EMR Updates and Clinical Visit Summaries (CVS)
As most of you are painfully aware, on July 1, 2014 our Centricity Electronic Medical Record (EMR) underwent an upgrade to put us in compliance with 2014 CMS certification requirements for Meaningful Use (MU).
Believe me when I say, figuratively, literally, and viscerally – I feel your pain. The lag in usability due to changes in screen types and placement of icons was anticipated. The upgrade created unanticipated problems including multiple issues with interfaces, ordering prescriptions, and most painfully, Clinical Visit Summary changes.
Since the release of the upgrade on July 1, the Clinical Support Services (EMR) team, many others in and outside of the IT Department, Senior Leadership, and I have spent hours on the phone with GE (our EMR vendor), attempting to identify quick fixes. We and a host of other organizations across the country have made our displeasure heard loud and clear.
I personally apologize for any pain this has created in your various clinical endeavors. The Clinical Support Services team and I will continue to meet with GE and outline various ways to improve these issues as quickly as possible.
Clinical Visit Summary
One of the “Core” measures of Meaningful Use outlines “Provide Clinical Summaries for Patients for Each Office Visit”; the threshold for meeting this performance measure is 50% of all office visits. On the surface this looks relatively easy, and during the 2013 4th quarter MU attestation period, a majority of providers performed at very high levels.
Due to the changes in MU the requirements for information in a Clinical Visit Summary (CVS) have also changed. Presently, as mandated by CMS, the following components make up a CVS:
- Patient name
- Provider’s name and office contact information
- Date and location of the visit
- Reason for the office visit
- Current problem list
- Current medication list
- Current medication allergy list
- Procedures performed during the visit
- Immunizations or medications administered during the visit
- Vital signs taken during the visit (or other recent vital signs)
- Laboratory test results
- List of diagnostic tests pending
- Clinical instructions
- Future appointments
- Referrals to other providers
- Future scheduled tests
- Demographic information (sex, race, ethnicity, date of birth, preferred language)
- Smoking status
- Care plan field(s), including goals and instructions
- Recommended patient decision aids (if applicable to the visit)
As you can imagine, all this information crammed into a CVS creates a very lengthy document. GE is working to improve this document into something more manageable. I have attached a future sample for the CVS. I will continue to work closely with GE in re-designing this content to be provider-friendly. I will also continue to relay the concerns that many of you have voiced about a more efficient manner to edit the CVS without the dreaded comment – “This information is available, but your provider has decided to withhold it.”
As we continue to utilize the Patient Portal and an increasing number of clients sign up for this service, providers will be able to send CVS to the Patient Portal – www.myttpelpaso.org ; thereby eliminating or drastically reducing the need for paper in our clinics.
So What’s Next?
Hopefully over the next two months, we will come to an agreement with GE on changes to the CVS. A simple reduction in length will ease some of the pain and frustration providers are experiencing using the GE EMR upgrade.
Thereafter, as we continue to work with GE to make improvements to the CVS and other EMR functionality, the CSS team and I will update faculty and staff via email. As I previously stated, the changes in the EMR were intended to “add value, track care coordination, allow patients to access their information online, and fulfill CMS requirements.” Though we are progressing, we have yet to meet the ultimate goal but we will continue to strive forward.
I appreciate your patience in these electronically trying times.
Please feel free to contact me with any questions or concerns.
Ogechika K Alozie, M.D., M.P.H., CPHIMS
Chief Medical Informatics Officer (CMIO)