SIMS

Transcription

SIMS

The SIMS Partnership
Transforming health care delivery
Transition to the Electronic Patient Record (EPR)
Successes and Lessons Learned
University Health Network
Tim Tripp
Diamond Watson-Hill
Katherine Henning
October 28, 2010
The
University Health Network (UHN)
Three Hospitals – One Vision
SIMS Partnership
Toronto Western Hospital
Toronto General Hospital
Princess Margaret Hospital
Fast Facts:
~750 beds
~257,000 patient days
~943,000 ambulatory visits
~10,856 employees
~3,488 students
~573 active staff
~1,741 volunteers
~ Budget $1.4 billion
Data Source: Fast facts Fiscal Year 2008/09, UHN Intranet
2
The
Agenda
SIMS Partnership
• UHN IM Background and Strategy
• EPR Adoption Model
• Medication Order Entry/Medication
Administration Record
• Electronic Discharge Summary
• Advanced Clinical Documentation
3
The
SIMS Partnership
UHN IM Background and Strategy
4
The
SIMS Partnership
Information Management Strategies at UHN
care@uhn
Integrating
Care
Taking
Charge
• Systems Integration
(PMH)
• Y2K readiness
• Customer service
• Systems reliability
•
•
•
•
•
Clinical content
CDS
Telecommunications
Internet/Intranet
Community
integration
Information
Enabling Care
•
•
•
•
•
Access
Patient Safety
Accountability
Patient Experience
Community Focus
IM Strategy 2014
Transforming Care
• Provide Safe, Quality Care
• Ensure Business Continuity
• Integrate Care Environments
IM Strategy 2014
Transforming Care
Information
Enabling
Care
2009
care@uhn
1995
1998
2000
2003
2008
2014
5
The
SIMS Partnership
Schematic of EPR Environment
Chart Locator
Inventory
TLC
PYXIS
Management
Pharmacy
Medispan
PHS
OTTR
Microbiology
CancerFacs
Finance
EPR
GRASP
Medical Imaging
ORSOS
Apollo Cath Lab
Blood Bank
Endoscopy
Scanned
Documents
Med2020
Nutrition
Labs
6
The
SIMS Partnership
EPR Development at UHN: A Snapshot
PHARMACY
STD CLINICAL DESKTOP
RADIOLOGY SYSTEM
ED WHITEBOARD
LABS & PATH
ECHO & ECG SYSTEM
DIAGNOSTIC ORDERS & RESULTS
SCHEDULING
EPR Cache
Upgrade
SCANNING
MEDICATION OE/MAR
PROBLEM LIST PILOT
eNOTES & ADV. CLIN. DOC.
2001
2002
2003
2004
2005
2006
2007
2008
2009
7
The
SIMS Partnership
UHN EPR Volume
• 2009 data:
Mysis Modules
Reg/ADT Accounts
Processed Visits (monthly avg)
Order Entry - Labs, Radiology, DT
Chart Review - Onsite Access
Chart Review - Remote Access
MOE MAR
Clinical Documentation
Physician Inbox
Privacy Lock Box
University Health Network
3+ Million
120,000
24,000 Procedures*


All Patients
Height, Weight, Allergy,
Admission Assessment


*2007 data
8
The
SIMS Partnership
The Future of EPR within UHN
• Upcoming initiatives:
–
–
–
–
–
Blood Transfusion CPOE
Advanced Clinical Documentation
RN/Allied Health Focussed Assessment
Facility Merge
Positive Patient Identification (ID)
• Opportunities:
– Problem List / Controlled Medical Vocabulary (CMV)
– eMPI – duplicate records
– Integrated Scheduling
9
The
SIMS Partnership
EPR Adoption Model
10
The
SIMS Partnership
EPR Adoption Model
11
The
SIMS Partnership
EPR Future Development
Certification
ARRA Hospital (Stage 2)
ARRA Ambulatory Certification
Downtime Data Access
SQL Reports Package
Integrated Medication Management
Rx Inventory
Retail OP Pharmacy
Med
Order Entry
Integrated Med
Reconciliation
Interactive Whiteboard
Pharmacy
Processing
Interoperability
PHI Portability
ePrescribing
Med
Admin
Integrated Pt. Education
Physician Doc
Immunizations
Monitor Data Capt
Evidence Based OS
Problem List
Lockbox: Patient; Visit; Problem
Sequestration
QuadraMed Integration
- Affinity
- QES
- Acuity Plus
Security
Services
Enterprise Auth
(LDAP)
Data Review
French Lang Support Enhance
Event
Scheduler
Radiology
Ancillary Services
Clinical Lab
Workflow Management
Patient Record Access Control
“Condo” Support
Bio-Surveillance
Department Solutions
Order Entry
CPOE
Template Mgmt
Clinical
Alert Engine
Patient Mgmt
Order Mgmt
CDS
Results Mgmt
M34 Postal Code
Configuration Content
- Core
- Rehab
Advanced Drug Knowledge Services
(Incl. Canadian Drug Files)
Controlled Medical Vocabulary / Clinical Concept Layer
12
Production Database
Caché
Shadow Database
The
SIMS Partnership
• Initial data mapping to a Controlled Medical Vocabulary –
Clinical Concepts
• Focus on Continuity of Care Document creation (CCD =
structured data = key to interoperability)
• Benefits:
– The foundation for interoperability and standardized reports that can be
shared across multiple sites
– The foundation for concurrent coded documentation based on the
codified procedures and terms utilized within the templates
13
The
Clinical Concept Layer (An Enabling Technology)
SIMS Partnership
Physician Doc (5.3)
SQL Reports
General Data Services / API’s
(3rd Party Content Conduit)
Interoperability (5.2)
SQL Queries
Clinical Concept Layer
CMV Data Map (5.2)
QCPR Customer Configuration “A”
Clinical Concept Observation Table
QCPR Customer Patient Data “A”
Caché Database
14
The
SIMS Partnership
• 2011:
– Fully codified problem list with CMV utilizing appropriate coding
schemes including the ability to transition to ICD-10
– Allows the clinician the ability to contribute and obtain a complete view
of the patients medical history across the continuum of care
• 2012:
– Implementation ready documentation templates based on best practice
reducing implementation time – quicker to production.
– Increased clinician satisfaction with efficient documentation tools
including ability to modify / create custom templates
– ProVation Order Sets: based on evidence & best practice
15
The
SIMS Partnership
Medication Order Entry / Medication
Administration Record
(MOE/MAR)
16
The
SIMS Partnership
Our Objectives
•
•
•
•
•
•
•
•
Eliminate medication transcription errors.
Ensure complete and legible medication orders.
Introduce clinical decision support alerts.
Eliminate pharmacy order entry and introduce online
verification of medication orders.
Introduce point-of-care medication administration
documentation.
Standardize order sets and order screens.
Reduce reliance on the paper health record.
Improve clinical processes and policies.
17
The
SIMS Partnership
100 % of eOrders are Legible & Complete
Paper Order Sheet
Nurse Medication Order Administration
Screen
100% of orders are complete
and legible
18
The SIMS Partnership
100% of Drugs and Order Screens
Are
Standardized
Standard Order Screen (Online)
 130 Common order and
Standard Order screens
 Over 10,000 typical
orders built
Pre-Printed Order Sheet (Paper)
Pre-Printed Order Sheet (Online)
19
The
SIMS Partnership
100% Standardized eMAR
Paper MAR
Electronic MAR
 100% Standardization of medication administration times
 No Transcription Required (for most medications)
 Immediate electronic access to MAR and medication history at the
point of care
20
The
SIMS Partnership
Results Realized
• UHN experience
published in 2006
• Provides insight into
implementation
processes, clinician
experiences and
overall successes of
the initiative
21
The
SIMS Partnership
Electronic Discharge Summary
22
The
SIMS Partnership
23
The
SIMS Partnership
24
The
SIMS Partnership
Evolution
Handwritten Dear Doctor Letter +/- Discharge
Summary
Electronic Dear Doctor Letter
Electronic Discharge Summary
Discharge summary with medication reconciliation
and decision support
25
The
Enable the creation of high quality
discharge summaries
SIMS Partnership
• Note completed prior to discharge
• Documents:
– Allergies presented with specific reaction
– All discharge medications with name, dose, frequency
and duration
– Results of normal and abnormal hospital investigations
pertinent to presenting complaints
– Arranged medical follow-up
– Pending laboratory results
• Uses a structured format vs. a letter style
26
What Is Necessary for High-Quality Discharge Summaries? van Walraven AJ of Medical Quality.1999
The
SIMS Partnership
Data Elements in UHN’s Discharge Summary
• Discharge and Diagnosis
–
–
–
–
–
–
Admission date and location*
Discharge Date*
Discharge Disposition
Most Responsible Diagnosis
Pre and Post Co-morbidities
Procedures
• Physician Notes
– Patient History
– Course in Hospital
• Labs (initial, latest)*
• Radiology*
– Allergies and
Medications
• Allergies and Reactions*
• Discharge Medications*
• e Prescription
– Follow-up Plan
• Lab Work
• Radiology
• Future Appointments
– Physicians to receive a
copy*
* Pre-populated from EPR
27
The
SIMS Partnership
Electronic
Patient Record
Family MD
HL7
Patient Demographics
ADT & Allergies
Completed note
Data repository
Medications
Labs, Radiology
Discharge Summary
Application
28
The
SIMS Partnership
29
The
SIMS Partnership
30
The
SIMS Partnership
31
The
SIMS Partnership
32
The
SIMS Partnership
Results
• Currently, 70% of discharge summaries
produced using the electronic discharge
summary
• Significant savings on
transcription achieved with this
implementation
• Technical issues currently being addressed
to allow us to move to 100%
33
The
SIMS Partnership
Expanding the use of electronic synoptic
notes at UHN
34
The
SIMS Partnership
Current Use of Electronic Synoptic Notes at UHN
UHN is actively promoting the adoption and
implementation of synoptic notes as a standard to
improve the quality of care
eCancer
Tools
Depict
Surgical
Synoptic
Patient
Note
Operative
Note
Bladder
Kidney
Testes
EPR
CPAC
Ovarian
Surgical
Note
CAIS
Clinical
Anaesthesia
Note
Data repositories & reporting
Clinical Research
UHN Registries
e.g., staging, tissue banks
Procedure
Note
Legend
In Use
In Development
AFP Innovation Fund
Bronchoscopy
Upper GI endoscopy
Colonoscopy
Cystoscopy
Interdisciplinary care teams
UHN extended care team
Referring/ Family physician
CPAC
Other provincial
jurisdictions
Provincial
Registries
35
The
SIMS Partnership
Benefits of an Ambulatory Synoptic Note
Patient
Care
• Seamless flow of
information across
the continuum of
care
Acces
s to
realtime
test
results
Struct
ured
reporti
ng
Pointofcare
docum
entatio
n
Advan
ced
Clinica
l
Docu
mentat
ion
Stand
ard
forms
+
templa
tes
Integr
ation
with
resear
ch
Integr
ation
with
referra
ls
Research
• Structured data
capture
• Clinical trials
information tracking
Education
• Documentation standards
for clinical notes
• Teaching and training tool
for medical students,
residents, and fellows
36
The
SIMS Partnership
Surgical Synoptic Note Information Flow
Physicians access the
Surgical Synoptic
Patient Note through
the EPR
EPR
Inbound HL7
Web-based
synoptic note
application
Clinic Note discrete data
elements
Outbound HL7
Patient Demographics
ADT
Notes are auto-faxed
to community
physicians
SNOMED CT
vocabulary
database
37
The
SIMS Partnership
Surgical Synoptic Note – History of Present Illness
Benefits
• Single streamlined
process for capturing
consult and clinic
information
• Smart navigation shows
only pertinent servicespecific templates
• Automated import of
patient demographics
data saves time
• Powerful communication
tool linking acute care
and primary care
physicians; auto-faxing of
patient notes to primary
care physicians
• EPR integration – note
available real-time in
chart review
• Eliminate dictation and
transcription
38
The
SIMS Partnership
Surgical Synoptic Note - Annotation Tool
• Clinicians often
use freehand
drawings to
supplement their
clinical
documentation
and
communications
with patients
• The ambulatory
documentation
tool provides
clinicians with
the ability to
draw and store
these drawings as
part of the
clinical record
39
The
SIMS Partnership
Surgical Synoptic Note - SNOMED Integration
•
•
•
The Surgical Synoptic Note project uses SNOMED
CT to model diagnoses, physical exams, chief
complaints, procedures, diagnostic tests etc.
Over 1300 terms have been directly mapped to
SNOMED CT
The application’s search functionality uses special
ranking algorithms to provide users with a simple,
intelligent interface for accessing clinical concepts
40
The
SIMS Partnership
Surgical Synoptic Note Outcomes
The application was developed to provide 4 ambulatory surgical clinics
(General Surgery, Orthopaedics, Plastics, and Urology) with a method to
document consultation and follow-up notes.
System went live on June 25th, 2009.
Surgical Synoptic Patient Note is a patient-focused initiative that offers:
Patient Benefits
•
Supports better-informed, safer and more
timely clinical decisions
•
Reduces the delay between surgical
documentation completion and
availability
in EPR chart review
•
•
Provider Benefits
•
Assists healthcare professionals to make
critical decisions on patient treatment and
follow-up effectively and efficiently
•
Standardization and improvement in the
quality of notes
System/Sector Benefits
•
Greatly improves access to usable
electronic data for patient care,
research and reporting, and
organizational planning
•
Provide structured evidence-based
medical content to ensure optimal
patient outcomes
•
Improves quality of care by adhering to
best practice guidelines, improving
disease management and reducing
medical errors
Reduces time and effort to access patient
information from multiple sources
•
•
A centralized electronic library of highquality clinical templates
•
Electronic tool allows documentation to
be captured by clinicians at the point of
service
A training and teaching tool for medical
students, residents and fellows; guides
them through the consultation and followup process
Hard dollar savings derived from the
elimination of dictation and transcription
•
Synoptic data captured as part of routine
standard care can be easily extrapolated
for secondary use:
•
Improved communication across the
continuum of care
– No transcription or scanning
delay after documents are
completed
– Outcomes and organizational
planning
– Research
•
Direct data capture will improve the
quality of data transferred to cancer
registries, tissue banks, and research
databases
41
The
SIMS Partnership
Surgical Synoptic Note – The Road Ahead
• Complete functional enhancements:
– Automated billing
– Lab and radiology results pulled
from EPR
– Physician to-do list
• Enhance integration with EPR:
– Send patient vitals to EPR via an
HL7 assessment interface
• Expand to other services and areas at
UHN
– Surgical and non-surgical, inpatient,
ambulatory etc.
• Align with the EPR clinical
documentation roadmap
42
The
SIMS Partnership
Synoptic Reporting – Emerging Opportunities
Information Flow
Future Benefits of Synoptic Reporting to Provincial Healthcare
Expansion of Synoptic Reporting Benefits
Ancillary
Data &
Services
Existing Dataflows Supported by the Surgical Synoptic
Patient Notes
Surgeon enters data, at the point
of care, into a synoptic template
that captures data in a structured
& standardized manner:
·
·
·
·
·
·
Patient demographics
Chief complaint
Past medical history
Physical assessment
Impression & Plan
Meds & Allergies
Clinic Note
Faxed
Referring
Physician
CCO Data
Repositories
Research
Surgeon
H
I
A
L
L
R
S
Health Information
Data Warehouse
EHR Data
& Services
Local Database
Clinical Trials
EPR
Registries
Data &
Services
SNOMED CT
Tissue Banks
Benefits
Benefits
Benefits
·
·
·
·
· Direct data capture improves the quality
of data sent to cancer registries, tissue
banks, & research databases
· Allows for accurate collection &
comparison of cancer data which
directly impacts cancer screening &
treatment protocols
· Biobanking – allows for integration of
clinical and biological profiles
· Accurate diagnoses & staging to guide
treatment planning & to make informed
patient care decisions
· Structured reports have high integrity
as a research tool
· Data available for surgical outcomes
studies & information surrounding
variations on practice and outcomes
· Data can be used to monitor the quality
of reporting in Ontario & to support
service planning & research
· Synoptic reports will enable the
collection of surgical, clinical, pathology
& outcomes data for quality monitoring
& improvement
· Clinicians get real-time practice
comparisons to provincial averages
· Integration of data with provincial EHRs
·
·
·
·
Structured data helps establish standards of care & reduces medical errors
Positively influences practice as new techniques and information are rapidly disseminated
Seamless integration of clinical best practice guidelines
Synoptic template is an education tool that reminds clinicians of the steps & details of the event
(reason for referral, surgery, etc.) for optimal quality control
Synoptic reporting enhances the clinicians & care teams’ ability to measure & monitor the
process of care and assess impact on outcomes
Improved accuracy & completeness of clinical documentation
Improved workflow by a) auto faxing clinic notes to referring physicians & b) making information
immediately available to other care providers with access to the EPR
Eliminates costly dictation, transcription, and scanning expenses
43
The
SIMS Partnership
The Future
• UHN’s goal is to have complete and accurate clinical documentation to enhance
patient care and facilitate the reporting of vital health information that is critical to
optimal management of Ontario’s healthcare system
• The electronic health record of the future will be one that requires structured data
as a standard of practice
UHN
• Providing clinicians
Stage 6
with the tools to
Surgical Synoptic Patient Note,
Discharge Summary, OR Notes
deliver outstanding
patient care is an
Stage 4
eMOE, Allergies documentation,
essential part of
Insight alerts
UHN’s Information
Stage 3
Management
RIS PACS, eTriage, eMAR,
Drug-drug Checking
Strategy and the
reason why UHN is
Stage 2
a Canadian leader in
Digital documents, QCPR
EMR adoption
Data from HIMSS Analytics 2010
Stage 1
44
Pharmacy, Radiology & Lab Info
• Clinical Outcomes
Systems

SIMS

Transcription

Similar documents

Bald is beautiful - South Florida Business Journal

Arlies Cottage, Arlies Lane, Stalybridge, Greater Manchester, United

J.. first-hand eXJl.erience

We`ll have you up and running in minutes... Parent

We`d need another five staff without SIMS!

SIMS makes the grade in Portugal

Moving SIMS into the Classroom

CSM - SIMS, Inc.

Therapeutic Use of Life Simulation Games for People

Sunday, November 10, 2013 - Temple Of Deliverance HCG