Date: To: From:

June 10, 2011 Clinical Providers Brett Moran, MD Chief Medical Informatics Officer Parkland Health & Hospital System John Jay Shannon, MD Executive Vice President and Chief Medical Officer Parkland Health & Hospital System

Subject:

Unsigned Verbal Orders and Notes in Parkland EPIC In Basket

Dear Provider, You have been identified as having unsigned verbal orders in your Parkland Epic In Basket. These orders have been attributed to you and it is critical that you review them and sign off on all of them by 23:59 pm, on June 19, 2011. Regulatory Organizations, to include Centers for Medicare and Medicaid Services (CMS) and The Joint Commission, mandate that verbal orders be signed by a provider within 48 hours of a nurse entering them. Similarly, CMS requires any cosign requested documents be signed in a timely manner. We ask that you go to your Parkland Epic In Basket and review the messages and sign them. Anything in the following folders should be signed: Cosign Meds, Cosign Notes, Cosign Non-provider Entered Orders, and Cosign Orders. Should you have any orders or notes that have been misattributed (i.e. you feel you didnt give the verbal order) and for which you are uncomfortable completing, please forward to your Parkland Service Chief for them to review, redirect, or sign as they see appropriate. We have made great strides to assure correct attribution and feel that there should be very few misattributions, and from the department assignment virtually none are incorrect. Recall, to forward messages, simply click the forward button in your inbasket. Fill in the name of person to whom you wish to forward (last name, first). Then select the Reassign responsibility button at the top of the message if it is not already selected, and click accept at the bottom of the message to send. We will be providing your Parkland Service Chiefs with periodic updates so that they may monitor your progress on completing this task. Due to the inordinate number of messages and need to correct this as soon as possible, we are asking that you complete all verbal orders and notes, or direct them to your Parkland Service Chief, no later than 23:59 pm, on June 19, 2011. After 23:59 pm on June 19, 2011, any house officer with remaining messages of unsigned verbal orders or cosign notes in his/her In Basket may be pulled from service on his/her next assigned day of duty to complete the task. In addition, a written notification, to be placed in your Residency personnel file, will be sent to your Program Director relating a lapse in Professionalism. For nonhouse staff providers, overdue messages of unsigned verbal orders or notes in his/her In Basket after 23:59 pm, on June 19, 2011 will be forwarded to the appropriate Parkland Service Chief for appropriate management, a written communication will be provided to your immediate supervisor, and be placed in your Parkland Credentialing Quality File. We understand there are ongoing issues with the In Baskets and we are working diligently to eradicate them, including locking down certain orders (e.g. pick-up-blood and miscellaneous dietary messages) such that they cannot be ordered as verbal orders, and aggressively educating non-providers on the correct use of order modes, particularly written orders and protocols. We

are also in the midst of working with nursing to address misattributed orders both through feedback when this happens as well as creating a process for providers to bounce these orders back to the nurse. We are also in the progress of sending transcriptions and chart deficiency notices to the inbasket, rather than through email, for easier access to information in the correct context, so effectively using the In Basket will become even more important. Stay tuned for more details on these projects in the near future. In the meantime, however, we must continue to provide excellent patient care, and part of that requires actively using the In Baskets. We appreciate your immediate attention to addressing the unsigned verbal orders and notes in your In Basket. As we learn as an organization how to leverage the benefits of the electronic health record, it is vital that we also develop safe and effective practice habits relative to this vital tool for delivering care for our patients. In Basket hygiene is simply one aspect of professional clinical practice.