Implementing a Medical Device Module in the EHR

Transcription

1 Implementing a Medical Device Module in the EHR A Critical Patient Safety Enhancement Robert E. Watson, Jr., M.D., Ph.D., Cradick, Connie M., P.M.P., Samanthie Epps, M.B.A., William D. Mauck, M.D., Patrick Luetmer, M.D. American College of Radiology Annual Conference May 2015 Washington, DC 2015 MFMER slide-1

2 Disclosures Nothing to disclose for all authors MFMER slide-2

3 Purpose / Introduction Implanted medical devices (IMD) are becoming increasingly common. Failure to identify the presence of some IMD can lead to serious injury or death in MRI MFMER slide-3

4 Purpose / Introduction In contrast to the widely accepted need to reliably access a patient s allergies current medications allergies in a unique and defined site in the electronic health record (EHR), information about a patient s Implanted medical devices medications is frequently incomplete and fragmented across multiple locations in the EHR, clearly posing a patient safety risk.??? Implanted medical devices 2015 MFMER slide-4

5 Purpose / Introduction We report the successful implementation of a Medical Device Module in the EHR at our tertiary care institution MFMER slide-5

6 Purpose / Introduction A key facet of the Medical Device Module is a multitiered blaze alert system highlighting the presence of high risk implanted devices in MRI to ordering providers MRI schedulers MRI radiologists and technologists Example of one type of Blaze alert, notifying radiologist and MRI staff of the presence of an MRI high risk device 2015 MFMER slide-6

7 Device Module Implanted medical device data collection Implanted medical device data storage Implanted medical device data access 2015 MFMER slide-7

8 Device Module Implanted medical device data collection Implanted medical device data storage Implanted medical device data access 2015 MFMER slide-8

9 Device Module IMD data collection 3 tiered approach to collecting IMD data SIMS (Surgical Information Management System Manual uptake at patient encounters Patient provided pre-visit information Automatic Feed From Surgery (SIMS) Manual Updates via Intake Process Automatic Feed From Pre-Visit Questionnaires Electronic Health Record 2015 MFMER slide-9

10 Device Module Implanted medical device data collection Implanted medical device data storage Implanted medical device data access 2015 MFMER slide-10

11 Device Module IMD data storage IMD information is housed in a central repository, the Medical Device Flowsheet. This is available at a common location in the EHR for all staff Easy Navigation to Flowsheet from Devices tab Medical Device Flowsheet 2015 MFMER slide-11

12 Device Module Implanted medical device data collection Implanted medical device data storage Implanted medical device data access 2015 MFMER slide-12

13 Device Module IMD data access Patient s IMD information can also be accessed through different portals that converge on the single site LastWord Flowsheet Viewer Synthesis Viewer 2015 MFMER slide-13

14 Devices Module // MRI Ordering Scheduling Safety check and exam protocoling 2015 MFMER slide-14

15 Devices Module // MRI Ordering Scheduling MRI Safety check and exam protocoling 2015 MFMER slide-15

16 Devices Module // MRI Ordering During ordering process, if a device is present in the implanted devices module, it will be carried over, prepopulating the order screen for the provider 2015 MFMER slide-16

17 Devices Module // MRI Ordering Scheduling MRI Safety check and exam protocoling 2015 MFMER slide-17

18 Devices Module // MRI Scheduling Presence of MRI high risk devices is highlighted on MRI scheduling screens Passive Alert Lists High Risk Devices For example, a patient with a deep brain stimulator system can be safely scanned provided a transmit / receive head coil is used and the specific absorption rate is restricted. But, it is essential to know of the presence of the system. Severe patient injury could result if the presence of the device is not recognized and the patient is scanned improperly. Passive alert permits Scheduling office to confirm with service that they are aware of the presence of the device, and wish to continue with scheduling so that the patient can be scanned at the proper site with special precautions 2015 MFMER slide-18

19 Devices Module // MRI Ordering Scheduling MRI Safety check and exam protocoling 2015 MFMER slide-19

20 Devices Module // MRI MRI Safety check and exam protocoling Radiology Blaze Alerts Quickly Identify Patients With High Risk Devices Orange Passive Alert Indicates High Risk Device Present Orange Passive Alert Indicates High Risk Device Present New Tab for Notes and Communications Specific to the Devices 2015 MFMER slide-20

21 Devices Module // MRI MRI Safety check and exam protocoling Devices module provides alerts to the presence of MRI high risk devices with and Orange flag in MRI patient list identifies presence of high risk device When protocoling MRI exam, again alerts that a high risk device is present. Clicking on this tab brings up screens below; in this case, identifying presence and type of an implanted aneurysm clip MFMER slide-21

22 Results Manual intake process takes only 1-2 minutes: During 2 week pilot, 24% of 6261 outpatient visits in clinics with high device utilization (CV, Pain, Neurologic Surgery) required intake assessment. IMD information was gathered at 760 visits, average time of 1-2 min with 21% of IMDs identified as high risk. IMD commonly encountered in MRI Over 1 month, 900 of ~5130 (17.5%) patients at MRI check in had an IMD, more granular IMD documentation took 2-3 min and research of a single IMD averaged 6 min MFMER slide-22

23 Results 60% of IMD in SIMS tracked in EHR Of 150,000 items within Surgical Information System, ~90,000 were identified as devices to track in the EHR. Significant level of EHR alert generation After a load of historic data from 1995 forward and full implementation, 82 alerts/week (60%) are generated at time of inpatient MRI order and 106 alerts/week (8.3%) at in/outpatient MRI protocol/check in Moderate frequency of over alerting at MRI order and MRI protocol and checking after SIMS interface activated Over-alerting reduced after SIMS corrected to identified and exclude temporarily implanted devices in ORs 2015 MFMER slide-23

24 Results: Implanted Device Data Implanted devices - Initial data Total patients = 1,049,351 Based on this initial data, the device list being captured was amended. Very low risk devices such as clips and suture/staples were removed due to their frequency and relative lack of clinical significance MFMER slide-24

25 Results: Dramatic Reduction in MRI Appointment Delays, Cancelations and Reschedules Initial results indicate approximately a 53% reduction in MRI appointment delays, cancellations, and reschedules related to devices over a 3 month sample MFMER slide-25

26 Results: Excellent Intake Compliance Metrics 2015 MFMER slide-26

27 Implanted Device Reconciliation User Impact A Team-Based Solution Impacts Entire Institution Area Outpatient Frequency First appointment for an episode of care Primary Care Once per year Hospital Inpatient Admission and discharge Emergency Department Every visit Surgical Specialties First appointment for an episode of care Outpatient Procedural/Surgical Areas Admission Regional Lab PAC MRI Varies based on appt. All appointments 2015 MFMER slide-27

28 Conclusions and Lessons Learned An implanted medical device module is feasible and can provide critical patient safety information at time of MRI ordering and check in. In a short amount of time, this has produced initial significant decreases in appointment delays, cancellations, and rescheduled exams in MRI. An initial rollout of the devices module involved areas associated with many high risk implanted devices: Cardiology, Pain Medicine, Neurology, and Neurosurgery. A staged roll out subsequently expanding to other areas was valuable in that it allowed initially identified shortcomings to be addressed before going forward. While not specifically measured, it is anticipated that there are significant gains in efficiency in that this critical patient information can now be located in a single reliable location in the EHR. Compliance with data collection has been excellent, and other clinical areas are now benefitting by having ready availability to this essential patient information MFMER slide-28