Computer-based physician order entry: from simple orders to clinical pathways

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1 Computer-based physician order entry: from simple orders to clinical pathways Service of Medical Informatics Geneva University Hospitals Mathias Tschopp Magali Despond Damien Grauser Jean-Christophe Staub Christian Lovis auteurs

2 Background Geneva University Hospitals 4 main geographical sites 2000 beds admissions / year outpatient visits / year 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 2

3 Clinical Pathways Definition Definition Schedules of medical and nursing procedures, including diagnostic tests, medications, and consultations designed to effect an efficient, coordinated program of treatment Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 3

4 Background Presco (our CPOE) Modular component of our HIS prescriptions / day Written in Java 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 4

5 PresCo Types of orders Diet Mobilization Monitoring Limitation of care Specialized consultations Nursing interventions Laboratory tests Drugs Radiology 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 5

6 PresCo Advanced functionalities Reminders (missing mandatory items) Alerts (drug interactions, redundant order) Information (drug description, guidelines) In-place follow-up notes Ordersets Flow management (clinical pathways) 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 6

7 PresCo Advanced functionalities Simple order Furosemide 40mg po 1x/j Orderset Aspirin 100mg po 1x/j Clopidogrel 75mg po 1x/j Metoprolol 25mg po 4x/j Enalapril 5mg po 2x/j Atorvastatine 40mg po 1x/j Enoxaparin 40mg sc 1x/j Na, K, CK, CK-MB, Trop, Creat 3x/wk Rest in bed Pulse,BP 3x/d Weight 1x/wk Clinical Pathway 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 7

8 Clinical Pathways List of tasks to be dealt with: Orders (simple or part of sets) Clinical documentation Alerts Clinical information Phases 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 8

9 Workflow Engine - JBPM JBoss jbpm (Business Process Management) Free Good integration with Java Application Servers Easy graphical development environment 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 9

10 Workflow Engine (standard use) editor writer Start Document creation Correction/validation End Publication/storage 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 10

11 Workflow Engine (for clinical pathways) Care giver start Phase 1 Phase 2 end Exit the clinical pathway 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 11

12 Workflow Engine (JPDL language) 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 12

13 Example: Heart failure clinical pathway 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 13

14 Example: Heart failure clinical pathway 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 14

15 Example: Heart failure clinical pathway 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 15

16 Example: Heart failure clinical pathway 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 16

17 Example: Heart failure clinical pathway 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 17

18 Example: Heart failure clinical pathway 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 18

19 Why use a workflow engine? Separate workflow logic from UI screens Execute code when going from one node to another Take advantage of JBPM administration tools 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 19

20 Evaluation Relatively new implementation Dashboards Indicators comparison (retrospective or prospective) Standardized approach (selection bias) 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 20

21 Thank you for listening Service of Medical Informatics Geneva University Hospitals Mathias Tschopp Magali Despond Damien Grauser Jean-Christophe Staub Christian Lovis 2008 Hôpitaux Universitaires de Genève - service d informatique médicale - unité d informatique clinique 21

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