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CLINT Implementation Phases and Functionalities

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Page 1: CLINT Functionalities.doc

CLINT Implementation

Phases and Functionalities

Richard Kremsdorf, M.D.CHW Information Officer for Medical Informatics

Susan Perry, R.N.

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DRAFT

CHW Information Officer for Enterprise Clinical Applications

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FUNCTIONALITIES BY WORK PROCESSES........................................................................................5

RESULTS RETRIEVAL....................................................................................................................................5CLINICAL CARE DELIVERY AND DOCUMENTATION.....................................................................................5INPATIENT CARE MANAGEMENT..................................................................................................................5DEPARTMENTAL OPERATIONS......................................................................................................................5ADMINISTRATIVE PROCEDURES....................................................................................................................5

FUNCTIONALITIES BY PHASES.............................................................................................................6

PHASE I.........................................................................................................................................................6Phase IA....................................................................................................................................................6Phase IB....................................................................................................................................................6Phase IC...................................................................................................................................................6

PHASE II........................................................................................................................................................7Phase IIA..................................................................................................................................................7Phase IIB..................................................................................................................................................7Phase IIC..................................................................................................................................................7

PHASE III.......................................................................................................................................................7

PHASE IA.....................................................................................................................................................10

RESULTS RETRIEVAL..................................................................................................................................10(2)Lab results review by encounter........................................................................................................10(9)Radiology transcribed results............................................................................................................11(3)Microbiology results review..............................................................................................................11(4)Blood gas results review....................................................................................................................12

CLINICAL CARE DELIVERY AND DOCUMENTATION...................................................................................13(84)Printed medication administration records(MARs)........................................................................13(15)Transcription...................................................................................................................................13(59)Physician patient list........................................................................................................................14

DEPARTMENTAL OPERATIONS....................................................................................................................15(1)Laboratory departmental functions...................................................................................................15(34)Pharmacy departmental functions...................................................................................................15(10)Radiology departmental functions...................................................................................................16

ADMINISTRATIVE PROCEDURES..................................................................................................................17(83)ADT(Admission, Discharge, Transfer) system focused on the needs of the acute care setting (hospital, attached ambulatory clinics, attached ambulatory surgery).................................................17(53)Order entry to all departments........................................................................................................17

PHASE IB......................................................................................................................................................20

RESULTS RETRIEVAL..................................................................................................................................20(57)Physician Rounds Report.................................................................................................................20(5)Longitudinal lab results review.........................................................................................................20(11)Longitudinal radiology results.........................................................................................................21

CLINICAL CARE DELIVERY AND DOCUMENTATION...................................................................................22(20)Bedside numbers..............................................................................................................................22(35)Medication allergies, height, weight................................................................................................23(33)Medication profile............................................................................................................................23(82)Medication vending machines.........................................................................................................24

INPATIENT CARE MANAGEMENT................................................................................................................24(38)Drug utilization evaluation studies..................................................................................................24(44)Case finder reports..........................................................................................................................25

ADMINISTRATIVE PROCEDURES..................................................................................................................26(63)Electronic and printed Order Sets for common clinical pathways/standard orders.......................26

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PHASE IC.....................................................................................................................................................27

CLINICAL CARE DELIVERY AND DOCUMENTATION...................................................................................27(39)Medication charting.........................................................................................................................27(21)Clinical management flowsheets.....................................................................................................27

INPATIENT CARE MANAGEMENT................................................................................................................28(22)Discharge planning screens.............................................................................................................28

ADMINISTRATIVE PROCEDURES..................................................................................................................29(55)Electronic communication among all clinical caregivers...............................................................29

PHASE IIA....................................................................................................................................................30

RESULTS RETRIEVAL..................................................................................................................................30(6)Lab order status available on HIS.....................................................................................................30(7)Blood bank product availability........................................................................................................30

INPATIENT CARE MANAGEMENT................................................................................................................31(28)Microbiology/antimicrobial therapy alerts.....................................................................................31

DEPARTMENTAL OPERATIONS....................................................................................................................31(16)Electronic report distribution..........................................................................................................31(36)Alerts to Pharmacist........................................................................................................................32

ADMINISTRATIVE PROCEDURES..................................................................................................................32(60)Physician phone directory...............................................................................................................32(56)Web access for caregivers...............................................................................................................33

PHASE IIB....................................................................................................................................................35

RESULTS RETRIEVAL..................................................................................................................................35(12)Images of digital modalities(CT, MRI, Ultrasound, Nuclear Medicine).........................................35

CLINICAL CARE DELIVERY AND DOCUMENTATION...................................................................................35(32)ICU/OR/OB monitor to computer download...................................................................................35(23)Nursing physical assessment...........................................................................................................36(19)Remote access from MD home, office..............................................................................................36

INPATIENT CARE MANAGEMENT................................................................................................................37(37)Drug-lab alerts................................................................................................................................37

ADMINISTRATIVE PROCEDURES..................................................................................................................37(65)Electronic file cabinet for protocols, schedules, standard documents, policies and procedures....37(64)Review of OR, Cath Lab, PT, Endoscopy (et al.) schedules............................................................38(54)Cross-continuum patient registration system..................................................................................38(61)MPI across >1 site of care..............................................................................................................39(58)Housestaff sign-out cards/Problem List..........................................................................................40

PHASE IIC....................................................................................................................................................41

RESULTS RETRIEVAL..................................................................................................................................41(18)Pathology transcribed results..........................................................................................................41

CLINICAL CARE DELIVERY AND DOCUMENTATION...................................................................................41(24)Patient careplans/pathways.............................................................................................................41(25)Documentation of patient care activities and interventions by nursing..........................................42(26)Documentation of all ancillary caregiver interventions..................................................................42

INPATIENT CARE MANAGEMENT................................................................................................................43(8)Critical lab alerts...............................................................................................................................43

DEPARTMENTAL OPERATIONS....................................................................................................................43(17)Electronic Signature........................................................................................................................43

PHASE III.....................................................................................................................................................45

CLINICAL CARE DELIVERY AND DOCUMENTATION...................................................................................45(31)Anesthesia record............................................................................................................................45(13)Telemedicine:CME..........................................................................................................................45(73)Telemedicine: Remote diagnostics...................................................................................................46

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INPATIENT CARE MANAGEMENT................................................................................................................46(27)Alerts to RNs and MDs....................................................................................................................46(81)Physician order entry.......................................................................................................................47

DEPARTMENTAL OPERATIONS....................................................................................................................47(14)Digital radiography including PACS..............................................................................................47

ASSUMPTIONS...........................................................................................................................................49

SUPPORT RELATED......................................................................................................................................49TECHNICAL RELATED.................................................................................................................................49

INDEX BY FUNCTIONALITY NAME....................................................................................................50

INDEX BY FUNCTIONALITY NUMBER...............................................................................................52

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Functionalities by Work Processes

Results Retrieval

Clinical decisions commonly depend on the results of diagnostic testing. Such information needs to be pervasively available so that caregivers can make the most appropriate and expeditious decisions wherever they are physically located, unencumbered by competition for the physical asset(the chart), and with data presented in the way that optimizes understanding of the clinical problem. Data from prior encounters enhances understanding of the patient’s clinical trajectory, highlights potentially significant issues, and reduces duplicative evaluations.

Clinical Care Delivery and Documentation

Patient care is a Team activity. Consequently, sharing information among, and coordinating the activities of, the caregiver team is essential for clinical effectiveness. The information with the greatest impact is that which is used by the most people, unambiguous in its significance, and directly needed for the most important clinical decisions. Gathering all the data needed for a clinical judgement and presenting it optimally results in greater clinical effectiveness.

Inpatient Care Management

While primary caregivers focus on the patient in front of them, others look at a larger population, ensuring that the resources and needed attention are applied where most needed. Identifying those patients where there is likely to be a need for more help, more expertise, or there is an opportunity to improve the effectiveness of care is a key way to leverage data that has been gathered in the course of Clinical Care Delivery. Fundamentally, it is a way to make sure no one “falls through the cracks” and that resources are focused on those in greatest need.

Departmental Operations

Bedside patient care depends on the support of many people and systems outside the patient room. These departments are “high transaction volume” environments where high service levels are essential for the rest of patient care to be efficient. Happily, extensive automation has already occurred in these areas, though gaps remain.

Administrative Procedures

Many work processes must occur to enable and implement direct patient care. They are closely related to patient satisfaction and efficiency of operation of the clinical staff.

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Functionalities by Phases

The CLINT Functionalities were defined and prioritized by broad-based discussions throughout CHW among more than 250 caregivers, technicians, administrative staff, managers, and executives. Then, extensive Assessments of these Functionalities were done throughout CHW through contacts with over 200 CHW caregivers. The Tiers from the Discussions and the Learnings from the Assessments have been combined into the Phases which are described in this document. The CLINT Phases form a logical sequence that describes how an organization can implement the CLINT Functionalities—getting the most value and least disruption up front and building on the foundation of the earlier Phases.

Phase IEstablishes infrastructure and incorporates workflow improvements for the high volume, high value clinical transactions…

Phase IAThe most basic administrative and clinical transactions have to work before more complex

workflows can be affected. These are high volume and high value clinical transactions, which must be done, so that if there are inefficiencies the impact will be felt in delayed or ineffective clinical decisions, staffing to offset the inefficiencies, or poor service levels.

The effective accomplishment of these Functionalities also establishes the basis for doing more complicated Functionalities, by getting devices in place where caregivers can get to them, deploying passwords and familiarity with the system, and creating the habit that “the computer is where you look for information.”

Phase IBThese Functionalities get more deeply into caregivers’ workflows, focusing on those tasks that can

be cumbersome to do manually and whose workflow can be relatively straightforwardly improved. For example, data which is sought by many different personnel in the hospital, and which therefore can have a huge impact on clinical decision-making, is put into electronic form so it can be made available in different ways, each optimized to serve a different purpose. Calculations are done automatically, improving availability, accuracy and efficiency.

Phase ICFunctionalities requiring and supporting inter-departmental collaboration are added here, building

new ways to do work. Paper Medication Administration Records go away, leading to much more flexibility in displaying the effects of medication therapy using Clinical Management Flowsheets and enabling even better medication monitoring.

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Phase IIBroadens the range of caregiver activities included and builds more sophistication and complexity into the tools…

Phase IIAThe electronically enabled caregiver at this point can no longer accept paper-based methods, so

the range of tasks is broadened, with the easier extensions of the electronic capabilities established in Phase I.

Phase IIBMore complex and more technically challenging work processes are tackled here. Many more

decisions about clinical processes, such as the degree of detail required for documentation, are made. Multiple organizational groups and technologies interact, which is harder to make work than in earlier Phases, but builds on existing knowledge and trust.

Phase IICThe remainder of the bedside and paper workflow is captured and integrated, tying in the new pieces with all that has already been done.

Phase IIITackles the more challenging work processes in more specialized environments…

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Phases Work Process Functionality

IA Results Retrieval Lab results review by encounterRadiology transcribed resultsMicrobiology results reviewBlood gas results review

Clinical Care Delivery and Documentation

Printed medication administration recordsTranscriptionPhysician patient list

Departmental Operations Laboratory departmental functionsPharmacy departmental functionsRadiology departmental functions

Administrative Procedures ADT(Admission, Discharge, Transfer) systemOrder entry to all departments

IB Results Retrieval Physician Rounds ReportLongitudinal lab results reviewLongitudinal radiology results

Clinical Care Delivery and Documentation

Bedside numbers(vitals, I&O, weights, oximetry, …)Medication allergiesMedication profileMedication vending machines

Inpatient Care Management Drug utilization evaluation studies

Casefinder reports

Administrative Procedures Electronic and printed Order Sets for common clinical pathways/standard orders

IC Clinical Care Delivery and Documentation

Medication chartingClinical management flowsheets

Inpatient Care Management Discharge planning screens

Administrative Procedures Electronic communication among all clinical caregivers

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Phases Work Process Functionality

IIA Results Retrieval Lab order status available on HISBlood bank product status

Inpatient Care Management Microbiology/Antimicrobial Therapy Alerts

Departmental Operations Electronic report distributionAlerts to Pharmacist

Administrative Procedures Physician phone directoryWeb access for caregivers(including Medline)

IIB Results Retrieval Images of digital modalities(CT,MR, US, NM)

Clinical Care Delivery and Documentation

ICU/OR/OB monitor to computer downloadNursing physical assessmentRemote access from MD home, office

Inpatient Care Management Drug-lab alerts

Administrative Procedures Electronic file cabinet for protocols, schedules, Review of OR, Cath Lab, PT schedulesCross-continuum patient registration systemMPI across >1 site of careHousestaff sign-out cards/Problem List

IIC Results Retrieval Pathology transcribed results

Clinical Care Delivery and Documentation

Patient careplans/pathwaysDocumentation of nursing interventionsDocumentation of all ancillary caregiver interventions

Inpatient Care Management Critical lab alerts

Departmental Operations Electronic Signature

III Clinical Care Delivery and Documentation

Anesthesia recordTelemedicine: CMETelemedicine: Remote diagnostics

Inpatient Care Management Alerts to RNs and MDsPhysician order entry

Departmental Operations Digital radiography

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Phase IA

Results Retrieval

(2)Lab results review by encounter

Description

1. All disciplines of clinicians use computers to retrieve the latest lab results, on any patient from any patient care area

2. Each result arrives via electronic interface to laboratory system

3. Results are grouped by billing encounter

4. Abnormal values are flagged in some way

5. Data must be presented in format acceptable to clinicians

6. Data elements being compared to establish trends are displayed contiguously, either up or down

7. Results can be displayed in clinically meaningful groups, not only in the orderable panels

8. Previous results for this encounter must be routinely displayed to facilitate recognition of trends in the data

9. Data is retained on-line for at least 6 months

10. Preferably, data should be discrete and in a standard coded format

Primary Users

1. Physicians

2. Nurses

3. Pharmacists

Rationale

1. Improves availability of information while reducing paper production and distribution costs

2. Improves both caregiver and lab efficiency by reducing phone calls to lab

Dependencies

1. Departmental lab computer system

2. Interface from Departmental lab computer system to HIS

Barriers

1. Device availability

2. Display format which is effective for clinical decision-making

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(9)Radiology transcribed results

Description

1. Transcribed reports describing the findings of all imaging studies are available on-line for review within a reasonable period of time(i.e. <24 hours)

2. Status of ordered studies can be reviewed on-line

3. Previous studies are listed

4. Preliminary versus Final status is visible

5. Electronic signature of reports

Primary Users

1. Physicians

2. Nurses

3. Radiology fileroom staff

4. Radiology Techs

5. Radiologists

6. Respiratory Therapists

Rationale

1. Reduces phone call and trips to Radiology department

2. Facilitates more complete understanding of patient condition

Dependencies

1. Radiology Departmental Functions

Barriers

1. Inadequate turnaround time to meet clinicians’ needs

2. Many process steps to report availability causes delays

(3)Microbiology results review

Description

1. Clinicians use computer to retrieve results of cultures, antimicrobial sensitivity testing, and Minimal inhibitory concentration testing

2. Specimen type, site, and collection time, and method of testing clearly identified

3. Date culture turned positive indicated for critical specimens e.g. blood and CSF

4. Primary Users

5. Physicians

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6. Infection Control nurse

7. Pharmacists

Rationale

1. Time sensitive information that requires frequent review must be available on-line to reduce time until clinical care is altered based upon culture results

2. Is separate from Lab Results Review because of extra complexity

Dependencies

1. Lab results review by encounter

Barriers

1. Complexity of result mapping

(4)Blood gas results review

Description

1. Caregivers should be able to find current and recent studies expeditiously

2. Results should indicate amount of supplemental oxygen in use

3. When patient is receiving mechanical ventilatory assistance, ventilator settings should be included

Primary Users

1. Physicians

2. Nurses

3. Respiratory therapists

Rationale

1. Blood gas studies commonly indicate a critical patient condition and as such must be handled in a more timely manner than most lab studies

2. Blood gas studies are commonly done outside the routine laboratory and use a different reporting mechanism, which slows data availability

3. Must be able to correlate lab result with the clinical setting of the patient

4. Physicians need access to data while located in non-critical care settings

5. Data from prior studies is essential to understanding current results

Dependencies

1. Lab results review by encounter

Barriers

1. Instruments that don’t support standard electronic connection

2. Data entry of ventilator settings

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Clinical Care Delivery and Documentation

(84)Printed medication administration records(MARs)

Description

1. Pharmacy departmental system creates printed document that is used by nursing to document whether a medication has been administered

2. Updated Medication allergies are printed on the document

3. Reasons for not giving a medication are indicated

4. Medication name(both generic and trade) is easily legible

5. Dosage formulation is designated(e.g. two 50 mg capsules)

Primary Users

1. Nurses

2. Physicians

3. Pharmacists

Rationale

1. Handwritten MARs are subject to transcription errors

2. Handwritten MARs are time inefficient for the nurses

3. Medication allergies are available for review at time of medication administration

4. Electronic MARs are even better but are in a later phase

Dependencies

1. Pharmacy Departmental Functions

Barriers

1. Requirement for collaboration between nursing and pharmacy departments

2. Requirement for timely printing and distribution

3. Multi-day MARs are often out-of-date because of medication changes

4. Single day MARs obscure the trend of medication usage

(15)Transcription

Description

1. Transcribed reports of the specified types on patients who received care at a CHW facility will be available for review on-line within a reasonable period of time(i.e. <24 hours)

a) Transcription(H&P, Consults, D/C Summary, Procedure Reports, ER Visits, Pathology), cardiac cath reports

b) Echocardiogram transcription

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c) Noninvasive vascular transcription

d) Treadmills

2. Text of EKG report

3. Reports should be available on-line for no less than two years after creation, preferably indefinitely

4. It should be easy to determine what types of reports are available

5. There should be regular reporting on turnaround time from dictation to on-line availability

6. Some discrete coded data elements should be captured from studies with quantitative results

7. EKG graphics stored and viewable on-line

Primary Users

1. Physicians

2. Nurses

3. Medical Records staff

4. Billing staff

Rationale

1. Increases availability of clinical data because paper chart often unavailable

2. Easier to find on-line than in paper chart

3. Easier to create duplicate reports for inter-facility transfers and record requests

4. Improves availability of information for Billing Office

Dependencies

1. Interface to Transcription system/vendor

Barriers

1. Ability to store and display text documents

2. Workflow to update manually signed documents

(59)Physician patient list

Description

1. Report or display that lists all patients a physician is interested in

2. Includes all roles a physician may have, such as Attending, Consulting, Referring or simply covering for another physician

3. Patients can be added or removed, patient location is displayed with basic descriptive information such as medical record number, age, sex. Patient location is updated by the ADT application for transfers, discharges

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4. Display identifies patient for access to clinical information on-line

Primary Users

1. Physicians

Rationale

1. Streamlines access to clinical data

2. Enhances efficiency of physician rounds by giving correct patient location

3. Information is used to facilitate report distribution to treating and Referring physicians

Dependencies

1. ADT

Barriers

1. Flexibility to accommodate complex physician needs

Departmental Operations

(1)Laboratory departmental functions

Description

1. Automates internal operations of department

2. Electronic connection to instruments and HIS reduces errors and improves response time

3. Quality assurance measures are automated ensuring quality and regulatory compliance

4. Manages tracking of send-out specimens

5. Results of send-out specimens are viewable by caregivers

Primary Users

1. Lab technicians and managers

Rationale

1. Standard capability for high volume laboratory

Dependencies

1. ADT and order entry interfaces to HIS

Barriers

1. Instruments that don’t support standard electronic connection

(34)Pharmacy departmental functions

Description

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1. Automation of the workflow within the pharmacy for tasks such fill lists for patient cassettes, labels for iv infusions, piggybacks and injectables.

2. Mechanism for charging for medication usage

3. Duplication, drug-drug, drug-food interaction checking

4. Reporting on drug utilization for real-time decisions and retrospective analysis

5. Supports appropriate allocation of tasks between pharmacist and pharmacy technicians

Primary Users

1. Pharmacists

2. Physicians(medication list)

3. Nurses

4. Infection Control (via reporting of TB drug usage)

Rationale

1. The high volume, expense, and risk of medication usage make pharmacy applications essential and highly productive

Dependencies

1. ADT

Barriers

1. Integration with core system

(10)Radiology departmental functions

Description

1. Automates internal operations of department

2. Creates requisitions, flashcards, jacket labels, transporter slips and other documents

3. Exact procedure performed(which may vary from that ordered) is logged into system

4. Charges captured and sent downstream

5. Displays worklists

6. Produces departmental work and quality statistics

7. Scheduling of outpatient exams

Rationale

1. Reduces administrative burden of department

2. Improves turnaround time

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Dependencies

1. ADT and Order Entry interfaces

Barriers

1. Integration with core system

Administrative Procedures

(83)ADT(Admission, Discharge, Transfer) system focused on the needs of the acute care setting (hospital, attached ambulatory clinics, attached ambulatory surgery).

Description

1. Demographic and insurance information is expeditiously gathered

2. Encounter history is readily available, showing a patient’s prior encounter registrations

3. Screen designs increase the likelihood that valid data is collected

4. Available beds are displayed and assigned

Primary Users

1. Admitting office

2. Administrative staff

Rationale

1. All subsequent computer-based activities with a patient record require valid information, collected as early in the process as possible. In different areas, the type and volume of information will vary and the system should accommodate this variability.

Dependencies

1. Adequate patient volume

Barriers

1. Needs of Patient Accounting system

(53)Order entry to all departments

Description

2. Communicate need for all patient-related orderable items in a facility

3. Ensures timely delivery of orders, fully specified with all information needed for timely and complete fulfillment

4. Captures charges and allows analysis of utilization

5. Permits review of order status

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Primary Users

1. Clerical staff

2. Nursing

3. Departmental staff implementing orders

Rationale

1. More efficient and accurate than paper-based ordering

Dependencies

1. ADT interface

Barriers

1. Ability of downstream systems to accept transactions

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Phase IB

Results Retrieval

(57)Physician Rounds Report

Description

1. Display a substantial fraction of the information that physicians wish to review during patient care rounds in an effective format , organized by patient

2. Report should include all data available electronically

3. Minimum data set would be labs performed or reported since “yesterday’s rounds” and medication list

4. In more advanced form, would include vital signs, intake and output, medication charting and microbiology and blood gas results

Primary Users

1. Physicians

2. Nurses

3. Pharmacists

Rationale

1. Enhanced efficiency of physician rounds

2. Thorough evaluation of clinical information more routinely done due to ease of access to the data

Dependencies

3. Lab Results Review by encounter

4. Clinical Documentation

Barriers

1. Availability of essential data

2. Varying physicians’ clinical requirements and preferences

3. Coded laboratory values

(5)Longitudinal lab results review

Description

1. Lab results are viewed over multiple registrations by use of a unique identifier, such as medical record number

2. User can easily review all prior results

3. Data is displayed such that review for trends is facilitated

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4. User can control amount of prior data displayed

5. Prior data kept on line no less than 2 years

Primary User

1. Physicians

2. Nurses

3. Quality Coordinators

Rationale

1. Prior abnormal values more likely to be noticed

2. Prior values establishes expectations for current results

3. Review of computer-based data vastly faster and more available than review of paper-based chart

Dependencies

1. Lab results review by encounter

2. Common patient identifier across encounters for the data sources involved

Barriers

1. Capacity for large volume data storage

(11)Longitudinal radiology results

Description

1. Radiology transcribed reports are viewed over multiple registrations by use of a unique identifier, such as medical record number

2. Sorting or filtered by report type

3. Reports should be available on-line for no less than two years after creation, preferably indefinitely

Primary Users

1. Physicians

2. Nurses

3. Radiologists

4. Radiology Techs

Rationale

1. Displays radiologic history to ensure comprehensive understanding of patient status

2. Reduces unnecessary repetition of imaging studies

Dependencies

1. Radiology transcribed results

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2. Common patient identifier across encounters for the data sources involved

Barriers

1. Capacity for large volume data storage

Clinical Care Delivery and Documentation

(20)Bedside numbers

Description

1. Quantitative measures of patient status that are routinely obtained will be entered into the computer in a timely fashion and available in a variety of display formats wherever computer access is available

2. Vital signs, height, weights, oximetry are entered

3. Point of care testing such as fingerstick glucose and stool occult blood is captured

4. I&O are entered and total and net values are calculated

5. Devices for Point Of Care data entry are available

Primary Users

1. Physicians

2. Nurses

3. Quality Coordinators

4. Pharmacists

5. Dieticians

Rationale

1. Quantitative measures are universally obtained on patients regardless of nursing theory.

2. Data acquisition and codification is much more straightforward than for textual information

3. There is a tremendous amount of secondary usage of this information in various reports

Dependencies

1. Routine physician utilization for Results Retrieval

2. Simultaneous availability of (57) Physician Rounds Report

3. See Assumptions

Barriers

1. Major change in workflow for nearly all caregivers

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(35)Medication allergies, height, weight

Description

1. Each patient’s medication allergies should be available on-line for use by pharmacist, nurse, and physician

2. It should be printed on reports, such as medication administration records

3. Allergies should be coded so that drug-allergy checking may be done electronically

4. Height and weight are captured and available for use by pharmacist

5. Updates done by pharmacist should display on screens used by caregivers

Primary Users

1. Pharmacists

2. Physicians

3. Nurses

Rationale

1. Adverse drug events occur in 10% of hospital admissions and many of these are preventable and due to known allergies

Dependencies

1. Pharmacy departmental functions

Barriers

1. Simultaneous availability of information on remaining paper-based documents limits utility of on-screen display

(33)Medication profile

Description

1. Active and PRN medications are listed with dose, frequency, order date

2. Inactive medications are listed separately

Primary Users

1. Physicians

2. Nurses

Rationale

1. Drug therapy is a fundamental treatment modality and is expensive and has high potential for harm. When the medication list is not readily available, sub-optimal therapy commonly occurs

Dependencies

1. Pharmacy departmental functions

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Barriers

1. Display flexibility

(82)Medication vending machines

Description

1. Hardware device maintains inventory of commonly used or controlled medications and dispenses and documents unit doses

2. Receives ADT from external systems

3. Receives medication profile from external systems

4. Handles reporting for controlled substances

5. Documents medication administration to Clinical Documentation system

Primary Users

1. Pharmacists

2. Nurses

Rationale

1. Reduces access to controlled substances

2. Improves documentation of medication usage

3. Improves available of medications in inventory

4. Reduces lost charges for floor stock drugs

Dependencies

1. Pharmacy departmental system

2. Interfaces

Barriers

1. Interfaces

2. Requires restocking

Inpatient Care Management

(38)Drug utilization evaluation studies

Description

1. Flexible reporting permits assessment of drug utilization patterns for improvements in concurrent care

2. Flexible reporting permits assessment of drug utilization patterns for retrospective analysis

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Primary Users

1. Pharmacists

Rationale

1. Cost and quality control

Dependencies

1. Pharmacy Departmental Functions

Barriers

1. Availability of a Clinical Pharmacist to act on the findings

(44)Case finder reports

Description

1. Contemporaneous Reports identify patients for whom defined data is outside the expected range and these Reports are used to guide some form of intervention in patient care

2. Reporting that maximizes value of already captured data elements to improve care

3. [Example: charge nurse uses Actionable Abnormal Labs report to identify labs warranting clinical intervention]

4. [Example: house supervisor/charge nurse uses Unstable Patients report to identify those patients who might benefit from increased staffing, clinical oversight ]

5. [Example: respiratory therapist uses Marginal Respiratory Status report to identify those patients who are having trouble with their breathing]

Primary Users

1. Physicians

2. Nurses

3. Quality Coordinator

Rationale

1. Prevents patients from “falling through the cracks”

Dependencies

1. Clinical Documentation

2. Lab Results Review by encounter

Barriers

1. Availability of necessary data elements

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2. Adjustment of work processes of those with responsibility for dealing with the findings

Administrative Procedures

(63)Electronic and printed Order Sets for common clinical pathways/standard orders

Description

1. Multiple orders may be placed with a smaller number of keystrokes than when placed individually

2. Complicated order details are pre-filled

3. Standard orders for procedures and periods of care can be printed for signature

Primary Users

1. Nurses

2. Patient Care Unit clerks

3. Recipients of previously erroneous orders

Rationale

1. Expedites placement of repetitive or urgent orders

2. Reduces error rate for unusual studies

3. Concretely implements clinical paths

Dependencies

1. Order Entry

Barriers

1. Consensus on clinical pathways/order sets

2. Workflow to make them available

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Phase IC

Clinical Care Delivery and Documentation

(39)Medication charting

Description

1. Medication profile is updated by electronic transactions from pharmacy departmental system

2. Nurses identify pending medications

3. Nurses document administration of medications as well as reasons why medications are not given

4. Physicians have reports indicating which medications have been administered

5. Information is recorded in format that makes it available to other reports

6. Medication cost is automatically charged when administration is documented

Primary Users

1. Physicians

2. Nurses

3. Pharmacists

Rationale

1. Speeds identification of next medication due

2. Reduces likelihood a medication dose will be missed

3. Eases analysis of medication usage

Dependencies

1. Pharmacy departmental functions

Barriers

1. Major change in workflow

2. Clarifies deficiencies in paper charting

(21)Clinical management flowsheets

Description

1. Reports that integrate data of different types, such as lab, clinical observations, and medication administration, are displayed together to facilitate the optimal analysis of a clinical problem for patient care

2. Reports show the relationships between the data, such as the response in clinical terms of the usage of a medication

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3. Both primary effects and potential adverse effects are shown

4. Reports show effects over varying periods of time, which can be easily altered

5. [Examples: Anticoagulation, Antibiotic Usage, Diabetic Control, Mechanical Ventilation, Potassium and Magnesium Replacement]

6. [Note: is usually not used for capture of data]

Primary Users

1. Physicians

2. Nurses

3. Quality Coordinators

Rationale

1. Greater efficiency since data needed is expeditiously gathered and displayed in integrated fashion

2. Optimal analysis of clinical problems

3. Elevates sophistication of analysis for more naïve clinicians

Dependencies

1. Extent of Clinical Documentation determines richness of flowsheets

Barriers

1. Major change in workflow

Inpatient Care Management

(22)Discharge planning screens

Description

1. Screens capture and display the information needed for the patient care team to share estimated discharge date, destination, and needs as well as contacts with Significant Others

Primary Users

1. Physicians

2. Nurses

3. Case Managers

4. Home Health

5. Chaplains

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Rationale

1. Enhances coordination of the discharge planning team by increasing the availability of the information and the number of staff who can ensure its validity

Dependencies

1. Utilization of system for other functions

Barriers

1. Lack of integration with any other Case Management system that might exist

Administrative Procedures

(55)Electronic communication among all clinical caregivers

Description

1. E-mail is pervasively available and commonly used by caregivers to share clinical information about patients

2. Confirmation that message has been received is available

Primary Users

1. Physicians

2. Nurses

3. All caregivers

4. Executive team

5. All clinical managers

Rationale

1. Phone calls and faxes are less efficient

Dependencies

1. Pervasive utilization

Barriers

1. Concern about confidentiality

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Phase IIA

Results Retrieval

(6)Lab order status available on HIS

Description

1. User can use the HIS to identify the status of a lab order i.e. whether a specimen has been obtained, has a preliminary or final result available

Primary Users

1. Nurses

2. Clerical staff

3. Physicians

Rationale

1. Reduces calls to lab trying to verify status

Dependencies

1. Departmental lab computer system

2. Interface from Departmental lab computer system to HIS

Barriers

1. Ability of Order Entry to accept two way interface to Lab Departmental system

(7)Blood bank product availability

Description

1. User can look on HIS to identify whether blood is available in the blood bank for a particular patient

2. User can use computer to identify number of units of different types that have been transfused to a patient

3. Blood utilization review is aided by reports that integrate clinical results with transfusion information

Primary Users

1. Operating Room

2. Nurses

3. Physician

Rationale

1. Reduces calls to blood bank by nurses and physicians

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2. Expedites review of transfusion status

Dependencies

1. Interface to HIS

Barriers

1. Timely data entry on BB system

Inpatient Care Management

(28)Microbiology/antimicrobial therapy alerts

Description

1. Based on results of coded Microbiology results from Lab system, current antimicrobial therapy is evaluated based on rules

2. System identifies potentially significant cases of ineffective therapy(bug resistant to current therapy)

3. System recommends alternate therapy to optimize antimicrobial therapy

4. Effective notification system for distribution of alerts to users

Primary Users

1. Pharmacists

2. Physicians

Rationale

1. Optimizes effectiveness of antimicrobial therapy with potential for shortened length of stay, reduction in drug costs

Dependencies

1. Pharmacy departmental functions

2. Coded Microbiology data from Lab

3. Coded Medication in Pharmacy system

Barriers

1. Few Lab systems generate coded Microbiology results

2. Physician community needs to agree on “preferred” therapy

3. Physician community needs to be willing to change therapy in response to alerts, alert-prompted suggestions

Departmental Operations

(16)Electronic report distribution

Description

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1. When hard copies are prepared, their distribution should be electronically facilitated in some way e.g. sorting, remote printing, electronic distribution, faxing

Primary Users

1. Administrative staff

2. Physician offices

Rationale

1. Improves report availability, especially to off-site areas

2. Reduces report turnaround time

3. Reduces manpower applied to report distribution

Dependencies

1. Transcription

2. Radiology Transcription

Barriers

1. Multiple systems generating reports via different mechanisms

(36)Alerts to Pharmacist

Description

1. System identifies potential adverse drug events

2. System checks for potential dose/weight appropriateness

Primary Users

1. Pharmacists

2. Nurses

Rationale

1. Reduces adverse drug events

2. Improves adverse drug event reporting

Dependencies

1. Pharmacy departmental functions

Barriers

Administrative Procedures

(60)Physician phone directory

Description

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1. Physician office address, phone number, fax number, email address, pager number(with permission) are available

2. Physicians may be selected by specialty

Primary Users

1. Physicians

2. Nurses

3. Administrative staff

Rationale

1. Obviates need to publish paper directories

2. More likely to be valid since only needs to be updated in one place

Dependencies

Barriers

1. Additional MD database to be maintained

(56)Web access for caregivers

Description

1. Web browsers are generally available throughout the facility

2. Reference material and medical literature searches would be available

3. Internal documents such as Nursing Standard Practice and Continuing Education Class Schedules would be posted and available on internal network

4. Access to external Internet

5. Icon access to Pubmed for Medline searching

Primary Users

1. Physicians

2. Nurses

3. Pharmacists

Rationale

1. Advances in web technology can be used to simplify workflow problems at vastly lower cost than traditional healthcare applications

2. Expeditious access to vast array of clinical knowledge

Dependencies

1. Use of PC as end user device, not dumb terminal

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Barriers

1. Concern about time wasted “surfing the Web”

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Phase IIB

Results Retrieval

(12)Images of digital modalities(CT, MRI, Ultrasound, Nuclear Medicine)

Description

1. Digital images of these modalities are captured directly from the imaging device, without use of a scanner

2. Images are interpreted without printing of film

3. Prior images are available for side by side comparison

4. Images available outside Radiology department over the network

Primary Users

1. Physicians

2. Operating Room

3. ER

4. Neurosurgeons at home

Rationale

1. Reduction in lost images

2. More efficient film reading

3. Images distributed electronically so they may be read by domain expert

Dependencies

1. High speed LAN

Barriers

1. Image resolution concerns

Clinical Care Delivery and Documentation

(32)ICU/OR/OB monitor to computer download

Description

1. Critical care devices such as pressure monitors, infusion pumps, urimeters feed clinical documentation system

2. Clinical data in clinical documentation system is integrated with non-ICU/OR documentation systems

Primary Users

1. Nurses

2. Physicians

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Rationale

1. Large volume of data entry simplified by electronic entry, so long as accuracy is validated

Dependencies

1. Clinical documentation system in ICU/OR

Barriers

1. Large number of artifacts generates spurious and potentially misleading data

2. Process efficiency difficult to achieve

3. Non standard device interfaces

4. Identification of patient, datatype

(23)Nursing physical assessment

Description

1. Multiple screens used by nursing staff to document patient’s physical status

2. Shift reports created for permanent medical record

3. Data available for review on multiple other reports

4. Data coded, minimal freetext

5. Displays focus attention on abnormal or changing values

Primary Users

1. Physicians

2. Nurses

3. Quality Coordinators

Rationale

1. Increases availability of information

2. Permits rules to be based on such information

Dependencies

1. Bedside numbers

Barriers

1. No established standard for nomenclature

(19)Remote access from MD home, office

Description

1. All capabilities used by the physician within the hospital should be available remotely—either by dialup, Internet, or extension of the network.

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2. Measures in place to ensure confidentiality standards are met

Primary Users

1. Physicians

2. Physician office staff

Rationale

1. Improved communication with reduction in telephone calls and faxes

2. If system is effective, there will be substantial demand for remote access

Dependencies

1. Routine physician utilization

Barriers

1. Security concerns

2. Offsite support burden

Inpatient Care Management

(37)Drug-lab alerts

Description

1. System identifies potentially significant drug-lab, interactions

Primary Users

1. Physicians

2. Nurses

3. Pharmacists

Rationale

1. Reduces adverse drug events

Dependencies

1. Pharmacy departmental functions

2. Lab results review by encounter

Barriers

Administrative Procedures

(65)Electronic file cabinet for protocols, schedules, standard documents, policies and procedures

Description

1. Documents are available electronically

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2. Documents may be printed as needed

Primary Users

1. Nurses

2. Nursing Administration

Rationale

1. Ensures adequate inventory of current reports wherever needed

2. Permits updating entire “inventory” of reports by a single electronic change

Dependencies

1. Device availability

Barriers

1. Large volume of documents in different formats

(64)Review of OR, Cath Lab, PT, Endoscopy (et al.) schedules

Description

1. Schedules for patient activities that are used by many others besides those performing the activity are available for review by others

Primary Users

1. Physicians

2. Nurses

3. Therapists

Rationale

1. Obviates need for distribution of paper schedules

2. Improves patient confidentiality by avoiding bulletin board posting of schedules

3. Enhances planning for patients’ other care activities

Dependencies

1. ADT interface

2. Scheduling system for involved areas

Barriers

1. Integration with existing scheduling systems

(54)Cross-continuum patient registration system

Description

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1. Patient registration system tailored to meet the needs of each provider environment (hospital, ambulatory surgery, home health, DME, long-term care, birthing centers, etc.) across the entire continuum of care.

2. Demographic and insurance information is expeditiously gathered from patients with maximum sharing of information from site to site.

3. Encounter history is readily available, showing a patient’s prior encounter registrations with site of care, diagnosis

4. Screen designs increase the likelihood that valid data is collected

Primary Users

1. Physician office administrative staff

2. Admitting office

3. Administrative staff

Rationale

1. All subsequent computer-based activities with a patient record require valid information, collected as early in the process as possible. In different areas, the type and volume of information will vary and the system should accommodate this variability.

Dependencies

1. Master Patient Index

Barriers

1. Varying needs

(61)MPI across >1 site of care

Description

1. Patients are identified on-the-fly using match-and-tag logic by interface transactions from systems that have a separate registration function

Primary Users

1. Physicians

2. Billing office staff

3. Administrative staff

Rationale

1. Allows consolidation of registration, billing, and clinical information from multiple sites of care

Dependencies

1. Linkage to ADT systems

Barriers

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1. Absence of data from non-owned entities

(58)Housestaff sign-out cards/Problem List

Description

1. Patients being cared for by physicians who are going off duty are “signed-out” to the covering physician. This document summarizes the care concerns of the departing physician.

2. Document lists all of a patient’s active problems

3. Document should be viewable by other physicians and nurses also

Primary Users

1. Physicians

2. Nurses

3. Housestaff

Rationale

1. Enhances continuity of care

2. Expedites signout process

3. Permits more comprehensive signout

Dependencies

1. Pervasive housestaff physician usage

Barriers

1. Data entry

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Phase IIC

Results Retrieval

(18)Pathology transcribed results

Description

1. Transcribed results of cytologic and histologic examinations are available electronically for clinician review

Primary Users

1. Physicians

Rationale

1. Results of pathologic studies are needed for clinical decision making and for informing patients and their families

Dependencies

1. Anatomic pathology laboratory system

Barriers

1. Anatomic pathology transcription formats are often different from standard transcription formats

Clinical Care Delivery and Documentation

(24)Patient careplans/pathways

Description

1. Documents describing the intended treatment plan for a variety of different diseases and treatments are available

2. Screens facilitate the capture of such information

3. Reports indicate progress over time and variances from expected careplan/pathway

Primary Users

1. Nurses

2. Physicians

Rationale

1. Standardizes care, with consequent improvements

Dependencies

1. Routine clinician usage

Barriers

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1. Standardization of pathways

(25)Documentation of patient care activities and interventions by nursing

Description

1. Multiple screens used by nursing staff to document patient care activities and interventions

2. Significant clinical and psychosocial events are documented for review by subsequent caregivers

3. Shift reports created for permanent medical record

4. Data available for review on multiple other reports

5. Data coded, minimal freetext

Primary Users

1. Physicians

2. Nurses

3. Other caregivers

Rationale

1. Increases availability of information

2. Permits rules to be based on such information

Dependencies

1. Agreement on level of detail to be documented

Barriers

1. Consensus development

(26)Documentation of all ancillary caregiver interventions

Description

1. Multiple screens used by ancillary staff to document all ancillary caregivers’ patient care interventions

2. Shift reports created for permanent medical record

3. Data available for review on multiple other reports

4. Data coded, minimal freetext

Primary Users

1. Ancillary staff

2. Physicians

3. Nurses

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Rationale

1. Increases availability of information

2. Permits rules to be based on such information

Dependencies

1. Agreement on level of detail to be documented

Barriers

1. Consensus development

Inpatient Care Management

(8)Critical lab alerts

Description

1. When the result of a test exceeds a previously specified value, automatically notify key users such as nurses, physicians

2. Site controls the tests and the trigger points

3. Control duplicate alerts within a defined time period

Primary Users

1. Nurses

2. Physicians

Rationale

1. Reduces time until clinical decision-makers are aware of critical circumstances

Dependencies

1. Discrete, coded lab data

Barriers

1. Routine computer use by caregivers is required for alert delivery to be timely

Departmental Operations

(17)Electronic Signature

Description

1. Transcribed Reports that are available on-line may be validated by the physician

2. List of reports pending signature is available

3. User can review and edit reports

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4. On-line viewing and hard copies indicate preliminary or finalized nature of status

Primary Users

1. Physicians

2. Medical records staff

Rationale

1. Reduces trips to medical records department

2. Reduces chart pulls

3. Reduces number of incomplete charts

Dependencies

1. Transcription

Barriers

1. Security concerns

2. Need to sign other documents that are not in electronic form

3. Workflow to manage updating and signature of Preliminary on-line documents when they are signed manually

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Phase III

Clinical Care Delivery and Documentation

(31)Anesthesia record

Description

1. Key clinical events are concurrently captured into an electronic record, including vital signs, medications, fluids, operative events

2. Data captured is integrated with data from Recovery Room, ICU, and med-surg patient care area

Primary Users

1. Anesthesiologist

2. Recovery Room, ICU, med-surg patient care area staff

3. Physicians providing peri-operative care

Rationale

1. Complex care administered in OR is difficult to sort out post-operatively

2. Heavy burden of intra-operative documentation can produce incomplete records

Dependencies

1. Non-OR documentation systems

Barriers

1. Linkages are complex because of need for matched coding schemes

2. Fast pace of care intolerant of slow process or poor data displays

(13)Telemedicine:CME

Description

1. CME

a) Videoconferencing across >1 region for purposes of interactive education of any caregiver group

Primary Users

1. Physicians

2. Nurses

3. Other caregivers

Rationale

1. Enhances availability of services

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2. Reduces expenses of travel, non-productive travel time

Dependencies

1. WAN or alternate high speed connection

Barriers

(73)Telemedicine: Remote diagnostics

Description

1. Remote diagnostics

(a) Diagnostic equipment such as stethoscopes, cameras obtaining diagnostic quality information, which is analyzed by a remote clinician for the purpose of diagnosis or therapy

Primary Users

1. Physicians

2. Nurses

3. Patients

Rationale

1. Enhances availability of services

2. Reduces expenses of travel, non-productive travel time

Dependencies

1. WAN or alternate high speed connection

Barriers

1. Patient acceptance

Inpatient Care Management

(27)Alerts to RNs and MDs

Description

1. System processing of manually entered and interfaced data identifies conditions that warrant notification of caregivers or alterations in care

2. Alerts are delivered within the caregiver’s normal workflow

3. Changes that are needed based on the alert are facilitated

Primary Users

1. Nurses

Rationale

1. Reduces likelihood that important events go unnoticed

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Dependencies

1. Clinical Documentation

2. Lab Results Review

3. Routine utilization of system

Barriers

(81)Physician order entry

Description

1. Physician directly enters orders into system, which are executed electronically

2. Information is provided to the ordering physician to promote selection of optimal diagnostic or therapeutic measures

3. Warnings about potentially dangerous conditions are provided in the course of order entry

4. Assistance is ordered to make ordering easier such as displaying prior values that are germane to the order or calculations

Primary Users

1. Physicians

Rationale

1. Ordering is a key time in clinical decision making

2. Prospective assistance is much less intrusive to workflow than after-the-fact alerting

Dependencies

1. Physician utilization

2. Prospective Alerting infrastructure

Barriers

1. Cultural

2. Requirement for enhanced efficiency

3. Complete Orders require capture of much information that does not add value to physicians’ analysis process(e.g. mode of transportation to Radiology)

Departmental Operations

(14)Digital radiography including PACS

Description

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1. All images including fluoro, angiograms, and plain radiography are captured digitally

2. Images are interpreted without printing of film

3. Prior images are available for side by side comparison

4. Images available outside Radiology department over the network

Primary Users

1. Physicians

Rationale

1. Reduction in lost images

2. More efficient film reading

3. Images distributed electronically so they may be read by domain expert

Dependencies

1. Images of digital modalities(CT,MR, US, NM)

Barriers

1. Image resolution concerns

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Assumptions

Support Related1. Security measures protect confidentiality of patient information

2. Users receive adequate training

3. Policies and procedures needed to support these applications and the inherent changes in work processes will be in place

4. Manual fallback procedures and materials are available

Technical Related1. Response time of system meets users needs

2. Adequate number and types of devices for intended users and technical resources for installation and support

3. Devices are positioned close enough to normal work area to improve workflow

4. User interface is acceptable

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Index by Functionality Name

FuncNum Functionality Name Page83 ADT(Admission, Discharge, Transfer) system focused on the needs of the

acute care setting (hospital, attached ambulatory clinics, attached ambulatory surgery).

17

36 Alerts to Pharmacist 3227 Alerts to RNs and MDs 4631 Anesthesia record 4520 Bedside numbers 227 Blood bank product availability 304 Blood gas results review 1244 Case finder reports 2521 Clinical management flowsheets 278 Critical lab alerts 4354 Cross-continuum patient registration system 3814 Digital radiography including PACS 4722 Discharge planning screens 2826 Documentation of all ancillary caregiver interventions 4225 Documentation of patient care activities and interventions by nursing 4238 Drug utilization evaluation studies 2437 Drug-lab alerts 3763 Electronic and printed Order Sets for common clinical pathways/standard

orders26

55 Electronic communication among all clinical caregivers 2965 Electronic file cabinet for protocols, schedules, standard documents, policies

andprocedures37

16 Electronic report distribution 3117 Electronic Signature 4358 Housestaff sign-out cards/Problem List 4032 ICU/OR/OB monitor to computer download 3512 Images of digital modalities(CT, MRI, Ultrasound, Nuclear Medicine) 356 Lab order status available on HIS 302 Lab results review by encounter 101 Laboratory departmental functions 155 Longitudinal lab results review 2011 Longitudinal radiology results 2135 Medication allergies, height, weight 2339 Medication charting 2733 Medication profile 2382 Medication vending machines 243 Microbiology results review 1128 Microbiology/antimicrobial therapy alerts 3161 MPI across >1 site of care 3923 Nursing physical assessment 3653 Order entry to all departments 1718 Pathology transcribed results 4124 Patient careplans/pathways 4134 Pharmacy departmental functions 1581 Physician order entry 4759 Physician patient list 14

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60 Physician phone directory 3257 Physician Rounds Report 2010 Radiology departmental functions 169 Radiology transcribed results 1119 Remote access from MD home, office 3664 Review of OR, Cath Lab, PT, Endoscopy (et al.) schedules 3873 Telemedicine: Remote diagnostics 4613 Telemedicine:CME 4515 Transcription 1356 Web access for caregivers 33

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Index by Functionality Number

FuncNum Functionality Name Page1 Laboratory departmental functions 152 Lab results review by encounter 103 Microbiology results review 114 Blood gas results review 125 Longitudinal lab results review 206 Lab order status available on HIS 307 Blood bank product availability 308 Critical lab alerts 439 Radiology transcribed results 1110 Radiology departmental functions 1611 Longitudinal radiology results 2112 Images of digital modalities(CT, MRI, Ultrasound, Nuclear Medicine) 3513 Telemedicine:CME 4514 Digital radiography including PACS 4715 Transcription 1316 Electronic report distribution 3117 Electronic Signature 4318 Pathology transcribed results 4119 Remote access from MD home, office 3620 Bedside numbers 2221 Clinical management flowsheets 2722 Discharge planning screens 2823 Nursing physical assessment 3624 Patient careplans/pathways 4125 Documentation of patient care activities and interventions by nursing 4226 Documentation of all ancillary caregiver intervention 4227 Alerts to RNs and MDs 4628 Microbiology/antimicrobial therapy alerts 3131 Anesthesia record 4532 ICU/OR/OB monitor to computer download 3533 Medication profile 2334 Pharmacy departmental functions 1535 Medication allergies, height, weight 2336 Alerts to Pharmacist 3237 Drug-lab alerts 3738 Drug utilization evaluation studies 2439 Medication charting 2744 Case finder reports 2553 Order entry to all departments 1754 Cross-continuum patient registration system 3855 Electronic communication among all clinical caregivers 2956 Web access for caregivers 3357 Physician Rounds Report 2058 Housestaff sign-out cards/Problem List 4059 Physician patient list 1460 Physician phone directory 3261 MPI across >1 site of care 3963 Electronic and printed Order Sets for common clinical pathways/standard

orders26

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FuncNum Functionality Name Page64 Review of OR, Cath Lab, PT, Endoscopy (et al.) schedules 3865 Electronic file cabinet for protocols, schedules, standard documents,

policies and procedures37

73 Telemedicine: Remote diagnostics 4681 Physician order entry 4782 Medication vending machines 2483 ADT(Admission, Discharge, Transfer) system focused on the needs of the

acute care setting (hospital, attached ambulatory clinics, attached ambulatory surgery).

17

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