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The Rounds

Monkeypox Overview
What is Monkeypox?
Monkeypox is a rare disease caused by infection with the orthopox virus. 
What are the symptoms?
People with monkeypox get a maculopapular vesicular rash and may be painful or itchy. It can appear on the face, mouth, hands, feet, chest, genitals or anus. The illness typically lasts 2-4 weeks.
Symptoms may include:
  • Fever
  • Chills and exhaustion
  • Swollen lymph nodes
  • Muscle aches and back aches
  • Headache
How is Monkeypox spread?
  • Direct contact with monkeypox rash or respiratory secretions from a person with monkeypox. 
  • Contact with objects, and surfaces that have been used by a person with monkeypox.  
I have symptoms, what should I do?
  • If you experience symptoms of Monkeypox illness (fever, rash, swollen lymph nodes and chills) please isolate at home, inform your school’s Occupational Health and contact your healthcare provider for testing considerations.  
  • Please do not come to work if you develop symptoms until your Occupational Health clears you to return to work.
Swabbing of sores is sent to the lab for PCR testing.

Antivirals, such as tecovirimat (TPOXX), may be recommended for people who are more likely to get severely ill, like patients with weakened immune 
The monkeypox vaccine JYNNEOS—can prevent monkeypox in people who had a significant exposure to the virus.
Harris County Public Health recommends vaccination for people who have had an exposure to monkeypox and in people who are at risk for contracting monkeypox, including people who: 
  • Have been identified by public health officials as a contact of someone with monkeypox,
  • Know one of their sexual partners in the past two weeks has been diagnosed with monkeypox, or
  • Have had multiple sexual partners in the past two weeks in an area with known monkeypox 

How to order JYNNEOS.


Physician IT/Informatics Satisfaction Survey Results 
The Physician IT/Informatics Satisfaction Survey held in March 2022 had a total of 341 responses, consisting of 207 physicians, 88 physician residents or fellows, and 46 advanced practice providers. 
The survey asked respondents to rate factors such as the EHR’s efficiency, functionality, impact on care and so on. Harris Health scored really well; a Net EHR Experience Score of 60 which puts the organization in the 94th percentile for EHR satisfaction.
Harris Health clinicians overall scored slightly higher than the collaborative average in their agreement that their clinical practice is enhanced through EHR use. A high percentage of users agree that they are receiving EHR support in these areas: timely EHR support, have a voice, fixes are timely, changes well communicated, and IT improving EHR.
Based on the results, the following have been determined as opportunities for improvement: 
Refine best practice alerts in the system as well as optimize the management of order sets
  • Alerts User Committee (formed in January)
Increase adoption of personalization tools
  • Leveraging Signal Data
Focus on ongoing education
  • Ambulatory site visits to provide efficiency tips
  • Monthly Newsletter Provider Efficiency Tips 
Improve Dictation options 
  • 3M Fluency Direct (Currently in testing phase with plan to go live later this month)
  • Mobile Dictation to be implemented after going live with Fluency Direct Microphones 

New Order Sets and Epic Upgrade Preview

The development of new order sets supports our journey to becoming a High Reliability Organization (HRO), with the goal of zero patient harm. 
  1. ​A new Tracheostomy / Laryngectomy Order Set is available to clinicians in Epic, which outlines the principles of management for patients who have a new or existing tracheostomy or laryngectomy.

    Nursing and Respiratory Therapy interventions as well as consult orders have been pre-selected by default to provide ease and efficiency for the clinician when placing these orders.

    The attached provides a graphical overview of the new Tracheostomy / Laryngectomy Order Set.

  2. There also is an order for Patient Own Medication that providers must document as part of the medication reconciliation process. See Policy 521.00 Patient Medications Brought From Home.

  3. The next Epic Upgrade is scheduled for Sunday, Dec. 4, 2022.

    Available now through Friday, Sept. 2, the upgraded version of Epic is available for review and pre-testing through Citrix Epic Upgrade icon (instructions below). Please take this opportunity to look over the new version and provide feedback to your Epic support team.

    If you are unable to log into the preview environment, please submit a Cherwell ticket to the IT Service Desk.

    Important Upgrade Information
    Please see documents for features coming with the upgrade in the Epic Upgrade Presentation folders on the Virtual User Acceptance Testing site under each Epic group.

    To access the Epic Upgrade environment for review:
    a) Click on the link to access Citrix.*
    b) Click on APPS icon and then Categories.
    c) Perform Testing from the Citrix Epic Upgrade folder, using the Epic Upgrade icon. 


*If you have trouble, right click and copy the hyperlink to the address bar.
Clinical Documentation Improvement Tip
Best Documentation Practices: 
  • Specify the degree of Malnutrition (Mild, Moderate, Severe)
  • Review nutritional diagnoses in dietary consults
  • Document nutritional diagnoses and treatment throughout the record (unable to code from dietitian consults)
  • Include evidence-based criteria (i.e., ASPEN to include muscle wasting, grip strength, fluid accumulation, % weight loss)
Remember to clinically validate your diagnosis within the medical record with justifiable, supported clinical criteria.

For a comparative example and other helpful information, please view the attached slide
Provider Kudos 
Exceptional comments from our patients about our doctors
Patrick McColloster, MD 
Family Practice
Casa De Amigos
Baylor College of Medicine

“I love Casa De Amigos Clinic, and I really, really appreciate and love Dr. Mccolloster. He's a very good doctor and he's very thorough. I've been in his care for 16 years and I don't regret any year that I've been with him. Thank you.”

Anita Lakhu Rohra, MD
3A / Emergency Center
Ben Taub Hospital
Baylor College of Medicine 
“Dr. Rohra from ER treated me very well. If it wasn't for her, I could have died. The team of doctors who treated me was excellent.”​

Amit Mayur Mehta, MD
Emergency Center
Lyndon B. Johnson Hospital
McGovern Medical School at UTHealth
“Dr. Amit Mehta is the best. He is very caring and understanding! 

Thank you for your service!