HED Upgrade Issues Educational Update 5 17 12 by fDQ7Zq


									           New Version HED – Current Issues and Educational Update May 17, 2012

Scanning Downtime Documents: in an informal survey of many (but not all) units today, we
found that over 1/3 of patients who had been here during downtime had been discharged and
their unscanned documents had gone to MIS for post-discharge scanning. As much as ½ of
scanning of Downtime documents had already been completed by units. The remaining units
had varying amounts of unscanned Downtime documents left from this past weekend. Based
on this, we have agreed on the following plan:
     If you have unscanned downtime documents and the capacity to scan, we’d like the
        MRs to go ahead and scan these documents.
     If you have very large quantities of downtime documents that are not scanned and
        because of the business on the unit or lack of MR coverage cannot scan this material on
        the unit, you may bundle and send to MIS for scanning.
     If real-time scanning has NOT yet been implemented on your unit, leave the downtime
        documents in the Blue Chart until discharge and MIS will scan with other permanent
        medical records documents after discharge.
     Regardless of which option you use, documents need to be prepared for scanning:
            o Each page should have date,time, and patient ID label attached.
            o Multi-part forms (such as Downtime Nursing Flowsheets and Downtime MARs)
               should be arranged in order, all pages facing in the same direction.
            o All downtime documents for a patient should then be put together and scanned
               together to ensure the different pages of a single document are indexed

Current Issues:
    Driver Issue – right after I sent this update yesterday, we finally tracked down a source
       of some issues we’ve been seeing. Over 500 CWSs scattered across the house were
       missing a driver required for the new version of HED to work correctly in some
       situations. We did an emergency push to get this driver pushed out to those CWSs that
       were missing it. Some of you may have noticed CWSs re-booting when no one was
       signed on of after you signed off after this push was done. We think this corrected the
    There is a problem with the Shared Session Software that allows HED to communicate
       with the Clinical Workstation (CWS) and with Starpanel.
           o We temporarily removed the link from HED tool bar that allows direct entry to
               StarPanel on the same patient. This link was not working. The most efficient way
               to get to StarPanel is to open StarBrowser from the Task Bar at the bottom of
               your screen. The patient census for the unit will be in the top frame and you
               should be able to open an individual patient’s record or interact with the patient
               using the Actions Menu.

           o The Shared Session server is requiring proactive technical intervention every 30
             min. to prevent issues from impacting users.
       o Although we think this issue is largely corrected, if you log onto a CWS with your
         RacF ID and Password, click on the HED icon, but instead of opening the
         application, you get an HED sign on box and have to enter ID and Password
         again, this is a symptom of a Shared Session problem on this device and needs to
         be reported to the Help Desk. Please provide them your name and Rac F ID, the
         CWS ID (from yellow sticker on device) and describe what happens when you
         attempt to open HED so that they can have the correct information to fix this
         problem promptly. There has been an increase in instances of this problem in
         the past hour that is being looked at closely right now. Please report to Help
         Desk if this happens to you.

   CWS issues
        o The new version of Shared Session and HED did not get pushed to all CWS Sun.
            afternoon and the CWS Team has been working since that time to manually
            intervene with any CWS missing the correct versions of software.
        o We have seen a couple of instances of a Portal Error – you may see an error
            message “a problem has been detected which would prevent communication
            with the portal application, please exit now an restart application to continue."
            This is also related to Shared Session and should be reported to the Help Desk.
        o If the HED icon for the Live version of the application is missing or if when you
            click on that icon, you get a gray screen that just sits there and does not log you
            on or if when you log into HED, you are in the old version, these are issues that
            need to be reported to the Help Desk immediately. Again, they need your name
            & Rac F ID and the device ID of the CWS to fix.
   Configuration Errors - Intermittent issues when changing patients or screens (both in
    and outside of HED/AdminRx). There were a variety of symptoms to this – error
    messages, getting kicked out of a session, Force/Cancel errors. We have not yet found a
    cause or identified a pattern for these random issues so need you to report to Help Desk
    every time these happen so that we can find and fix the source problem. Here is a copy
    of the error message you’d see.
   Internal Application Errors – we have seen some of these and in most cases, if you click
    the OK button, it allows you to continue. If this does NOT work, report to Help Desk.
    [Anytime you report an Internal Application Error, please click on the Details button and
    have that message up on your workstation so the Help Desk can remote to this device
    and capture the message to send to technical support team.]
   We have a report from one user that when he initially charted a dose as not given but
    then went to delete that entry later because they did want to give the dose, HED re-
    booted itself. If you experience anything similar to this, please report to the Help Desk
    so we can evaluate.

   Response Time – the fix made May 15 improved the response time in AdminRx but we
    are still seeing slowness with initial loading of HED that we are working to correct. We
    know that for some patients with long length of stay who have had lots of data charted,
    the over-all response time if very slow. With the old version of HED, we had tools to
    allow us to archive some of the patient data and that improved systems response time.
    Our technical team is working with our vendor to make this partial archive process work
    with the new version and as soon as that is completed and tested, we will begin to use
    with patients having extreme slowness. There are some other fixes being looked at to
    decrease response time so we will keep you posted. Response time improvement is the
    number 1 priority !

NEW Functionality Not previously communicated:
 Tabs – we know that for some units, the new constraints around number of Tabs shown
  being limited to 10 is causing concern. We are seeing what changes we can make and
  think it is likely that in the near future, we will at least be able to removed Tabs that are
  never used (such as the Adult Vitals/I&O Tab displaying on devices in Children’s
  Hospital). Update on this issue since yesterday: They have been able to remove the
  Adult Vitals/I&O Tab from devices in Children’s & Psychiatric Hospitals and they have
  been able to get Peds ED-specific Tabs to display on devices in that area. They will
  continue to work through issues from other areas. Stay tuned for updates!
   We are getting a lot of feedback about the new screen attributes.
        o The font is smaller (It is different but it is NOT smaller).
        o The screen background makes glare from overhead lights problematic in some
        o Other people think the screens are easier to read as the font is “crisper”.
    We do not have much control over screen colors and fonts as that’s a part of the core
    application that is not configurable by us. However, we are looking at different options
    for monitor screen adjustments that might help with the glare. We’ll keep you posted
    on developments.
   For any first/only dose of a NEW med. order, IF a nurse needs to administer that dose
    prior to the scheduled start time for the order, they will see this screen. If click the “New
    Order” button, they will get a “no order found error” to over-ride. If they click the OK
    button, you are given the option to give against a future schedule or give an extra dose.
    (Eg. Patient is being changed from IV antibiotic to PO and first dose is due at 10am. The
    nurse is giving that 10am first dose at 9:45 so that would be prior to the “official” start
    time. In this case, it might make the most sense to click OK and select the option to give
    against a future schedule – the 10am dose. ).

   In order to use Enter and Tab keys to move cursor from field to field, you must enter
    data first (use navigation keys) and THEN change the date/time. If you are back charting
    and change date/time first, the Enter & Tab keys do not work.
   DAS views (to import data from monitors and ventilators) are different with this new
    version. Only the most recent set of data displays in DAS when the pop-up screen is the
    regular size. Workaround: To see data from previous intervals, maximize the window
    (using maximize button in upper right corner of screen) and you’ll see all of the data.

   If the Detail button on the HED screen obscures part of the screen: Use the
    Minimize/Maximize buttons in upper right corner of screen and this will resize screen
    and get rid of this issue.
   Correction from Yesterday’s Communication! In AdminRx, the Annotation (aka Post It
    Note feature) do not display initially for administered or Not Given meds. Once you have
    entered reason not give or scanned the med and Pt. and get to the confirm screen, you
    will see an annotation box and can then enter a comment.

   Selection of items in individual drop down boxes can no longer be done by just typing
    the first letter of the word.

   Vitals/I&O Tabs are now population-specific. Peds-specific I&O Values will NOT be
    visible on the Adult Vitals/I&O Tab and Adult-specific values will not be visible on Peds
    Vitals/I&O Tab. Make sure you use the right tab for the patient in the instances were
    more than one Vitals/I&O Tab is available.

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