Women’s Health Newsletter
May 2014
In This Edition Tips & Tricks Prenatal Card View Uterine Contraction Monitoring Method
Technical Corner Network Sync Troubleshooting
Best Practice FetaLink 2013.01 Upgrade myStation Use
Save the Date AWHONN Annual Convention
Coming Soon Women’s Health Tech and Unit Secretary Playbook Release
Did You Know FetaLink Downtime Process Strategy Portal
Global Corner First Qatar Client Live
Women’s Health Newsletter On the Cover
Tips & Tricks
Lillian Maxine Bateson
This month’s cover baby is Lillian
Prenatal Card View The prenatal card view on the Pregnancy Summary page must be mapped properly in order for documented informa on to show up correctly. If your cards look like this, and you know that data such as the blood pressure has been documented, open the Bedrock.exe tool and check your mapping.
Bateson.
Her mom is Cerner Associate Tiffany Bateson, a Solution Designer with the Innovations Development team.
Each data element must be mapped to an event set. See the example screenshot below for mapping of “blood pressure” and “weight”. Once you are in Bedrock.exe, follow this path: Quality ReporƟng and MPage set up > MPage > MPage set up > Select Pregnancy MPage v5 > Assessment and IniƟal Physical Exam.
May 2014
Tips & Tricks continued
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Uterine Contraction Monitoring Method FetaLink has the ability to pass the alpha response for Uterine Contrac on Monitoring Method off of the fetal monitor into PowerChart iView. This value will be displayed in iView when pulled in with maternal vitals as "None," "Intrauterine Pressure Catheter," or "External Toco" as standard, but can be customized for your domain. This build is not required, however it is an op on that any client can take advantage of. If you currently do not have this built in your domain and would like to have discussion to possibly add it, please reach out to your Cerner contact to get more informa on on how this can be accomplished. Addi onal informa on on configuring alpha responses can be found here.
WomensHealth@Cerner.com and we will include it in our monthly newsletter.
Women’s Health Newsletter Technical Corner
Cerner Babies
Charlee Miller
Network Sync Troubleshooting A common issue that may affect one or more of your FetaLink PCs is the presence of an orange banner bar when you open a fetal strip. The orange banner bar represents a me synchroniza on issue between the data the applica on is receiving and the PC itself. So, how do we fix that? Let’s start by iden fying where the mestamps are coming from. A common misconcep on is that the me in FetaLink is obtained from the fetal monitor itself. While it is important to keep the me on the fetal monitors accurate for paper strip prin ng and in the event of down me, there are actually two primary components to provide me to the FetaLink applica on. The first component is the Fetal Monitor Connec vity Engine (aka, the Black Box CE) which is the source of me for the data itself. The Fetal Monitor Connec vity Engine receives its me from one of two sources depending on your configura on. The first op on is the two nodes of the Produc on CareAware iBus cluster, which is our recommended standard. This source ensures that regardless of changes to your NTP source, as long as the clustered pair stay synchronized, so will the CEs. The second op on is to sync the connec vity engines directly to your Network Time Protocol (NTP) server directly. For either of these methods to work successfully, the FMCEs on your network must be able to communicate directly to their me source.
Carter Cao
Elise McWilliams
To iden fy your NTP source, browse to iCommand > Configura on > System > Configura ons and select CCE3BlackBox (Note: If you are using TouchScreen connec vity engines for FetaLink, you will also want to review CCE3TouchScreen profile). Here you can verify the correct Time Zone is selected, NTP Synchroniza on has been enabled, and review the sources for NTP synchroniza on. We recommend iden fying at least two sources for redundancy assuming mul ple sources are available. Any changes to the NTP se ngs for the CEs will require two reboots of each device. The first will apply the se ng and the second ac vate it at the opera ng system level. The second component is the PC that the FetaLink applica on is running on. Typically this refers to a bedside, nursing sta on or central sta on PC but it can also refer to a Citrix server should the app be being u lized remotely. When you open a single or mul -pa ent view inside of the applica on, the app will use your local me to determine where it should collect data from the server. In the event the clock was in front of the actual me, you have a delay in the loading of the strip as the app waits for data from the device.
May 2014
Technical Corner continued
Cerner Babies
Conversely, if the me were to be behind the data flow, you may find yourself looking at a strip in the past. Addi onally, an interac on with the strip is expected to be in real me and an offset in me could result in a misinterpreta on by the clinician. FetaLink leverages the Windows Time service (W32Time) to provide me to the applica on. Windows has historically been a poor keeper of me as it is not uncommon to see variance between PCs even when they are properly configured for NTP synchroniza on. To combat this, the FetaLink team recommends modifying the registry configura on of the W32Time service to decrease the frequency of synchroniza on events and keep the PCs in check. The contents of the registry key modifica on can be seen on the Install FetaLink PC guide located on the FetaLink Reference Pages. Applying the key is as simple as crea ng a .reg key containing the configura on, opening the file to apply it and either reboo ng the computer or restar ng the Windows Time service.
Hudson Arensberg
In recent months however, we have observed an increasingly common issue with the registry key deployment model. Windows Group Policy has been found to overwrite this key if enabled in your Ac ve Directory configura on. While this setup will vary, many sites have either had to modify their Group Policy or create an excep on group for PCs where the FetaLink applica on is deployed.
Lucina Walker
Now that we have outlined the possible causes of a me synchroniza on error, we can look at iden fying the source. There are a few ways we can go about verifying me synchroniza on, but the easiest can occur on the unit with very li le effort. As a general rule, if a single PC shows mul ple strips in orange when looking at a mul pa ent perspec ve, the PC is typically the culprit. Conversely, if the same device is shown in orange on mul ple PCs, it is likely the FMCE. To verify me on the CE, you can connect directly to the device via SSH (Pu y, MobaXterm, etc.) and run the date command. The easier method however is to open iCommand > Management > Device, double click the device in ques on and select the 2nd or 3rd tab on the le side of the view. You will see data coming in from the device (assuming the device has been turned on) and the mestamp presented will mimic that of the me on the device itself. As always, for addi onal assistance in troubleshoo ng this or any FetaLink issue you may also engage our Direct Care Support team via phone or SR and they will be glad to assist.
Grayson Lewis
Women’s Health Newsletter End of Support
Best Practice
End of Support for FetaLink on CareAware iBus 1.3
FetaLink 2013.01 Upgrade Did you know that our FetaLink team ran a study on the new 2013.01 upgrade for one of our FetaLink clients, Olmsted Medical Center.
Cerner has set an end-of-support
Prior to installing the new FetaLink version, Olmsted was experiencing a daily average of 38 FHR alarms and had been live for 211 days. A er comple ng the 2013.01 FetaLink upgrade, which now includes the new signal strength aler ng capability, the
date of June 30, 2014 for all
client went from that daily average of 38 alarms to 10. This is a 71% decrease in
versions of FetaLink on CareAware iBus 1.3.
daily FHR alarms and resulted in some very happy users. If you would like more informa on about the 2013.01 FetaLink upgrade, please contact Russ Snyder at RSnyder@cerner.com
Additionally, support for FetaLink Release 1.9.2 and earlier releases will end on that date.
Please refer to Priority Review Flash PR13-0083-0 for additional details.
myStation Use as told by Fisher –Titus Medical Center The CareAware mySta on is a welcomed enhancement to our birthing rooms. The pa ent and her family enjoy the 42 inch flat screen TV throughout their stay. For entertainment, the mySta on is a smart TV that allows you to surf the web and keep up with social media with the use of a wireless keyboard. Aside from the mul tude of cable channels, there are music channels to promote relaxa on. Movies-on-demand are another popular feature and are free of charge. But mySta on is more than just entertainment. It provides a more secure environment for our pa ents. In conjunc on with our Sonitor® badges, every employee who enters her room has their photo ID, name, and creden als displayed on the mySta on screen. From housekeeping to physicians, this keeps the pa ent informed of who is entering their room and adds an extra layer to our infant security. Pa ent Educa on is another feature that has been well-received. Nursing places an order for any per nent educa on and the educa on video will display in the pa ent’s mySta on things to do list. The pa ent will select and watch the video at their convenience. This, in turn, completes the order. Two of our most popular educa on videos are “Infant CPR” and “Baby’s First Months.” Are you interested in learning more about how MySta on can benefit your L&D? If so, please contact John Folmnsbee at john.folmnsbee@cerner.com or 816-982-7377.
May 2014
Save the Date
End of Support
AWHONN Annual Convention
End of Support for FetaLink 1.9.3
Are you headed to the 2014 AWHONN Annual Conven on in Orlando, FL from June 14 – 18? Be sure to stop by the Cerner booth #1111 and see our Women’s Health team demonstrate the latest and greatest in PowerChart Maternity, FetaLink and FetaLink+! We will also have associates on-hand showing off more Cerner solu ons that complete the Women’s Health workflow, including: CareAware myStaƟon - a fully interac ve pa ent system aimed at engaging pa ents and families throughout the en re care process by providing comprehensive communica on educa on, communica on, and entertainment offerings, Bridge Breast Milk Management – barcode scanning technology that helps caregivers give the correct mother’s milk to the correct infant at the me of feeding, and CareAware Connect – a clinical mobility solu on that delivers communica ons (voice, text, alerts) and electronic health record workflow tools on a single smart phone device. We can’t wait to see you there!
Cerner has set October 15, 2014, as the end-of-support date for FetaLink 1.9.3, which corresponds to the announced end-of-support date for CareAware iBus 2.0. Before October 15, 2014, you must
Coming Soon Women’s Health Tech and Unit Secretary Playbook Release We are excited to announce the upcoming release of playbooks for Women’s Health Tech, Women’s Health Inpa ent Unit Secretary and Women’s Health Ambulatory Unit Secretary Posi ons by the end of 2014! These Playbooks will provide a comprehensive approach to maximizing the produc vity through op mal design, configura on and preference standards based on the best prac ce observed by Cerner across our client base. Each playbook will include the following: Standards – se ngs for preferences and privileges that are derived from the accumulated experience of implemen ng PowerChart Maternity and FetaLink Content – configura on of any applicable tools that will enhance produc vity Workflows – op mal workflows to support the appropriate role Training – guidance in the prac cal applica on of each playbook By the fall, all Women’s Health Tech and both Women’s Health Unit Secretary Playbooks can be accessed from the Venue Experience site.
upgrade to FetaLink Release 1.9.4 or later and CareAware iBus 2.1 or later.
Please refer to Priority Review Flash PR14-0083-0 for additional details.
Women’s Health Newsletter Maintaining Industry Awareness National Women’s Health Week, May 11-17, 2014
Did You Know FetaLink Downtime Process We o en get ques ons surrounding down me procedures and how FetaLink is impacted. Let’s take a few minutes to review what is meant by down me and its varia ons. Millennium DownƟme
National Women's Health Week is a national effort by an alliance of government organizations to raise awareness about manageable steps women can take to improve their health.
Some mes, par cularly during events such as planned code upgrades, system maintenance, or during daylights savings me, Millennium (including PowerChart Maternity) may be temporarily unavailable. Follow your hospital’s policies and procedures regarding documenta on during Millennium down me. Millennium is used by FetaLink for a variety of func ons. The pa ent record, user security, user sign-on, CAMM interac on, and clinical record are all examples of things that interact with the Millennium environment. If Millennium is unavailable for planned or unplanned outages, there are some limits on capabili es within the FetaLink applica on. What the users see: Down me Mode (FetaLink releases prior to 1.9.4)
The focus is on the importance of
Millennium Down me Mode (FetaLink 1.9.4 and higher) Errors are seen when the user a empts to do the following tasks.
incorporating simple preventive and positive health behaviors into everyday life.
1. Unable to search for new pa ents 2. Unable to finalize episode 3. Unable to create new episode 4. Unable to archive data 5. Authen ca on Impact:
Finalize Episode, Pa ent Archive, and Prin ng op ons are disabled. Extended View displays up to 24 hours of pa ent history data. Archive Perspec ve is unavailable. An unassociated pa ent can be monitored, but not associated to a device. Strip annota on is available, but the annota ons do not post to Millennium un l the system is back up
May 2014
Did You Know continued Recommended Workflow: 1. Unable to search for new pa ents - Monitoring data is captured and can be viewed within FetaLink. Once Millennium is available again, it is possible to perform a retro-ac ve associa on on the pa ent to assign the strip to the pa ent. 2. Unable to finalize episode - Disassociate the pa ent from the monitor and transfer the pa ent to a hold bed un l the system is available again. 3. Unable to create new episode - Monitoring data is captured and can be viewed within FetaLink. Once Millennium is available again, it is possible to perform a retro-ac ve associa on on the pa ent to assign the strip to the pa ent. For archived data, it is necessary to wait for Millennium availability. 4. Unable to archive data - This should not affect the user. The service responsible for archiving data stops if Millennium is unavailable. 5. Authen ca on - There is a mechanism to enable down me authen ca on. The only caveat is that a user who wants to log in during a down me, should have logged in the last 30-45 days with their current creden als. Addi onal informa on is available here. It is important to understand that FetaLink sits on its own opera ng system, and uses its own iBus. This design ensures that clinicians will be able to con nue to use FetaLink for real- me monitoring and aler ng, even if other services are unavailable. There are a few other scenarios in which fetal monitoring workflows may be impacted that it may be helpful to men on.
Maintaining Industry Awareness continued During National Women's Health Week, women should discuss with their health care professionals which of the tests are right for them, when they should have them, and how often. Maintaining regular check-ups is one of five health habits that can improve a woman's health. The others include physical activity, a healthy diet, not smoking and follow
CAMM DownƟme Although rare, there may be unforeseen or planned scenarios that will result in a CareAware Mul Media outage for a period of me. In uncommon situa ons, a CAMM down me may occur due to a need for maintenance and upgrades. In prepara on for those planned down mes, a clear communica on plan between the clinical staff and the system support teams is essen al, to ensure that everyone understands when the planned CAMM down me starts and ends. The clinical staff should be familiar with their ins tu on’s policies and procedures regarding down me scenarios. The following informa on will help guide users and system administrators during CAMM unavailability.
general safety rules.
Women’s Health Newsletter Pregnancy Facts
Did You Know continued
Each year in the United States, there
What the users see: Error messages when trying to do the following tasks:
are approximately six million pregnancies. This means that at any one time, about 4% of women in the U.S. are pregnant.
Nigeria has the highest twinning rate in the world at around 4.5%. Some
1. Unable to finalize an episode 2. Unable to create a new episode 3. Unable to retrieve archived episodes Impact: CAMM is used for the long term storage and retrieval of saved monitoring data. Data is migrated to CAMM by services that run on the CareAware iBus. These services have criteria that define how frequently they execute and how much data they copy to CAMM with each execu on. The database size on the CareAware iBus servers will con nue to grow since the device data can no longer be archived. If this is not corrected then the CareAware iBus servers will stop func oning when the disk becomes full. Recommended Workflow:
experts attribute this number to the large consumption of yams.
The average size of a full-term baby in the U.S. is 8 pounds. This is an increase from an average size of 6 pounds 30 years ago.
During Down me 1. 2. 3. 4. 5. 6. 7.
Users are unable to perform the following tasks: Create or update a reason for monitoring Finalize an episode View more than 24 hours of data in the extended view The archive process is paused For pa ents currently on the census, con nue the normal workflow For new pa ents, document on the device only, do NOT associate the device to the pa ent 8. Stop barcode/HCIS services to prevent use of P2DA 9. Because FetaLink would be unavailable for data capture to permanent storage during a CareAware Mul Media down me, It may be necessary to begin prin ng from the fetal monitor to ensure a con nuous record. Follow your ins tu on’s policy concerning ambiguous system availability.
May 2014
Did You Know continued
Package Release
A er Down me
Two reporting packages became
1. Retroac vely associate the new pa ents to their devices 2. Restart the Archive and Archive Data Manager to make sure everything comes back up successfully 3. Cycle server 354 4. Once CareAware Mul Media is available for long term storage and retrieval of saved monitoring data, users may return to their normal workflow. Con nue to follow your ins tu on’s policies and procedures concerning labeling and saving paper strips to the pa ent’s medical record. For details on this situa on and other similar scenarios, please refer to: FetaLink System Availability FetaLink Device Unresponsive
generally available on April 30.
Ambulatory Reports (April 2014)
#73101—PowerChart Maternity Inpatient Reports (April 2014)
Included in this release:
Strategy Portal
The Delivery Summary report supports multi alpha results for
Ever wonder what Women’s Health func onality has been recently released? Ever want to see our vision for the future?
Oxytocin Inductions and Oxytocin Augmentations
The Women’s Health Roadmap can be access here. Details of specific ini a ves can be found by selec ng its hyperlink. Because priori es some mes shi based on the needs of our client base and market trends, the Women’s Health Team aims to keep this as up-to-date as possible. This will allow you to have quick and easy access to our strategic development.
#73100—PowerChart Maternity
Fetal Presentation populates in the Prenatal Summary
Infection Hx event_cds documented as “No” are no longer displayed in the Infection History section
Women’s Health Newsletter
May 2014
Global Corner
Social Media
First Qatar Client Live
Become a member of our Women’s Health Collaboration Community on uCern.
uCern is a great way to stay up to date on the latest developments around PowerChart Maternity and FetaLink, hear about upcoming events, network and share tips and tricks with your peers.
If you are not already a member, we hope you’ll sign up soon!
On April 25, 2014 the Women’s Health Team welcomed its first live client in the State of Qatar.
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Qatar is located in Western Asia, on the northeasterly coast of the Arabian Peninsula. Al Khor Hospital is located in the coastal city in northern Qatar, 50 kilometers north of the capital, Doha.
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Al Khor offers general medicine, general surgery, emergency medicine, pediatrics, and obstetrics and gynecology services. Yearly deliveries average around 850. The Women’s Health team is excited to welcome the Al Khor Hospital team to our client family and are eagerly an cipa ng the Women’s Hospital go live later this year.
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If you are interested in printing this newsletter, you can download a printable PDF on our Women’s Health Collaboration Community uCern page.