August 13, 2019

eStar updates on daily oral anticoagulants, media tab of chart review, more

eStar Update: New Order Panel for Daily Oral Anticoagulants (DOACs)

A Sentinel Event Alert from The Joint Commission recommends specific actions to improve safe prescribing of direct oral anticoagulants (DOACs) for both inpatients and outpatients. To respond to the Alert, eStar now features a new order panel that supports appropriate dosing and monitoring for DOACs, including:

  • Apixaban (Eliquis)
  • Rivaroxaban (Xarelto)
  • Dabigatran (Pradaxa)
  • Edoxaban (Savaysa)

This change is already live and impacts all clinicians.

The new DOAC order panel:

  • Guides proper dosing based on indication and patient-specific factors, (e.g., renal function)
  • Provides recommended baseline and ongoing laboratory monitoring
  • Includes hyperlink to VUMC Periprocedural Guidelines for advice on timing for stopping/starting DOACs
  • Highlights warnings and contraindications for use of DOACs

Clinicians should use the new DOAC order panel every time a DOAC is prescribed. The new order panel will appear as preference list option any time a clinician attempts to prescribe a DOAC (regardless of “favorited” orders). They should also remove any favorited orders on preference lists that contain DOACs.

Clinicians should order medication by first selecting indication and then selecting the appropriate dose from the panel. The prescribing indication will appear on the order, patient’s medication label, and AVS instructions and medication list. It is also assigned to the prescription Sig and is carried over to inpatient orders generated during transitions of care. Clinicians should be careful to select the correct indication, as it will carry through from inpatient to outpatient. The correct indication facilitates correct dosing, safe transitions of care, and improved medication reconciliation.

eStar Update: New Filters in Media Tab of Chart Review

Beginning August 14, new filters will be available in the Media tab of the Chart Review activity. This change, which impacts all clinical users of eStar, makes it easier to find clinically relevant information about patients. Users can apply more than one filter to sort information in the Media tab and can also

customize the filters using the wrench.

Review Tip Sheet “Managing New Filters in the Media Tab of Chart Review” (available in Hubbl) for more information.

eStar Update: Associating Additional E&M Codes with Diagnosis

Beginning August 14, clinicians will now be directed to choose diagnoses to associate with additional evaluation and management (E&M) codes. Additionally, auto-association of charge codes will no longer take place.

This change will help improve satisfaction through more accurate patient coding and billing process, as well as reduce follow-up with clinicians to clarify diagnoses

Previously, eStar automatically associated primary visit diagnosis to Level of Service (LOS) and all additional E&M codes. If there was more than one diagnosis, all diagnoses were auto-associated to all charge codes. With the change, eStar will now issue a hard stop that directs the clinician to choose additional diagnosis for each additional E&M code. This diagnosis association can be completed as part of the Wrap-Up activity

For more information, review Tip Sheet “Associating Additional E&M Diagnoses” (available in Hubbl).

New Encrypted Pagers for VUMC Colleagues

Over the last several weeks, Vanderbilt University Medical Center (VUMC) has been updating our systems for clinical communications (texting and paging). These changes have been necessary to ensure that we comply with updated guidelines from the Centers for Medicare and Medicaid (CMS), which specify that all pages and texts containing protected health information (PHI) must be encrypted.  

We began this transition by expanding the use of MH-CURE by Mobile Heartbeat to care team members across VUMC—a rollout that impacted both personally and VUMC-owned devices. The expansion of MH-CURE allows care team members to securely send and receive texts, as well as receive pages, containing PHI without violating CMS guidelines.

The next phase of this project is the transition to secure, encrypted pager technology. We have been working with our paging vendor, American Messaging Systems (AMS), to update our infrastructure and devices. As part of this process, colleagues who require an encrypted pager will “swap” their existing pager for a new one. These colleagues include:

  • Residents and fellows
  • Team members who see patients at off-site locations (e.g., Stallworth, the VA, etc.) or in locations with Wi-Fi and cellular data connectivity challenges
  • Team members with specific clinical workflow requirements that require a pager

Colleagues who currently forward pages to a mobile phone via SMS (Short Messaging Service, more commonly known as “text message”) have two options:

  1. The user can opt for a physical pager, and a new encrypted pager will be provided.
  2. The user can opt for receiving messages via MH-CURE, and pages will be directed to their personal mobile device running the MH-CURE application (instructions available here for installing MH-CURE).

Over the next several months, VUMC and AMS will receive shipments of new pagers that support encrypted paging. We will work with clinical and administrative leadership to best determine when and how pager users will turn in their existing pager and, if necessary, receive an encrypted one. These details will be communicated to pager users as they are finalized with each area/department. Please look for more information in email and MyVUMC.

Please note the following:

  • Paging workflows will not change.
  • Numbers for existing pagers will be transferred to the new encrypted device.
  • At the end of the pager exchange program, forwarding of pages to mobile devices via SMS will be discontinued and all remaining unencrypted pagers will be disabled.
  • All pages sent through AMS will also be delivered via MH-CURE. This change ensures that a page sent through eStar paging or Synergy, for example, will still be securely delivered.  Please note: this functionality is scheduled to be live in late August 2019.