd chance you’ve never heard of it (where have you been?), is a video conferencing platform that lets users communicate via virtual meetings. It’s a powerful tool that has, along with its competitors, allowed us to maintain productivity throughout the pandemic while also keeping safely separate from one another. Children’s has an enterprise account, but Zoom also allows individuals to create accounts of their own. Many of you have already done this, which is totally acceptable; however, individual users are often not utilizing the built-in security features that Zoom offers.  This creates a security risk.

Therefore, beginning Nov. 1, all accounts created in Zoom with a Children’s email address will require the use of the waiting room feature and meeting passwords. This change will apply to all Children’s domain accounts, whether assigned through Children’s, or self-requested through Zoom. While it may not seem like much, this will make meetings as secure as reasonably possible and keep unwanted guests out.

As a reminder, Children’s encourages the use of Zoom for meetings with 50 or more participants and Virtual Care appointments. WebEx is to be used for all other use cases.

Thank you for your cooperation, your understanding and for all you do to make our digital world safe and sound. Please contact Mark Vande Brake if you have any questions about Zoom, or reach out to me regarding any other technology issues.

Special thanks to Melissa Rappl, chief information security officer, and Mark Vande Brake, teleconference/av analyst, for their contributions to this week’s piece.

Stephen Dolter, M.D., CMIO

Technically Speaking: Sharing Resident Notes

Medical records belong to patients… or, in pediatrics, parents. At any time, a parent (or guardian) can walk into Health Information Management (HIM) and request a copy. But that’s a pretty big hurdle, so the government has been working to make accessing records easier for patients and families. In 2020, the ONC* Cures Act Final Rule (an information-blocking provision) went into effect. This stipulates, among other things, that health care organizations cannot block electronic access to most parts of a patient’s medical record; they must be shared freely. This includes (but is not limited to) clinical notes, lab and imaging results and medication and allergy lists.  You can read all about it here, but be prepared to spend several days digesting it. Fine. No big deal. We’ve actually been doing this for years.

But what about resident notes? Lots of us use those as a framework for our own notes.  Addend, make changes and sign. What happens to those? Well, up until now, the attendings had to click a button at the top of the note to share it. Otherwise it didn’t go anywhere. The reason behind this is that we didn’t want families to be confused by reading a resident note before an attending had a chance to review it and make corrections. Any inconsistencies could undermine trust in the team and/or hospital. So, because the note was created by a resident, it wasn’t shared by default. In cases when the attending forgot to click Share, we were out of compliance. Houston, we have a problem.

Fortunately, Epic came through with a fix. We are now able to separate sharing from releasing when it comes to notes. Sharing now simply means that a note is eligible to be released electronically. It’s not until it’s released that it actually gets pushed to patients and families.  And what magically releases these notes now? Voila—an attending signature! So going forward, all resident notes will be shared… it’s just that they won’t get released until they’re signed by a staff physician.

Parallel to all this, the Centers for Medicare and Medicaid Services (CMS) relaxed their restrictions on attendings utilizing student documentation for billing purposes. This led to student notes being addended and signed. Fortunately, the above also applies to student notes; they’re only released when signed.

Compliance achieved? Yep. Extra work required? Nope. Actually, this new behind-the-scenes workflow requires less work for us! That’s a win in my book!

If you have questions or concerns about this new process, please reach out! Thanks for all you do to keep our patients safe and our organization in compliance!

* Office of the National Coordinator for Health Information Technology

Stephen Dolter, M.D., CMIO

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