PAH integrated electronic Medical Record (iemr) Project

Transcription

1 Princess Alexandra Hospital PAH integrated electronic Medical Record (iemr) Project Emergency Research Group 24 th January 2013 Renea Collins Clinical Lead iemr 1

2 Objectives To provide a common understanding of the ehealth context and history of the iemr Program To provide an overview of the iemr, the PA s approach to its implementation and current status To discuss implications & issues on how the iemr will impact clinical research & clinical trials Current as at 24 January

3 ehealth History and Context Current as at 24 January

4 Current Situation in Queensland Health Clinicians and supporting staff spend significant amounts of time trying to access patient information and on administrative paperwork. Prevention and Wellness Primary & Community Care Pre Admission & Admission Theatre & Procedures Acute Care Phase Discharge Primary & Community Care Outpatients Primary & Community Care Clinical Support Services (including Pharmacy & Diagnostics) Current as at 24 January

5 ehealth Vision ehealth Strategy 2006 Patient centred clinical information systems Supporting the patient journey Supported by enabling infrastructure and infostructure iemr solution is a part of the ehealth strategy along with EDS, Viewer, Tactical ereferrals and with a variety of specialist system solutions Pharmacy & Diagnostics Discharge & Outpatients Acute Care Phase General Practitioner Prevention & Wellness Person Centred Care Primary & Community Services Pre Admission & Admission Theatre & Procedures Clinical Suport Services Current as at 24 January

6 Current Situation Primary storage 300,000 records Secondary storage 600,000 records 2000 charts movements per day Information does not transfer with the patient, stays at PAH Records are usually stored in the most vulnerable place of a hospital PAH Medical Records Current as at 24 January

7 Current Situation in Queensland Health Sometimes readable Sometimes not Current as at 24 January

8 PAH integrated electronic Medical Record To improve patient safety and quality of care, the PA is changing from paper to electronic medical records in 2013! From this to this! Current as at 24 January 2013

9 iemr Program - Release One Current as at 24 January

10 The iemr Program The iemr solution will enable a patient-centric focus to health care delivery across a networked model of care and will bring about significant changes to the business processes and clinical processes within Queensland Health. It will enable Queensland Health clinicians and supporting staff to securely access a single view of a patient s medical record delivered through the use of information and communication technology. The areas of priority identified by Queensland Health clinicians in the ehealth strategy include: order entry results reporting medications management clinical documentation discharge summary scheduling. The iemr strategy was informed by the Consultation Event and is based on the principle that the NSW State Build + Cerner START will be applied as a baseline. Current as at 24 January

11 Key themes* emerging from the iemr consultation event 1. Availability of devices 2. Access to scanning 3. Integrated medication solution 4. Governance of Queensland Health content and forms 5. Information security/privacy 6. Specialties and sub-specialty solutions 7. Information analysis and reporting 8. External system integration 9. Unique patient identification 10. Integration to bedside devices 11. Specialty hardware 12. System downtime procedures 13. Integration and interfaces 14. Access to information 15. Work practice considerations 16. Alerting and decision support 17. Scheduling * Themes are a focus for the Program going forward Current as at 24 January

12 iemr Four Releases September 2011 emr Agreement SOA emr Agreement Release 1 Release 2 Release 3 Q R1 Core Build, Document Scanning R2 Order Entry, Results Reporting, Adverse Reactions and Alerts, Some Structured Clinical Notes R3 Clinical Documentation (Structured Notes) Release 4 R4 Referrals, Waitlist Management and Scheduling, Medication Management Current as at 24 January

13 Release One System Cerner Millennium is the suite of products CORE is the foundation of the system itself on which all future Releases are based Cerner PowerChart is the application in which the iemr is viewed Cerner ProVision Document Imaging (CPDI) is the scanning application Cerner Millenium Reporting will provide a number of detailed reports on the iemr solution P2Sentinal is the security, auditing and compliance solution for tracking end user access to information Current as at 24 January

14 What is in scope for Release One? Delivery of a scanning solution: Core build and Document Scanning capability to electronically capture and store an image within a designated area, thus enabling ease of access to users Hospitals in scope: Release 1: PAH, RBWH (including GARU), Royal Children s Hosp, Cairns Base Hospital, Mackay Base Hospital From Release 2: Townsville Hospital, Gold Coast HHS (Gold Coast University Hospital, Robina Hospital, Carrara Community Health) Software solutions: PowerChart, Cerner ProVision Document Imaging (Scanning), P2Sentinal (Auditing) Admissions, Discharges & Transfers (ADT) interfaces: To receive patient and reference information from: HBCIS and Client Directory to populate the Cerner Millennium Functionality: System reporting, label printing, forms capture, data migration Current as at 24 January

15 Release One - Core Build Builds the foundations of the system for all releases Identifies the following: Reference data fields Patient locations Printing locations User access security groups Users of the system Order of Filing Current as at 24 January

16 Release One Document Scanning Single patient record - incorporates information on the same patient from all iemr sites into the one record Forms barcoded Statewide Order Of Filing (OOF) Scan at end of current inpatient episode of care Current as at 24 January

17 Existing patient medical record to iemr journey Go Live Historical Paper Record iemr solution Current Episode Chart iemr solution Current Episode Chart Historical Paper Record Today Release One Future Current Episode Chart Batch Scanning Current as at 24 January

18 Proposed OOF Notates Modification 4 Current as at 24 January

19 Proposed OOF (cont d) Notates Modification 5 Current as at 24 January

20 Document view by type folder view A Yellow folder will only appear if a form was scanned to the location within the Order of Filing. The location of the form is determined by the barcode on the form. When more than one form is scanned under a Yellow folder, it will be displayed in the order scanned. Scanned forms are represented by the Red square. The admit date/time and the name of the form is displayed. Current as at 24 January

21 Document view by encounter folder view Current as at 24 January

22 Document type by date folder view Scanned images/documents are grouped and displayed by the Admission Date. The order of the scanned images/documents under each Admission date folder is sequenced the same as By type without the Yellow folders. The admit time, document type and name of the form is displayed. Current as at 24 January

23 Flowsheet View Results view is another way to organise and view scanned documents. In this example, the patient has one encounter and all scanned documents are sorted by Admit Date. You can filter your view by checking and unchecking sections in the Navigator pane. Current as at 24 January

24 Release One Benefits Realisation Summary The benefits include: Short-term: Concurrent access to patient clinical records Reduced time spent locating and waiting for a patient s medical record Long-term: Reduction in administrative and clinical time through reduced volume of physical chart retrievals, chart maintenance, logistical activities and preparation of the charts for clinics Reduction in annual space allocation required for chart storage Current as at 24 January

25 PAH iemr Project Release One Approach Current as at 24 January

26 PAH Site Team Structure PAH-ieMR Project Board: Senior representatives from Medical, Nursing, Allied Health, Mental Health, Corporate Services, HIMS, iemr Program, Clinical Governance, Finance, and Clinical IT Site Reference Group: Clinical Lead + Change Leads Change Champions: All Units: Doctors, Nurses, Allied Health, Administration Site Project Team: Clinical Lead, Project Director, HIMS Lead, Technical Lead, Change & Comms Mgr, Training Mgr, Project Officers Current as at 24 January

27 Forms Current as at 24 January

28 Breakdown of Forms by Type Current as at 24 January

29 V2.0 06/2012 Barcoded Form Example NUTRITION & DIETETICS DEPARTMENT, PRINCESS ALEXANDRA HOSPITAL REMEMBER TO: PATIENT IDENTIFICATION LABEL REMEMBER TO: Elevate patients to during feeding Check formula for use-by date Shake formula well before use Check max. hanging time of formula and discard time of equipment Complete label on formula bottle Contact Dietitian if problems arise PLEASE NOTE: This is a starter regimen only organise Dietitian review on first working day 1) If the patient weighs less than 50kg, commence feeding at 20mls/hr Nutrison increasing by 20ml/hr q24h. Feeds NOT to start at 40ml/hr. 2) Monitor electrolytes daily (K, PO4, Mg) and replace if low. Do NOT increase rate if electrolytes drop. 3) Do not start feeds if electrolytes (K, PO4, Mg) are low and have not been replaced to within the recommended range. 4) Do NOT use starter regimen for Renal Patients. Contact ward dietitian during business hours or on call dietitian during weekend or public holidays (see below). Ready to hang feeds eg Nutrison Decanted feeds eg Resource Plus Max. hanging time 24 hrs Max. hanging time 4 hrs DATE TIME FORMULA Giving Sets (gravity or pump) 500 ml Container FLUSHES Flush feeding tube with 50 ml water whenever feeding is temporarily stopped before & after any medication is given by tube and every 4/24 (to prevent tube clogging) Replace at 0600 hrs daily unless otherwise indicated HOURS TO RUN RATE (ml/hr) Signature Day 1 NUTRISON 24/24 40 ml/hr & q4h 50ml water flushes RMO to review IV fluids with reference to enteral fluid intake PATIENT IDENTIFICATION LABEL REMEMBER TO: Elevate patients to during feeding Check formula for use-by date Shake formula well before use Check max. hanging time of formula and discard time of equipment Complete label on formula bottle Contact Dietitian if problems arise PLEASE NOTE: This is a starter regimen only organise Dietitian review on first working day 1) If the patient weighs less than 50kg, commence feeding at 20mls/hr Nutrison increasing by 20ml/hr q24h. Feeds NOT to start at 40ml/hr. 2) Monitor electrolytes daily (K, PO4, Mg) and replace if low. Do NOT increase rate if electrolytes drop. 3) Do not start feeds if electrolytes (K, PO4, Mg) are low and have not been replaced to within the recommended range. 4) Do NOT use starter regimen for Renal Patients. Contact ward dietitian during business hours or on call dietitian during weekend or public holidays (see below). Ready to hang feeds eg Nutrison Max. hanging time 24 hrs Decanted feeds eg Resource Plus Max. hanging time 4 hrs Giving Sets (gravity or pump) 500 ml Container FLUSHES Flush feeding tube with 50 ml water whenever feeding is temporarily stopped before & after any medication is given by tube and every 4/24 (to prevent tube clogging) DATE TIME FORMULA HOURS TO RUN RATE (ml/hr) Day 1 NUTRISON 24/24 40 ml/hr & q4h 50ml water flushes Replace at 0600 hrs daily unless otherwise indicated RMO to review IV fluids with reference to enteral fluid intake Day 2 NUTRISON 24/24 60 ml/hr & q4h 50ml water flushes Signature Day 2 NUTRISON 24/24 60 ml/hr & q4h 50ml water flushes Day 3 NUTRISON 24/24 60 ml/hr & q4h 50ml water flushes NB fluid requirements will usually not be met by starter regimen Day 1 Day 2 TOTAL daily fluid intake from feeds and flushes: < 1300 ml 1700 ml Day 3 NUTRISON 24/24 60 ml/hr & q4h 50ml water flushes NB fluid requirements will usually not be met by starter regimen Day 1 Day 2 TOTAL daily fluid intake from feeds and flushes: < 1300 ml 1700 ml Dietitian Pager # Saturday/Sunday/Public Holiday contact (10am 2pm): N:\Nutrition and Dietetics\2.0 Administration\2.2 Forms\Patient Current as at 24 January

30 End User Device Allocation Current as at 24 January

31 iemr Program Device Allocation Model The model is only a guide Consultation with clinicians in all clinical units at each facility is required to comprehend the full level of requirements and their constraints Recurring costs will be met by the Divisions Existing administration / ward clerk computers and NUM / management computers are excluded from this calculation Current as at 24 January

32 Simulation Room Bldg 1, 2H.8 Current as at 24 January

33 iemr Program & Research Discussion Points What information is currently recorded/placed in the PAH medical record Is it related to a current admission/outpatient/ed encounter If not able to be scanned to a PAH encounter how to scan this clinically relevant information? iemr Access/Security profiles for research staff Only access to PAH as an organisation? Current as at 24 January

34 Questions Current as at 24 January

35 Information and Contact Details PA Intranet Clinical Informatics & Technology Services (CITS) fault.asp Videos: Introduction and progressive development of iemr: PA Intranet Home Page > Quicklinks> Learning >emr Intro iemr Sept 12 Current as at 24 January