Part II: Meaningful Use and Discharge Wins

This is Part II of our three-part Multidisciplinary Discharge Series.




Kerri: The new Meaningful Use Care Plan requirements created a lot of customer buzz this year. How is Avera Health documenting Care Plan to meet Meaningful Use requirements?


Greg: Currently, we created a Word document with four generic care plans that can be used for any patient. The nurse will then copy and paste that into the free text Care Plan text field. With the new DTSs MEDITECH recently delivered (CS PCM 5553, CS MIS 16727, MG PCM 1508, MG MIS 12186), we are now in the process of incorporating the Care Plan directly into Physician Documentation by utilizing the Prob2 component. However, with some time constraints, we are not quite there yet.  


Kerri: Excellent to hear you are looking to incorporate your Care Plan documentation requirements into Physician Documentation using the Problem List (Prob2) component. This option is more aligned with our MEDITECH Best Practices because it will allow your Care Plans (Problem, Goal, Provider Instructions) to be more specific to the individual patient.  Pat, would you like to comment on how your organization is documenting Care Plan for Meaningful Use?


Pat: We struggled with the Care Plan. We had huge conversations that this is not the nursing care plan; this is the physician care plan, and we did not want nurses put in the position of writing out the providers' plan of care. The providers voiced that their follow-up and referrals are the major plan of care. So right now, we use the free text Care Plan in Discharge.


Kerri: Since going LIVE, how has the Discharge routine help improve discharge planning communication and patient safety at your organization?


Pat: We’ve had some great successes. I’m married to someone who works for a durable medical equipment company and delivers DME. Previously, this was all done on paper and a lot of times he would get calls late on a Saturday that a patient was getting discharged; nobody had looked ahead of time to determine if the patient needed a hospice bed, or a wheelchair, or oxygen.


The Discharge routine puts it in everyone’s face and serves as a constant reminder to check and plan for the patient’s DME needs ahead of time. Having all of that information — like DME or medications not being reconciled, or follow-up referrals — allows everyone to see what is needed so they can start working on it now.


The biggest thing, especially on our surgical units where it was common for the surgeon to write “continue all home meds,” and in order to give the patient something that was legible, the nurses were having to hand type all of this information into the computer again and again. There was just a lot of double and triple work for the nurses before. I tell the nursing staff a lot — now that physicians are coming on board with CPOE, and with Multidisciplinary Discharge, all the double and triple work is being taken away from them. They are finally starting to get some of the perks, and who doesn't like that?


Kerri: Absolutely! Its great to hear that our 5.66 Discharge routine has helped to streamline discharge planning at your facility, while giving the nurses more time to focus on the task at hand—which is taking care of their patients. 


Pat: Exactly. Everyoneis on the same page now because they are all seeing the same information. There’s just a lot more communication that happens, even off the computer.


Greg: I would like to echo a lot of what Pat said. We hear a lot of comments from nurses about how much time they have gotten back — and really, that has to do with the medications because they no longer have that transcription aspect. From a safety standpoint, one less time the orders have to be transcribed, the more safety we have. We have also gone up with the Ambulatory Hold Queue, where we now have our Discharge LAB orders sent into the hold queue, so on our clinic side, those orders are available when that patient arrives, and the patient no longer has to bring in a sheet of paper with his or her lab work information. That has been another patient satisfier for us.


Kerri: Were there any small changes made to your discharge process that ended up being big wins for your organization?


Pat: Absolutely. I think the biggest win was making a user-friendly Discharge Desktop by creating step-by-step instructions embedded in the text of the desktop. We really leveraged the instruction text (reminder text) next to the Discharge Desktop components to help instruct the user where they need to go. We also lined it up so that the most important things were not only marked as required, but also located at the top of the screen with easy-to-read instructions (reminder text). So for example, we have text that reads, “Step 1: Write Discharge Order,” followed by “Step 2: Reconcile Home Meds and Write Prescriptions,” followed by “Step 3: Referrals and Follow-up Orders,” followed by “Step Last: Document - pull in Scripts/Referrals.”


So, it wasn’t until after that the physicians started getting into the right flow. They learned that if they followed these steps, they could then automatically pull in some of this information to their documentation.


Greg: We looked at this from an efficiency standpoint for the providers and the one big thing that we were able to do is create over 10 AOM Order Sets that included all of our common discharge orders. For example, the provider could select our Discharge Cardiology order set, or our Discharge General order, and be able to select the common orders from that order set. This provides such a huge efficiency for our providers because they don’t have to go searching for those orders.


The other thing that we wanted to do was create one Discharge Instructions Pdoc template for all providers across all of our hospitals, no matter what destination the patient was going to. This was a big challenge and big win because it takes out the guess work of what template the provider needs to fill out. It includes all of our quality measures documentation and all of our discharge instructions, including documentation needed for long term care and nursing homes. Not only is it easier for providers to use one template, but it also saves them a couple of clicks as well.




Before You Go
Please see the the Read More section to the right of the page to find supporting documentation, screenshots, and bios. Any questions should be directed to Kerri L. Nash at (781) 774-2605 or kriel@meditech.com.

Join the discussion on MEDITECH Commons to share your experience with the Discharge routine and connect with peers.