Computerized Emergency Department System By Frank Hsu
By Frank Hsu December, 9, 2008 Course Professors: Dr. Nancy Staggers and Dr. Scott Narus
The key sponsors of the Project <ul><li>A couple of clinical information technology managers </li></ul><ul><li>The chief pathologist </li></ul><ul><li>A couple of laboratory managers </li></ul><ul><li>The chief pharmacist </li></ul><ul><li>Three senior emergency physicians. </li></ul><ul><li>The director of nursing </li></ul><ul><li>Three senior emergency nurses. </li></ul><ul><li>A couple of emergency administrative managers </li></ul>
The Characteristics of the CEDS <ul><li>The lack of availability of ED physicians will reduce the productivity of the ER services. The lack of provider access to vital patient data constantly impairs the ED diagnoses and delays the delivery of care. </li></ul><ul><li>The enhancement of the CEDS system’s accessibility to clinical workstations could result in more organized and efficient operations with tracking patient records, ordering lab tests, documenting interpretations and sharing information among other providers. </li></ul><ul><li>The implementation of accurate procedures and rules for the ED staff to follow will not only prevent common medical errors, such as adverse drug events and never-events, but also can alert the ED staff that a patient has a critical condition and needs the most appropriate immediate intervention. </li></ul><ul><li>The ED system operates and interacts with other healthcare center facilities to make their workflow processes and functions efficient. The operations management includes electronic registries, clinical documentation, practices of triage, knowledge-based clinical guidelines, specific interventions, computerized prescription writing, and utilization allocation. </li></ul>
The vision of the project <ul><li>Implementing wireless services at the healthcare center are important steps which will allow the ED staff to access the latest patient’s records anywhere, such as a patient tracking board, PDAs, tablet PCs, etc. </li></ul><ul><li>Fast retrieval of patient medical records with reliability and accuracy. </li></ul><ul><li>Quickly identifying and solving patient medical problems and making appropriate therapeutic treatments with a basic knowledge support system. </li></ul><ul><li>Having a significantly greater number of clinical contributions for the improvement of patient satisfaction. </li></ul><ul><li>Reducing many manual tasks for the ED staff, such as clinical documentation and nursing documentation. </li></ul><ul><li>A successful implementation of such an ED system will advance the quality of care and affordability of the healthcare center to the leading edge of emergency medicine in Utah. </li></ul>
The benefits for the project <ul><li>The project will integrate the processes of an ED’s workflow to expedite ED operations. It helps the ED staff practice their work more smoothly and decreases the pressure associated with clinical documentation. </li></ul><ul><li>The ED staff will have extensive information and instructions about what is occurring and what needs to be done. Clinicians will also have detailed data of all medical examinations and accurate information that they can use to act upon and later. </li></ul><ul><li>With the information provided by the system, patients’ ED visit times will decrease. Patients will spend less time waiting, rooms will turn over faster, and patient frustration associated with long visits will decrease. Patients will be more likely to continue utilizing the medical services of a specific ED. The decreased visit times will mean the clinicians can see more patients within the ED. This will increase the revenue of the healthcare center. </li></ul><ul><li>ED clinicians need to get patient data as quickly as it is available in an intuitive format. With screens that are easy to use, the patient medical reports can be identified at a glance without navigating through many pages. </li></ul><ul><li>To facilitate a seamless continuum of patient care, this project would also serve as a standardized communication system linking the emergency department information to the rest of the health care center facilities for inpatient admissions and dispositions. </li></ul>
Needs for the project <ul><li>From the previous ED system, there was a great deal of inefficiency in the integration of the healthcare center and poor layouts when the ED nurses worked on that documentation system. The laboratory system was not viewable while using that system. </li></ul><ul><li>Streamlining the processes of emergency workflow has become imperative to strengthen the competitiveness of the healthcare center in a cost-effective manner in this region. </li></ul><ul><li>Developing a robust system and providing the best quality emergency services without making the mentioned mistakes have become a high priority goal at healthcare center. </li></ul><ul><li>The adoption of both a reliable and accountable computerized prescribing system as well as a decision support system has become an important approach to minimize potential medication errors and create a competitive advantage over competition. </li></ul><ul><li>The CEDS would reserve many flexible functions for future expansion and integration of other ED systems through service-oriented architecture (SOA). </li></ul>
Project team organization and their responsibilities <ul><li>The PM should understand the proper use of human resources, organizational structure and politics, implementation skills, and data management by managing project scope, time, cost, and quality to achieve the project objectives of on-time and on-budget delivery of the system. </li></ul><ul><li>Team member #1: a.) analyzes and designs any data conversion plans. b.) outlines the display of disease symptoms and signs. c.) determines components requested and useful interfaces for current and future needs. </li></ul><ul><li>Team member #2: a.) documents integration events and critical processes. b.) builds a testing procedure manual for each component. c.) documents cross module information within and between groups in the ED. </li></ul><ul><li>Team member #3: a.) provides the deployment of the application integrations. b.) provides scheduled status reports to each team leader. c.) proposes recommendations to the project team on any changes needed to the implementation policy and procedure. </li></ul>
Risks and risk mitigation tactics <ul><li>1.) The potentially difficult challenge of smoothly integrating the existing functions, systems and database into the CEDS. </li></ul><ul><li>Mitigation: A thorough study, close examination, and detail-oriented analysis of the current ED environment. An assessment of this investigation should be fully documented to record the current hardware infrastructure and software configuration. </li></ul><ul><li>2.) The appropriate summarization of applicable medical literature from the proper resources. </li></ul><ul><li>Mitigation: At the current phase of implementation, the information organization and update may be managed through manually inputting to the CEDS by authorized ED staff. Inputting will ultimately be done automatically by utilizing ontology concepts, semantic webs and networks, even artificial intelligence; to collect medical resources for future implementation. </li></ul><ul><li>3.) User resistance to new software implementation in the emergency workplace. </li></ul><ul><li>Mitigation: User involvement, communications and technical skills, instructor–led classes, and on-site or online training classes, and efficient user support. </li></ul>
Testing Strategies <ul><li>1.) The current ED workflow shall be thoroughly analyzed. The format and content of prescription order entry, lab results, evidence-based recommendations, clinical documentations, and managerial reports must be verified in the test environment. </li></ul><ul><li>2. ) Building a test plan, test sequences, test scripts, and the collection of pertinent data for each functional testing. At the same time, data exchanges with current existing systems for integration tests shall be identified. </li></ul><ul><li>3.) Any identified software problem shall be documented and resubmitted to the development team for corrections. If the issue is a minor problem, it shall be fixed to meet the timeline requested. If the issue cannot be resolved in a short period of time, the issue should be forwarded to the implementation committee or to the steering committee for further discussion and negotiation. </li></ul><ul><li>4.) The test platform and agreement shall be approved by all responsible executives at all levels. </li></ul>
The main elements of the go-live plan <ul><li>All necessary hardware, software, interface, network, and database shall be installed and tested before each phase of deployment. Before go-live starts, technical team members will need to set up configuration to fit the live environment. </li></ul><ul><li>The system analysts will evaluate what data will need to be converted and prepared for each phase of deployment. The test patient data will be closely monitored by watching data following through each system. </li></ul><ul><li>During the go-live period, team members, such as emergency nurses and physicians, shall carefully monitor the accuracy of the data displayed on their screens. </li></ul><ul><li>Because the ancillary system will cross departmental boundaries, each department shall be communicable during each relevant phase of the go-live plan. Well constructed fallback plans will be built in to cope with unexpected failures. Contingent recovery plans will flip back to pre-installation status if any unwanted events occur. </li></ul><ul><li>A buy-in among all relevant divisions and departments shall be approved to lay out the management of a triage and reporting mechanism after go-live. </li></ul>
The framework for the series of implementation <ul><li>Data derived from maintenance evaluation activities can be input for the design of a new solution to the same information management problem. Therefore, using the PRECEDE-PROCEED model, all implementation processes will be documented, and the CEDS will be evaluated for the ROI analysis. Consequently, any suggestions and recommendations generated will direct the future training, developments, and managements. As long as the CEDS is used in the ED, all maintenance activities shall always be continuously visible to the user support. </li></ul><ul><li>All content of this presentation can be referred to: </li></ul><ul><li>http://computerizedemergencydepartmentsystem.blogspot.com/ </li></ul>
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