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Kansas Collector Users Group Meeting Agenda

Wednesday, June 12, 2013 1:00 pm – 3:00 pm

Webinar Only

Participants: Nancy Akin, KDHE Leslie Bedene, Mercy – Ft. Scott Jenna Bloomfield, Cloud County Health Center Daniel Breeden, Wamego City Hospital Jan Bryan, F.W. Huston Medical Center Whitney Bures, Community Memorial Healthcare Kellie Burnell, Kansas Medical Center Cathy Claussen, Decatur Health Systems Lynda Cross, Nemaha Valley Community Hospital Kristine Crowe, Digital Innovation Julie Dillingham, KDHE Alvina Fant, KU Hospital Debbie Filson, Ashland Health Center Roxie Geist, Trego County Lemke Memorial Hospital Margaret Gillen, Kingman Community Hospital Irina Giller, Digital Innovation Mary Gray, Mitchell County Hospital Health Systems Anthony Guidi, Digital Innovation Amy Harvey, Olathe Medical Center Martha Hett, Lindsborg Community Hospital Laurie Hoffman, Greeley County Health Services Vicki Howe, Ness County Hospital Melissa Hultman, Providence Medical Center Jessica Johnson, Wesley Medical Center Kris Kindler, Jewell County Hospital Annette Kramer, Overland Park Regional Medical Center Pam Kvas, Newton Medical Center Barb Lindsey, Pratt Regional Medical Center Connie Little, Girard Medical Center Cassie Look, Rice County Hospital Rhonda McClure, Stafford County Hospital Natha Manges, Mercy Regional Health Center - Manhattan Kimberly McGowen, Hutchinson Regional Medical Center Brenda Messenger, Mercy Hospital Scott Messer, St. Lukes South Hospital Heather Nunamaker, St. Francis Health Center Tina Pendergraft, Satanta District Hospital

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Gail Philips, Bob Wilson Memorial Grant County Hospital Mary Reif, VCHP Katerina Rhynes, Wesley Medical Center Kristie Royer, Mercy Hospital – Independence Rosanne Rutkowski, KDHE Stacy Scott, Sabetha Community Hospital Dawn Sheltrown, Stormont Vail Healthcare Erin Stahl, Rooks County Health Center Kristin Steele, Ellinwood District Hospital Cammie Townley, Hays Medical Center Lois Towster, Overland Park Regional Medical Center Debby Trujillo, VCH Dee Vernberg, KDHE Dwayne Walker, KU Medical Center Jessica Weikle, Salina Regional Health Center Angela Welch, Ransom Memorial Hospital Angela Whalen, Wichita County Health Center Jennifer Whipple, Lane County Hospital Kenna Young, Lawrence Memorial Hospital Lisa Zenger, Washington County Hospital Nancy Zimmerman, Comanche County Hospital WELCOME AND INTRODUCTIONS DEE VERNBERG Dee opened the meeting at 1:00 PM, introducing herself and the Trauma program staff. TRAUMA PROGRAM UPDATE ROSANNE RUTKOWSKI Staffing: Dee has returned. We appreciate everyone’s patience and understanding these past two months as we tried to fill in during her absence.

Regional Trauma Councils: The last regional trauma council general membership meeting is scheduled for next week in the SE. The agendas for these meeting are on our web site.

Regional Trauma Plans: These documents are scheduled for review the end of June in Wichita.

Level IV Designation: The complete list of Level IV trauma centers is on our web site. We have two applications in review.

Level IV Workshop: This class was scheduled for June 27th but was cancelled due to end of year state fiscal restrictions on bill paying.

ACT Meeting was held in May. We have new members and the Governor’s office is currently working on appointments for the upcoming terms.

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Annual Report: We are updating our annual report.

May was Trauma Awareness Month: In collaboration with Vanderbilt University Trauma Program, Tim McGraw, Taylor Swift, Keith Urban recorded a song “Highway Don’t Care.” Tim has a 16 year old daughter. It’s a song about consequences of distracted driving. It is a top-viewed video on YouTube.

MAP-21, the Moving Ahead for Progress in the 21st Century Act (P.L. 112-141), was signed into law by President Obama on July 6, 2012. Funding tied to states having distracted driving laws in place. Excellent web site for distracted driving information is: www.Distraction.gov

Trauma Registry: We are in the testing phase of the updates of the registry enhancements. We hope to be able to implement enhancements soon. Hospitals will be able to run reports using their own data and/or look at statewide/regional data.

REGISTRY ANNOUNCEMENTS DEE VERNBERG Dee started out by launching a poll for the users to answer. Poll: Which type of trauma registry do you use?

• Web Registry = 64% • Local Registry = 31% • I don’t know = 5%

If you do not know what type of registry your hospital uses, please contact Nancy Akin, KDHE nakin@kdheks.gov . ICD-10 Software Compatibility

• ICD-10 coding will be required October 1, 2014 • Hospitals are completing surveys on whether or not existing software programs are ICD-10

compatible. Collector will be compatible. o Diagnoses will change. o Procedures will change

• Please send these surveys to Nancy Akin nakin@kdheks.gov and she will get the appropriate person at Digital Innovation to complete.

March User’s Group Minutes

• These minutes were not completed at the time of this meeting but are posted on the Trauma Website now http://www.kstrauma.org/collector_usergrp.htm#minutes .

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Digital Innovation Conference • Digital Innovation is the vendor for software. They have an annual conference every year

that provides opportunities for training. It will be held in October in Kansas City. Please watch for more information.

INTRODUCTION TO ENHANCEMENTS DEE VERNBERG & NANCY AKIN We are in the process of working on the Web Portal and some of the modules will go live soon.

• New Kansas Web Portal o Available to both Local and Web Registry Users

• Login for New Web Portal o Users will assign their own password o Login instructions will be provided to all users prior to activation. Notification will

come directly from Nancy Akin – KDHE nakin@kdheks.gov. Web Portal – The screen shot below shows the first screen you will see when you go to the website.

• Each User will have their own login

o User ID: Your Hospital Facility Number and User Initials (first and last) 17XXXXNA (if you don’t know your facility ID, please contact Nancy Akin)

o Password: A temporary generic password will be assigned.

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o Users will change their password to one of their choice during initial login, but these passwords must be 8 characters long and have two special characters and two numbers.

o Nancy Akin nakin@kdheks.gov will email each user login instructions when the site goes live.

To log onto the Kansas web portal (see screen shot below):

When you initially log onto this site, you will need to change your password (see screen shot below).

Change your initial password to one that is 8 characters long with 2 special characters and 2 numbers (see screen shot below).

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• Please make a note of your password, because we will not have access to them anymore.

What will be on the web portal?

The reason you care about the web portal is: 1. The web portal will be where you will go to pick up reports that you have access to

(This will be where you pick up your data reports). 2. The web portal will have tools for analyzing your data (The driller will go live first).

Later web users will also have a tool called report runner. 3. The web portal will be the home for the enhanced web registry. 4. The web portal will have an application for local users to check their submissions.

Minimum Password Length: 8 Number of Special Characters: 2Number of Numbers: 2

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Training Materials o Documents describing driller (this was included for this webinar). We can send

these out to you on request and will offer them again when we have training webinars.

o We will have document describing dashboards.

• Enhanced Web Registry o Note: This will go live later with the implementation of ICD-10.

• Clinical Update in June or early July o Local Users will get an update link from DI o Web Users – update is done for you

COLLECTOR UPDATES 1. Outcome memo 2. Discharge to option changes 3. Hospital & EMS name changes & additions 4. Add chief complaint to core and change name to Mechanism of Injury 5. Off-road vehicle – change how this opens up and move it to ED page 6. OR Disposition – add discharge home 7. Ventilator – days, hours and minutes are displayed 8. Report Writer

a. Update data completeness report (include EMS at discharge, core trauma activation).

b. Be able to choose records by discharge date. Outcome Memo Field This will allow core users to have more room to write narratives about patient care or discharge. (see screen shot below). Do not put PI or other confidential information in this memo field.

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The outcome memo field was added because there was only one other memo field in the registry under the e-codes (see screen shot below)

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• “ Discharge to” changes (see screen shot below) o Retire: 21. discharge to same or lower level of care (do not use this option now) o Change: “Discharge to high level of care” changed to “Discharge to acute care

hospital”. o Add Protective Services o Add Women’s Shelter o Add Repatriation

• Hospital & EMS name changes o Minor EMS changes o Hospital

St. Johns Maude Norton Hospital changed to • Mercy Maude Norton Hospital

More rehabilitation and skilled nursing facilities/units o If you cannot find a hospital, please contact Nancy Akin (785-296-3180 or

nakin@kdheks.gov ) or you may use search feature. o If you have any other facility name changes, email Dee dvernberg@kdheks.gov .

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• Chief Complaint is new for core users and web users (The name will change to: Injury Mechanism). This field will be placed on the ED tab for web users. For local users, the name will simply be changed to injury mechanism (See screen shot below)

• The variable “Off-road vehicle” will be moved from the Prehospital tab to the ED tab. Currently appropriate e-codes open up the “off road vehicle” variable on the prehospital tab (see screen shot below).

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How “off road vehicle” variable is opened up NOW (this will change in the update)

• Chief Complaint (Injury Mechanism) & Off-road vehicle The chief complaint (off-road vehicle option) will open up the off-road vehicle variable to prepare for ICD-10 and to make it simpler & more accurate for registrars (see screen shot below). Please note: Another chief complaint option, 7. Farm/Heavy Equipment Incident, will also open up the off-road vehicle variable pending approval at the July 24 Policy Group Meeting.

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• OR Disposition – we are adding another option “Discharge to home” (see screen shot below).

• Ventilator Days The ventilator Days variable currently in the registry is a core variable. If a registrar enters the start and stop dates and times in the tracking section, the Vent Days variable will be autopopulated using NTDS rules. The new variable “total ventilator time” will also be autopopulated if the registrar enters the start and stop dates and times in the tracking page.

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These results will be the actual time the patient was on a ventilator displayed in days, hours and minutes (see screen shot below).

• Report Writer Changes (Local Users only). o There is an update to a standard report “data completeness report” so that “EMS

at discharge” and the “ core activation field” are displayed. o Local users will also be able to choose patients to analyze by discharge date (see

screen shot below) as well as ED arrival date.

Discharge Date to be added here

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TRAUMA REGISTRY DEMONSTRATION: “HOW TO ACCESS DATA REPORT ACCESS & USE OF DRILLER” DIGITAL INNOVATIONS STAFF

• Accessing your data report – Kristine Crowe, Digital Innovations o Click on “View Reports” link (see screen shot below). o When you double click on the “view reports” link, a second window will open.

o The purpose of the screen in the screen shot below is to search for any reports that have been posted for you by KDHE. The facility will default to your own facility and your own reports. Some reports will be posted for certain regions. If you are in that region, you will see these reports as well.

o Each person that logs in will only have access to reports that have been posted for him/her. For the data report, only certain individuals at your facility will be able to view these reports. To look at your data report, choose “data report” from the “Report Type” drop down box (see screen shot below). You can also search by report name or report type, as well as reporting year or period (e.g. q1 or 2) –( See search button on the left hand side of the screen shot below). Note: Facility will always default to your facility. The data report will open in a separate window as a PDF document.

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• Using Driller – Anthony Guidi, Digital Innovations

o This tool reports from a data warehouse that is refreshed overnight from the dataset that is updated by KDHE. The Trauma Data Explorer will allow you to drill down into the data. Anthony showed how to display different reports. You will be able to use queries to look at a subset of patients (e.g., only Falls, or a particular age group) and will be able to set date ranges for your reports. Dee stated that the exciting part of the Driller is that this will allow the user to look at their data graphically. These graphs allow you to describe your patient population and to perhaps identify data entry errors. Please Note: The Driller will only show you findings from the data that you have sent to KDHE.

There will be webinars later on how to use the driller. These webinrs will show you step by step how you can examine your data. You should have received DI Driller materials from Dee. Please keep the information, as it will be useful to you when we have these webinars. These materials will also be available for those attending the webinars and on request.

OTHER ISSUES WITH THE REGISTRY GROUP DISCUSSION • Some registrars reported having problems using the EMS Linkage module. For some the

issue is an error message that instructs them to try again in 20 minutes even when the record seems to be in the KEMSIS database. Dee asked that participants speak to Nancy Akin when they have these problems. Nancy will need to know any error messages that you might have, the exact date and time of these problems, and the trauma numbers of the records that are not linking correctly. Nancy indicated that she has access to information that will help DI to pinpoint the problem. Dee and Nancy will follow-up with DI about this issue.

• Amy, Stormont-Vail, has noticed that KEMSIS takes forever to load. She wondered if, after she logs in, if she could select the dates they desire, rather than waiting for it to load the entire month. Dee said that she will follow up on this.

• Kenna, Lawrence Memorial, said when they code a patient who is going home in “discharge to”, the EMS called and arrived date/time fields open which does not make sense since patients usually go home by POV. If a patient goes home, the date and time the discharge EMS arrived and left hospital should not be active. Nancy will follow up with Kenna about this issue.

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Obtaining KEMSIS user names and passwords Nancy Akin • Can I link EMS Records directly from KEMSIS?

o You can if You currently have an assigned KEMSIS User ID and Password from KBEMS Or your hospital receives patients from a KEMSIS participating EMS agency

(see screen shot below for how to view participating hospitals on the KEMSIS website).

o To view participating hospitals and EMS agencies, log into: www.ksbems.org/ems/ Click on “Resources” at the top of the screen.

• Do you already have a KEMSIS log-in or need a log-in? o Contact Nancy Akin (785-296-3180 nakin@kdheks.gov to request a log-in. o KEMSIS log-in will be sent to you by Joe Moreland (KBEMS). This could take 30 to

45 days. o When you receive a KEMSIS Login or already have a log-in:

Contact Nancy Akin to assist you in setting up your EMS Linkage account in Collector.

• Why would you want to use the linkage feature?

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o By entering only the ED Arrival Date/Time, the linkage feature will populate: A portion of your Demographic Tab. Available Data under the Prehospital Tab (Incident Information). Many data points on the Prehospital Transport Provider Tab. You will need to double-check each of these tabs to make sure the fields

are populated and correct. o Contact Nancy Akin with questions:

785-296-3180 nakin@kdheks.gov

SCENARIOS Dee Vernberg 1. Suppose a patient had a syncopal episode at home and fell injuring her face. What is wrong with the coding below? When would you use an n/a for the transport provider 1 mode?

Answer: The mode should not be n/a in this case. The patient probably came to the hospital either by POV or EMS (see screen shot below).

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• When would you use a n/a for the transport provider 1 mode? Answer: User n/a for Transport Provider 1 if a patient or visitor was injured in your facility.

2. Suppose you are reviewing trauma records and you find a record coded like the screen shot below. What is wrong with the coding below? Incorrect Coding of unknown Incident time

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Answer: In the screen shot above, the || in the incident time indicates that incident/injury time is not applicable. Injury time may be unknown and should be coded with ? (See screen shot below).

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Correct Coding of unknown incident time

3. Suppose you are coding a record of a patient who is brought to your hospital by EMS. What is wrong with the coding in the screen shot below? Incorrect Coding for Activation

Answer:

• If you have an activation policy, you should have “Y”, “N”, “?” for activation if the patient is seen in the ED.

• If you don’t have activation policy: o Since EMS transported this patient to you from the scene in this scenario, they

probably called ahead of time with some type of Code. If EMS called ahead of time with Code Blue or Code Black, then the activation field should be coded as “Y”, otherwise please code as “N” or “?”.

• It was noted that the trauma team is not activated for all patients who are entered into the registry. This is true. Dee stated that if you know you have an activation policy, you will have a “yes” or “no”. If you don’t have an activation policy and patient comes by EMS, the rule is “yes’ or “no”. If EMS calls ahead of time with code blue or code black, code “activation” as “yes”; otherwise “no” or “?”. Do not use “n/a” if they are brought in by EMS.

• One participant said they sometimes get trauma patients from an outlying facility and the trauma team is not activated because the patient is coming in to see a particular surgeon or orthopedic physician. Dee stated in this case, you may want to use “no.”

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• Duane, KU Medical Center, stated that they have direct admit patients that are considered non-trauma patients but these patients are included in their registry and meet state criteria. In this case, use “n/a” or “no” for activation. Dee replied that if a patient does not come to the ED (e.g. direct admit), then you can use n/a”.

• Lois Towster suggested that the activation should be yes or no – either you have one or you don’t. Direct admits would be the only time you would have “n/a”. Any patient that comes through ED is a potential activation.

5. Suppose a patient was injured in a Motor Vehicle crash what is wrong with the coding

below? Incorrect Coding

Answer: In most motor vehicle crashes (except those that are at the race track), equipment would be not applicable (see screen shot below), because most drivers or passengers do not wear helmets, protective clothing or eye protection (see options for protective devices in screen shot below). In most Motor Vehicle Crashes, you will have a valid value for restraint (including ?) and airbag (including ?), but equipment is in most cases “ not applicable”.

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Options for protective devices

Correct Coding

FUTURE TRAINING OPPORTUNITIES FOR ENHANCEMENTS DEE VERNBERG

• We will offer webinars, after you have access to Driller. We are in the process of testing to make sure that when you get on Web Portal, you only see your data and that the data are correct. I hope this should not take too long. If you need data reports for PI now, Dee will email them to you. If there is an issue with Portal and a delay, she will email data reports to you and keep them on the portal.

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• We will offer webinars on Dashboards. These will be most useful if you are involved in the regional trauma councils or need regional trauma data.

• Either Nancy Akin or Dee Vernberg will send you an email announcing these webinars.

OTHER BUSINESS • Duane, KU Medical Center, asked about mapping issues with Comprehensive and Core

QA/QI. Dee said that the mapping occurs from the Comprehensive back to the core, because there is more detail in the comprehensive QA/QI options than the core QA/QI options. So a registrar who is collecting comprehensive data, should enter any complications first in the comprehensive QA/QI section and then go back to the core QA/QI to see if they should code any complications here (those that did not have an exact match with the comprehensive QA/QI).

o Dwayne reported that he was also having some NTDB validator problems and problems with TQIP reports. Dee said that she would follow up on these issues.

2013 MEETING DATES: • September 11, 2013 • December 11, 2013

ADJOURN at 2:45 pm