The Kaiser Permanente CareVue Project team would like to
share the many questions and responses we have encountered
related to the Kaiser Permanente Northern California CareVue
Project.
Whether you are a seasoned CareVue user or soon to be new
CareVue user, we hope this communication tool will assist
you to better understand CareVue and how it is and will be
used at Kaiser.
We have several categories of CareVue related questions and
their corresponding answers. Hopefully, this will help you
find the answer to your question quickly.
If you have a question that is not answered here, please
forward your question to the CareVue Project Team via the
feedback form.
Application:
Q1:
How are lab values or other tests that have overlapping reporting
(report over 3 days) reported in CareVue? (3/26/03)
Kaiser implemented a general lab interface to CareVue seven
years ago and will continue with this lab interface to the
11 new CareVue sites. Lab reports that are text based and
not currently written to interface to CareVue (like reports
for Microbiology- preliminary, final or revised reports often
generated over several days) are not planned to be implemented
at this time. There is a microbiology interface that may be
purchased separately in the future.
Lab results for active CareVue patients will post to the
CareVue flowsheet as soon as they are sent by the lab system.
If, for some reason, the lab result is delayed by the lab
system, the lab value, when released by the lab system, will
post to CareVue and the appropriate patient’s flowsheet
as long as the patient is still an “active” patient
in the system (i.e., the patient has not been discharged).
If a patient is no longer an active current patient in CareVue,
the message will not be posted to the patient. Labs continue
to be reported to the Kaiser Mainframe computer. Caregivers
currently get lab results either by accessing the data through
CIPS, or the nursing staff transcribes the information onto
the paper flowsheet as it comes to the unit via a printer.
If a patient is discharged, all lab results are printed. If
a patient is transferred to the ward, lab results will be
available in CIPS.
Please note that the final printout of the lab results is
the legal medical record; these printed results are what is
placed in the medical record. CareVue receives the results
from the lab system, but it does not be become the final repository
for Lab results.
Q1:
How long does it take to configure Decision Support Display
(DSD) for specialty groups? (3/26/03)
It is very easy to configure specialty flowsheets, or DSDs.
They can be developed for both the general physician group,
and specialties within that group, for example cardiology,
or anesthesia research, as well as other disciplines such
as Dietary, or QA.
We know that each facility will need forms and flowsheets
specific to their patient population and needs. One example
is “Quick Look.” This document takes the information
that physicians, for example, routinely review and displays
this information in the Quick Look Flowsheet. The configuration
team would like to provide each new facility with a “Quick
Look” type of flowsheet document so that it could be
used as part of the education of Staff (MD and others) about
what DSDs can uniquely provide for users.
The time to develop these DSDs is dependent on the complexity
of the request, but the configuration can usually be completed
within a day. The group who wishes to use a DSD will need
to provide a list of the data items they wish to see, and
be available to work with the configuration team to answer
questions and review the proposed flowsheet. This collaboration
can be done in person, or by phone, e-mail, and fax, and does
not require much time. Configuration changes can be made quickly,
but testing, “publishing” and “activating”
these changes to present the new information to the users
for charting does need to be planned as part of the configuration
update and management process.
The CareVue Configuration Managers will be soliciting comments
and suggestions throughout the educational process. Prior
to the actual Go-Live date, we can incorporate those suggestions
into the configuration. It is the intent of the configuration
team to have a Quick Look DSD in place for the actual Go-Live;
other specialty DSDs can be developed as users see what possibilities
CareVue offers to suit their unique needs.
Please note that all changes to the standard CareVue Configuration
will need to be approved by the CareVue Operations Group and
Oversight Committee before they are implemented.
Q1:
Who will be charting in CareVue? (3/26/03) For the initial New Site Implementation in 2003,
Nursing and Respiratory Therapy will chart and enter data
in CareVue. Other Disciplines will be able to view (per policy)
the patient CareVue chart but will not use CareVue to “chart.”
At a later date, as other disciplines plan to convert to using
electronic charting in the ICU, they can have their documentation
needs configured in CareVue to enable data entry in the ICU
CareVue chart.
Q2:
What will be charted in CareVue? (3/26/03) A new ICU Standard CareVue configuration is being
developed for use for all new sites in 2003. New sites will
phase in the use of CareVue functionality. During Phase I
(Care Documentation), CareVue will electronically document
vital signs, intake and output, physical assessments, ventilator
settings, and care activities and nursing care treatments.
Medications are charted in the CareVue Administration Record
at 4 of the 6 ICU’s that have been using CareVue over
the last 7 years. For new CareVue sites, medications will
be part of Phase II CareVue functionality implementation (Medication
Administration Management). The new ICU Standard Configuration
will be centrally managed and updated. All sites, new and
current, will have the new ICU Standard configuration loaded
as part of the Phase II functionality use of CareVue. This
will allow standardization of medication administration documentation
across all ICU’s.
Phase III functionality is planned to automate the Care Management
Documentation process (Care Plan/Paths/Plan of Care) and Structure
Templates for Progress Notes to support standards of practice
and rapid multidisciplinary progress notes documentation.
Q3:
How are late entries dealt with once the chart is archived
and/or late entries made to a hardcopy of the ICU stay? (3/26/03) If a patient is still an active patient on the CareVue
System, the user can, up to the set 10-hour back-charting
time, select the patient and chart in the CareVue record as
the user would normally chart and store in CareVue. The system
administrator can configure CareVue to allow back charting
from 0 minutes to 24 hours from the current time. Initially,
this time will be set for 10 hours but monitored and “tightened
up” as staff adapt to using an electronic system. The
time configured for back charting in CareVue will be set by
hospital policy. The hardcopy print of CareVue remains the
permanent record at this time.
If the patient is an Active CareVue patient, but the back
chart event is greater than the set 10-hour period, CareVue
will not allow “back charting.” A late entry progress
note entry can be made in the CareVue progress note application
and stored in CareVue. The user should follow standard late
entry charting guidelines already in place (i.e., note the
time of the late entry, document the event and the time of
the event being represented in the late entry).
If the patient is not an active patient in CareVue and has
been discharged, the late entry should be done on a hospital
approved paper progress note, as defined in Policy/Procedures
for CareVue and Nursing Documentation. This should be a very
rare event, not a common practice. Handwritten corrections/additions
to the CareVue printout should not be made.
A manual, handwritten entry to a printed CareVue record,
cannot assure that other users would know that a late entry
was added to the patient record. Hand entries to the printout
could embed the additional information as well as mask the
original entry, since space is limited in the printout. Also,
if certain pens are used, the ink can bleed into the paper
and blur the information on the backside of the printout.
(CareVue prints information on both sides of the paper.)
A separate progress note form would be a better “flag”
to other caregivers that non-CareVue documentation was added
to the patient’s medical record. Handwritten additions
are not retrievable electronically. Also, as the report interface
and record storage is intended to capture CareVue generated
reports/ records and store them for medical legal back up/
protection, any hand written “late entries or updates”
to a CareVue record would negate the value and user confidence
of the medical record retrieved electronically from storage.
The electronic storage can only ensure the information that
was stored in CareVue and used for decision making by clinicians.
Q1:
Who will need training? (3/26/03)
Staff nurses in the critical care department, respiratory
therapists, unit assistants, and care partners/nursing assistants
will need training in CareVue documentation for entering and
storing data. Physicians and other disciplines will need training
in accessing and viewing data (patient record) in CareVue.
Q2:
How much time will be devoted to training the various groups
of CareVue users? (3/26/03)
The CareVue Super Users (expert users) will be given
3 days of training (Train-the-Trainer).
End users will receive 1-8 hours of training, depending on
their discipline:
Staff nurses will need 8 hours of training.
Respiratory therapists will need 3 to 4 hours of training.
Unit assistants and care partners will require about 2
hours of training.
Doctors and other disciplines that only view CareVue data
will usually find 1 hour of informal training adequate.
The CareVue system will be in place in your institution
for 6 weeks prior to your go-live date. All training should
be completed in that time.
Q3:
How will the various groups of CareVue users set up their
accounts? (5/28/03)
All staff who view and/or chart CareVue data will need their
own CareVue account. Since the Super Users are leading the
end-user training, they will learn to set up accounts for
their facility during their Train-the-Trainer session. All
Super Users will be able to set up accounts after training
is complete. The Super User will distribute a Password Authorization
tool for users to complete prior to Go-Live. Super Users can
then establish a CareVue account for each end user. Ideally,
the account should be established prior to training. The CareVue
account requires that the user have a RACF User ID. (The CareVue
User ID will be the RACF User ID assigned to the user.) IT
issues the RACF User ID; if the user does not have a RACF
User ID, the Nurse Manager, Super User and end-user will need
to work with IT to assure that the basic information needed
to give the user an ID and password is completed.
Q4:
Where will the training be held? (3/26/03)
The Super User training sessions will be centralized and held
in the Biomedical Engineering offices in Berkeley. The end-user
training will be held in your own institution. Jon Blasingame
and the Philips Installation team will work with your local
site reps and user group to plan and set up your site’s
training room.
Q5:
What tools are needed in preparation for the end-user trainings?
(3/26/03)
The project’s Clinical Team is developing a standard
end user and Super user Training packet. Super Users will
be trained in how to deliver end user classes at their site.
The project is employing the Train-The-Trainer model with
Super Users. Local site representatives and participants on
the Configuration Team will also be developing clinical scenarios
for charting practice.
Training on Basic PC skills and keyboard use will not be
provided by trainers or Super Users.
Q6:
What education will be available for medical records staff?
(3/26/03)
The project team recommends that the local sites’ CareVue
users group include Medical Records as part of their team.
The local CareVue user group should now be reviewing the new
Standard Configuration being developed for use in all ICU’s.
Each site has a Clinical Lead person and several staff participating
on the CareVue Configuration Team. The Super Users and local
user group can plan inservices for all departments at their
hospital where CareVue will impact directly or indirectly.
Medical Records will need to be able to read the printed record.
Also, Medical Records representatives will be contacted for
inservicing on accessing of the Report Interface and Storage
product being implemented. This will start in May 2003.
Q7:
What people, tools, or written guides are available to physicians?
(3/26/03)
CareVue is a computer information system that captures data
entered or “documented” by Respiratory Therapists
and Nursing Staff. All other disciplines will be able to review
this documentation. The Project Clinical Configuration Team
(nurses from each facility working together to develop a standard
regional CareVue configuration) is in the process of pulling
together the materials we will use for training. (See
Q5 in this category).
Tools to be developed will include an overview of CareVue,
documentation guidelines for RNs and RTs, a FAQ sheet, a glossary
of terms, and in-depth training documents. The physician liaisons
(Dr. Patel, Dr. Fisk, and Dr. Franco) will determine if additional
“special” materials will be needed for physician
use.
Historically, the physician training has been difficult to
schedule, and physician users have had poor attendance at
pre-scheduled hands-on training due, in part, to schedules
and patient care responsibilities. At the very least, physicians
will need to learn how to navigate through CareVue and review
data. Therefore, local users groups, in planning for physician
training, will evaluate “Lunch and Learn,” structured
class sessions, and “adopt a Doc” strategies.
Physicians may also be introduced to CareVue at a regularly
scheduled conference or meeting.
Q8:
How do you train physicians in a scattering of outlying areas?
(3/26/03)
If these physicians frequently review ICU patient charts,
provision should be made by the local CareVue user group for
their education. One of the questions that each facility’s
CareVue user group will need to address is the issue of where
the education will take place.
Q9:
Will training have to be site specific with access to the
dedicated PCs? (3/26/03)
The project was scoped to provide assistance to local sites
with their initial training room/environment set up. Each
site will have its own logistic and pace/technical issues.
The project plans to use a subset of the PCs’ carts
ordered for the site for the initial training equipment. KPIT
has requirements for desktop application running on Kaiser
PC’s. CareVue, a mission critical clinical application,
is initially being deployed on dedicated PC’s or “desktops”.
There are plans to have CareVue “run through”
the KPIT desktop integration process, but cannot be scheduled
to be completed this year (2003).
Also see Training/ Education – Q4.
Q1:
What do the CareVue carts look like? (3/26/03)
On the project web site there is a CareVue Specification Document
that shows the equipment being installed, including the cart.
We will soon have pictures posted of the cart. Santa Teresa
4E (contact Julie Read) has installed the new Carts and PC’s.
They are a good user reference as well. The cart is the Stinger
Industries “Levator” adjustable open cart. The
cart will have a UPS/Isolation transformer. The CPU will be
mounted to the base of the cart. The Display is a Philips
Standard 17” color display.
Q2:
Are the portable “carts” configured to allow a
place to hold a chart and a place to chart on the progress
notes? (3/26/03)
Yes, the Cart Specification shows a pullout writing surface.
Also additional accessories can be purchased from the cart
manufacturer.
Q1:
Does the Fire Marshall have a problem with CareVue carts in
the hallways? (3/26/03)
This is one of the issues that was addressed very early in
the implementation period.
The facility review performed by Philips Engineers, Kaiser
National Facilities planners and Biomedical Engineering looked
into this problem at each facility. All issues that the project
team is aware of have been resolved to the satisfaction of
the Fire Marshall involved.
Q1:
What interfaces are available? (3/26/03)
For this implementation, Kaiser’s “Legacy”
systems to be interfaced include RILIS –Lab and PATDEM.
A Device Interface is being implemented using Philips Device
Link product. The PB840 ventilator and PB 7200 can be implemented
during this project. CareVue also has Device Link software
drivers written for many other devices, including for IV infusion
pumps and urinary/Foley catheters. Kaiser has not purchased
these to implement at this time.
Q2:
What additional interfaces are planned for the future? (3/26/03)
The prototyping of a Pharmacy Interface is being planned for
2003.
Q3:
What is the Lab interface? (3/26/03)
The interface implemented to CareVue is the HL-7 based interface
with the messages from lab (lab results) coming from RILIS
via the Kaiser Corona Interface to CareVue. CareVue receives
these lab messages, and translates and maps the data into
the correct place in the CareVue flowsheet for each corresponding
patient. Kaiser has been using a Lab interface to CareVue
for 7 years. This was the first clinical interface ever implemented
at Kaiser for inpatients.
Q1:
Who will support CareVue once we “Go Live” with
the system? (3/26/03)
During the Super User and End User Training, the “Problem
Escalation Process” will be reviewed. A written guide,
the CareVue Resource Book, will also be provided and a copy
will be placed on every unit. Questions regarding documentation
can be directed to the Super Users (usually staff nurses).
Basically, after the end user has performed any initial troubleshooting,
the primary responder to assist end users is one of the Super
Users at the local site. Biomedical Engineering (Biomed) is
the next level for problem escalation and problem management.
If the Super User or Biomed personnel need further assistance,
a call to the Philips Atlanta Response Center is available,
24 hours a day, 7 days a week, via the Support Contract purchased
by Kaiser Biomedical Engineering. A Problem Escalation Flow
Diagram describes the troubleshooting process; this document
can be found in the CareVue Resource Book.
Biomed will also receive in-depth training on the products
as well as the support of the products and system. For local
Biomed instrumentation staff, the training is a formal three-level
training plan, targeting system function and administration;
the Biomed System Engineers will complete two levels of technical
training.
Further support is available through the Oversight Committee,
the regional configuration manager(s), and the Philip’s
Response Center.
Q1:
How are daily additions added to the medical record? (3/26/03)
CareVue is configured to allow end users to “tailor”
their view of the flowsheet by adding new documentation rows,
based on the patient’s presentation, to the flowsheet
as needed. This is normal charting behavior and is written
into CareVue’s functionality for users. The complete
configuration database for the flowsheet is quite large, but
the user can easily “tailor” or customize the
patient flowsheet view to reflect the changing condition of
that patient. Flowsheet Rows can be added or DC’d by
the end user at the bedside. The end users’ choices
do not affect the overall “database” of choices
available to any other user to “tailor” the flowsheet
based on their patient’s documentation needs. Also see
Q2 below.
Q2:
Who is responsible for the printing of CareVue documents?
(3/26/03)
Documents that are a permanent part of the patient record
can be printed automatically at set times daily. If a patient
is transferred or discharged out of a CareVue unit, the chart
will need to be manually printed. That is the responsibility
of the nurse or the unit assistant. Policies and procedures
for this process will be reviewed during training.
Q3:
How do these documents get into the Medical Record? (3/26/03)
The nurse or unit assistant files them in the chart.
Q4:
Hardcopy prints for the ICU – How are daily additions
added to the medical record? New data only? For continuity,
how are lab values or other tests that have overlapping reporting
reported (report over 3 days)? (3/26/03)
CareVue is printed out every day. Until we do have a total
electronic medical record, the hardcopy is the legal record.
It is placed in the patient’s medical record. See Documentation
Q3 for further information. Lab results are automatically
posted to CareVue but they are not printed. Instead, the lab
summary for the patient’s stay is printed upon discharge.
Some information (e.g., culture sensitivity results) is not
currently interfaced to CareVue. All labs are also available
via CIPS.
Q5:
How are delays captured in the conversion from the electronic
medical record to hardcopy? (3/26/03)
The user defines the time interval for when the data will
be “captured” for printing (e.g., 0700- 1159 Nov
3 2003). Also scheduled printing of specified time intervals
can be configured. Effectively, there is no delay to capture.
The installed printers are high volume duplex HP Laser jet
printers. Printouts (CareVue Reports) are queued up to the
printer designated CareVue Network printer. The printout is
immediately completed upon the request message being sent
to the printer. Additionally, a second printer is being installed
at each site to ensure a ”redundant” printer.
Q6:
How will electronic charting and conversion to and from affect
the “coders” in Medical Records? Will they have
electronic access and how will they toggle back and forth
to capture data for Medicare etc.? (3/26/03)
Medical Record Coders can always look at the CareVue hardcopy.
If physicians begin to chart in CareVue, the documentation
will actually be more legible, time stamped and signed, unlike
current MD documentation. Also, physicians could work with
the CareVue configuration team to develop structured text
templates to ensure compliance to appropriate documentation
regulations for procedures, events, H&P’s etc; to
improve state PRO and QA Reviews related to charting compliance;
improve documentation to optimize billing and coding for reimbursement;
and decrease risk and legal exposure due to non standard,
unclear care management documentation. Physician data entry
and use of structured text is not currently scheduled for
2003.
Q7:
What will happen to the paper documentation on Go-Live day?
(3/26/03)
The paper flowsheet for nursing and respiratory therapy will
be taken away, and all patient charting will occur in CareVue.
The system will have been in place for 6 weeks so no physical
work will occur in the units during the Go-Live day. Members
of the Philips team, the Kaiser regional team, the local Super
Users, or a combination of these groups will be available
at the site to support the staff on Go Live day. Also, transition
support for all sites will be planned and detailed with checklists
one month prior to Go Live. Go Live days should present no
surprises and actually are usually very welcome NON events.
Q1:
How will electronic charting affect coders in Medical Records?
There will be no effect directly, only more legible documentation.
Coders will still review the paper record (CareVue printout)
as before. There is no current plan for any interface to directly
support electronic automated coding.
The CareVue Data Archive that is being implemented may provide
data in the future (under review) to another larger Kaiser
Reporting Environment (ORACLE Environment that includes other
Kaiser system Data.) It is from this other environment that
the clinical data could be evaluated for other Kaiser uses.
Q2:
What is the relationship of the CareVue program to EPIC?
Epic is the vendor for the automated medical record, scheduling
and billing system. The timeframe for implementation of Epic
is 3-5 years. The current plan is to upgrade CareVue and install
the new version in the current facilities. CareVue will be
rolled out to all Northern California Adult Critical Care
Units by November of 2003.
The ability to archive and access the data and the ability
to interface with both devices and systems is critical to
improving Kaiser’s use of CareVue. This will move CareVue
at Kaiser from a stand-alone automated nursing flow record
to documentation, quality outcomes data monitoring and reporting
system.
Q1:
How are lab values or other tests that have overlapping reporting
(report over 3 days) reported in CareVue? (3/26/03)
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