EHR Questions?

Hospital Based Questions:

  • On-Site Support M-F 8am - 4pm
    • CSM-M
      • Direct 414.585.6288
      • Vocera 414.585.1995
    • CSM-O
      • Direct 262.243.6708
      • Vocera 262.243.6707

**Vocera: say "Informatics EHR Support"**

Clinic Based Questions:

EHR Updates & Announcements

IMPORTANT UPDATES from Ascension Wisconsin Columbia St. Mary's - 2/23/2018

Date:     2/23/18
To:         CSM Medical Staff
From:    Rick Shimp MD,
             Suzanne Wilkerson MD
RE:       Suicide Screening and Risk Assessment
              Informed Consent

Columbia Suicide Severity Rating Scale (C-SSRS), Implementation Thursday March 1st
In order to ensure that we are compliant with The Joint Commission Patient Care Standards that govern how we screen and assess patients for suicide risk, we are implementing new screening and assessment tools within our EHR for both Columbia St. Mary’s campuses. It is a requirement that we use evidence-based tools for screening and assessing our patients and that we do this in all inpatient and outpatient areas within our hospital facilities. (These areas include ED, Testing and Treatment, Hospital Based Outpatient Clinics, Day Surgery, Women’s Hospital, Behavioral Health and all Medical/Surgical and ICU units.) Based on this requirement, we have elected to implement the Columbia Suicide Severity Rating Scale (C-SSRS).
*Ambulatory Clinics will continue to utilize their current screening processes at this time and will not be transitioning to the new screening tool.
As Columbia St. Mary’s-Milwaukee prepares for an upcoming Joint Commission survey it is vital that leaders and associates can communicate clearly about why these changes are being made and how to utilize the tools.
 
Nursing staff will soon be trained regarding the use of the C-SSRS Screening Questionnaire during the patient intake process. Patients who screen high risk for suicide require a C-SSRS Risk Assessment and a physician order for suicide precautions. Personnel responsible for Risk Assessments will vary depending on the intake location of the patient.

Intake Location of High Risk C-SSRS screening
C-SSRS Risk Assessment performed by
Emergency Department
Emergency Department Physician
Behavioral Health
Behavioral Health RN
Inpatient Area
Case Manager
Outpatient Area
Emergency Department Physician  via transfer to ED

 
If you are the attending physician you will be notified of all positive screening results.  While the screening and assessment processes are changing, our current procedures for the care of high suicide risk patients is not impacted.
 
Columbia-Suicide Severity Rating Scale reference site
 
Contact Information regarding the C-SSRS:
EHR questions:
Clinical questions: 
 
 
Informed Consent, Implementation Thursday March 1st
In order to ensure that we are compliant with The Joint Commission Patient Care Standards that govern safe practices regarding informed consent, Ascension Wisconsin has developed a new policy. To support policy changes, we are changing the paper consent permits, and implementing new tools within our EHR for both Columbia St. Mary’s campuses. Changes are listed here.
·         Separate permits for blood and procedures will replace our current combined permit (see attached).
o   “Authorization and Consent to Surgical/Other Invasive Procedure”
o   “Consent for  -or-  Refusal of Transfusion of Blood or Blood Products”
·         Physicians will no longer sign the paper procedural permit/consent.
·         Physicians must document procedure and blood product administration informed consent conversations in the electronic medical record. **
·         Nurses will no longer be responsible for confirming the physician’s documentation of informed consent.
 
**Each Physician can individually determine where in the medical record to attest to the informed consent discussion. The following tools will be made available on March 1st to support an efficient workflow. (See attached Job Aid)
o   Custom PowerNote Template “Attestation Informed Consent Discussion”
o   Autotext
o   Enhancement of current PowerNote templates:
§ Moderate Sedation Pre-Assessment H&P
§ Day Surgery H&P
§ H&P Update
 
Contact Information regarding the Informed Consent:
EHR questions:
Suzanne.Wilkerson@ascension.org (pager 414-557-6860)
Policy and Procedure questions:
 read more ...

Columbia St. Mary's Hospital EHR Medical Staff Newsletter: December 2017 - 12/8/2017

Attached is the Hospital EHR Medical Staff Newsletter for December.  Most of the items in this edition address EHR enhancements related to improving our regulatory compliance. Please take the time to review carefully. As always, a copy of the newsletter will be available on DocPort.

 
Topics this edition include
Alert – Therapeutic Duplication, 12.12.17
Alert – Missing Patient Status Order, 12.12.17
Update - External Records Access to Wheaton Epic
Code Status order enhancement, 12.12.17
PowerNote enhancement for “Restraint/Seclusion-Violent Behavior” template, 12.12.17
In-House Support – Update regarding staffing change
 
 
For questions, comments, or suggestions regarding the EHR or this newsletter, please contact me directly.
Suzanne Wilkerson, MD_ Medial Director Hospital Clinical Informatics
Suzanne.wilkerson@ascension.org, 414-326-2519 (office), 414-557-6860 (Pager)
 read more ...

Columbia St. Mary's Hospital EHR Medical Staff Newsletter: October 2017 - 11/1/2017

Attached is the Hospital EHR Medical Staff Newsletter for October. 

It has one very important topic: Order/PowerPlan Changes to support TJC medication order compliance, Week of 10.30.17
 
It is critical that you thoroughly review this information as soon as possible as changes will be implemented in the EHR next week.
 
While these changes are meant to limit the manual work needed to comply with CSM policy and TJC guidelines, there will possibly be a learning curve for some. Default instructions for adhoc order sentences, PRN subphases, and PowerPlans were developed in cooperation with pharmacy, nursing, and physician staff. Ordering providers are always responsible for reviewing orders and adjusting based on a patient’s clinical situation and needs.
 
The design changes have been extremely extensive involving hundreds of PowerPlans and thousands of orders.  As always, if you find any of the new orders or PowerPlans are creating workflow issues, or it appears there has been a design error, do not hesitate to let me know so we can make necessary improvements accordingly.
 read more ...

Ascension Columbia St. Mary's Hospital EHR Medical Staff Newsletter: September 2017 - 10/13/2017

Attached is the Hospital EHR Medical Staff Newsletter for September.  Please carefully review both the newsletter and other attachments.

Topics this edition
External Records Access to Wheaton Epic, 10.3.17
Documents Folder Changes, 10.10.17
New Implant Scanning & Documentation Process, 9.26.17
In-House Support Reminder
 read more ...

Ascension Columbia St. Mary's Hospital EHR Medical Staff Newsletter: July 2017 - 7/7/2017

Attached is the Hospital EHR Medical Staff Newsletter for July. 
Please take the time to carefully look over the Newsletter and attached job aid.

Topics this month
Unsigned Order Alert, Update
Auto-Text Functionality Enhancement, effective 7.11.17
PowerNote Template Enhancement, Moderate Sedation Pre-Assessment H+P, effective 7.10.17
Nuance eScription Update
In-House Support Reminder
 
For questions, comments, or suggestions regarding the EHR or this newsletter, please contact me directly.
Suzanne Wilkerson, MD_ Medial Director Hospital Clinical Informatics
swilkers@columbia-stmarys.org, 414-326-2519 (office), 414-557-6860 (Pager)
 read more ...

Urgent Ascension CSM EHR Update, Restraint Orders and PowerPlans - 6/7/2017

Date: 6/7/2017
To: Medical Staff and Resident Physicians of Columbia-St. Mary’s
From: Suzanne Wilkerson, MD, Medical Director Hospital Informatics
RE: Restraint Orders and PowerPlans 

Use of a Restraint PowerPlan is required for all patients placed in restraints.
 
Effective Wednesday 6/14/17, Restraint Orders and PowerPlans will be updated. The update includes clarified nomenclature and instructions to better match recent policy updates as well as addition of the new Physical Hold for Violent Behavior order. 
 

Current PowerPlan Name
Updated PowerPlan Name, 6/14/17
When to use this PowerPlan
Restraint Order(s) within the plan
Restraints Disruption of Medical Treatment Initiation/Continuation
Restraint for Non-Violent Behavior
Indicated for a confused or sedated patient who may interfere with medical care necessary for the healing process.
 
Restraint for Non-Violent Behavior
Restraint/Seclusion Behavioral Medicine
Restraint/Seclusion for Violent Behavior
Indicated for a patient who exhibits behavior that threatens harm to self of others.
5 Point Restraint for Violent Behavior
Physical Hold for Violent Behavior
Seclusion Behavioral Medicine Unit Only

 
Attached are Job Aids (details on use of Restraint PowerPlans) as well as the most recent Policy Statement.
 
For questions regarding orders and PowerPlans please contact me at Suzanne.wilkerson@ascension.org or page 414-557-6860.
 
For questions regarding policy please contact  Susan Leuck at Susan.Leuck@ascension.org.
 read more ...

Ascension Columbia St. Mary's Hospital EHR Medical Staff Newsletter: June 2017 - 6/2/2017

Attached is the Hospital EHR Medical Staff Newsletter for June.  Please take the time to look it over carefully.

For questions, comments, or suggestions regarding the EHR or this newsletter, please contact me directly.
Suzanne Wilkerson, MD_ Medial Director Hospital Clinical Informatics
swilkers@columbia-stmarys.org, 414-326-2519 (office), 414-557-6860 (Pager)
 
This information can also be accessed on DocPort at   https://docport.columbia-stmarys.org/
 
Topics this month
Unsigned Order Alert, 6.5.17
Controlled Substance Rx and the WI HOPE (Heroin, Opiate, Prevention, and Education) Law Alert, 6.6.17
In-House Support
 read more ...

Ascension Columbia St. Mary's Hospital EHR Medical Staff Newsletter: April 2017 - 4/28/2017

Attached is a very brief Hospital EHR Medical Staff Newsletter for April. Please review. Topics covered are as follows.

Topics this month
C. difficile testing, EHR Clinical Decision Support, Enhancement Effective 5.1.17
Quality Document Committee (QDC)
In-House Support
 
Also, in the next week we hope to finalize an alert to assist with compliance with the Wisconsin HOPE law related to prescribing controlled substances.  We will also soon be revising our restraint order sets and providing associated information. Please watch your inbox closely.
 
For questions, comments, or suggestions regarding the EHR or this newsletter, please contact me directly.
Suzanne Wilkerson, MD_ Medial Director Hospital Clinical Informatics
suzanne.wilkerson@ascension.org, 414-326-2519 (office), 414-557-6860 (Pager)

 

 read more ...

Columbia-St. Mary's Ascension: CPOE Enhancement - Home Insulin Pump Orders, Effective 4/24/17 - 4/21/2017

CPOE Enhancement - Home Insulin Pump Orders, Effective 4/24/17

 
A new policy and process has been approved to guide clinicians regarding care of an adult patient admitted to the hospital with a home insulin infusion pump. Please review the following information, as well as the attached job aid, regarding associated EHR enhancements. I have also attached the policy.
 
Nurse workflow:
·         Upon intake, evaluate the patient’s capability to self-manage his/her insulin pump per policy.
·         For patients who are capable of insulin pump self-management, document the insulin pump’s basal and bolus-meals settings on the Documented Medication by Hx.
·         Document physician ordered basal and bolus insulin administration on MAR.
 
Provider workflow for patients who are capable of insulin pump self-management:
·         Continue nurse Documented Medication by Hx. insulin pump basal and bolus-meals settings with admission medication reconciliation.
·         Initiate the Insulin Pump-Patient Owned PowerPlan.
 
If, per nursing assessment, a patient does not meet policy criteria for self-management of their insulin pump while in the hospital the following alert will fire once per provider per encounter.
These patients can be managed with usual nurse administered insulin orders.
 
 
For questions regarding the EHR process please contact me.  For questions regarding the policy contact Brent Jones, MD.
 
 
Suzanne Wilkerson, MD
Medical Director Hospital Health Informatics
 
Ascension | Columbia-St. Mary’s
Mailing address:
2320 N. Lake Drive, Room 3603
Milwaukee, WI 53211
ascension.org/Wisconsin
 
 read more ...

Ascension Columbia St. Mary's Hospital EHR Medical Staff Newsletter: March 2017 - 3/31/2017

Attached is the Hospital EHR Medical Staff Newsletter for March.  This month it is a 10 minute read instead of the usual 5 minutes as I did not send out a letter in February. Please take the time to look at over carefully.

For questions, comments, or suggestions regarding the EHR or this newsletter, please contact me directly.
Suzanne Wilkerson, MD_ Medial Director Hospital Clinical Informatics
swilkers@columbia-stmarys.org, 414-326-2519 (office), 414-557-6860 (Pager)
 
 
Topics this month
C. difficile testing, EHR Clinical Decision Support, Effective 4.4.17
Controlled Substance Rx and the WI HOPE (Heroin, Opiate, Prevention, and Education) Law
Lab Recurrent Frequency Orders – duration requirement, Effective 4.4.17
Medical Unit Name Changes, Effective 3.28.17
Blood Bank Summary Page, Available 4.11.17
Blood Culture PowerPlan - Guidance, Effective 4.4.17
Vascular Imaging Ultrasound Order Name Changes, Effective 3.30.17
Reminder - TORB/VORB and avoidance of duplicate orders
In-House Support
 read more ...

CSM - CRITICAL NOTIFICATION REGARDING MID-LEVEL AND RESIDENT ADMISSION ORDERS - 7/1/2015

To:          Mid-level providers,  Resident Physicians, and Supervising Physicians 

From:    Suzanne Wilkerson, MD
Hospital EHR Medical Director
 
Date:     May 7, 2015
 
Re:         CRITICAL NOTIFICATION REGARDING MID-LEVEL AND RESIDENT ADMISSION ORDERS
 
Supervising physicians and HIM have been noticing sporadic problems with Admission Orders not routing to the appropriate physician.  Through some research, it was discovered that the problem is limited to use of favorite PowerPlans that have the admission order pre-checked.
 
We are working with Cerner on a technical solution to this problem, but in the meantime, the problem can be avoided by not using PowerPlan Favorites with a pre-checked admission order.  To alleviate continued issue, all Mid-Level Providers and Residents should immediately uncheck admission orders in Favorites and then resave the Favorite.  Favorites can be resaved without making a change to the Favorite names.  The resaved Favorites will have new dates listed by them which will help with differentiation from old Favorites.
 
If despite using Favorites PowerPlans without pre-checked admission orders, you notice that orders are still being misrouted, please contact a Clinical Informatics team member or me.  In order to research any such incidents we will need, Patient Name,FIN#, date of order, name of intended physician, and name of physician that received misrouted orders.  HIM should also be contacted so that the order can be re-routed to the correct physician.
 
On a related note, please continue to be aware that some mid-level providers and residents, via the “orders for cosignature”  button at the bottom of the Orders section of the patient chart, are inadvertently endorsing orders that have been sent to a supervising physicians.  Please do your best to not make the same mistake.
 
Thank you for your patience.
 
Contact information:
Suzanne Wilkerson, MD                                Clinical Informatics                                         
swilkers@columbia-stmarys.org               Monday – Friday, 8am – 4PM
414-326-2519 (office)                                     “EHR Support” via Vocera
414-557-6860 (pager)                                     Ozaukee: 262-243-6707
                                                                                Milwaukee: 414-585-1995

 

 

CSM EHR Notice: Power Plan Changes on 05/12/2015 - Favorites Will Not Be Lost or Disabled - 5/8/2015

There will be edits to the PowerPlans listed below on Tuesday 5/12/15. Edits are needed to correct a diluent in some IV sets within the plans. These changes will likely not be obvious to the ordering provider.

Providers who have favorites created from these plans will not have their favorites lost or disabled. They will, though, see an alert that changes have occurred. Resaving the favorite with the same name will turn off the alert.

Please see the attached job aide regarding disabling the alert and resaving any affected favorite PowerPlans.

Do not hesitate to contact me with any questions.

Suzanne Wilkerson, MD
Columbia-St. Mary's , Hospital EHR Medical Director
phone (414) 326-2519 mobile (414) 690-5499
Swilkers@columbia-stmarys.org

Job Aid: Resaving a Favorite PowerPlan

List of affected plans:

 

Clinical Response Center (CRC) | Effective 04/14/2015 - 4/7/2015
Quicker Resolution on EHR Calls to the IS Service Desk 
  • A new Service Desk model, Clinical Response Center (CRC), will be implemented at CSM beginning 8pm April 14, 2015. CRC is shared across Ascension Health Ministries, and offers a quicker resolution for EHR-related calls to the IS Service Desk. The IS Service Desk phone number for any issue continues to be 414-326-2400.
  • When you call the IS Service Desk, your call will be transferred to the CRC who will help troubleshoot and resolve your issue without needing to wait for an analyst to call you back. Issues unable to be resolved will be escalated to our own IS staff for assistance.
  • CRC will have 24-hour coverage M-F, 0000 through 2300 and Saturday and Sunday from 0500 to 1530. Outside of these times, calls to the IS Service Desk will be routed to our CSM IS support team on a priority level, as they are done today.

For hospital EHR workflow questions and onsite support at CSMO and CSMM, continue to contact the Clinical Informatics team via Vocera “EHR Support”.

 

Pre-operative Electronic PowerNote Go-Live Date of 3-2-15 Deferred - 2/27/2015

From: Suzanne Wilkerson, MD, Hospital EHR Medical Director
 

As per my letter of 2-25-15, we had plans to start mandating all pre-operative H+P updates be completed with an electronic process starting 3-2-15. Some physicians have been voluntarily creating electronic updates over the past couple of weeks in anticipation of the mandate. Review of the electronic H+P update process these physicians have been “piloting,” has revealed some unexpected flaws that create significant workflow issues and put our HIM compliance at risk.

One of the benefits of moving all physician documentation away from paper is to improve safety and quality through more integrated communication between physicians and other caregivers. Updating H+Ps that were initially created in an encounter that is different from the surgical encounter is a process that is more complex than anticipated. Due to these complexities it is felt that staying with paper at present is the safer choice in regards to H+P updates.

As such, until further notice, all H+P updates must be done on our paper update form. If there is no H+P available for an update, and a new H+P is needed the day of surgery, physicians can follow their current processes whether it be use of PowerNote or paper to complete this document. Despite the delay for H+P updates, all other physician documentation that is presently mandated to be electronic will remain electronic, including post-operative documentation.

Due to this change, I have updated the perioperative Quick guide and it is attached.

We remain very committed in our movement towards an integrated paperless record. I hope to have an electronic process in place for H+P updates within 3 months, if not sooner. The goal is to have this process be efficient for all staff including medical staff, nursing, and HIM. Apologies for this last minute change, but a hard decision needed to be made to avoid broad implementation of a process that is not working as planned.

Thank you for your patience and support. As always, your guidance for improving our processes are appreciated. I can be reached via page at 414-557-6860 for any questions, comments or concerns.

Quick Guide - Electronic PowerNote Perioperative Documentation

 

Perioperative/Periprocedure Electronic Documentation - 2/25/2015

FROM: Suzanne Wilkerson, MD | Hospital EHR Medical Director

As you should all be aware, the Provider Electronic Documentation mandate went into effect January 12th on Ozaukee and River Woods campuses and February 16th on the Milwaukee campus. Though the mandate is for all Provider hospital documentation, we have discovered with the implementation process some areas that require additional tools within the EHR to achieve full compliance and efficient transition from paper. Some of these tools have already been put in place and some are in process.

The areas of the hospital most affected by this mandate have been the surgical and procedural departments. Since the above go-live dates, full compliance has been expected with electronic post-operative documentation. Conversely, there has not yet been full enforcement of the electronic process for pre-operative H+P updates due to the need for creation of electronic documentation tools to support variable workflow and patient situations. As these tools are now in place, starting 3-2-15 it is expected that all pre-operative H+P updates will be electronic.

Attached is a quick guide as well as more detailed job aides to assist you with your perioperative electronic documentation.

As documentation requirements fall under department procedural policy and medical staff policy, any necessary enforcement will come from Surgical Department and Medical Staff leadership. My role is to work with you to make sure you have the necessary skills and tools to complete the documentation electronically. The Clinical Informatics team members and I want to assist you in making the transition to electronic documentation efficient and unobtrusive. If you need 1:1 assistance, please having nursing staff assist you in contacting in house Clinical Informatics support Monday – Friday, 8am – 4pm. Outside of these hours I can be paged (414-557-6860).

Thanks you for your support. Please do not hesitate to contact me if you have any questions, comments, or concerns. Your guidance for improving our processes are always appreciated.
 

Quick Guide - Electronic PowerNote Perioperative Documentation - UPDATED 02/27/2015

Job Aid: Day Surgery H&P

Job Aid: History and Physical Update with AutoText

Job Aid: Brief Post-Op Note (PowerNote)

 

Changes to EHR log-on (Effective 1/27/15) - 1/15/2015
Beginning January 27, you must log into the EHR with your network ID and password instead of your current EHR User Name and Password. Your network ID and password are the same user id and password you use to access email, the Ascension portal, and many other applications. Be aware you will not receive any reminder to log into the EHR with your network ID and password. You will NOT need to type WIMIL\ in front of your ID when logging in to the EHR.

If you receive an “Invalid User Name and/or Password” message when logging in, check to make sure you are using your network password rather than your previous EHR password.

The EHR log-on change is part of a broader project that will allow quicker access to many applications, and improved remote access from offsite locations.
For questions, contact the IS Service Desk at 414-326-2400.
 

PowerNote-Paperless Documentation Mandate - 1/7/2015

This Notification letter serves as an update to communication sent from the Medical Staff Office on 10-31-14

Effective on dates shown below, we will not be allowing written Physician and Midlevel Provider Documenation in the hospital

Mandates

  • January 12, 2015, go-live date for mandatory PowerNote: Ozaukee and Riverwoods campuses
  • February 16, 2015, go-live date for mandatory PowerNote: Milwaukee campus
  • Dicatation will continue to be available for H+Ps, Consults, Discharge Summaries, and Operative Reports.
  • PowerNote will be mandated for non-dictated physician documentation such as daily progress notes, and other documentation that is currently being written on paper templates or paper progress notes in the hospital record

Implementing an EHR has created challenges for every health system. We are no exception. We need all staff to assist us in this effort. Your support and participation is greatly appreciated. Please don't hesitate to contact any of us with questions or concerns regarding these exciting changes for 2015

 read more ...

EHR Password Changes - 12/3/2014

 

Effective Monday, Dec. 8, the rules for the Cerner Millennium EHR passwords will change in order to make them more user friendly while still maintaining our necessary level of security.

The changes are:

  1. Password durations will be extended from 90 days to 365 days.
  2. The minimum password length will be changed from six characters to eight.
  3. Passwords will now be case sensitive.
  4. A number and a special character (e.g., !, $, #, %) are required.

You will be required to choose a password that conforms to these standards the next time your password expires. If you wish to proactively change your password, you can do so by selecting "Task," then "Change Password" in the upper left corner when logged into the EHR.

These changes apply to all Health Ministries and were adopted by Ascension after review of industry best practices. Similar changes to other application passwords will take place at a future date.

For questions or issues, contact the IS Service Desk at 414-326-2085.

 

Electronic (Paperless) Documentation - 2015 Mandate - 10/31/2014

In January 2012, all Hospitalists and most ED physicians started using PowerNote to document their patient encounters. In addition, many of you have voluntarily chosen to document in the EHR. Since then, we have struggled with the confusion of a "split" patient record and many physicians have asked that we complete our transition to having all physician notes visible in the EHR. As there is currently minimal information in the paper chart, many providers and clinicians neglect to review this information, putting our patients at risk.

The benefits of transitioning from paper documentation are many, including:

  • Improved access to patient information across any CSM facility where our patients receive care
  • Improved safety and quality through more integrated communication between physicians and other caregivers

In order to successfully transition away from paper, resources have mobilized to provide strong foundation:

  • Templates: Custom PowerNote templates have been created and will continue to be developed and optimized as needed
  • Support: In-house EHR support was implemented at both campuses during August and September. Additional support will be mobilized during the initial phases of electronic transition.
  • Training: PowerNote classes for new users will be available November 24th through December 17th. A training schedule will be communicated next week.
  • Optimization: Drop-In sessions will be available and communicated at a later date. Users can learn tips/tricks, and how to use the system more efficiently.
  • Access: Additional desktops deployed on inpatient units.

We are currently in the process of identifying Providers that are not using PowerNote. A separate letter will follow Providers that must attend training. PowerNote training sessions will be held at the Heritage Center and Ozaukee campus.

 read more ...

Important EHR Changes: PowerNote and Orders - 9/30/2014

From: Suzanne Wilkerson, MD, Hospital EHR Medical Director

Please review the following changes that will be taking place in the EHR this week. Both of the changes have more detailed information in the documents linked at the end of this announcement.

  1. PowerNote: Midlevel Provider, Resident, and Student Co-signature Process Changes
    1. In May it was communicated that there would be changes in the PowerNote endorsement process. These changes were inadvertently not implemented at that time, but will be implemented this week. These changes will provide the following benefits.
    2. Our endorsement process will now better comply with policy in a more automated way.
    3. Documents not yet authenticated (co-signed), while visible in EHR documents as “preliminary,” will not be releasable by HIM. Only co-signed/”final” documents will be releasable by HIM.
    4. The supervising physician will now be able to make corrections within the body of the note allowing for less confusion and safer communication on the final document. (If needed, HIM and other clinical staff will be able to see a history of preliminary versions of documents.)
    5. Documents requiring endorsement that are not properly forwarded will be identified by HIM as unauthenticated and incomplete.
  1. Orders: Addition of “Level of Care” Field to Admission and Transfer Orders
    1. CMS Quality Guidelines require admission and transfer orders specify a patient’s “Level of Care.” Our current orders specify “Location” but not “Level of Care.” While usually the two are interchangeable, “Location” is not considered sufficiently clear for CMS compliance metrics. In an effort to improve our compliance, the following two changes will be made on 10/1/14. (These changes will NOT impact PowerPlan Favorites.) The changes include a new required field, “Level of Care,” in all admission and transfer orders. Also, for patients on acuity adaptable units such as the AAU in Ozaukee, a Change Level of Care order will be periodically needed.
       

Detailed Informational Documents:

If you have questions regarding these changes please contact a Clinical Informatics team member using Vocera at 262-243-6707 on the Ozaukee Campus or 414-585-1995 on the Milwaukee campus. When you connect with Vocera via these numbers and ask for “EHR support” you will be connected to a Clinical Informatics team member. In house EHR support is available Monday – Friday 8am to 5pm. Alternatively you can call or email me at 414-326-2519, swilkers@columbia-stmarys.org

 

Hospital Physician EHR Update: September 2014 - 9/19/2014

Inside This Issue:

  1. Real-Time Support Pilot, Update
  2. Survey
  3. PowerForms, Tips & Tricks
  4. Discharge Order
  5. Docport
 read more ...

Hospital EHR Survey - 9/12/2014

The Hospital and Clinic Informatics support teams have developed a brief, standardized survey to monitor and optimize the functionality and effectiveness of the EHR. Data from this survey will drive enhancements and our user support model. Your opinions and ideas are critical to patient outcomes and satisfaction. Furthermore, we are continually striving to improve your experience with using the EHR.

The hospital survey is intended for all Medical Staff and Allied Health Professionals who see patients at either or both campuses, Milwaukee and Ozaukee.  It is located at http://cast.ninja/Survey/1/EHR_Survey.html

Please take a few minutes to complete this brief survey of 8 questions by September 30th. It is accessible from smartphones, tablets, and home computers. If clicking the link does not work, you can cut and paste it into your web browser.

Thank you and please call us if you have any questions regarding the survey.
 

Barb Pilliod, Director of Clinical Informatics
Suzanne Wilkerson, MD, Hospital EHR Medical Director

 

Hospital Physician EHR Update: July 2014 - 7/25/2014
Inside this Issue:
  1. Real Time Support - August 4th
  2. Palliative Care Enhancements -  August 4th
  3. Direct Viewing of Radiology Images from the EHR - July 15th
  4. Discharge Medication Reconciliation Changes - July 30th
  5. Tips/Tricks
 read more ...

Hospital EHR Upgrade Communication: Providers/Clinicians July 21, 2014 - 7/22/2014
In this Communication:
  1. Medication Reconciliation Enhancements
  2. Medication History Snapshot
  3. External Rx History
 read more ...

Hospital EHR Physician Update: June 2014 - 6/19/2014


Welcome to the inaugural Columbia St. Mary’s Hospital EHR Physician Update. The newsletter will be released at least monthly. With urgent matters, additional issues will be released as needed. The purpose of this newsletter is to keep physicians and other providers informed of EHR topics critical to efficient EHR use and quality healthcare for our patients. If there is a topic you would like covered in the future, please contact Suzanne Wilkerson, MD: 
swilkers@columbia-stmarys.org  |  414.326.2519

In this Issue:
  1. Welcome
  2. Physician Informatics Council: New Members
  3. PowerNote Templates
  4. Problem List: SNOMED Conversion
  5. Electronic Coding Queries
 read more ...

CSM Blood Management - 5/28/2014

As part of the CSM Blood Management program, providers are ordering fewer PRBC for transfusion.  In a non-bleeding patient that needs a transfusion, it is best to order one PRBC and assess the need for  any other  transfusions.

 read more ...

Important Updates and Information Regarding Upcoming EHR Changes - 5/22/2014

Please review the details below regarding changes that will be implemented in the EHR on Tuesday May 27th.

If you have any questions regarding these updates, please contact Suzanne Wilkerson, MD at 414-326-2519 or swilkers@columbia-stmarys.org

  1. Continuity of Care Documents and the Discharge Order

Per guidelines of MU2, we will soon start creating Continuity of Care Documents (CCDs). CCDs allow communication between different health systems and different electronic health record platforms when transmitted electronically.

CCDs will be created for patients expected to receive post-hospital care from non-CSM affiliated facilities or physicians.* In order to assist Case Management and HIM in identifying these patients, we will be updating the discharge order on 5/27/14. The update will add a section to the discharge order. The added section will require a yes/no answer to the following question: “Non-CSM Post DC Follow-up?”

Also, accurate completion of Follow-up in the Depart section of the EHR by physicians, other providers, and case management will further assist HIM in efficient electronic transfer of the CCDs.

* Any physician not employed by Columbia St. Mary’s Community Physicians or Madison Medical Affiliates is considered a non-CSM physician. Any facility other than CSM-Milwaukee, CSM-Ozaukee, Riverwoods, Sacred Hearth Rehabilitation Institute, Orthopedic Hospital of Wisconsin, and Columbia Center is considered a non-CSM affiliated facility.

  1. Midlevel Provider, Resident, and Student PowerNote Co-signature Process Changes

Starting 5-27-14, there will be some slight changes with the hospital electronic document (PowerNote) endorsement process. These changes will provide the following benefits.

a. Our endorsement process will now better comply with policy in a more automated way.

b. Documents not yet authenticated (co-signed), while visible in EHR documents as “preliminary,” will not be releasable by HIM. Only co-signed/”final” documents will be releasable by HIM.

c. The supervising physician will now be able to make corrections within the body of the note allowing for less confusion and safer communication on the final document. (If needed, HIM and other clinical staff will be able to see a history of preliminary versions of documents.)

d. Documents requiring endorsement that are not properly forwarded will be identified by HIM as unauthenticated and incomplete.

Please review the attached job aide for instructions on this new process.

 read more ...

ICD-10 Rollout - 3/28/2014

October 1st, 2014 will bring an explosion in the number of codes used to document diagnoses and procedures – as ICD-10 goes “live.” We’ll all need to be much more detailed and specific in our documentation.
 

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DME and Oxygen Orders: A Two Step Process - 3/20/2014

DME and Oxygen involves a two step documentation and ordering process.  Please see the read more link below for details on how to complete the process.

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UPDATE: Positive Networks and Apple OS X Mavericks - 3/19/2014

A communication was sent out on Thursday, March 6th, informing you that Positive Networks will run on Mavericks OS (10.9.2). Unfortunately, an issue was discovered that prevents some devices from connecting to the CSM EHR when running Mavericks. ANX is working on a resolution for this issue and expects to have the problem resolved soon. In the interim, please postpone upgrading to Mavericks if you use Positive Networks on your Mac to access the CSM EHR. Another communication will be sent as soon as Positive Networks has a resolved this issue. Please feel free to contact the Positive Networks Service Desk if you have any questions at 1.877.488.8269, option 1, option 1 to speak with a live agent.

 

EHR Available on Mac OS X Mavericks! - 3/7/2014

Accessing the EHR remotely via ANX Postive Networks is now supported for Mac OS X Mavericks. Click below for more information on the Docport EHR Mac support page.

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Barcode Medication Administration (BCMA) - 2/21/2014

Coming in March to River Woods and a CSM hospital near you: Barcode Medication Administration (BCMA)

Activation of BCMA begins at the Columbia St. Mary’s (CSM) – Ozaukee campus on March 3, 2014 and continues on a rolling schedule through the month of March with one to two units/departments brought live daily. Activation will transition to River Woods on March 11, the Women’s Hospital on March 12, and the CSM – Milwaukee campus on March 17, respectively. You will notice clinicians (RNs/RTs) utilizing a barcode scanner within the patient’s electronic chart to document medications administered at the point of care.

More information on the rollout can be found by following the link below.

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EHR Upgrade Communication - 2/11/2014

On Tuesday, February 18, 2014, CSM will be installing an upgrade to the EHR. Please refer to  upgrade communication via the 'Read more' link below.

These enhancements are needed in order to:

  • Continue work requested by our end users…you!
  • Enhance customization capability 
  • Meet Meaningful Use criteria

Questions and/or Issues regarding the upgrade?

Please call the IS Service Desk:

  • Internally call 85-2400 
  • Externally call 414-326-2400
 read more ...

Quality Measures and the EHR - 2/6/2014

To: All CSM Medical Staff

From: Suzanne Wilkerson, MD - Hospital EHR Medical Director

The Centers for Medicare and Medicaid Services (CMS) have defined clinical Quality Measures for monitoring hospitals and medical professionals. Columbia St. Mary’s reports compliance metrics for the following six quality measures: Venous Thromboembolism (VTE), Stroke, Pneumonia, Heart Failure, Acute Myocardial Infarction, and Surgical Care (SCIP).

Over the past year, through vigilance and teamwork, we have made great improvements in our quality compliance metrics. On Monday February 24th we will be updating Lighthouse®, our EHR Quality Measure tool. We expect this updated technology will further assist us in monitoring care as we continue to meet and exceed our goals.

Web based training modules have been developed to help you learn more about the tool as well as the details of CMS outlined Quality Measures. The training materials are available online through DocPort and CSM intranet (training access information attached). There are three modules: Inpatient, Emergency Department, and SCIP. This allows you to focus your training on the information relevant to your area of patient care.

I highly recommend you review a training module soon. Then, on February 24th start using this EHR tool as you care for your patients. Please keep in contact with me and share your observations regarding the strengths and weaknesses of the tool. I would also like to know how it best fits into an efficient workflow for you. With your engagement we can work together to maximize the benefits of this tool and plan further improvements.

Contact information for questions and comments:
Swilkers@columbia-stmarys.org
414-326-2519

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CPOE PowerPlan Favorites – Critical Update - 2/6/2014

To: All CSM Medical Staff

From: Suzanne Wilkerson, MD - Hospital EHR Medical Director

The content of most PowerPlans will be updated on Tuesday February 11th. This process will inactivate previously saved favorites made from these base plans. We understand that loss of previously saved favorites has significant negative impact on workflow for many of you. While changes to PowerPlans over time are inevitable, we continue to strive to make these changes infrequent. The last time there was widespread inactivation of favorites was September 2013. PowerPlan changes this month are driven by a variety of situations including regulatory changes regarding admission and DME orders, updates in best practice guidelines, Quality Measure enhancements, and Meaningful Use mandates such as BCMA (bar code medication administration).

While most PowerPlans favorites will be affected, there is no impact to favorites for individual orders. If PowerPlan favorites are an important part of your workflow, you will need to rebuild these favorites after February 11th. It is most efficient to save favorites as PowerPlans are used in real time. Creation of favorite PowerPlans outside your normal patient care workflow is not recommended. In an effort to streamline your rebuild process, you may decide that you want to print your favorite PowerPlans prior to February 11th so that you can reference the printed copy when recreating your favorite. Please contact me if you would like technical help printing and/or rebuilding these favorites. I will be able to arrange 1:1 assistance for you.

Favorite PowerPlans are utilized for a variety of reasons. We are interested in the reasons that physicians and other providers find favorites helpful. If you regularly rely on favorites, please email me the reasons so that we can perhaps work towards a more permanent solution for your needs. For example, if you are using favorites due to laterality, or specific diagnoses, we can discuss creation of additional base PowerPlans that will benefit you and your colleagues. We also can create custom patient discharge instructions for you that can expedite placement of discharge orders.

Thank you for your patience as we work as a team to optimize and enhance our EHR.

Contact information for 1:1 assistance:
Swilkers@columbia-stmarys.org
414-326-2519
 

 

EHR Quality Measures - 2014 Go Live Education - 2/3/2014

Quality Measure Education includes Web-based training (WBT) and instructor-led education sessions on Nursing and Provider (Physician/PA/APN) workflow for upcoming EHR Quality Measure functionality tools.

Applies to:
ED, Inpatient, Perioperative Nursing and Providers (Physician/PA/APN)

Excludes:
Behavioral Medicine, Women’s Health, SHRI, Outpatient Nursing and Providers (Physician/PA/APN)

PROVIDER Education

Available on Docport

• Links to web-based training under Quick Links > EHR Information and What’s Up Doc?

Attend Instructor-led education session for real-time Q&A, workflow discussion and demo. (Link to PDF)

Quality Measure – Provider Education Links

Inpatient Module – Inpatient Providers (Physician/PA/APN)
 

ED Module – ED Providers (Physician/PA/APN)
 

SCIP Module – Perioperative Providers (Physician/PA/APN)
 

 read more ...

Dose Range Changes for Providers - 1/23/2014

Beginning February 11, to prepare for barcode medication administration, all PowerPlan medication order sentences with a dose range will be updated to reflect the highest end of the dose range in the dose field. The dose range will continue to appear in the order comments.  Please follow the link below for additional information.

 read more ...

Important Updates and Information regarding the Electronic Health Record - 12/16/2013

Below are 5 important topics that need to be reviewed. Job aides are linked below for items #1-4. Please take the time to review these job aides thoroughly. If you have any technical questions about the ordering process or alerts, please contact Suzane Wilkerson, MD, Hospital EHR Medical Director at 414-326-2519 or swilkers@columbia-stmarys.org.

  1. Restraints

CMS and Joint Commission have specific rules and regulations about the use of medical restraints. During our mock surveys, we have been out of compliance with these regulations. Restraints used to protect the physical safety of the non-violent or non-self-destructive patient must be ordered by a physician. In addition, restraint orders must be renewed every 24 hours based on patient evaluation.

In an effort to improve regulatory compliance and assist with ease of placing initial and renewal medical restraint orders, the restraint PowerPlan and alert will be updated and released the week of December 16th. A critical step in turning off the alert will be canceling the old order when placing the renewal order. This can be done in one step by using “cancel/reorder” on the active continuation order.

If you have questions about the standards or policy please contact Pat Gosch, Director Accreditation at 414-326-1732 or pgosch@columbia-stmarys.org .

Order Priority Job Aid December 2013

  1. VTE prophylaxis

Since January 1, 2013, Columbia-St. Mary’s has been submitting the VTE Quality Metric as part of the hospital’s on-going public reporting of data. The VTE Metric examines the use of mechanical and chemical prophylaxis as tools for prevention of DVTs and PEs in the hospital setting. The metric also examines the treatment of VTE patients in terms of overlap therapy and appropriate monitoring of patients receiving unfractionated Heparin along with specific discharge instructions for patients treated for VTE and prescribed warfarin at discharge. We have found in our monthly record reviews that we are not adequately meeting our compliance goals with the prophylaxis metrics. Patient assessment for VTE and bleeding risk and placement of appropriate orders needs to occur within the first two days of admission.

In an effort to improve our quality compliance, a VTE electronic form (PowerForm) and alert will be activated the week of December 16th. It can assist providers with assessing a patient’s VTE risk, ordering appropriate prophylaxis, or documenting contraindications to prophylaxis. Any inpatient or observation patient who does not have an active order for VTE prophylaxis or documented reason why no VTE prophylaxis ordered will have the form fire as a reminder alert when providers open the patient record. (In order to allow time for placement of proper orders, the reminder alert will not fire for the first 6 hours of admission.)

If you have questions about quality measure standards or guidelines, please contact Greg Bruder, Coordinator Quality Outcomes at 414-270-4920 or gbruder@columbia-stmarys.org

VTE Risk Job Aid December 2013

  1. Urinary Catheters

Reminder: Urinary catheter orders must be renewed within 24 hours or 7 days depending on the original order type. We do have a reminder alert in place, but compliance with proper placement of initiation and continuation orders is still inadequate. A critical step in turning off the alert is canceling the old order when placing the renewal order. This can be done in one step by using “cancel/reorder” on the active continuation order.

If you have questions about urinary catheter standards or guidelines, please contact Paula Pintar, Director of Infection Prevention at 414-291-1711 or ppintar@columbia-stmarys.org.

Urinary Cath Job Aid December 2013

  1. Order Priority

Some providers have noticed problems with the proper collection of ordered labs and imaging tests. An EHR functionality issue has been identified which is contributing to the problem. When an order sentence is selected from the pre-defined order sentences or within a PowerPlan, but manually changed while entering the order, the Requested Start Date and Time will NOT automatically correct (i.e.- changing from Stat to Future AM or Future AM to Routine).

To avoid order timing problems, never change order priority. If you have an open unsigned order and need a different priority, then cancel the order and create a new order with the proper priority. If a PowerPlan does not contain the order priority you need, use “add to phase” to add a new order.

  1. Uninitiated PowerPlans

Sometimes a Provider will inadvertently create more than one PowerPlan. In this situation a PowerPlan may be signed (planned) but never initiated by the nurse or Provider. Unfortunately uninitiated PowerPlans, while created in one encounter, are visible in future encounters. This clutters the orders menu, and there is a risk that the PowerPlan may be mistakenly initiated. Starting the week of December 16th, we are going to launch an automatic process that will “expire” any outstanding uninitiated PowerPlan that are greater than 90 days old. (Oncology PowerPlans will be excluded from this process.) 90 days was chosen to avoid expiration of PowerPlans created purposely for future encounters. In addition to this automatic process, please continue to discontinue any unnecessary, uninitiated PowerPlans that you find cluttering the orders menu.

 

Oncology Changes that Impact Inpatient Providers - 10/29/2013

PowerChart Oncology will go live at the Water Tower Medical Commons and CSMO Medical Oncology clinics beginning Monday, November 4th. With the Oncology implementation, oncologists will begin using CPOE to enter their orders for chemotherapy and supportive medications.

There are new PowerPlans that begin with the letters “ONC”. These are chemotherapy treatment plans for the clinics and inpatient and are not to be ordered by providers who do not work in the Medical Oncology clinics.

Certain oncology medications are ordered at times for non-oncology related indications. We have added some additional order descriptions to assist the oncologists with their patients’ specific needs. For example, today when you search for “sodium ferrate gluconate complex” there is only one order to choose from. You will now see two orders to choose from: “sodium ferrate gluconate complex” and “sodium ferrate gluconate complex/NS 100 mL”. In all cases, non-oncologists should continue to choose the order that does not include the diluent.

 

OpenNotes - 10/28/2013

The Physician Division Operations Council and Hospital Physician Informatics Council have endorsed the implementation of OpenNotes. OpenNotes is an initiative that invites patients to review their visit notes written by their doctors, nurses or other clinicians via patient portal, CSMConnect.  See the EHR OpenNotes page at the read more link below for more information.

 read more ...

Hidden Stand-Alone Orders - 10/23/2013

A PowerPlan should be used to ensure all other required orders (lab monitoring, patient care) have been placed. For this reason, the following stand-alone orders will be hidden, effective 10/25.

THESE STAND ALONE ORDERS HAVE BEEN HIDDEN: ORDER THIS INSTEAD:
Insulin Insulin Infusion
Heparin Heparin Low Does Infusion Therapy
Argatroban Argatroban Continuous Therapy Protocol

 

 

ALERT: Hemogram Orders - 10/18/2013

There has been a defect identified with Hemogram orders in all PowerPlans. Hemogram with Differential orders in PowerPlans will not fire to lab correctly if collection time is changed (for example if order is Future AM in PowerPlan and physician changes to TIMED collect). We are working with Cerner on a solution to this defect.

In the meantime, if a provider does not find the appropriate Hemogram order in a PowerPlan, then “add to phase” should be used to enter the desired order to the PowerPlan. DO NOT modify details on Hemograms in PowerPlans.

 

ePrescribing Upgrade Changes - 10/7/2013

On Wednesday, October 16, 2013 an upgrade will be installed to the ePrescribing module. The upgrade is required to continue ePrescribing functionality and will provide Surescripts changes related to Meaningful Use reporting.

  1. An additional preview screen will display whenever a prescription is electronically sent to the pharmacy.
    1. The screen may indicate missing details.
    2. Sign will not be available if the prescription contains missing details.
    3. Click Modify to return to the scratchpad.
  2. Medication search functions when prescribing will change.
    1. Medications no longer available by brand name will now only display by searching using the generic name. (ie: Flexaril will only be able to be located by searching the generic name “cyclobenzaprine”).
    2. Updates to the Multum medication database occur monthly. Medications may be impacted each time the monthly upload is completed as these items become obsolete or no longer available by the brand name.
    3. Impacted medications will automatically be removed from Favorites.
  3. An additional field will display on the scratchpad: eRx Product Type
    1. Field will default National Drug Code (NDC) information behind the scenes for MOST prescriptions.
    2. If the medication is available but does not have a current NDC number, an error will display on the preview screen indicating the need to populate the eRx Product Type Field. Users will need to manually select “SUPPLY” from the drop down in the eRx Product Type field.
  4. Medications prescribed that are now obsolete or no longer available by the brand name may require additional steps when processing subsequent refills using the Cancel/Reorder option.
    1. The original order may need to be canceled and a new medication order created.
    2. The conversion screen may display requesting the user to identify the medication that would need to replace the original selection.

Please see the attached job aid for additional details.

 read more ...

Revised Instructions for Reviewing PowerPlans in Zynx ViewSpace - 9/25/2013

Linked below you will find revised instructions for reviewing PowerPlans in Zynx ViewSpace.  ViewSpace is an on-line forum for PowerPlan/Orderset review. 

Once the build team has a rough cut of a PowerPlan (Orderset), they will have it published to ViewSpace.  Physicians and clinicians reviewing the PowerPlan will be notified as to which file to look in and houw long they have to make comments.  Those comments will be compiled into a report and given back to the build team.

In ViewSpace, reviewers can access the evidence (both Zynx and custom), access the quality measures, leave comments on any individual line item and on the order set as a whole. They can also read the comments of other reviewers and reply to them.

The PowerPlan builder saves and uses the comments for Edits.

 read more ...

MANDATORY INFORMATION - Co-Signing of Resident Admit and Discharge Orders - 9/4/2013

"Order to Admit" and "Order to Discharge" MUST be co-signed by attending faculty physician within 48 hours of entry.

Recent clarification of the Wisconsin Administrative Code and Conditions of Participation by CSM Legal Counsel reveals that the “order to admit” and the “order to discharge” must be signed by a physician (MD/DO) who holds current hospital admitting privileges. As a result, effective Thursday, September 5, 2013 residents may enter the “order to admit” and “order to discharge” only as verbal or telephone orders, and the attending faculty physician must co-sign both orders within 48 hours of entry.

Residents should follow the instructions in the attachment linked below when entering an “order to admit” and “order to discharge” in the electronic health record. Please read the instructions carefully to ensure that telephone/verbal orders are forwarded to the correct attending (ordering) faculty physician for co-signature. If you have questions after reading the instructions, please contact Dr. Suzanne Wilkerson.

Finally, please note that the above ruling does not apply to those services rendered to patients registered as outpatients, including observation and/or day surgery patients.

Thanks for your ongoing support regarding this mandatory action.

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CPOE Power Plan Favorites, Revised Implementation Dates - 8/9/2013

This is an update to the August 5th announcement regarding PowerPlan Favorites. That letter listed August 13th as the date when changes would be made to base PoerPlans impacting associated saved favorites. This date has been delayed to September 17th for many plans. Please see the letter linked in this announcment for details.

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CPOE PowerPlan Favorites - 8/5/2013

Please be aware that on Tuesday, August 13 there will be system changes that will impact some PowerPlans and associated favorites. Affected PowerPlans are listed in the letter linked below.  Not all PowerPlans will be affected, and no individual order favorites will be affected.

 read more ...

How to Correct a PowerNote - 5/3/2013

Correcting a Power Note Created Using an Incorrect Encounter, Date or Note Type

A document created using an incorect Encounter, Enicounter Date, or Note Type, will result in that document being electronically misfiled in teh patient's chart.  This could pose a safety issue and repeat work.  View the demo and job aid below to learn how to correct this.

2 - 3 Minute Demo

Job Aid