Women’s Health Newsletter
May 2015
In This Edition Content Releases Package 80964 Package 80957 EGA rule
Tips & Tricks EDD Maintenance Multi-Phase PowerPlans
Package Release PowerNote
Did You Know Neonate Summary 5.4
What We’re Doing FetaLink 5 Update FetaLink+ Release 3.1
Women’s Health Workshop AWHONN Reception Global Corner Bath Royal United Hospital Trust
Women’s Health Newsletter Content Releases
On the Cover
Peyton Helen Weldy
Package 80964: PowerChart Maternity Inpatient Reports (April 2015)
This month’s cover baby is
Reports included in this package:
Peyton Helen Weldy.
Her parents are Cerner Associates Kaisha Weldy, Solution Results
Manager
with
the
Open Pregnancies by EGA‐EDD
OB Ac vity Log
Delivery Summary
Fetal Well‐Being
Extractable Birth Log Book
Prenatal Summary Genview
Labor & Delivery Summary Genview
Pregnancy Summary Genview
Newborn Discharge Informa on Summary
Correc ons on this package:
Women’s Health team and
1‐7867070017 ‐ The Extractable Birth Log may display results from prior to the preg‐ nancy onset_dt_tm
Ryan Weldy, Knowledge Archi-
1‐9287405507 ‐ wh_psg_ob_exams and wh_psg_lab_results contains a table which is not supported in PowerNotes.
tect with the MillenniumPlus
1‐8619136179 ‐ Women's Health scripts to honor pregnancy org security when u lized as smart template or in GenView
Platform Dev team.
Note: There is an Excep on Package ‐ 80940 (Women’s Health: Smart Templates needs to honor encounter org security ‐ Preference Only) which is added as an unen‐ forced package dependency. Note: CR 1‐9643242338 was discovered a er the package was released. We are work‐ ing on a resolu on and will post updates when the fix is packaged and released.
Package 80957: PowerChart Maternity Ambulatory Reports (April 2015) Reports included in this package:
Open Pregnancies by EGA‐EDD
Fetal Well‐Being
Prenatal Summary Genview
Labor & Delivery Summary Genview
Pregnancy Summary Genview
May 2015
Content Releases continued
Thank You
Correc ons on this package: 1‐9287405507 ‐ wh_psg_ob_exams and wh_psg_lab_results contains a table which is not supported in PowerNotes.
FetaLink Technical Training Thank you to everyone who attended
1‐8619136179 ‐ Women's Health scripts to honor pregnancy org security when u lized as smart template or in GenView
our two-day FetaLink Technical
Note: There is an Excep on Package ‐ 80940 (Women’s Health: Smart Templates needs to honor encounter org security ‐ Preference Only) which is added as an unen‐ forced package dependency. Note: CR 1‐9643242338 was discovered a er the package was released. We are work‐ ing on a resolu on and will post updates when the fix is packaged and released.
Training. It was a successful event with over 40 clients in attendance. Topics discussed included:
In-depth installation procedures and best practices
EGA rule Extra! Extra! Read all about it! The EGA rule is FINALLY done and will be released on May 20!!!!!! This is the EGA at Delivery rule that is in our content packages. The rule has been updated to recognize each dynamic group so that in the event the mother has mul ‐ ples and the babies are delivered on separate days, each baby’s EGA will be reflected appropriately in the mom’s chart and can then be copied over to the babies chart. There are a few new things that you will need to know as the workflow for the rule to evoke is slightly different now. Basically, when a date and me of birth is documented and the first result copy occurs to the baby’s chart, the rule will evoke and run. It will trace back the path to find which baby the EGA needs to be documented on and place that EGA within the proper dynamic group for that baby. Then, when the second result copy happens, that EGA will copy over to the baby’s chart. Currently this rule will be packaged on its own for the May 20th package, but when we repackage the content the next me, we will roll it into our PowerChart Maternity Inpa ent package. Please watch the Women’s Health Collabora on Community for the package number and the announcement of its release on May 20.
Upgrade and migration education
Front end management and maintenance
Device strategy, management and deployment
Troubleshooting scenarios and procedures
Upgrade strategy and overview using the Solution Deployer
FetaLink 5
If you missed this training event, we are planning to have another one in the fall. More information will be posted on uCern.
Women’s Health Newsletter Troubleshooting
Tips & Tricks
Prenatal Visits component in the
EDD Maintenance The EDD Maintenance sec on allows the user to calculate the Es mated Due Date (EDD) and Es mated Gesta onal Age (EGA) once the method and date have been entered using the Add Pregnancy ac on. The system determines an authorita ve EDD and uses that value for the dura on of the ac ve pregnancy or un l the authorita ve value is changed.
Obstetrics View.
Within the Pregnancy Summary through the EDD Maintenance component, the user is able to:
Setting up Pregnancy MPages 5.4 Direct entry functionality was released in MPages 5.4 within the
This feature allows providers to
Add, Modify, View, or Delete the EDD/EGA
All EDD/EGAs are displayed from the start date of the ac ve pregnancy unless deleted
document their prenatal visit information from the workflow view with-
To add a new EDD using the EDD Maintenance window, the user will navigate to the Pregnancy Summary and choose the (+) to add the new value.
out the need to navigate to Interac-
tive View. To configure this functionality in your
domain, you will need to install the
1. Click Add to open the Add EDD Maintenance dialog box.
following two packages:
2. Select the method of EDD to be recorded. Based on the method selected, certain fields are required as indicated by a yellow background.
3. Complete all required fields as well as any addi onal informa on.
76725 MPages: Pregnancy Summary Configuration 5.4 (December 2014)
4. Click OK in the lower right hand por on of the dialog box. When mul ple values exist, the system calculates off of the “Authorita ve” EDD. The first EDD is always considered the Authorita ve value as that is the only EDD added. For an EDD added a er the first, the end user will need to choose “Use this es mate for EDD calcula ons” for the new value to become the Authorita ve EDD.
May 2015
Tips & Tricks continued
Troubleshooting continued
79589 CareConcepts Services
(listed as an unenforced de-
pendency)
If running CareConcept Services
earlier than SP 2012.01.38, there
Once the user has chosen the value that is to be authorita ve, it will then be reflected within the component designated by a checkmark and the new EDD and EGA will dis‐ play on the Pregnancy Overview component.
also needs to be a code value in
code set 57 with a CDF meaning INDETERMINAT and an instance of server #531 running. Otherwise,
you may experience an error when saving results or adding a baby to the dynamic group. SP 2012.01.38
and later and all 2015.01 SPs do
not require this CDF meaning.
For addi onal informa on about the EDD Maintenance tool, please use this link: All About EDD Maintenance.
Women’s Health Newsletter Maintaining Industry Awareness National Women’s Health Week The goal of National Women’s Health Week is to empower women to make their health a priority. The week also serves as a time to help women understand what steps they can take to improve their health. The 16th annual National Women’s Health Week kicks off on Mother’s
Tips & Tricks continued Multi-Phase PowerPlans Our Mul ‐Phase plans are designed so that the mul ple phases can occur concurrently or sequen ally over me. Once the plan is ordered, the user can select the desired phase(s) to ini ate and the other phases will remain in a planned status un l needed. A phase that is in a “planned” status means the phase has been saved to the pa ent’s record, but the orders have not been made available to the ancillary departments or the nurse’s ac vity list. A phases that is in an “ini ated” status means the orders have been made real and communicated to the ancillary departments and made available on the nurse’s ac vity list. Mul ‐Phase plans also have the ability to cross encounters which allows the clinicians to ini ate phases on different encounters. To use the cross‐encounter func onality the cross encounter a ribute must be selected on the plan. The planned phases will re‐ main ac ve and available for ini a on on other encounters even though the current encounter has reached a status of discharged.
Day, May 10, and is celebrated until May 16, 2015.
Visit the National Women’s Health
Week website to find out more.
Women’s Health Inpa ent license includes two Mul ‐Phase PowerPlans:
OB Cesarean Sec on Delivery Acute
OB Triage Mul phase
Women’s Health Ambulatory license includes one Mul ‐Phase PowerPlan:
OB Antepartum Management
May 2015
Package Release Inpatient and Ambulatory PowerNote Package Release Update Last month the newsle er explained the Women’s Health Inpa ent and Ambulatory PowerNote packages were delayed from release in April in order to include updates to the OB Exams and OB Lab Results smart template layout. Currently these templates contain a table/grid format that is not displayed correctly within PowerNote. With this new package, when the wh_psg_ob_exams and wh_psg_lab_results smart templates are used in a PowerNote, they will no longer be displayed as rows in a table format, but rather be grouped. The table layout will s ll be displayed in the Prenatal Summary and Pregnancy Summary Genviews as below: New Layout for PowerNote
Maintaining Industry Awareness March of Dimes The March of Dimes recently kicked off its 2015 imbornto campaign, which celebrates and thanks parents for all that they do. It taps into the collective hopes,
dreams and aspirations that we have for our babies and ourselves.
All babies are born to do something great; something special and theirs alone. But they can’t do it on their
Exis ng Table Layout for Genviews
own. Thanks to your support, the
March of Dimes can help babies be
Packages are set for release on May 20, 2015:
81587 PowerChart Maternity PowerNote Inpa ent (May 2015)
81590 PowerChart Maternity PowerNote Ambulatory (May 2015)
born strong and healthy.
Women’s Health Newsletter End of Support
Did You Know
End of Support for FetaLink 1.9.4
Cerner has set October 15, 2015, as the end-of-support date for FetaLink 1.9.4, which corresponds to the announced end-of-support date for CareAware iBus 2.1.
Neonate Summary 5.4 - Date, Time of Birth Did you know that with the 5.4 Neonate Summary release the Overview, Task Time‐ line, and Hyperbilirubinemia components will now func on off of a date, me of birth that is result copied to the baby’s chart instead of a date, me of birth from registra‐ on? Once the user documents the date, me of birth on the mother’s record, and performs result copy, the three components will populate accordingly. If the baby doesn’t deliver in‐house, the user will be able to document the date, me of birth on the baby’s record. There is a Bedrock filter to map the date, me of birth for the Neonate Summary. The 5.4 Neonate Summary package number is 76726 and the 5.4 component library is package 76720.
Only critical defects will be corrected after October 15, 2015, for FetaLink
What We’re Doing
1.9.4. FetaLink 5 Update Please refer to the following flashes on the Flashes page of Cerner.com for more details: PR15-0034-0 End of support for
The Women’s Health Team is excited about our latest version of FetaLink currently in development, known as FetaLink 5. This major release will streamline workflows, enhancing the clinical user experience. It is being developed on an updated framework that will create a new look and feel for the solu on, paving the way towards con nued integra on with PowerChart Maternity.
FetaLink 1.9.4
Due to the extensive development efforts, the release is delayed and development is expected to con nue through the end of 2015 and into 2016.
PR14-0264-0 End of support for
For a list of the features and benefits that will be part of FetaLink 5, please see our update here.
CareAware iBus 2.1
Updates to our FetaLink development roadmap will be located in our Solu on Strategy Portal here.
May 2015
What We’re Doing continued
In The News
FetaLink+ Release 3.1 FetaLink+, our mobile fetal monitoring solu on for OB Providers, is now offering ver‐ sion 3.1, which became available in the App store on April 15, 2015. This latest release enhances the Pregnancy Summary Review, offering a more comprehensive view of the pa ent’s clinical picture.
Indiana University Health Indiana University Health, along with
FetaLink+ Release 3.1 has added the following features to the Pregnancy Summary Review sec on:
has brought the Nurse-Family Part-
The Labor Assessment component now displays.. This table view of cervical exams over me assists the clinician in assessing the mother's progression through labor The PowerChart Touch Problems component is now included
private donors and federal grants,
nership Initiative to the state. The partnership, through referrals from other local agencies, identifies moth-
ers living in poverty who have recent-
ly become pregnant for the first
time. The nurses visit the moms as many as 65 times over the next 2.5 years, from early in their terms into
their children's infancies, teaching
them about things like healthy life-
style choices during pregnancy, the benefits of breastfeeding and positive interactions with their babies.
FetaLink+ Reference Pages can be found here.
Read more about the Nurse-Family Partnership here.
Women’s Health Newsletter Popular Baby Names for 2015 Boys 1. Liam
Women’s Health Workshop Please join the Women’s Health team May 27‐28 in Kansas City for our Women’s Health Workshop event. Registra on is now open!
2. Noah
Visit h ps://events.ucern.com/WOMEN15/ for more informa on or to register. This will be a great networking and learning opportunity for clients and also poten al clients. Our tenta ve sessions schedule includes:
3. Mason
Postpartum Hemorrhage presented by Angie Conner, RN, BSN from Floyd Medical Center
Baby Friendly presented by J. Lynn Nelson, RN, BSN, IBCLC and Jessica Alford, RN, BSN from the Women’s Health team
FetaLink Lessons Learnt presented by Brian Broomell, MS, RN from Sinai Hospital of Bal more
Perinatal Core Measures
Q&A with Cerner Panel
Build and Maintain New Innova ons
4. Ethan 5. Logan 6. Jackson 7. Lucas 8. Jacob 9. Aiden 10. James 11. Benjamin
For more informa on or ques ons, please reach out to a member of the Women’s Health team or Abby Clement at abby.clement@cerner.com.
12. Alexander
13. Oliver
14. Elijah 15. Jack 16. Luke 17. Michael 18. William 19. Carter 20. Owen
May 2015
AWHONN Reception
Popular Baby Names for 2015 Girls 1. Emma 2. Olivia 3. Ava 4. Sophia 5. Isabella 6. Mia 7. Charlotte 8. Madison 9. Amelia 10. Emily 11. Abigail 12. Ella 13. Lily 14. Chloe 15. Harper 16. Evelyn 17. Zoey 18. Hannah 19. Avery 20. Sofia
Women’s Health Newsletter Mother’s Day
Global Corner
Mother’s Day is a holiday honoring motherhood that is observed in different forms throughout the world. The American incarnation of Mother’s Day was created by Anna Jarvis in 1908 and became an official U.S. holiday in 1914. Celebrations of mothers and motherhood can be traced back to the ancient Greeks and Romans, who held festivals in honor of the mother goddesses Rhea and Cybele, but the clearest modern precedent for
Bath Royal United Hospital Trust Originally beginning as the Bath Casualty Hospital and Bath City Dispensary and Infirmary, the Bath Royal United Hospital Trust (RUH) has been providing services to the city and the surrounding area since its establishment nearly 240 years ago in the late 18th century. Today, the RUH maternity service supports 4,000 deliveries each year. These services are primarily midwife‐led. Mothers only come under the care of a consultant if a caesarean is required (25% of births) or mother and baby are in other high risk categories. Antenatal and postnatal care is focused not only at the main hospital in Bath, but also at four birthing centres in the surrounding community hospitals covering 607 square miles. In the late summer of 2014, the RUH was given the opportunity to deploy Cerner Millennium funded by the UK Governments’ na onal contract, if the hospital could complete the implementa on before the end of the financial year. With a number of factors, including code freeze, winter pressures on the Trust, and implementa on of other key applica ons (also required before the end of the financial year); the hospital was le with a very short 12‐week window to implement maternity instead of the usual minimum of 24 weeks. To achieve these accelerated mescales, the Trust followed a number of key princi‐ ples:
Taking the Cerner PowerChartMaternity standard design with as few changes as possible
Achieving the same (or be er) levels of func onality as compared to the legacy system, to achieve paper‐light, but not full paperless implementa on
Using a small commi ed team to improve and speed up communica on and simplify project management work
Ensuring the team had the skills to support a rapid development approach ‐ to “tweak” the system if (and when) any issues occurred, minimising the need to involve third par es
Mother’s Day is the early Christian festival known as “Mothering Sunday.”
May 2015
Global Corner continued The Trust spent the first month building the team, agreeing on the system design and building in the development environment. The Trust team included two expert midwife users, Kate Hickens and Mary Pyne. They worked with Claire Bell and Jessica Flower from the Trust change team designing new process flows, culmina ng in a three day “Valida on” workshop. Each day of the workshop repeated the same agenda: full system demonstra on in the morning and a hands‐on valida on session in the a ernoon in very small groups with over 90 key maternity staff. At the end of the three days, six changes to the process flows had been iden fied, built, tested and revalidated by users and all process maps were signed off by their respec ve owners. The workshop also focused on iden fying and documen ng poten al benefits of the system with the users as part of the programme benefits management approach. In parallel to the process work, Chris Ruddick and Becci Thorne within the Care Record System (CRS) team were building the system in the development environment. In four short weeks, Becci created the build including 198 beds, 21 appointment types, and 151 slot types as required by the service. Chris developed innova ve workflows in PowerChart, such as the management of referrals from midwives to consultants and the manage‐ ment of maternity screening programme. In addi on, an interface was built to the order communica on system to support the management of pathology reports.
Mother’s Day continued Once a major tradition in the United Kingdom and parts of Europe, this celebration fell on the fourth Sunday in Lent and was originally seen as a time when the faithful would return to their “mother church”—the main church in the vicinity of their home— for a special service. Over time the Mothering Sunday tradition shifted into a more secular holiday, and children would present their mothers with flowers and other tokens of appreciation. This custom
The second month prior to implementa on was all about tes ng the system. Bre Jenkins for the RUH was responsible for tes ng using adapted Cerner test scripts. The scripts had been reviewed by Kate, Mary and Jessica to ensure they reflected the new workflows. Access to “expert” midwife users during the tes ng process signifi‐ cantly reduced the me understanding and challenging current and future flows, suppor ng the tes ng process. Chris and Bre worked closely together addressing any tes ng issues that arose completely within the Trust team.
eventually faded in popularity before merging with the American Mother’s Day in the 1930s and 1940s.
Women’s Health Newsletter Mother’s Day continued The roots of the modern American Mother’s Day date back to the 19th century. Ann Reeves Jarvis helped start
Global Corner continued At the same me, Jessica and Claire led on crea ng all training materials, including training plans, user guides, quick reference guides and mappings to the exis ng legacy system to help users find informa on in Cerner. With such short mescales, a decision was made to have one uniform training course covering all func onality. The final month prior to implementa on focused on building and tes ng in the Millen‐ nium produc on environment while training 300 staff and manually transferring 4,000 pa ent records. Go Live
“Mothers’ Day Work Clubs “ and “Mothers’ Friendship Day.” Julia Ward Howe campaigned for a “Mother’s Peace Day” to be celebrated every June 2. Other early Mother’s Day pioneers include Juliet Calhoun Blakely, and the duo of Mary Towles Sasseen and
Given the short mescales, data migra on from the legacy system into Cerner was manual. The EPR development team built a simple tool to display the legacy data and a simple PowerForm to input the data. This form included opening the pregnancy, add‐ ing demographics and obstetrics history, any pa ent risks and any future appoint‐ ments. Using these tools, the small migra on team (based largely in the exis ng CRS team) quickly achieved a high transfer rate of 30 seconds per pa ent. All 4,000 pa ent details being transferred in eight working days! Supplemen ng the implementa on team, the Trust recruited two external trainers to support the training of the 300 members of the maternity staff over the four weeks prior to go live. Training sessions were held over three different sites and at mes to support midwife working pa erns, including weekends and evenings. Matching the shi pa erns in this way, and with a huge commitment on the part of the maternity service to support the training programme, over 90% training compliance was achieved.
Frank Hering.
Prior to go live the team also performed baseline measurements of key processes as part of the benefits management plan
The official Mother’s Day holiday
On November 15th, 2014 the Trust went live with the maternity service and Millenni‐ um.
arose in the 1900s as a result of the efforts of Anna Jarvis, daughter of Ann Reeves Jarvis.
Business Change, trainers, testers, expert midwives, system builders, Cerner maternity and the project management team all became part of the floor‐walking team, covering the five sites 24/7 for three weeks. Meanwhile, at the Trust’s main site in Bath, the “Go Live” support team was led by Chris Ruddick and supported by Cerner and BT staff (who were, importantly, all on‐site).
May 2015
Global Corner continued Any issues raised through the floor‐walking team were assessed by Chris, Jessica and the support team with the solu on. New work flows were developed, tested and im‐ plemented within hours. Examples included:
redesign of home visit appointment management
redesign of availability of blood screening informa on
redesign of the flow of informa on to Primary Care
One of the reasons for this extended period of support was due to staffing pa erns and rela vely low rates of births in the community birthing centres.
Mother’s Day continued Anna Jarvis had originally conceived of Mother’s Day as a day of personal celebration between mothers and families. Her version of the day
involved wearing a white carnation
Benefits
as a badge and visiting one’s mother
The Trust immediately saw benefits in having, for the first me, one clinical record across the l/caediatric pathway. Babies being transferred now only have to be regis‐ tered into one system, cu ng administra ve me by 20 minutes. Maternity staff have no ced how much more clinical informa on is available electronically, such as opera on notes, reason for admissions, newborn checks, and Day 5/6 Health Visitor le er. In consulta on with Primary Care during go live, we reduced the duplica on of maternity informa on, thus reducing the amount of paperwork they receive. Three months post go live, key benefits were measured again. The following table summarises the number of hours that will be saved each year across each of the pro‐ cess flows measured. This adds up to 1,650 hours or approximately one whole me equivalent midwife.
or attending church services. But once Mother’s Day became a national holiday, it was not long before florists, card companies and other merchants capitalized on its popularity.
By the time of her death in 1948 Jarvis had disowned the holiday altogether, and even actively lobbied
the government to see it removed
from the American calendar.
Source: History.com
Women’s Health Newsletter
May 2015
Global Corner continued
Social Media
Lessons learnt
Become a member of our Women’s
While the Trust did achieve clinical safe implementa on in 12 weeks, it was at a cost. The team o en worked very long hours over a sustained period. More importantly, there was a significant impact on the sense of ownership of the system from the maternity service ‐ the system was imposed on them, rather than the service leading the project.
Health Collaboration Community on
We recognise that four more weeks for implementa on would have addressed many of the issues raised in this ar cle par cularly in rela on to change and training includ‐ ing:
More me for users to lead on the system design
More me to train champions users to support go live and make the service “self‐sustainable” earlier
More me for training and developing training materials and resources. In hind‐ sight, a number of courses more tailored to the needs of the different roles such as community midwife vs those working the central delivery suite, would have been more effec ve.
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!
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Looking back four months on from go live some of the key lessons the Trust has learnt are:
The benefit of using small, mul disciplinary and mainly Trust‐based teams in improving communica on and streamlining the project.
Avoiding over‐designing prior to go live. The Trust had to rely on system suppliers to design a system that works as it was taking the standard build. What was learnt is that o en it is not un l users operate the system in the real world that it can be assessed where fine tuning is required to reflect local workflows.
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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.