October 20: COVID-19 UPDATE

October 20, 2020  //  FOUND IN: Announcements

Please share this information with your teams and front line staff, especially those who may not access emails or computers.

NEW TODAY: Here’s the latest information about Michigan Medicine’s management of operations:

  • COVID-19 PATIENT STATS
  • TEAM MEMBER COVID-19 TESTING
  • U-M CAMPUS COVID-19 TESTING
  • UPDATE ON NEW RULES FOR INFORMATION BLOCKING
  • BUS AND SHUTTLE PROTOCOLS
  • MICHIGAN MEDICINE SAFETY MEASURES CONTINUE
  • U-M SURVEILLANCE TESTING PROGRAM
  • MASKS REQUIRED FOR ALL VISITORS
  • TOWN HALL VIDEO
  • CONTINUOUS, TARGETED EYE PROTECTION

DAILY COVID-19 PATIENT STATS

Today’s census for COVID-19 inpatients and those patients under investigation (PUI) are noted below: 

 TOTAL INPATIENTSTESTED POSITIVEPUIICU POSITIVE
ADULT181713
PEDIATRIC1100

COVID-19 Patient Percent Positivity (7 day moving average)

Symptomatic testing: 3.16%

Asymptomatic testing: 0.66%

Discharges: 803 total COVID-19 discharges to date, 7 in the last 24 hours.  These numbers include patients discharged to skilled nursing facilities but excludes deaths and discharges to hospice. 

Deaths and hospice: Since March 10, Michigan Medicine hospitals have had 128 total deaths or discharges to hospice, 0 in the last 24 hours.

TEAM MEMBER COVID-19 TESTING STATS*

POSITIVE589
NEGATIVE8482
TOTAL TESTS9071

* Data from 3/10 through 10/19. The testing stats reflect just Michigan Medicine employees, not all University of Michigan employees. It also reflects only those who sought testing at or were hospitalized at Michigan Medicine or reported their testing to Occupational Health Services. Some Michigan Medicine employees may have been tested outside our system.

U-M CAMPUS COVID-19 TESTING STATS*

POSITIVE770
TOTAL TESTS35,189

* Data from 3/8 through 10/19. U-M campus testing stats reflect clinical care and surveillance conducted by University Health Service and Occupation Health. Michigan Medicine employees are not reflected in campus numbers.

Quarantine and Isolation Housing: Currently, 148 in isolation housing due to positive test results, 162 in quarantine after exposure or while awaiting test results.

More COVID-19 related campus information available at: https://campusblueprint.umich.edu/dashboard/

UPDATE ON NEW RULES FOR INFORMATION BLOCKING

“Information Blocking”, the practice of NOT releasing notes, results, or reports to patients immediately upon their being signed or finalized, will no longer be allowed per federal legislation after November 1st.  FAQs, screen shots and additional information will be coming soon on the in progress “Information Blocking” webpage.

While there are eight exception categories to this legislation, “Preventing Harm to a Patient or Other Person” is the only exception applicable to delaying release of results or notes to the patient portal.  Justifications for delay and restriction must be based on the provider’s professional judgment that automatic release of a result (e.g., test, radiology report, note) is reasonably likely to cause substantial harm the patient and/or another person.  

With regard to MiChart notes, the note types impacted by this legislation are:

  • Progress Note
  • Consult Note
  • H&P Note
  • Procedure Note
  • Discharge Summary Note

Creating and Sharing Notes – Current State

  • Most notes have a default setting in MiChart to release, indicated by the highlighted “Share w/Patient” button
  • If a provider creates a note and unclicks the “Share w/Patient” button, that note will not be shared with the patient, but will still be available to other providers via Care Everywhere, the Provider Portal, and Health Information Exchange (HIE) feeds
  • Some departments’ MiChart configuration is set to have all of their notes institutionally restricted from release to the Patient Portal, Care Everywhere, the Provider Portal, and HIE feeds, even if the “Share w/Patient” button is highlighted.  Some examples are Psychiatry, Neuropsychology, Social Work, Peds SCAN, etc.

All five categories of notes that were created after June 2017 will become available to patients via their portal after November 1.  The only notes that will remain restricted are those that were manually restricted by the author, regardless of whether or not the department was previously institutionally restricted.  Options for the author to retroactively restrict a note are being explored.

Creating and Sharing Notes – Future State

  • Notes will continue to have a default setting in MiChart to release, indicated by the highlighted “Share w/Patient” button; in order to restrict the note, the button must be unclicked
  • If a provider creates a note and unclicks the “Share w/Patient” button, they will be required to specify a reason (e.g. potential for patient harm)
  • Notes will still be shared with other providers via Care Everywhere, the Provider Portal, and HIE feeds
  • Notes from previously “restricted departments”, will now be released, with the following exceptions: adolescent proxy access, Federal Part II Substance Use Disorder information from our “Part 2 Programs (UMATS, ALD Clinic and the Obstetrics Department’s Partners for the Future), research studies, SCAN (Suspected Child Abuse and Neglect)

Historical Notes

Epic (prior to June, 2017)

  • Notes were not released to the Patient Portal; there was no “Share w/Patient button available

Out of an abundance of caution, some notes will continue to be blocked until an evaluation process for the Standard of Preventing Harm to Patient is developed.  The notes being held will originate from the departments that are currently being institutionally restricted

CareWeb (prior to August, 2012): 

  • These documents cannot be released via the Patient Portal, therefore they will be restricted under the Content and Manner” exception allowed by the legislation

CareWeb notes will not be released via the Patient Portal, but patients may request them via existing Health Information Management processes

Research Notes

Process changes for delaying the release of results were shared in the 10.7.20 communication. There is one update to the information that was given.  Out of an abundance of caution, research notes will NOT be released regardless of study status, until a process for evaluation has been developed.  Research results and notes are not required to be released while the research is active and ongoing.

Please continue to contact Kimberly Bologna, Project Manager, Office of Clinical Informatics If you have questions.

BUS AND SHUTTLE PROTOCOLS

As a reminder, for those riding buses or shuttles to and from work, please be aware of the following measures required to keep our employees safe:

·       All riders must wear a mask

·       Window will remain open for ventilation despite cooler temperatures, so dress appropriately

·       Number of riders is limited to seated capacity

·       Duration of bus or shuttle ride remains less than 15 minutes

Thank you for following these guidelines in order to keep our work force safe and healthy.

MICHIGAN MEDICINE SAFETY MEASURES CONTINUE

The recent Michigan Supreme Court ruling to strike down emergency orders issued by Governor Whitmer in response to the COVID-19 pandemic does not change Michigan Medicine policies or affect coronavirus orders issued under the Public Health Code. Michigan Medicine requirements for universal mask use remain in place, as do other safety measures including hand hygiene and social distancing when possible. The safety of Michigan Medicine patients, visitors, faculty, staff and learners remains our number one priority.

U-M SURVEILLANCE TESTING PROGRAM

Michigan Medicine employees can participate in the University of Michigan Community Sampling and Tracking program, a free voluntary surveillance program which offers testing for asymptomatic faculty, staff, and students without known exposures to COVID-19. Information about this program, including how to enroll, can be found at https://campusblueprint.umich.edu/monitoring-testing/

MASKS REQUIRED FOR ALL VISITORS    

For the safety of our patients and colleagues, all visitors must wear a mask when inside a Michigan Medicine facility. The number of visitors remains restricted to one per adult patient and up to two per pediatric patient, but they must comply with the mask policy in order to remain in the building. If you see a visitor without a mask, please politely remind them of our focus on safety and our mask policy.

TOWN HALL VIDEO 

Leaders hosted a virtual Town Hall last Friday to provide updates on COVID-19 preparedness, family care issues, and the work of the Anti-Racism Oversight Committee.  If you missed it, you can watch the video by clicking here.

CONTINUOUS, TARGETED EYE PROTECTION

Safety remains the highest priority for Michigan Medicine as the COVID-19 pandemic continues. To ensure staff safety, continuous targeted eye protection (CTEP) will be rolled out to staff for use during all patient encounters.  This was previously rolled out in the emergency departments and in ambulatory care and will now be expanded to inpatient and procedural areas. During the week of 10/19/2020, eye protection will be distributed to individual units.

What is Continuous, Targeted Eye Protection?

Continuous, Targeted Eye Protection means wearing eye protection when caring for patients, being in the patient room, or at the bedside. The goal of this is to prevent exposure to COVID?19 in patients, family members, or visitors that may be infected without symptoms.

Is the expectation for “continuous, targeted use of eye protection” the same as universal masking?

No. Universal masking is required for all employees unless they are in a private office or eating/drinking, regardless of whether they are providing patient care or not. “Continuous, targeted use of eye protection” is specific to patient?facing activities, and it does not apply to activities or work that is not patient?facing.

What does patient?facing mean?

Patient facing activities means providing patient care or being the in the patient room/care space.

Do I need to wear eye protection if I am walking through an inpatient unit?

No, if you are not providing care to a patient or entering their room/care space, you do not have to wear eye protection, even if a patient may travel through the space.

Do I need to wear eye protection in a setting with bays?

Yes, because permanent barriers do not exist and there are likely to be a variety of unexpected interactions, for example a family member poking their head out and needing to talk.

Why is eye protection needed if patients are being tested for COVID?19?

As we move into the respiratory season, we anticipate an increase in respiratory illness including, COVID-19. Testing patients helps to identify those that have COVID-19 upon admission. Continuous targeted eye protection will be protective, should patient develop COVID while hospitalized. In addition, visitors are not tested, so this will be protective should a visitor have unrecognized COVID-19.

Where should providers without a “home” unit obtain their eye protection?

Eye protection can be obtained on any unit you are rounding on and can typically be found in isolation carts/cabinets and clean supply rooms. Once eye protection is obtained, it should be kept and reused.

Each staff member will be provided 1 set of goggles to wear and disinfect.  Some staff may already have eye protection and should continue to use it. Goggles should be reused as much as possible. The lenses will snap off and can be replaced if they become fogged or scratched.  It is the staff member’s responsibility to change their lenses as needed.

More information about continuous, targeted eye protection is available by here.

Weekly bulletins and policies are posted on Michigan Medicine Headlines at https://mmheadlines.org/covid-19-updates/.  Please bookmark this site and refer to it for the most up-to-date information. 

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