Quarterly Meeting – 21 July 2012
PLEASE ATTACH RELEVANT HANDOUTS
People attending: Yves, Steven, Luis, Steve C, Andy (“Deuce”), Alex C, Dave, Andrew, John Day, Eric, Jobert, Ron, Jason, Wes
Facilitator: Ron // Minute-taker: Andrew
1. Medic Training – Dave/Eric Dave: TC set goal to evaluate candidates at end of August. At the rate medic trainees are coming into shift, does not seem on track to finish. Medic trainees should make an appt to talk to TC to make a plan Eric: Member training is coming up at the end of September. Ron: What are the issues in terms of not getting them signed off? Technical skills? Running the appt? Dave: Only 1 or 2 medics are shadowing when we have the opportunity to have 5 in a room. Look at the numbers Steve: Coming in sporadically rather than consistency also causes loss of knowledge. Jobert: “We’re definitely going to have new medics, right?” Why not allow medics to shadow into the member training. Dave: It’s a time commitment. Put’s addn’l pressure on the TC Eric: Special considerations, i.e. Matt’s hospitalization. Steve: Are we advising the group? Simply bringing it up? Making a plan Ron: Have a conversation now + have another conversation at the end of August to reiterate the commitment b/c training is coming. Jobert: Make sure enough medics are on shift. Ron: Compliance check for current medics as well. Dave: Consider assigning a mentor to each of the trainees. We’ll allow you to “choose”.
2. Cloud based database – Ron/Jason [PLEASE ATTACH SHEET ABOUT EMR’s PROs & CONs + changes in Client/Data flow] Jason: major pro – HIPAA compliance w/ off-site server (internet based) Ron: We’ve had system failures, and this is free! Capabilities: SOAP oriented charting, standardized client intake form, availability to all of clinic (facilitate intersection communication i.e. Med section referrals to GMHC), attach picture to charts, potential for providing test results. Would require computers in the room (potential distraction). There might be unnecessary fields + unsure about user-defined fields. Potential issues: internet die out, in-house stickering, CMR processing
Jason: discussed the sheet Dave: Quest integration – do we still get paper copies of results or notifications for abnormal results? Do we have to sift through all charts during the results shifts? Yves: Do we have a goal for today? Ron: Just to get the gist of how people are feeling about the change
Jobert: We should make this decision before next medic training to help set protocol. Also, research ways to obtain computers. John Day: Make sure to work with other collectives to train together. Stickers are probably something we can work around. Encourage real-time data entry
Steven: legibility + standardized layout are a plus as well. Reconsider whether we want to make lab results available to clients sans explanation. Are we going to continue using chart numbers? Dave: please acknowledge that this is a serious overhaul, not a casual part-by-part implementation Steven: We have paper charts as a backup
Jason: Demo-ed practice client Andrew: template in the notes section as a substitute for user-defined field? Jason: very possible, but maybe not searchable. Jobert: What happens if this service/company goes under? Something to consider/ talk to company about Jason: cloud can also check for allergies when prescribing. SOAP outline integrated. Assessment section has coded diagnoses but we don’t necessarily. Remember to “save” the chart as opposed to “signing” it (needs an MD) Yves: supports the switch – we should talk about producing a working group
Steve’s Motion (second by Eric/Jobert): GMHC supports proceeding forward with investigating and implementing an EMR system, as well as produce a working group that delivers a plan at the next quarterly meeting. Working group interest – Ron, Alex, Steven, Jobert, JD, Andrew Motion passes 0-0-11
3. Off shift tasks – Yves/Jason Yves: People either aren’t doing OST’s or aren’t doing stuff we’re aware of. 8-9 hour requirement by members. Puts a lot of weight on the coordinators. How do we enforce people completing OST’s. To facilitate OST’s, considering creating roles in particular areas of interest. Jason: Some people are doing things by themselves, which isolates the knowledge, which is troublesome if that person leaves. Yves: Also just consider it as a necessary spread of institutional knowledge and building of collectivity. Goal today is approving this creation of roles. How should we keep track and what consequences/impact should be imposed? Feedback about provided sheets of roles? John Day: Supports these roles – suggestions: 1) consider ways to bring other sections into this and 2) instill the ideal/attitude/culture/expectation of volunteering from the start not just on-shift, esp with the trainees Yves: These tasks aren’t necessarily things that have a specific timing but need to be done consistently and now there is a point person Jason: Some things are very essential – running out of medication Steven: Spreadsheet to provide transparency and codification of hours Ron: The thinking of having a point person is so that we don’t necessarily need to be tracked.
Dave: suggest someone to take care of cleaning donations. Also, reinforce that we’re trying to assign long-term roles Steve: Back store room organization should be a thing of its own. Largely in support of the list. Potentially add it to the bottom of the weekly shift list on the site?
Andrew: make the list available, but more as a monthly thing than weekly
Jason’s motion (Steve seconded): Empower coordinators to encourage members not engaged in OST’s to pick a role. Motion passes 1-0-11
4. GC resist guideline – John/Jason Jason: reviewed handout on treatment summary. Main point – culture-based test of cure due to increased cephalosporin-resistant gonorrhea. Involves urogenital swab for urethral. Throat and rectal are still swabs John Day: Quest does not seem to have urogenital swabs with medium available. Working with Jason from med section to produce protocol to culture known GC to test for resistance. Also, be wary of MSW due to risks regarding pregnancy/GC. Biggest concern – don’t miss the first case of resistant GC. Interest in moving forward from Women’s and Medic section. Jason: For 2)”alternative regiments” and 3)”suspected treatment failure” on the sheet, definitely TOC. 5)MSM to be discussed. Dave: NAAT as confirmatory + cultures for failures? Jason: NAAT possibly positive Dave: NAAT tends to be accurate w/in 3-4 days Steven: What’s the protocol for treatment failure? – Ans: we retreat at higher dose Steve’s motion (Eric seconded): Adopt NAAT’s as a test of cure, including MSM, unless person has physical discharge for culturing. John’s amendment: Culture before providing treatment if NAAT comes back positive. – friendly by motion maker/second John: 2.5” insertion + spin appears to be best urogenital swab technique Motion passes 0-0-12
5. BBC testing – Yves BBC would like to do van HIV testing on Sundays alongside the rest of clinic. Hope to get feedback + buy-in. Background: Goal is to reach out to young MSM of color and test them. We see a lot of resources at BFC tied up in the young college population. One extra BBC counselor on shift testing on the van. Minimal impact to GMHC shift. HPS currently asks people in line if their being seen with GMHC + 24 or younger. HPS counselor can also handle BBC clients. For HIV only (no GMHC), BBC protocol would accelerate b/c appts start with a fingerprick and completable in 20 minutes. Consider how we would also communicate this difference to clients (blood draw vs finger prick) + feedback about integration. Ron: HPS can deal with Dave: What’s HPS’s feedback?
Yves: Fine, but need to go to other sections and create a standardized/solid protocol. Needs to be brought to more meetings. Addn’l testing + addn’l training. HPS is recognizing that they are struggling and not necessarily being as possessive about HIV testing. Straw poll to support BBC testing on Sundays: 1-0-9
Jobert: supports, especially if it helps us with grants for both BBC and BFC, and obviously seeing more clients
6. Following protocol – Dave Dave: Stick to the protocol and make sure to record reasons for sending urine. Numbers show that sending extraneous urine tests outside of our protocol is returning negative results – expensive and stupid. We have protocols for a reason.
7. TCA v BCA – Jason BCA is supplied at a higher concentration and needs to be diluted. Should we order BCA or TCA? Eric: can do the dilution John: do we have an understanding of the grade of acid we’re looking at? Ans – only one seen on the site Jobert: In terms of liability, we should probably stick to using things as labeled. Jason’s motion (Dave second): Buy TCA over BCA because it is available at the appropriate dosage. Motion passes 1-0-9 with 2 present-not-voting
8. Tech needs – Ron Ron: With the help of Evan, we have developed a diagram of some section-specific technical wants/ needs. Now, we’re in the phase of developing specific needs and a strategy for obtaining needs so that Funding Committee has specifics. Our first obvious one would be cloud-based database. Jobert: Has this been brought to an ACCM? Yves: It’s handed over to CSC to be brought back to the ACCM. Ron: Anything else? Should we produce a group that formalizes it and prepares it by the 25th. We need stronger routers /a wireless network, laptops, a chosen operating system/interface. Windows may be necessary for imaging Jobert: A small label printer. John Day: consider placement installation of equipment given seasonal water leaks
9. Next QM – October 13 – Ron will reserve some sort of site – Tilden? Side note / informal update –
Steve: we should consider having a CSC update at each QM Eric: Church has been working with us to update the clinic floor plan. Church wants this taken on ASAP but the City of Berkeley is quite the hurdle. John Day: No discussion of cost per square foot. Jobert: Does the church have plans for funding?
John Day: The contractors will more or less be setting the rent. Eric: New zoning laws also need to be considered.
10. Announcement – Ron 11. Announcement – Dave: HAPPY BIRTHDAY, RON!!