Happy Birthday Teddy

After a year and half long search for our special puppy, Dale and I found Sharon Marples of Von Marc’s Kennels in Hayden Lake, ID.  We had grieved our great big Merlin boy, fostered a wonderful rottie we called Prince (later in his forever home renamed Walter), and nurtured our rescue pack during this time.  And I’d interviewed (and been interviewed by) some local and distant breeders.  I’d done a lot of research into Rottweiler health issues and genetics issues.  We’d also gotten Sofie through two CCL surgeries (knee ligament), and Lady through stomach surgery (gorilla glue).

Sharon’s dogs impressed us with their charming personalities and intelligence.  Sharon impressed us with her knowledge of the breed and her genuine and gracious efforts to educate the people attracted to the breed.  When we met her at a local dog show, and her dog, Anya rolled into my lap and let my toddler granddaughter pet her, we were in love.

We told Sharon that if she had the right puppy for us in a future litter, we wanted him.  We were looking for a pet quality dog that would have a stable temperament, willingness to work as therapy dog, intelligence to learn and work as service dog if needed, and courage to face any situation we would find ourselves in as a team.  Sharon told us, no guarantees, but she’d be in touch.

We wanted a puppy from Anya’s litter, but Dale had back surgery so  we had to wait.  When Hooker had a litter, we contacted Sharon again to let her know we were interested still.

March 31, 2008, Teddy was whelped. His mom, Von Marc’s Happi Hooker; and his dad, Clearwater’s Black Tie Affair.  Both dogs with more titles than I have room to type out here…international champions in conformation as well as holding working titles.  Both dogs have illustrious pedigrees.

Just before Memorial Day, we got the news that we would be traveling to Idaho to pick up our 8 week old special pup.  We were told that our puppy, Von Marc’s Essential Cat Scratch Fever, was pet quality because of an overbite.  In all other things, he was just like his littermates.  We fell in love with him right away.

Teddy is going to be one year old this week.  He’s exceeded our every expectation.  Ted has faced every challenge with enthusiasm and joy.  He loves his work as therapy dog in our clinic.  He adores his Great Dane big brother and respects his older sisters, Lady & Sofie.  He’s gentle with children, loves meeting new people, loves performing tricks (for a cookie) and is eager to work at dog school.  If I hadn’t broken my arm in October, he’d have his CGC by now.  (the test was the week I had surgery)    When I was incapacitated, he stepped in to help me.  He learned to pick up and give me things I’d drop.  He learned to put the laundry from the washer into the dryer, and to carry clothes out to the living room for folding (or tossing in the air for a game).  He even learned to help me put on my socks—pulling them up for me. 

He’s so smart he figured out how to open the front  door and let out all the other dogs without anyone teaching him.  He’s so steady that even the construction outside of our clinic doesn’t concern him.  Soon he’ll be competing in Rally.  I’m certain he’ll take to competing just as willingly as he’s taken to anything else I’ve asked of him.  At the age of 1 year, this dog amazes me every single day.  I don’t want to imagine life without Teddy in it.  He’s become my heart and my constant companion. 

Happy Birthday, Ted.  Here’s to our next year together, and many amazing years beyond…..

Security and Health Information

Yesterday I received some email from a patient’s mom with a question about her son’s health. Now, I do accept email from patients’ families, but it must be understood that this kind of communication is not private or secure at all. Public email can be intercepted on a number of levels and so should not be considered private at all. My answers attempt to be general and encourage families to keep it general and avoid communicating private information this way. If there is a sensitive topic, then it is best discussed in person actually.

Anyway, she had a question about her son and she included a picture taken with her cell phone to help describe the concern better. After the exchange, I copied the emails and a picture and created a “telephone encounter” note for her son’s chart. Prior to Epic, this would have been printed out and then filed in his paper chart. Now, however, the information goes into an electronic chart.

When I commented that I had made a note that was in his electronic chart and could be available for review by others who may provide health care for this child in the Epic system, she was alarmed. She wanted the note removed immediately. She was concerned for the privacy of her son’s health information. I had to reassure her that although the chart could be accessed by others in the Epic system, it was protected and secure and not available to be used inappropriately by anyone in the system. Did she believe this? I hope so. Yet, her concerns dredge up an important issue that is at the foundation of our nation’s movement to implement information technology.

Fir Creek Pediatrics is eliminating our paper charts. Right now they are in the chart rack behind the front desk. Soon they’ll be stored in the clinic basement stored in a big wall cabinet behind doors and secured by our office security system. What happens to information in an electronic chart? How safe is it? Who can access it? Where does it go? These important questions are on my mind as we move toward a mostly paperless medical record. Obviously they are also on the minds of our patient families.

All the FCP staff has a login and password to get into the server that houses our patient charts at MultiCare. When we are at the office, we are connected through a virtual private network that is protected by firewalls and encryption. Our own network also has a special password that each computer needs to know in order to connect. Each tablet PC that is used by direct care staff is also secured by the user’s fingerprint.

Patient care information is not stored on individual computers at all. All this information is encrypted, stored and backed up on multiple servers within MultiCare. Once we log onto the server, we have another login which is a five digit number and a password that includes letters & numbers. It is illegal (yes, illegal) and punishable by at a minimum firing, to share any of these passwords or logins. It must not be written down anywhere that it can be found and used by an unauthorized user.

Computers left unattended must be locked by securing the workspace or logged out of, and then unlocked with the pass-codes when needed again. Remote access is granted with another layer of security by the use of a RSA token that has a 6 digit number that changes every few minutes and is tied to the user login number.

Any time the chart is accessed, the server tags it with the user that is logged in, the date, time and what the user did with it. any note put in the chart stays there forever. It can be addended, but not deleted. This creates a digital trail that can be used to track and make sure that the chart’s protected health information and any other information held there is used appropriately.

So, the bottom line is that we have an ongoing duty to keep our patients’ health information secure and private. And it is my sincere mission and goal to ensure that transitioning to the electronic medical record not only increases this safety and security, but also enhances it.

Latest CDC Recommendations for Hib Vaccination

Recommendations

The following non-high risk children should be scheduled to receive the primary series of Hib vaccine as outlined below:

• If the child is at least 6 weeks but less than 12 months of age and has received zero, one, or two doses of Hib vaccine, schedule him/her for the first or next dose(s) immediately with a minimum of four weeks between the doses. These children will need one booster dose when the Hib vaccine shortage is over.
• If the child is between 12 and 14 months of age and has not had any doses of Hib vaccine, schedule appointments for two doses, eight weeks apart.
• If the child is between 12 and 14 months of age and has received Hib vaccine but did not complete the primary series before they turned 1 year old (i.e., had 1 dose of the Merck product OR 1-2 doses of the sanofi product), schedule an appointment for 1 additional dose, a minimum of eight weeks from the last dose.
• If the child is at least 15 months of age but less than 5 years of age and has not received any doses of Hib vaccine OR has not completed the primary series (i.e., had 1 dose of the Merck product OR 1-2 doses of the sanofi product), schedule an appointment for one dose.
• If the child is 5 years old or older and hasn’t received any Hib vaccine, Hib vaccine is not necessary.

Certain children are at increased risk for Hib disease, including children with asplenia, sickle cell disease, human immunodeficiency virus infection and certain other immunodeficiency syndromes, and malignant neoplasms. CDC recommends that providers continue to vaccinate these children with available Hib conjugate vaccines according to the routinely recommended schedules, including the 12 through 15 month booster dose. Providers who serve predominantly American Indian/Alaska Native (AI/AN) children living in AI/AN communities should continue to stock and use PRP-OMP– containing Hib vaccines (Merck product) and vaccinate according to the routinely recommended schedule, which includes the 2-dose primary series (ages 2 and 4 months) and a 12 through 15 month booster dose. This product is available from the VFC Pediatric Vaccine Stockpile, through their state immunization programs.

For more information about Hib disease and vaccination contact your state or local public health official or CDC at 1-800-232-4636/1-800-CDC-INFO or by email at www.cdc.gov/vaccines/about/contact/nipinfo_contact_form.htm. Information about current vaccine shortages and delays can be found at http://www.cdc.gov/vaccines/vac-gen/shortages/default.htm

Survival of Go-Live Week

On Wednesday, Fir Creek Pediatrics went "go-live" with Epic Ambulatory.  Epic is the electronic medical record (EMR) & system that is used by MultiCare clinics and hospitals in our area.  Kids that are seen at Mary Bridge ER or hospital or specialist clinics, Good Samaritan Hospital, and MultiCare urgent care clinics all have  a secure electronic chart that can be accessed by anyone in that system that provides care to them.  Now we can also access that chart and utilize to document care given in our clinic. 

This is the culmination of months of preparation.  Last summer we applied for a grant to upgrade our health information technology in the clinic.  The grant was offered by First Choice Health Insurance and a consortium of other parties interested in improving health care in Washington State.  This was all prior to our new president's initiative to stimulate the use of electronic medical systems.  We won the grant and got a check for $20,000.00 in October.  The money was to buy new hardware, software, and whatever else would be needed to put in place an electronic medical record in our clinic.

Meanwhile, we'd done some checking around.  We looked at various types of electronic medical record systems and evaluated their potential usefulness in the clinic, as well as cost effectiveness and tech support.  We also consulted with a good friend, Stacy Basse, who we knew worked at MultiCare in the IT department.  Stacy looked over our grant application and gave it to Rick Sheppard, who presented it to his department and suggested that Epic might be just what we were looking for.  He managed to talk the department into working with us as a "demonstration project."  (a mini-research study to test a project out)  Because of his influence, we were able to get an incredible amount of help and resources at a special reduced price in order to implement Epic Ambulatory in our clinic.

When the grant money arrived, we got to work purchasing new, more powerful computers for the billing and reception staff (ok, Theresa & Elisha).  And we bought tablet PC's for the back office (ok, Miki & Peach...and a spare for student or for just in case a computer needs repairs or something).  Also a big monster network color laser printer.

Another meanwhile....we moved to clinic to Lakewood.  The move delayed out progress with the project, and also increased its cost.  With a bigger clinic, more exam rooms, a basement.....etc....we had to expand our network.  We hired another good friend from the Geek Squad (Charles Paul, tech wizard extrordinaire and a really wonderful guy as well) to reorganize our network and get it up to speed for the big Epic switcheroo.  We wired the new clinic so that computers could be hardwired into the network.  And we also set up a wireless access point so that we could use the tablet pc's without wires.  We put in TWO internet connections.  One is dedicated to linking us directly to MultiCare's servers for the EMR through a virtual private network (VPN-an internet tunnel essentially).  The other is for our routine internet work like email, a Microsoft live office space for the clinic, and internet searches, etc.

We spent a few weeks learning how to use Epic, and also troubleshooting all kinds of issues that cropped up.  For example, making the printer work with all the computers; making the VPN work correctly so we could actually log-in.  We discovered that some of our hardware didn't work with the system.  Other hardware we ordered has to be sent back because it turned out we didn't need it after all or we ordered the wrong thing.

And then we dove in and Wednesday was no-paper-charts, throw caution to the wind, we're electronic now!  OH MY GOSH, What a day!  Each of us had a trainer assigned to work alongside us and help out.  We scheduled very few patients.  And yet, we all were confused and lost at least some of the time.  Thursday was a little better, but the front office was really having some frustration and confusion.  They need a card scanner after all (we thought the all-in-one printer and scanner would do the trick but it doesn't work with the Epic Citrix server apparently.)  Some of the things that needed printing weren't printing right or at all.  Everyone was exhausted at the end of it all.  We tried to schedule an office meeting so we could gather and talk about how things were going...but we just couldn't make the time in between learning and doing everything in a whole new way.

Friday was a little better again, but BUSIER.  We nearly had our usual amount of patients.  It took me about two hours after work to finish my charting for some reason.  Gak!   At least everyone else got home on time!

So, is it worth it?  Absolutely.  While I'm at home, if a patient calls, I can look their chart up and document the call.  If a prescription is needed, it only takes a couple of minutes to set it up and it's automatically faxed away electronically.  If a patient is in the ER, I can monitor their progress and even set up a reminder to call and check up on them in the morning.  I still don't know how to make an appointment.  But I can look at the schedule from anywhere I am.  I did a baby house call this afternoon, and was able to enter my entire charting document immediately and show the parents a growth chart....ok, I did enter the wrong birth date initially and got rude ugly beeps when I tried to put the first hepatitis B shot on a date before the birth date.....but I was able to correct that and everything fell together nicely.  Soon we'll be able to pack up the paper charts and store them in the new clinic's basement.  Life will be good.  But right now, my head is about to pop from learning so many new ways to keep track of my patient care.