Running head: HEALTH INFORMATION TECHNOLOGY

Health Information Technology University of Michigan Health System: Comprehensive

Wound Care Clinic
Jessica Ehinger
Siena Heights University

HEALTH INFORMATION TECHNOLOGY - UMHS

Introduction
The influential and impactful measures of the EPIC MiChart system is the required
information system technology of the University of Michigan Health System (UMHS). Working
directly in the ambulatory care clinic of Comprehensive Wound Care our healthcare team utilizes
this specific delivery system to aide in the direct progression of care. As integrated members of
the care team we have first-hand experience with this system, especially pertaining to the
adaptations the technology has deemed pertinent to our clinic. I will be discussing the impactful
influences and the delivery of our MiChart health information technology systems to a variety of
patients, covering the direct aspects correlated with everyday clinic flow and the technology
appropriate for wound care.
MiChart Background
The information system technology of the University of Michigan began in 2012, the UM Health System put into place MiChart an electronic health record (EHR) system purchased
from Epic Systems Corporation (University of Michigan, n.d. para. 1). The first phase of the
comprehensive electronic health information system known as MiChart goes online in the
emergency, outpatient, financial areas of University of Michigan Health System, and makes
possible a new Web-based patient portal (History University of Michigan, n.d., para.49). The
direct logistics of this health information system are presented as MiChart is changing the way
we create and access clinical information to care for our patients, conduct clinical research and
secure payment across the University of Michigan Health System. MiChart also has introduced
new ways for patients to take an active role in their health care, including the use of online
portals (University of Michigan, n.d., para. 3). The aspects discussed are vital components
presented in the Comprehensive Wound Care Clinic today. MiChart covers information system

HEALTH INFORMATION TECHNOLOGY - UMHS

technology in the forms of various tasks and applications we use to deliver care to our patients
on a daily basis.
Comprehensive Wound Care
Clinic Background
The Comprehensive Wound Care Clinic is a branch of the University of Michigan Health
System which implements and utilizes the MiChart information technology system. To truly
understand how it has influenced the care provided, it is important to understand what care is
delivered with the assistance of MiChart on a daily basis within the clinic. The true purpose of
the Comprehensive Wound Care Clinic is treatment of non-healing wounds can be challenging.
At the University of Michigan Comprehensive Wound Care Clinic, we are committed to treating
chronic wounds through a multidisciplinary approach, so you may heal and return to a normal
life. By bringing together specialists from all aspects of wound care into one location, you can
conveniently receive the best therapy options for wound healing (Wound Care Clinic, n.d.,
para.1). The options are endless and health information technology is right alongside to help
document, associate, and combine specialties to create the complete atmosphere for sophisticated
wound care treatments. Services include:

Wound evaluation and monitoring

Cleaning and bandaging

Advanced dressing selection

Pressure treatments, including compression wraps and negative-pressure wound therapy

Medications

Moisture treatments and tissue builders

Biological dressing/Skin substitutes

HEALTH INFORMATION TECHNOLOGY - UMHS

Physical Therapy, including electro-stimulation, a therapy that uses electric current to

trigger natural healing processes, and pulsed lavage, a treatment that uses pulsing water
to clean wounds,

Surgical therapies, if necessary, including removing unhealthy or dead tissue that

prohibits the healing of wounds, or wound biopsies to detect abnormal tissues or
infection,

Coordination of advanced surgical or medical care if indicated (Wound Care Clinic, n.d.,

para.6).
The successful integration of care and the background of MiChart create a profound
ambulatory care outlet for the patients referred by providers, self-researched and referred, and
individuals ready for successful wound healing techniques in a professional and comforting
environment.
MiChart Relationship
The MiChart information health technology system is vital, integrating clinic flow from
beginning to end. The utilization of accessing scheduling material, appointment times, and
patient after visit summaries is especially pertinent to our patients checking in and checking out
in the clinic. As a patient enters into the clinic MiChart allows the intake process to begin. The
individual can scribe vitals, document wound demographics from a progress photo to specific
measurements, and provide a detailed progress note of the visit with their physician, all with the
aided influence of Michart and its applications. Without MiChart and the templates developed by
that information system technology, the weekly or monthly visits many of our patients require
for their wound care could not be completed successfully.

HEALTH INFORMATION TECHNOLOGY - UMHS

The specific references made above are just the beginning to the information system
technologies that have shaped the Comprehensive Wound Care Clinic. The ever developing and
adapting MiChart guides the clinic and provides a means to how, when, where, and why we are
treating our patients. MiChart is the main health information technology outlet for the University
of Michigan Health System and it serves to produce an impactful and influential purpose,
allowing care to be specifically delivered to all patients that may visit the Comprehensive Wound
Care Clinic. Thoroughly discussing the aspects of MiChart and the attributes it has developed in
providing aide to the ambulatory clinic atmosphere is the main objective of this document.
Covering several aspects of the Comprehensive Wound Care Clinic and its physical therapy
department specifically, such as: wound documentation/photographing wound progress, implants
documentation (grafix, apligraf, and dermagraft), charge capture, wound supplies (wound
instructions summaries) and the progress versus treatment delivery performed in physical
therapy. Each of these MiChart health information specialties have shaped and will continually
add to the dynamics of how we operate the wound care clinic for the benefit of all patients
visiting the University of Michigan Health System.
Wound Documentation
A major aspect of our health information technology system coordinates our wound
documentation and wound photo progress note. Without the templates provided in smart phrases
and specific wound documentation features, what we do within the clinic would be very difficult.
With every specialty that visits our clinic there are different and elaborate ways each physician
prefers their documentation and utilization of MiChart. Every day of the week within the
Comprehensive Wound Care Clinic we are visited by several different specialties there to aide in
specific wound healing techniques. Monday through Friday the clinic is home to two nurse

HEALTH INFORMATION TECHNOLOGY - UMHS

practitioners specialized and certified in wound care. Tuesday we aide in the care of many
physical medicine and rehabilitation patients as a main provider is in clinic that day. Wednesday
through Friday physicians specialized in podiatry visit and we navigate the care of many diabetic
foot wounds. These aspects dictate the delivery of our care and the necessity that MiChart
performs for every patient within our clinic. Glandon, Slovensky, and Smaltz (2014) state
improving quality requires greater accuracy, reliability, and timeliness of clinical information at
the individual patient level (p.42). The provisions of MiChart have allowed the Comprehensive
Wound Care Clinic to do just that. Every patient checked in through MiChart automatically
receives what we call our wound care instruction form these forms aide in the documentation
portion of MiChart later assessed and completed by the physician.
Wound Photographing Documentation
An accessible aspect to our wound clinic specifically is that of documenting a patients
wound progress. Completing this task with the aide and influence of MiChart and the
technological advances of portable health information technology we can access MiChart on an
IPad. Taking the device from room to room to photograph and directly implant the image in the
specific patients chart. Without this development and influence from the health information
technology-MiChart having the visual aide within the progress note and media tabs would be
difficult. Often our providers are assessing and dictating while analyzing the images, they can
also begin a treatment plan before seeing the patient solely by reviewing previous images within
the MiChart notes and media applications. Often the delivery of care is made possible by the
images stored and can be viewed by all providers involved in that patients plan of care. Recently
implementing the use of an updated and clinic specific IPad, imaging the wounds on a busy
clinic day have improved. The health information technology before only allowed for USB

HEALTH INFORMATION TECHNOLOGY - UMHS

downloaded images, which meant care associates had to shuffle through hundreds of photos on a
cameras SD card. Which without security options and hard stops similar to the utilization of the
MiChart implemented IPad, mistakes could happen very easily. Often resulting in unidentified
images, an incorrect image in a patients chart, and no image at all. Which all of these aspects
result in unhappy physicians and incomplete wound care visit documentation in the progress note
application. Since the influence of the IPad with MiChart capabilities this issue has dissipated, it
is easy to navigate and identify appropriate patient. Snap a detailed image and save it directly
into a patients chart, allowing the physician to review it even before you step out of the exam
room designate by specific patient.
Wound Care Physical Therapy
Another added benefit to the Comprehensive Wound Care Clinic is that of our physical
therapy department. Without the delivery influences of MiChart the capabilities and rotation of
care could not be possible. Specifically, a role within the clinic aiding in the care provided by
wound care physical therapy MiChart is a crucial aspect. MiChart allows for reconciliation of
progress notes and documenting point of care requisitions to help decide whether a patient is in
need of a treatment or a physical therapy progress note. Treatment and progress note is the
description of the actions needed to complete the patients visit. Before a patient arrives clinic
associates have examined his or her chart, looking for specific dates that aid in deciding whether
a patients next visit is a treatment or a progress note. Without the strategic allowances of
MiCharts health information technology this process would be long and tedious. The production
of progress notes for a patient receiving physical therapy at the Comprehensive Wound Care
Clinic requires deciphering specific information previously charted. Information required is
stated as allergies, pain assessment, treatment details, dressing information, and Bates-Jenson

HEALTH INFORMATION TECHNOLOGY - UMHS

wound demographics. The delivery MiChart influences makes this process of information
gathering specific and easy to distinguish from all other documented progress notes. Overall
allowing for a patient to receive specific and individualized care per the severity of their wounds.
MiChart Charting Capabilities

Implants
The technology and implants applications developed by MiChart allows for the
Comprehensive Wound Clinic to offer and prescribe the benefits of artificially and naturally
occurring structures within the body to promote healing in the form of grafts. The documentation
technology of MiChart with the added sophistication of the implants application has allowed for
flawless and detailed wound progression charting. Any member of the care team can access the
template where MiChart has developed hard stops to prevent missed expiration dates and
documentation of all medications and solutions used during the procedure. This information
technology has shaped the dynamics of care recently within the Comprehensive Wound Care
Clinic preventing the occurrences of incorrect charting, missed expiration dates, and unidentified
solutions applied during the grafting process. The documentation information is then available
right from a patients snapshot, the information technology here has increased productivity and
allowed for complete documentation preventing medical mistakes resulting in patient harm.
Charge Capture
The Comprehensive Wound Care Clinic, as a member of the University of Michigan
Health System, is included in the ambulatory care setting. The revenue is based off the
procedures performed within the clinic on a daily basis. Actively as a member of the care team,
charge capture is a duty often performed utilizing the MiChart application. The health

HEALTH INFORMATION TECHNOLOGY - UMHS

information technology allows for the clinic to charge for services provided. Such as wound
debridement, specific dressing changes, and various clinic procedures. There was a specific time
when the MiChart charge capture option was not fully renovated and operational, yielding profits
from the clinic for some time. The healthcare information technology here was affecting the
clinic negatively, lacking several wound dressing supplies and compromising charting
correctively. Diagnostics were performed by MCIT, a component to successfully running a
healthcare information technology application and finally the charge capture was completed
correctly. This feature after a full renovation allowed for specific and correct charge capture of
every patient visit, once the wound care instruction forms were completed and released to clinic
staff. Allowing for all revenue to be received, there was no capability for lost revenue options
now that MiChart was updated correctly for the utilization of the Comprehensive Wound Care
Clinic. The system is running smoothly allowing for the delivery of the charge capture to
influence increased revenue for our clinic.
Medications & Orders
Another feature that has influenced and impacted the clinic through MiChart is that of
wound care supply ordering and documentation of a patients wound care instruction form. As
discussed previously every patient receives a wound care instruction form upon check-in. This
form allows communication between provider and clinic associates. With MiChart allowing for a
media application, the wound care instruction forms are compiled there for every patient. This
allows for reconciliation if ever to be a problem with wound care supplies, wound
documentation, or care provided during visit. It also yields the important information regarding
current wound care and exactly what that provider prescribes for that particular patient. Utilizing
the wound care instruction form within the meds and orders application in MiChart a care

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associate is able to specifically document wound specifics and supplies to meet that patients
need. Recently it has become a very detail-orientated process, the ordering facility many of our
patients utilize is MedEquip and wound supplies must match documentation. The information
technology here shapes and influences our care plans. Instructions need to be detailed and
include every aspect of the order, often orders are sent back because lack of information or
missing components pertinent to the patients wound demographics. This difficult back and forth
between media device and outside resource has molded and impacted our clinic specifically.
Documentation is critical and MiChart has created hard stops that can prevent the added
frustration when utilized correctively patients receive their supplies fully and without error.
Conclusion
The aspects discussed are the implications directly influenced and impacted by the
developments of the health information technology such as MiChart. Every dynamic of care
provided within the Comprehensive Wound Care Clinic was accessible by the developmental
impacts of health information technology. Without it our wound care documentation, implants
applications, specific ordering aspects, and physical therapy treatments would be obsolete. Thus,
the quality of care provided to every individual patient would be severely compromised and the
Comprehensive Wound Care Clinic within the branches of the University of Michigan Health
Systems would be neglecting the mission and vision of the institute. The University of Michigan
Health System specifies Our vision is to create the future of health care through discovery and
to become the national leader in health care, health care reform, biomedical innovation and
education (About the University, n.d., para.1). MiChart as an extension of the mission and
vision of the University of Michigan Health System has extended the delivery of care across a
numerous plethora of specialties both within inpatient and outpatient modalities. MiCharts

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influence and impactful measures allow for quality patient care and informational benefits to
continue to aide in the care of patients across the nation.

References
About University of Michigan Health System. (n.d.). Retrieved August 15, 2016, from
http://med.umich.edu/umhs/about-umhs/index.html
Glandon, G. L., Slovensky, D. J., & Smaltz, D. H. (2014). Information Systems for Healthcare
Management. Health Administration Press.
History of University of Michigan. (n.d.). Retrieved August 15, 2016, from
http://www.uofmhealth.org/about%2Bumhs/history
University of Michigan Medical School. (n.d.). Retrieved August 15, 2016, from
https://medicine.umich.edu/medschool/patient-care/improving-care/health-care
tactics/michartmyuofmhealthorg
Wound Care Clinic. (n.d). Retrieved August 15, 2016, from
http://www.uofmhealth.org/conditions-treatments/wound-care-clinic

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