Technically Speaking: A New Formula for Formula Orders

By Stephen Dolter, M.D., Chief Medical Informatics Officer

***Special thanks to Lauren Maskin, M.D., medical director of Inpatient Med/Surg Services, for her significant contributions to this week’s piece.

One of the pillars of delivering reliable, high-quality care is ensuring that provider orders in the EMR are clear and concise. But entering clear, concise orders isn’t always easy, especially when complex orders are required. One such complex order is for enteral formula, which requires the ordering provider to specify the name of the formula, its concentration, the route, additives and fortifiers, and additional instructions and comments.

Recent Eye on Safety events have highlighted the potential for confusion in our existing formula orders when recipes and water boluses are entered into the order’s free text area. A multidisciplinary team that reviewed these cases determined that the free text area provided too much room for interpretation, which led to different understandings between the formula lab, the bedside nurse, and the ordering provider.

In response, we’ve decided to modify the fields in the formula order to accommodate more precise information, eliminating the need to enter as much information in the free text field.  The new order will look like this:

This ain’t your grandma’s formula order!  Literally—it’s not.  It’s ours.

These changes will go into effect on March 22. As always, if you have suggestions for how we can optimize the EMR to deliver better patient care, please let us know! Stephen Dolter, M.D., CMIO

Technically Speaking: DUO for E-prescribing Controlled Substances

By Stephen Dolter, M.D., Interim Chief Informatics Officer

Believe it or not, we in IT are constantly looking for ways to make your digital lives easier. No, really—I’m serious.  Jerry Vuchak, senior vice president & chief information officer, has a simple mission statement that guides much of what we do—satisfy, simplify, secure. Our latest innovation checks all three boxes.

Currently, electronically prescribing of controlled substances (EPCS) at Children’s requires the use of a physical RSA dual-factor authentication fob. It’s clunky to use and surprisingly cumbersome to carry everywhere. The fob makes EPCS secure, but it’s neither simple nor satisfactory. 

Our new strategy will be to utilize the DUO dual-factor authentication app for EPCS. Most of you already have DUO installed on your mobile phones—it’s required for remote access and web mail, both at Children’s and UNMC.   

If you already have EPCS privileges, you’ll receive a text message in March that begins with, “Tap to activate Duo Mobile” and contains a hyperlink. If your phishing alarm goes off, good for you… but the message is legit. 

Just tap the link to add EPCS to your DUO mobile app. Once enrolled, you’ll be ready to use DUO for authentication once we go live at the end of March!  After go-live, you can turn in your old RSA fob to the Medical Staff office at your convenience. Interested in signing up for EPCS?  Stay tuned for Part 2 in March.

As always, if you have ideas for future columns, please let me know: mailto:[email protected]. Thanks for all you do! 

Technically Speaking: 45-Minute Meeting Times

By Stephen Dolter, M.D., Interim Chief Informatics Officer

Last week, I spoke about calendar permissions; this week, we’re diving right back into the world of the Outlook calendar and talking about meeting times. For as long as I can remember, the default Outlook event duration has been 30 minutes. Need more time for a meeting? Add 30 more…or another 30 on top of that. One meeting in isolation doesn’t cause any problems, but two or three in a row can put a serious dent in your productivity, job satisfaction and even your health.

Back-to-back-to-back meetings consume huge swaths of our time and keep us from spending even a few minutes on ourselves. And those that run just one minute long intrude into another event. What’s more, consecutive meetings confine people to their desk chairs for hours on end, which has been shown to have wide-ranging negative health consequences.

As part of creating a people-first culture, Children’s is taking action and strongly encouraging all employees to leave some personal time between meetings. IT is helping by having Outlook end all meetings one hour or longer 15 minutes early, so an “hour-long” meeting will actually be 45 minutes, an hour-and-a-half meeting will only be scheduled for 75 minutes, etc. 

Yay—no more back-to-back meetings!

Here are some suggestions for how to use those 15-minute blocks to be more productive and healthy:

  • Jot down some key points or follow-up tasks from the meeting that just ended.
  • Catch up on important e-mails you may have missed.
  • Preview the agenda for the next meeting.
  • Get up and move around; walk to the far end of your building and back.
  • Refill your water bottle or grab another cup of coffee.
  • Take a bathroom break.

Look for this change later this month. Please note that this feature is not available in Outlook for Mac. As always, if you have ideas for future columns, please email me: [email protected].

Thanks for all you do!

Technically Speaking: Outlook Calendar Permissions

By Stephen Dolter, M.D., Interim Chief Medical Informatics Officer

I’ll be the first to admit that without Microsoft Outlook, I’d be lost. Most of my days are packed with meetings, and more invitations are always just an inbox refresh away. The process of scheduling all these meetings is made easier by our ability to view other individuals’ calendars within the organization. But if you think that seems potentially intrusive, you’re not alone.  Fear not, though—there’s a solution!  Well, actually, four solutions!

Outlook features four separate and distinct calendar permissions that restrict the level of detail that colleagues can view on your calendar.

Beginning Monday, Feb. 15, the default calendar permission for users at Children’s will be set to Titles and 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 – Calendar – Calendar Options – Change the permissions.

If you have questions or need assistance, please contact me ([email protected]) or call the HelpDesk (402-955-6700). Thanks for all you do!

Stephen Dolter, M.D. | Interim CMIO

Technically Speaking: Antimicrobial Keyboards

By Stephen Dolter, M.D., Interim Chief Informatics Officer

We normally think of hospitals as places where sick patients go to get better, but there are hidden dangers within our walls that can jeopardize the very children we seek to heal.  Microorganisms that hide in plain sight on high-touch surfaces are some of the most omnipresent of those dangers.   

There is perhaps no higher touch surface in the hospital that is as difficult to thoroughly disinfect than a standard computer keyboard.  Keyboards are rife with crevices and angled surfaces. Making matters worse, they’re electronic and prone to permanent damage if they get too wet. 

To make keyboard disinfection easier, manufacturers now produce keyboards that are sealed to prevent liquid intrusion into their sensitive electronics. Some have flat surfaces that are easy to wipe down, but these devices are notoriously difficult to use due to the lack of key responsiveness. Others are wrapped in a thin layer of silicone, which allows for more responsive key movement. 

Because the Hubbard Center for Children will feature antimicrobial keyboards in patient care areas and because we want to provide the best possible hardware for providers and nurses, we have purchased a handful of sample keyboards for hospital staff to trial. These are currently available in the Medical Staff lounge, NICU and CCU. 

We would love to hear your feedback on these devices, specifically how they compare to existing models in the OR and elsewhere. I’m as picky as anyone when it comes to computer peripherals, but these keyboards are dynamite!  Please try them out and e-mail your impressions to either Holly Carr-Valdes or me (Stephen Dolter, M.D.).

As always, if you have ideas for future columns, please let me know. Thanks for all you do! 

“Technically Speaking” Column Launches – Your Source for IT News

By Stephen Dolter, M.D., Interim Chief Medical Informatics Officer

Welcome to Technically Speaking, your new primary source for Information Technology (IT) news that affects providers. One of my primary responsibilities as CMIO is ensuring providers are satisfied with the information systems they use at work. A big part of that satisfaction comes from staying informed. That is why we’re here; that is why we’re speaking.

Technically Speaking (Tech Speak for short) is like a newsletter…or maybe a blog…but also a bit like a recurring magazine column. We in IT know that ePIG, the Provider Informatics Group, meets regularly, but we also know that those meetings occur just once every other month. And we know that not everyone can attend. We also know that you all have email, but we don’t want to clutter your inboxes with messages if they aren’t urgent.

We instead envision a recurring publication that will not only keep you well-informed of IT happenings, but also provide you with tips and tricks that will help you through your digital days. And we will archive it here, so you can use it as a reference in the future. Don’t worry—ePIG will go on meeting to discuss large-scale IT projects, and if you need to know something right away, we will still communicate via e-mail. But for all the in-between communication, there’s Tech Speak.

In the future, we may experiment with different formats. We may have guest columnists. We may try to appeal to a wider audience. But whatever happens, we will keep speaking; you all deserve the best we have to offer. And we want you to speak to us as well! If you have questions or suggestions for future articles, please let me know: Stephen Dolter, M.D.

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