Key team members:

Sirisha Narayana, MD, Alvin Rajkomar, MD, Victoria Valencia, MPH, James Harrison, PhD MPH, Sumant Ranji, MD, Division of Hospital Medicine, UCSF.

Gurpreet Dhaliwal, MD, Department of Medicine, SF Veterans Affairs Hospital.

Background:

Time is money and timesheets are an essential procedure to appropriately calculate the number of hours employees have worked. Accurate and updated timesheets are legal documents and essential for protection in the event of potential litigation  over unpaid wages or missed meal breaks. If there is an issue with

Patients with serious illness and their families face difficult decisions when diseases progress, or when complications and hospitalizations occur. Patients’ wishes closer to the end of their life are not often known, communicated through the health system continuum or honored. This proposal is aimed at creating an electronic decision making tool that will help patients and families with planning for treatments and procedures related to advanced illnesses. It will also help in identifying surrogate decision makers and will develop an interface with Apex. 

The Apex interface to find information on advance directives and POLST forms is very basic and deficient when searching for surrogate decision makers. In several instances the information is inaccurate or incomplete, leaving providers in the very difficult position of trying to implement the best interventions for each patient. This effort usually requires a substantial investment of time and resources in the attempt to clarify important directives with the patients or to search for decision makers.

Aim:

1)      To reduce redundant and unnecessary  specimen collection from patients with a new order entry strategy

Background:

Efforts to improve physician education and patient safety often start by gathering data about when and where housestaff are engaging in direct patient care, administrative work, and learning activities. But the information from these self- or observer-reporting surveys is inherently unreliable, meaning that any conclusions based on its interpretation are faulty, and interventions to improve housestaff experience are unlikely to succeed.

Physician note-writing is an opportunity to teach, share ideas, and solidify clinical decision-making.  Yet as billing requirements and copy-paste functionality have increased in recent years, the utility of writing and reading these notes has declined steeply.  In addition to the dehumanizing "tyranny of clicks and auto-populated fields," (Rosenbaum, "Transitional Chaos or Enduring Harm?

There is increasing interest in the use of telehealth initiatives nationally.  Simultaneously, Medicare and other payors are increasingly recognizing that home-based care can be effective, cost-saving, and more person and family centered.  To date, opportunities for trainees to learn about home-based care are limited by current funding mechanisms.  For example, the primary care exception that allows residents to see patients in clinic and bill medicare, does not apply to the home setting.