Optimizing Epic for Future Standardized Patient Education

Optimizing Epic for Future Standardized Patient Education Jordan Stewart Lehigh Valley Health Network Research Scholar Program Mentor: Julie Vardaro, MHA Abstract Epic is a new electronic medical record system at Lehigh Valley Health Network for patients and providers to access healthcare information efficiently and effectively. Outpatient Epic went live in February 2015, and inpatient Epic is pending to go live August 2015. Epic allows all patient medical information to be stored in one multipurpose database that extends beyond their medical encounter. Patients are encouraged to sign up for their own patient portal which allows them to connect to their medical record through Epic. In order to optimize Epic for future standardized patient education, it is important to understand that technology is becoming a vital and pertinent form of communication between patients and providers. One benefit of having a complete medical record online is the ability for providers to get a full understanding of their patient by following them through the care continuum. Personal messaging and educational tools link through the Epic database where clinicians can respond and update the patients’ records. There will be many opportunities moving forward to give our patients the best possible education through their personal LVHN portal. The main focus of this study was to determine what the best practices are for utilizing the LVHN portal and Epic to educate patients. The findings of best practice research coincide with the Network’s triple aim: better cost, better health and better care. Background The Family Education Initiative is a committee formed through the Women and Children’s Service line with one goal being to create a process to consistently deliver education to patients; to serve as a model to be replicated across the Network. This was sparked by the realization that throughout the Network providers are not consistently giving out the same approved educational literature to their patients. Further research of the patient portal is a part of the group’s strategy moving forward. LVHN offers a patient portal to actively engage the patients to participate in their own care. For fiscal year 2016, the goal of the Network is simple - getting patients signed up to their personal LVHN portal. However, this process has been a challenge. Since Wave 1 Epic implementation went live in February in outpatient ambulatory settings, providers have given encouragement and outlined the benefits to their patients about utilizing the portal. Clinicians are finding it challenging with so little time in an office visit to get patients signed up in the exam room. Epic is the electronic medical record clinical database that Lehigh Valley Health Network chose to allow providers the ability to efficiently store personal health information about their patients. Epic goes a step further and collaborates with the LVHN portal so patients can view their personal electronic medical record. The LVHN portal serves as an application to link the patients with clinicians for several health related needs. Through the portal, the patient is able to ask questions to the clinical team through messaging, view lab results, request prescription refills, view their health summary and billing statements among many more options. Each feature encourages the patient to be actively involved in their own care. Following a trend cited by Zarcdoolas, “A number of social and economic factors, such as rising health care costs, a trend towards home health care, as well as shortages of health care workers, have encouraged consumers to increasingly assume a more active role in the management of their own health” (Zarcdoolas, 2013). Among senior leaders in the healthcare industry, Lehigh Valley Health Network has determined how convenience and technology lead to the best solutions for patient access to education and personal health related information. The Department of Community Health team was able align the role between technology and education through a focus group called Monday Morning Moms. This focus group involved 14 new mothers; questions asked of the group encompassed their time at LVHN throughout their pregnancy and after birth. All 14 women liked pregnancy apps on their smart phones, and most of the moms accessed information through their phones. Out of the 14 women, 8 of them utilized EMMI, which is a form of educational videos and materials specific to OB patients and their care. There was variation in how the explanation of educational tools was delivered. Of these 8 women, only 5 were told about EMMI by their OB doctor. As the network moves into developing a series of specific clinical pathways, there is a need for standardized protocols in all practices, which includes the clinical staff participating in informing the patients about educational tools. There was no standardized way of how the moms were told about EMMI. The role of the LVHN portal has potential opportunity in this area. While learning about operations within LVHN, it has become apparent that the different clinical settings and units of each inpatient/outpatient department lack a delivery of standardized education which impacts spreading the same consistent message. Some practices are handing out their own information that is not approved by the Department of Education. The goal of this project at the Network is to establish best practices for utilizing Epic to educate patients in a standardized way. Currently throughout the Network, colleagues are preparing for Wave 2 of Epic to go live in August. This is a huge opportunity to step in and decide what type of future patient education resources could be linked through Epic for the patient to access from their LVHN portal. Methodology Best practices were found through database research on electronic medical record systems. Limited published resources were available pertaining to Epic. Informational interviews were conducted, specifically with the director of nursing informatics to understand the background of the Epic database along with capabilities. An interview was held with a clinical coordinator to understand Epic in an outpatient practice. A conference call with the CNO and a nursing manager at Mercy Health in Ohio was conducted about the application MyChart Bedside. Active and current research through logging into Epic.com helped with discovering best practices among current health systems utilizing Epic. Findings and Recommendations During a meeting with one of the clinical coordinators in a Lehigh Valley Physician Group practice, she explained there have not been any changes in education since outpatient Epic began. These practices are still printing out Krames information. Krames, along with KidsHealth are two data pools of information that have gone through the Department of Education at LVHN and have been approved as appropriate literature to give to patients. Upon meeting with her, it was evident that there needs to be more of a push to get our patients signed up through the portal. Once patients are signed up and utilizing their EMR, the next step is to offer education through the portal. A recommendation to achieve this standardization in the future would be to upload only approved literature onto Epic for the patient to view in their portal. Source: Screenshot of My LVHN Epic Patient Portal Based on the findings of the enrollment procedure into the portal, the patients were given misleading and incorrect steps for the activation process through a letter via E-mail. Not only were the directions wrong, but the nine steps made it difficult for patients to sign up. There is a need for a simplified set up to make patients who are not proficient in computers feel comfortable and not get overwhelmed with information they do not have readily available. Currently, once the patient is logged into their portal, there is no link to offer specific patient education per particular health need. Source: Screenshot of MyLVHN Epic Patient Portal The screenshot above shows the links currently available once logged into the portal. There are only specific tabs regarding conditions and treatments. This becomes a problem when the patient may not have a particular ‘condition’ they want to search for, but instead a general health concern or question. There is a ‘Resource’ tab in the upper right hand corner of the patient portal, but it is underdeveloped and no options are generated under this tab. The ‘Resource’ tab would be an effective area to provide general education information that is service line specific and easy to navigate through. Ideally, this needs to be an area where all LVHN information is compiled from approved databases and can be accessed by patients. All the compiled educational information could be used similar to a catalogue, and the marketing team could potentially use this area to upload what they have created for community outreach events. Mercy Health System in Ohio was one of the first health systems to actively start using an inpatient interactive database through Epic called MyChart Bedside. This application is offered through Ipads in preferred units of their facility. Through MyChart Beside, the patients are able to see pictures of their nursing staff and attending physicians, as well as their current medications and the reason for their hospital stay. Mercy Health reports that patient satisfaction has gone up significantly since MyChart Bedside gives patients the ability to be actively engaged in their own health. Source: Mercy Health MyChart Bedside Presentation Above shows a screenshot highlighting the ‘To learn’ educational tab located after the main sign in page on the Ipad. Through this tab, patients are able to read the specific materials uploaded for them pertaining to their health, and they can also search for any additional information they may want. Mercy Health did note that a significant amount of manual effort went into making all patient education electronic, which is why they have focused on uploading specific disease or condition templates one at a time based on the majority of admission reasons. When determining how to get patients to actively engage in the portal through the Ipads, there were barriers for Mercy Health to consider such as age, ethnicity, education level and socioeconomic status. Surprisingly enough in a study found by the Advisory Board Company, age was not a major driver in portal adoption as shown in the graph below. Mercy Health commented that they are not having an issue with age adaptation and that overall MyChart Bedside has significantly improved the positive outcomes of the inpatient experience for patients and family members alike. Source: Advisory Board Company Epic.com is an interactive website that allows health systems who have access to Epic to browse through questions and findings of other Epic users. An interesting Advance Care Planning strategy has been implemented through Gunderson Health System. This allows patients over the age of 18 or those with chronic health conditions to actively plan and learn the options for the end of life decision making. Patients who have been educated through this ACP strategy have had reduced stress and lower anxiety. ACP has helped with the grieving process of patients and loved ones. Another recommendation which Sanford Health is actively participating in is video visits for their patients who do not have immediate, emergent medical needs. Video visits allow the patient to ask questions or concerns, while allowing providers to educate the patients on an intimate level about the next steps. This has proven to be successful thus far and has heightened patient satisfaction. Conclusion After reviewing the best practices, the following recommendations have been noted. There needs to be a simplified sign up into the LVHN portal. Investment in resources is crucial to consolidate all approved education materials. Further research and development of when and how to utilize and customize MyChart Bedside is needed. LVHN’s Epic team needs to be kept current with Epic education and customization. Technology is the future and patients want mobile and convenient use of information. Ideally the future of Epic will coincide between patients and providers both interacting effectively… “adoption by patients and endorsement by providers will come when existing patient portal features align with patients\u27 and providers\u27 information needs and functionality.” (Irizarry, 2015). Lehigh Valley Health Network has a significant financial investment in Epic, therefor this database needs to be used to its fullest ability enabling all potential opportunities. The triple aim of the Network, including better cost, better care, and better health will all be accomplished when patients have a standardized delivery of educational materials through their portal and Epic. References Epic. (2015). Retrieved July 24, 2015, from https://xgm.epic.com/sessions/?folder=2015 Events/XGM&open=MyChart Advisory Council (MyAC)#MyChartAdvisoryCouncil(MyAC) Friedman, R. (2015, July 20). The truth about patient portal use. Retrieved July 24, 2015, from https://www.advisory.com/research/medical-group-strategy-council/practice-notes/2015/july/the-truth-about-patient-portal-use?elq_cid=1554557&x_id=003C000001ie7GBIAY Irizarry, T., DeVito Dobbs, A., & Curran, C. (2015, June 23). Patient Portals and Patient Engagement: A State of the Science Review [Electronic version]. Journal of Medical Internet Research, 17(6). doi:10.2196/jmir.4255. Pahl, J. (2015). My Chart Bedside at Mercy Health (4-29). Zarcadoolas, C., Vaughon, W., Czaja, S., Levy, J., & Rockoff, M. (2013, August 26). Consumers\u27 Perceptions of Patient-Accessible Electronic Medical Records [Electronic version]. Journal of Medical Internet Research, 15(8). doi: 10.2196/jmir.250

Effects of Disclosing Autism on Coworker Attitudes

Individuals with autism tend to have difficulty with social relationships in the workplace, which makes it hard to obtain and maintain employment. In order to help individuals with autism navigate the workplace, it is important to examine possible stigma management strategies. Using principles from the Stereotype Content Model (SCM) theory, I investigated the effects of disclosing autism on coworker attitudes by having participants view and react to a video of an individual with autism. I also investigated the effects of displayed interpersonal warmth (e.g., greeting others) on potential coworker attitudes. Participants were randomly assigned to one of four conditions formed by the presence or absence of autism spectrum disorder (ASD) disclosure and the presence or absence of interpersonal warmth. After viewing the videos, the participants completed several measures designed to assess their interpersonal judgments, emotional reactions, behavioral intentions, and overall workplace attitudes towards the individual with ASD. Results showed that disclosure had a more pervasive positive impact on the participants\u27 reactions than did displayed interpersonal warmth. When ASD was disclosed, participants perceived the individual as more warm and competent, felt more admiration and less irritation toward him, were more likely to help and associate with him, and were more willing to work with him

Understanding Federal Funding of Appalachian Nonprofit Organizations Through Characteristic Analysis

How nonprofit organizations function and their relationship with federal funding is a topic that has been scrutinized in analytical literature. Appalachian nonprofit organizations and their unique attributes has also been a topic of interest. However, there is little in the current literature on the intersection between Appalachian nonprofit organizations and federal funding. This study expands on the topic by examining characteristics present in Appalachian nonprofit organizations and how they relate to the likelihood of receiving federal funding. Forty-nine Appalachian nonprofit organizations that were recipients of federal funding in the fiscal year of 2021 were chosen, and using information found on their publicly available websites, the following characteristics were analyzed for: racial diversity in staff and board, gender diversity in staff and board, board size, staff management, and online presence. The results of this study suggest that an Appalachian nonprofit organization’s online presence, management of staff, and size of board may have an influence on its likelihood of receiving federal funding. The gender diversity of an Appalachian nonprofit organization’s staff and board may not have an influence on its likelihood of receiving federal funding, and its racial diversity seems to have an inconclusive impact

The Rorschach’s (R-PAS) Capacity to Predict Quality of the Working Alliance

The aim of this study was to explore the Rorschach’s ability to predict the working alliance by investigating associations between specific Rorschach Performance Assessment System (R-PAS) variables and the Goals, Tasks, and Bonds dimensions of the Working Alliance Inventory (WAI). Specific R-PAS variables were chosen based their theoretical relatedness to the three dimensions of the WAI. The linear multiple regression results trended toward significance within the Goals domain, with the Human Movement Proportion score (M/MC) significantly predicting individual’s initial WAI Goals scores, indicating that individuals who possibly have difficulty modulating their emotions and tend to be more reactive in their responses may have a more difficult time creating and maintaining goals in therapy. The minimal significant finding is most likely due to a lack of statistical power due to a small sample size, making it challenging to detect meaningful relationships among variables. Unique to this study was the opportunity to examine a collective sample of Rorschach tests, which provided information regarding individuals’ psychological resources and their cognitive, affective, and relational functioning. From these data, a picture emerged of an individual who would likely consent to take a Rorschach and provide their data for research purposes, providing important clinical implications. Future research with a larger sample size will be necessary to thoroughly examine the relationship between the Rorschach and the WAI

НАВЧАННЯ З МУЛЬТИМОДАЛЬНИМИ ТЕКСТАМИ КРІЗЬ ПРИЗМУ КРИТИЧНОЇ ГРАМОТНОСТІ В КОНТЕКСТІ КЛАСУ АНГЛІЙСЬКОЇ МОВИ ЯК ІНОЗЕМНОЇ

This article explores the role of critical framing in selecting and using multimodal texts in an English as a Foreign Language classroom to engage students in the larger world and shed light on human experiences and contemporary global issues. Specifically, we invite educators to explore language and literacy practices using multimodal texts that can provide opportunities to examine implicit and explicit biases and power relations in the portrayal of global and cultural issues. We ground this discussion of cultural responsiveness in addressing pertinent contemporary issues using multimodal texts in critical literacy and multimodal semiotics within an English as a Foreign Language classroom context.У цій статті досліджується роль критичного фреймінгу у виборі та використанні мультимодальних текстів у класі англійської мови як іноземної, щоб залучити студентів до більшої спільноти та пролити світло на людський досвід і сучасні глобальні проблеми. Зокрема, ми запрошуємо викладачів досліджувати практичне використання мови та грамотності за допомогою мультимодальних текстів, які можуть надати можливість дослідити приховані та явні упередження та відносини влади у зображенні глобальних і культурних проблем. Ми обґрунтовуємо це обговорення культурної залучення у вирішенні актуальних сучасних проблем, використовуючи мультимодальні тексти в критичній грамотності та мультимодальній семіотиці в контексті вивчення англійської мови як другої

Jimmy Bedgood

SSgt. Jimmy Bedgood, May 20, 1946 - May 6, 1968 Native Sons Exhibit Pagehttps://kb.gcsu.edu/nativesons/1012/thumbnail.jp

The association between hysterectomy and ovarian cancer risk: A population-based record-linkage study

Background: Recent studies have called into question the long-held belief that hysterectomy without oophorectomy protects against ovarian cancer. This population-based longitudinal record-linkage study aimed to explore this relationship, overall and by age at hysterectomy, time period, surgery type, and indication for hysterectomy. Methods: We followed the female adult Western Australian population (837 942 women) across a 27-year period using linked electoral, hospital, births, deaths, and cancer records. Surgery dates were determined from hospital records, and ovarian cancer diagnoses (n¼1640) were ascertained from cancer registry records.We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between hysterectomy and ovarian cancer incidence. Results: Hysterectomy without oophorectomy (n¼78 594) was not associated with risk of invasive ovarian cancer overall (HR ¼ 0.98, 95% CI ¼ 0.85 to 1.11) or with the most common serous subtype (HR ¼ 1.05, 95% CI ¼ 0.89 to 1.23). Estimates did not vary statistically significantly by age at procedure, time period, or surgical approach. However, among women with endometriosis (5.8%) or with fibroids (5.7%), hysterectomy was associated with substantially decreased ovarian cancer risk overall (HR ¼ 0.17, 95% CI ¼ 0.12 to 0.24, and HR ¼ 0.27, 95% CI ¼ 0.20 to 0.36, respectively) and across all subtypes. Conclusions: Our results suggest that for most women, having a hysterectomy with ovarian conservation is not likely to substantially alter their risk of developing ovarian cancer. However, our results, if confirmed, suggest that ovarian cancer risk reduction could be considered as a possible benefit of hysterectomy when making decisions about surgical management of endometriosis or fibroids

Association between pelvic inflammatory disease, infertility, ectopic pregnancy and the development of ovarian serous borderline tumor, mucinous borderline tumor and low-grade serous carcinoma

Objective: Risk factors for ovarian borderline tumors and low-grade serous carcinoma (LGSC) are poorly understood. The aim of this study was to examine the association between infertility, pelvic inflammatory disease (PID), endometriosis, ectopic pregnancy, hysterectomy, tubal ligation and parity and the risk of serous borderline tumor (SBT), mucinous borderline tumor (MBT) and LGSC. Methods: This was a population-based cohort study using linked administrative and hospital data. Participants were 441,382 women born between 1945 and 1975 who had been admitted to hospital in Western Australia between 1 January 1980 and 30 June 2014. We used Cox regression to estimate hazard ratios (HRs). Results: We observed an increased rate of SBT associated with infertility, PID and ectopic pregnancy (HRs and 95% CIs were, respectively, 1.98 (1.20–3.26); 1.95 (1.22–3.10) and 2.44 (1.20–4.96)). We did not detect an association between any of the factors under study and the rate of MBT. A diagnosis of PID was associated with an increased rate of LGSC (HR 2.90, 95% CI 1.21–6.94). Conclusions: The association with PID supports the hypothesis that inflammatory processes within the upper gynaecological tract and/or peritoneum may predispose to the development of SBT and LGSC

Implications of Low Water Levels for Canadian Lake Huron Marina Operations

Recreational boating in the Great Lakes is suggested to fuel tourism and the Ontario economy. Like many other tourism sectors, boating-tourism is a highly climate-sensitive economic sector which significantly relies upon compromising climatic conditions. Climate change in the 21st century is projected to alter climatic parameters in the Great Lakes region, thereby generating low lake water conditions and inadequate water levels within some marina facilities that cater to recreational boats. This study examines the multiple implications lakeside marina facilities have previously endured during low water conditions and the possible implications they may experience during three scenarios of water level reductions as a result of climate change. Among the five Great Lakes, Lake Huron has become one of the most prominent lakes for understanding the relationship between climate variability and water-level fluctuations. A questionnaire was administered to 58 marina operators on the Canadian Lake Huron coastline. The questionnaire results were analysed, indicating implications Lake Huron marina operators experienced at their facilities during low water conditions and methods of adaptation that they used to overcome these conditions. The results also projected future implications that may result from climate change and reduced water levels. The most imminent impacts Canadian marina facilities on the Lake Huron coastline would endure as a result of climate change and low water conditions would be the loss of docking slips and potential marina closures. Without adaptation of marina infrastructure, future implications on some Lake Huron Canadian marina facilities may cause substantial economic loss for nearby communities and businesses. Economic losses resulting from lake level water reductions and reduced boat-based expenditures for two regions located on Lake Huron's Georgian Bay shoreline are derived in the study. It is anticipated that the results of this study will provide significant groundwork for systematic and regional evaluations on the impacts in which climate change has upon Great Lake marinas and boat-based tourism