September 2013 EHR Integration Patient Care Storyboard Page 1 of 5

Transcription

1 EHR Integration in Point of Service Systems: Patient Care Storyboard The Patient Medication Profile The Pharmaceutical Information Network (PIN) is one component of the EHR; it is the central repository of the patient s Medication Profile. Medication and allergy information is loaded into the EHR from pharmacies, physician offices, and Alberta Cancer Centers. To better understand the benefit of integrating the EHR with existing Point of Service (POS) systems (such as clinic EMR systems, pharmacy management systems and hospital systems), a typical scenario is described for the patient Mr. Adam Smith. September 2013 EHR Integration Patient Care Storyboard Page 1 of 5

2 This storyboard follows Mr. Smith from his initial visit to a walk-in medical clinic, then to a community pharmacy, the hospital, and finally, back to his family doctor. Patient: Adam Smith. Symptoms: Cough, weakness, general malaise. Adam Smith is a 77 year old male from Calgary, visiting his granddaughter in Edmonton. He has no history of allergies or chronic conditions, but has been experiencing a productive cough for a week, with some weakness and general malaise. His granddaughter convinces him to visit the local walk-in clinic, where he will see Dr. Jones. The clinic s EMR system is integrated with the EHR. 1 Adam visits out-of-town clinic. His EHR Medication Profile is retrieved by the clinic s EMR system. When Adam arrives at the clinic, the nurse at reception starts a file for him in the clinic s EMR system, confirming his PHN, name, date of birth, and gender. The EMR system automatically checks for current prescriptions and allergy records on the EHR and detects there is nothing current for Adam to be downloaded. When Dr. Jones sees Adam, she opens his patient record in the EMR system. Adam is prescribed an antibiotic. His EHR Medication Profile is automatically updated with the prescription. Dr. Jones decides that antibiotic therapy may be appropriate for this situation if things do not improve. She notes there are no other current prescriptions or allergies on Adam s file. She confirms this with Adam, and prescribes a course of Erythromycin. The EMR system automatically uploads the Erythromycin prescription to the EHR. Dr. Jones explains to Adam that if symptoms worsen over the next couple of days, he should begin taking the drug. September 2013 EHR Integration Patient Care Storyboard Page 2 of 5

3 2 Adam fills prescription at out-of-town pharmacy. Pharmacist reviews Adam s EHR Medication Profile. Adam has the prescription filled at the Get Well pharmacy near his grand-daughter's home. Get Well pharmacy uses a pharmacy system that is fully integrated, real-time, with the EHR Ken Wood is the pharmacist on duty, and confirms Adam s PHN, name, date of birth, and gender. Using the confirmed information, Ken finds Adam s integrated Medication Profile in the local pharmacy system. He confirms that the Erythromycin is currently Adam s only therapy and this will be the first dispense of that prescription. Ken consults with Adam regarding medical conditions, allergies, and other medications. Ken counsels Adam on his new prescription and advises to monitor for symptoms of intolerance and rare but possible allergic reactions. Adam confirms he is not on any other medications, and is not aware of any allergies. Pharmacy System is integrated with PIN and the dispense is immediately updated on the EHR. Ken enters the dispense against under the EHR prescription, right within his Pharmacy Practice Management System. The Levaquin dispense is immediately sent to the EHR from the integrated pharmacy system. 3 Adam experiences allergic reaction and calls 911. Adam is reluctant to take the Erythromycin and decides he will wait until morning to take his first dose. The next morning, within 30 minutes of taking the Erythromycin, Adam notices a rash that is rapidly developing on his body. His breathing is becoming labored. He calls his grand-daughter, who calls 911. By this time, his throat is beginning to swell. On the ambulance ride to the hospital, Adam loses consciousness and unable to communicate for himself. September 2013 EHR Integration Patient Care Storyboard Page 3 of 5

4 4 Hospital ER team reviews Adam s EHR Medication Profile. Dr. Park is the ER physician who begins to assess Adam s condition and symptoms. Adam s grand-daughter meets him at the hospital. She informs the ER team that Adam had visited a doctor about his cough. One of the ER team members gains details about Adam s identity from the granddaughter, and uses the information to access Adam s EHR Medication Profile. Hospital ER team notes that Ken s Medication Profile indicates he is taking Erythromycin. Adam is treated for anaphylactic reaction. Dr. Park is alerted by his team member that Adam s Medication Profile indicates he was dispensed Erythromycin the day before. The symptoms are consistent with allergic reaction to Erythromycin, and Dr. Park treats Adam for an anaphylactic reaction. Adam is discharged from hospital. Dr. Park prescribes Levaquin to replace Erythromycin. Once Adam recovers and is ready for hospital release, Dr. Park writes him a prescription for Levaquin in place of the Erythromycin, and advises Adam to inform his family doctor and pharmacist that he is allergic to Erythromycin. 5 Adam fills Levaquin prescription at outof-town pharmacy. Pharmacy sends dispense to EHR at end of day. Adam's hotel bell-man directs him to a 24-hour pharmacy that has not yet integrated with the EHR, but is connected to Netcare Portal, and, has also been submitting a file of Pharmacy Batch dispenses to PIN every night for over a year. Adam fills the prescription for Levaquin. The pharmacist on duty locates Adam's EHR Medication Profile on Netcare Portal. The pharmacist views the same profile that Dr. Park viewed and updated. The pharmacist dispenses the Levaquin. The pharmacy system automatically queues the dispense for submission to PIN in batch mode at the end of the day. September 2013 EHR Integration Patient Care Storyboard Page 4 of 5

5 6 Adam has recovered and doing well. Adam visits his own family doctor. Family doctor s EMR system automatically retrieves prescription from the EHR for Erythromycin and Levaquin. On the EMR system, the family doctor discontinues Erythromycin, renews Levaquin, and enters the allergy to Erythromycin. The EMR system automatically updates the EHR with the discontinue to Erythromycin, renewal of Levaquin, and new allergy. A few days later Adam is recovering from his cough and feeling much better. He returns to his home in Calgary and makes an appointment to visit his family physician, Dr. Chen, the following day. The clinic s EMR system is integrated with the EHR. When Adam arrives, Dr. Chen opens Adam s file on the EMR system, while they discuss Adam s conditions and recent treatment. Dr. Chen s EMR system automatically retrieves the EHR Medication Profile, and detects that two new prescriptions have been added, Erythromycin and Levaquin. Dr. Chen downloads the Levaquin prescription to Adam s file onto the local EMR system, and renews the prescription. Dr. Chen also discontinues the old prescription for Erythromycin with a reason of allergic reaction, and she enters the allergy into her EMR system. The EMR system automatically sends the new allergy, as well as the discontinue order for the Erythromycin, to the EHR. Adam and his granddaughter are very grateful for the care they received throughout his illness. Adam was especially impressed that the health care professionals he encountered seemed to be so well-informed about his medications. September 2013 EHR Integration Patient Care Storyboard Page 5 of 5