Surgical Clinic Module of HughesRiskApps

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Surgical Clinic Module of HughesRiskApps

  1. 1. Beyond the EHR Kevin S.Hughes, MD, FACSCo-Director, Avon Comprehensive Breast Evaluation Center Massachusetts General Hospital Surgeon The Newton-Wellesley Hospital Breast Center
  2. 2. EHR and productivity varies by specialty100 internists, pediatricians and family practitioners • Initial implementation – 25 to 33 percent drop in MD productivity • Over time – Internists • Slightly above original productivity – Pediatricians and family practitioners • Remained below original productivity • Explanations – Internists review data entered by others • EMRs more efficient – Pediatricians/family practitioners data entry and documentation • EMR more time-consuming Hemant Bhargava, UC Davis Graduate School of Management
  3. 3. • Quote from a breast surgeon recently on a new EHR• …our productivity is down 28%• Everyone attributes this to the learning curve of xxxx EHR.• I am the highest paid transcriptionist in the state• Each cancer patient chart takes me apprx 1 hour• For the first time in my career, I turned down an add-on patient from one of my outside referrers because I just could not spend one more hour putting a new patient into the computer• I spent 5 hours on Saturday and 4.5 on Sunday catching up on charts from Thurs and Friday and backloading charts of return patients for Tuesday
  4. 4. The EHR is a filing cabinet, not a database. The interface is the same for apediatrician, a neurosurgeon, a cardiologist, and everyone else, as if everyspecialist wanted data presented the same way. EHR Generic Database Filing Cabinet Interface Or Document Management System
  5. 5. Anesthesia, pathology and breast imaging have set up their own databases and interfaces to deal with their unique needs. They send free text reports into the EHR as the EHR lacks the ability to accept data. EHRAnesthesia Pathology Interface Interface Filing Cabinet Or Document Management System GenericMammography Interface Interface
  6. 6. HughesRiskApps Breast Surgery ModuleFree software available at:HughesRiskApps.net Kshughes@Partners.org
  7. 7. Less work + CDS = Higher QualityPatient enters data : Tablet PC iPad Website Patient education Clinical Decision al Support materials EHR Reviews Report & Pedigree Clinical Decision Reviews suggested Support Documents and management Orders
  8. 8. Breast Data Overlaps
  9. 9. EHR Breast RT Interface Surgery Interface Breast MedOnc Interface
  10. 10. Breast Surgery Module as the prototypeCan be adapted to other disciplines and othercancers easily • Designed to decrease clinician workload • Increase quality by facilitating appropriate course of action – Examples: • Risk algorithms run real-time • Referral letters generated real-time • Improve patient satisfaction – Provide educational materials real-time • Store data needed for certification by NAPBC, ACoS, QOPI, and others – Easily retrieves most data needed for certification with minimal work • Decrease cost – Per above, savings in staff and workload – Decrease in transcription costs of $6000 or more per clinician per year
  11. 11. HughesRiskApps modules follow a simple workflow Existing data Patient data entry Clinical Decision Support (CDS) Printout with suggested actions Clinician editing/enhancing Clinical Decision Support (CDS) Generate orders and documents
  12. 12. Choose how much data you want the patient to enter via the Tablet by choosing the type of survey• Standard – Basic risk information• MGH Standard – Basic risk information plus an extended medical history
  13. 13. Using the HughesRiskApps Tablet questionnaire(With added questions for the Surgery Clinic), apatient can enter her own data • Requiring little or no help from the staff, patients enter their own data. • 5th Grade Reading Level • Available in English, Spanish and Italian Sample screenshots follow
  14. 14. Additional data can be entered by Nurse, Assistant or Clinician
  15. 15. Can be entered by Nurse, Assistant or Clinician
  16. 16. Patient data is downloaded from theLMR (MGH home grown EMR) allowingcorrelation with patient entered data • Problem List • Medications • Allergies • Procedures Upload of data being developed. Interfaces with other EMRs in development.
  17. 17. Patient data is downloaded from theLMR (MGH home grown EMR) allowingcorrelation with patient entered data Upload of data being developed. Interfaces with other EMRs in development.
  18. 18. Patient data is downloaded from theLMR (MGH home grown EMR) allowingcorrelation with patient entered data Upload of data being developed. Interfaces with other EMRs in development.
  19. 19. Patient data is downloaded from theLMR (MGH home grown EMR) allowingcorrelation with patient entered data Upload of corrected data being developed. Interfaces with other EMRs in development.
  20. 20. Entered by MD
  21. 21. Entered by MD (Question set is appropriate to the Chief Complaint)
  22. 22. Entered by MD, but eventually will be an automatic interface with radiology system
  23. 23. Entered by patient via tablet, Clinician/Staff can edit and enhance
  24. 24. Entered by patient via tablet, Clinician/Staff can edit and enhanceSubTabs for Risk Factors, Family History (As Table), Pedigree, and Risk Analysis underTab for specific disease
  25. 25. Entered by patient via tablet, Clinician/Staff can edit and enhanceCan view/edit Family History via table or pedigree(See next slide)
  26. 26. Entered by patient via tablet, Clinician/Staff can edit and enhanceCan view/edit Family History via pedigree or table (See Prior slide)
  27. 27. Data entered by patient via tablet is used to run risk models
  28. 28. Entered by patient via tablet, Clinician/Staff can edit and enhance
  29. 29. MD enters Physical Exam with interactive breast diagram. Double click on lump to add information
  30. 30. Impression (s) are chosen by the Clinician
  31. 31. If the Impression includes surgery, Surgical Scheduling screen opens with appropriateprocedure pre-chosen.Clinician can edit or change procedure as needed
  32. 32. Orders are pre-filled based on impression and proceduresClinician can add/edit orders
  33. 33. A choice of letters and informationsheets are pre-chosen based on orders
  34. 34. H&P GeneratedCurrently in use, being modified and enhanced
  35. 35. Consent, Administrative Paperwork, Patient Education Materials printed
  36. 36. At post operative visits, pathology data is entered andthe computer organizes and summaries
  37. 37. Table (Above gray area) shows the procedures and a pathologic summary of the resultsThe more detailed pathology view (Below gray area) relates to the SELECTED procedure
  38. 38. Can view surgeries on a timeline
  39. 39. Future timelineWill soon also include Timelines for Breast Imaging, Chemotherapy, RT, and Hormonal Therapy In development Not yet available
  40. 40. Breast Surgery Module as the prototype Can be adapted to other disciplines that treat breast cancer, as there is significant overlap of data collected
  41. 41. When the final surgery is completed, the cancer summary is derived from the pathology ofthe individual procedures that had been entered by MD The source of this data can be seen at the procedures tab
  42. 42. After the final surgery, letters are generated to PCP summarizing care, and to Med and Rad Onc, asking for consultation/opinion
  43. 43. Summary of surgery is sent to primary and as part of referral letters to Medical Oncology and Surgical Oncology
  44. 44. Data needed for certification byNAPBC, ACoS, QOPI, and others shown as a report at any time
  45. 45. Breast Surgery Module as the prototype Can be adapted to other disciplines that treat breast cancer, as there is significant overlap of data collected
  46. 46. Breast Surgery Module as the prototype Can be adapted to other cancers• Ideally will serve as a module to any EHR

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