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CLINT Functionalities.doc

  1. 1. CLINT Implementation Phases and Functionalities Richard Kremsdorf, M.D. CHW Information Officer for Medical Informatics Susan Perry, R.N.
  2. 2. DRAFT CHW Information Officer for Enterprise Clinical Applications Page 2 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  3. 3. DRAFT FUNCTIONALITIES BY WORK PROCESSES........................................................................................6 RESULTS RETRIEVAL.....................................................................................................................................6 CLINICAL CARE DELIVERY AND DOCUMENTATION......................................................................................6 INPATIENT CARE MANAGEMENT..................................................................................................................6 DEPARTMENTAL OPERATIONS......................................................................................................................6 ADMINISTRATIVE PROCEDURES....................................................................................................................6 FUNCTIONALITIES BY PHASES.............................................................................................................7 PHASE I.........................................................................................................................................................7 Phase IA...................................................................................................................................................7 Phase IB...................................................................................................................................................7 Phase IC...................................................................................................................................................7 PHASE II........................................................................................................................................................8 Phase IIA..................................................................................................................................................8 Phase IIB..................................................................................................................................................8 Phase IIC..................................................................................................................................................8 PHASE III.......................................................................................................................................................8 PHASE IA.....................................................................................................................................................11 RESULTS RETRIEVAL...................................................................................................................................11 (2)Lab results review by encounter........................................................................................................11 (9)Radiology transcribed results............................................................................................................12 (3)Microbiology results review..............................................................................................................12 (4)Blood gas results review....................................................................................................................13 CLINICAL CARE DELIVERY AND DOCUMENTATION....................................................................................14 (84)Printed medication administration records(MARs) ......................................................................14 (15)Transcription...................................................................................................................................14 (59)Physician patient list........................................................................................................................15 DEPARTMENTAL OPERATIONS....................................................................................................................16 (1)Laboratory departmental functions...................................................................................................16 (34)Pharmacy departmental functions...................................................................................................16 (10)Radiology departmental functions...................................................................................................17 ADMINISTRATIVE PROCEDURES..................................................................................................................18 (83)ADT(Admission, Discharge, Transfer) system focused on the needs of the acute care setting (hospital, attached ambulatory clinics, attached ambulatory surgery).................................................18 (53)Order entry to all departments........................................................................................................18 PHASE IB......................................................................................................................................................20 RESULTS RETRIEVAL...................................................................................................................................20 (57)Physician Rounds Report.................................................................................................................20 (5)Longitudinal lab results review.........................................................................................................20 (11)Longitudinal radiology results........................................................................................................21 CLINICAL CARE DELIVERY AND DOCUMENTATION....................................................................................22 (20)Bedside numbers..............................................................................................................................22 (35)Medication allergies, height, weight...............................................................................................23 (33)Medication profile...........................................................................................................................23 (82)Medication vending machines.........................................................................................................24 INPATIENT CARE MANAGEMENT................................................................................................................24 (38)Drug utilization evaluation studies..................................................................................................24 (44)Case finder reports .........................................................................................................................25 ADMINISTRATIVE PROCEDURES..................................................................................................................26 (63)Electronic and printed Order Sets for common clinical pathways/standard orders.......................26 PHASE IC.....................................................................................................................................................27 Page 3 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  4. 4. DRAFT CLINICAL CARE DELIVERY AND DOCUMENTATION....................................................................................27 (39)Medication charting........................................................................................................................27 (21)Clinical management flowsheets.....................................................................................................27 INPATIENT CARE MANAGEMENT................................................................................................................28 (22)Discharge planning screens............................................................................................................28 ADMINISTRATIVE PROCEDURES..................................................................................................................29 (55)Electronic communication among all clinical caregivers...............................................................29 PHASE IIA....................................................................................................................................................30 RESULTS RETRIEVAL...................................................................................................................................30 (6)Lab order status available on HIS.....................................................................................................30 (7)Blood bank product availability........................................................................................................30 INPATIENT CARE MANAGEMENT................................................................................................................31 (28)Microbiology/antimicrobial therapy alerts.....................................................................................31 DEPARTMENTAL OPERATIONS....................................................................................................................31 (16)Electronic report distribution..........................................................................................................31 (36)Alerts to Pharmacist........................................................................................................................32 ADMINISTRATIVE PROCEDURES..................................................................................................................32 (60)Physician phone directory...............................................................................................................32 (56)Web access for caregivers...............................................................................................................33 PHASE IIB....................................................................................................................................................35 RESULTS RETRIEVAL...................................................................................................................................35 (12)Images of digital modalities(CT, MRI, Ultrasound, Nuclear Medicine).........................................35 CLINICAL CARE DELIVERY AND DOCUMENTATION....................................................................................35 (32)ICU/OR/OB monitor to computer download...................................................................................35 (23)Nursing physical assessment...........................................................................................................36 (19)Remote access from MD home, office.............................................................................................36 INPATIENT CARE MANAGEMENT................................................................................................................37 (37)Drug-lab alerts................................................................................................................................37 ADMINISTRATIVE PROCEDURES..................................................................................................................37 (65)Electronic file cabinet for protocols, schedules, standard documents, policies and procedures....37 (64)Review of OR, Cath Lab, PT, Endoscopy (et al.) schedules............................................................38 (54)Cross-continuum patient registration system..................................................................................38 (61)MPI across >1 site of care..............................................................................................................39 (58)Housestaff sign-out cards/Problem List..........................................................................................40 PHASE IIC....................................................................................................................................................41 RESULTS RETRIEVAL...................................................................................................................................41 (18)Pathology transcribed results..........................................................................................................41 CLINICAL CARE DELIVERY AND DOCUMENTATION....................................................................................41 (24)Patient careplans/pathways.............................................................................................................41 (25)Documentation of patient care activities and interventions by nursing..........................................42 (26)Documentation of all ancillary caregiver interventions..................................................................42 INPATIENT CARE MANAGEMENT................................................................................................................43 (8)Critical lab alerts...............................................................................................................................43 DEPARTMENTAL OPERATIONS....................................................................................................................43 (17)Electronic Signature........................................................................................................................43 PHASE III.....................................................................................................................................................45 CLINICAL CARE DELIVERY AND DOCUMENTATION....................................................................................45 (31)Anesthesia record............................................................................................................................45 (13)Telemedicine:CME..........................................................................................................................45 (73)Telemedicine: Remote diagnostics..................................................................................................46 INPATIENT CARE MANAGEMENT................................................................................................................46 Page 4 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  5. 5. DRAFT (27)Alerts to RNs and MDs....................................................................................................................46 (81)Physician order entry......................................................................................................................47 DEPARTMENTAL OPERATIONS....................................................................................................................47 (14)Digital radiography including PACS..............................................................................................47 ASSUMPTIONS...........................................................................................................................................49 SUPPORT RELATED......................................................................................................................................49 TECHNICAL RELATED..................................................................................................................................49 INDEX BY FUNCTIONALITY NAME....................................................................................................51 INDEX BY FUNCTIONALITY NUMBER...............................................................................................53 Page 5 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  6. 6. DRAFT Functionalities by Work Processes Results Retrieval Clinical decisions commonly depend on the results of diagnostic testing. Such information needs to be pervasively available so that caregivers can make the most appropriate and expeditious decisions wherever they are physically located, unencumbered by competition for the physical asset(the chart), and with data presented in the way that optimizes understanding of the clinical problem. Data from prior encounters enhances understanding of the patient’s clinical trajectory, highlights potentially significant issues, and reduces duplicative evaluations. Clinical Care Delivery and Documentation Patient care is a Team activity. Consequently, sharing information among, and coordinating the activities of, the caregiver team is essential for clinical effectiveness. The information with the greatest impact is that which is used by the most people, unambiguous in its significance, and directly needed for the most important clinical decisions. Gathering all the data needed for a clinical judgement and presenting it optimally results in greater clinical effectiveness. Inpatient Care Management While primary caregivers focus on the patient in front of them, others look at a larger population, ensuring that the resources and needed attention are applied where most needed. Identifying those patients where there is likely to be a need for more help, more expertise, or there is an opportunity to improve the effectiveness of care is a key way to leverage data that has been gathered in the course of Clinical Care Delivery. Fundamentally, it is a way to make sure no one “falls through the cracks” and that resources are focused on those in greatest need. Departmental Operations Bedside patient care depends on the support of many people and systems outside the patient room. These departments are “high transaction volume” environments where high service levels are essential for the rest of patient care to be efficient. Happily, extensive automation has already occurred in these areas, though gaps remain. Administrative Procedures Many work processes must occur to enable and implement direct patient care. They are closely related to patient satisfaction and efficiency of operation of the clinical staff. Page 6 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  7. 7. DRAFT Functionalities by Phases The CLINT Functionalities were defined and prioritized by broad-based discussions throughout CHW among more than 250 caregivers, technicians, administrative staff, managers, and executives. Then, extensive Assessments of these Functionalities were done throughout CHW through contacts with over 200 CHW caregivers. The Tiers from the Discussions and the Learnings from the Assessments have been combined into the Phases which are described in this document. The CLINT Phases form a logical sequence that describes how an organization can implement the CLINT Functionalities—getting the most value and least disruption up front and building on the foundation of the earlier Phases. Phase I Establishes infrastructure and incorporates workflow improvements for the high volume, high value clinical transactions… Phase IA The most basic administrative and clinical transactions have to work before more complex workflows can be affected. These are high volume and high value clinical transactions, which must be done, so that if there are inefficiencies the impact will be felt in delayed or ineffective clinical decisions, staffing to offset the inefficiencies, or poor service levels. The effective accomplishment of these Functionalities also establishes the basis for doing more complicated Functionalities, by getting devices in place where caregivers can get to them, deploying passwords and familiarity with the system, and creating the habit that “the computer is where you look for information.” Phase IB These Functionalities get more deeply into caregivers’ workflows, focusing on those tasks that can be cumbersome to do manually and whose workflow can be relatively straightforwardly improved. For example, data which is sought by many different personnel in the hospital, and which therefore can have a huge impact on clinical decision-making, is put into electronic form so it can be made available in different ways, each optimized to serve a different purpose. Calculations are done automatically, improving availability, accuracy and efficiency. Phase IC Functionalities requiring and supporting inter-departmental collaboration are added here, building new ways to do work. Paper Medication Administration Records go away, leading to much more flexibility in displaying the effects of medication therapy using Clinical Management Flowsheets and enabling even better medication monitoring. Page 7 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  8. 8. DRAFT Phase II Broadens the range of caregiver activities included and builds more sophistication and complexity into the tools… Phase IIA The electronically enabled caregiver at this point can no longer accept paper-based methods, so the range of tasks is broadened, with the easier extensions of the electronic capabilities established in Phase I. Phase IIB More complex and more technically challenging work processes are tackled here. Many more decisions about clinical processes, such as the degree of detail required for documentation, are made. Multiple organizational groups and technologies interact, which is harder to make work than in earlier Phases, but builds on existing knowledge and trust. Phase IIC The remainder of the bedside and paper workflow is captured and integrated, tying in the new pieces with all that has already been done. Phase III Tackles the more challenging work processes in more specialized environments… Page 8 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  9. 9. DRAFT Phases Work Process Functionality IA Results Retrieval Lab results review by encounter Radiology transcribed results Microbiology results review Blood gas results review Clinical Care Delivery and Documentation Printed medication administration records Transcription Physician patient list Departmental Operations Laboratory departmental functions Pharmacy departmental functions Radiology departmental functions Administrative Procedures ADT(Admission, Discharge, Transfer) system Order entry to all departments IB Results Retrieval Physician Rounds Report Longitudinal lab results review Longitudinal radiology results Clinical Care Delivery and Documentation Bedside numbers(vitals, I&O, weights, oximetry, …) Medication allergies Medication profile Medication vending machines Inpatient Care Management Drug utilization evaluation studies Casefinder reports Administrative Procedures Electronic and printed Order Sets for common clinical pathways/standard orders IC Clinical Care Delivery and Documentation Medication charting Clinical management flowsheets Inpatient Care Management Discharge planning screens Administrative Procedures Electronic communication among all clinical caregivers Page 9 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  10. 10. DRAFT Phases Work Process Functionality IIA Results Retrieval Lab order status available on HIS Blood bank product status Inpatient Care Management Microbiology/Antimicrobial Therapy Alerts Departmental Operations Electronic report distribution Alerts to Pharmacist Administrative Procedures Physician phone directory Web access for caregivers(including Medline) IIB Results Retrieval Images of digital modalities(CT,MR, US, NM) Clinical Care Delivery and Documentation ICU/OR/OB monitor to computer download Nursing physical assessment Remote access from MD home, office Inpatient Care Management Drug-lab alerts Administrative Procedures Electronic file cabinet for protocols, schedules, Review of OR, Cath Lab, PT schedules Cross-continuum patient registration system MPI across >1 site of care Housestaff sign-out cards/Problem List IIC Results Retrieval Pathology transcribed results Clinical Care Delivery and Documentation Patient careplans/pathways Documentation of nursing interventions Documentation of all ancillary caregiver interventions Inpatient Care Management Critical lab alerts Departmental Operations Electronic Signature III Clinical Care Delivery and Documentation Anesthesia record Telemedicine: CME Telemedicine: Remote diagnostics Inpatient Care Management Alerts to RNs and MDs Physician order entry Departmental Operations Digital radiography Page 10 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  11. 11. DRAFT Phase IA Results Retrieval (2)Lab results review by encounter Description 1. All disciplines of clinicians use computers to retrieve the latest lab results, on any patient from any patient care area 2. Each result arrives via electronic interface to laboratory system 3. Results are grouped by billing encounter 4. Abnormal values are flagged in some way 5. Data must be presented in format acceptable to clinicians 6. Data elements being compared to establish trends are displayed contiguously, either up or down 7. Results can be displayed in clinically meaningful groups, not only in the orderable panels 8. Previous results for this encounter must be routinely displayed to facilitate recognition of trends in the data 9. Data is retained on-line for at least 6 months 10. Preferably, data should be discrete and in a standard coded format Primary Users 1. Physicians 2. Nurses 3. Pharmacists Rationale 1. Improves availability of information while reducing paper production and distribution costs 2. Improves both caregiver and lab efficiency by reducing phone calls to lab Dependencies 1. Departmental lab computer system 2. Interface from Departmental lab computer system to HIS Barriers 1. Device availability 2. Display format which is effective for clinical decision-making Page 11 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  12. 12. DRAFT (9)Radiology transcribed results Description 1. Transcribed reports describing the findings of all imaging studies are available on-line for review within a reasonable period of time(i.e. <24 hours) 2. Status of ordered studies can be reviewed on-line 3. Previous studies are listed 4. Preliminary versus Final status is visible 5. Electronic signature of reports Primary Users 1. Physicians 2. Nurses 3. Radiology fileroom staff 4. Radiology Techs 5. Radiologists 6. Respiratory Therapists Rationale 1. Reduces phone call and trips to Radiology department 2. Facilitates more complete understanding of patient condition Dependencies 1. Radiology Departmental Functions Barriers 1. Inadequate turnaround time to meet clinicians’ needs 2. Many process steps to report availability causes delays (3)Microbiology results review Description 1. Clinicians use computer to retrieve results of cultures, antimicrobial sensitivity testing, and Minimal inhibitory concentration testing 2. Specimen type, site, and collection time, and method of testing clearly identified 3. Date culture turned positive indicated for critical specimens e.g. blood and CSF 4. Primary Users 5. Physicians Page 12 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  13. 13. DRAFT 6. Infection Control nurse 7. Pharmacists Rationale 1. Time sensitive information that requires frequent review must be available on-line to reduce time until clinical care is altered based upon culture results 2. Is separate from Lab Results Review because of extra complexity Dependencies 1. Lab results review by encounter Barriers 1. Complexity of result mapping (4)Blood gas results review Description 1. Caregivers should be able to find current and recent studies expeditiously 2. Results should indicate amount of supplemental oxygen in use 3. When patient is receiving mechanical ventilatory assistance, ventilator settings should be included Primary Users 1. Physicians 2. Nurses 3. Respiratory therapists Rationale 1. Blood gas studies commonly indicate a critical patient condition and as such must be handled in a more timely manner than most lab studies 2. Blood gas studies are commonly done outside the routine laboratory and use a different reporting mechanism, which slows data availability 3. Must be able to correlate lab result with the clinical setting of the patient 4. Physicians need access to data while located in non-critical care settings 5. Data from prior studies is essential to understanding current results Dependencies 1. Lab results review by encounter Barriers 1. Instruments that don’t support standard electronic connection 2. Data entry of ventilator settings Page 13 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  14. 14. DRAFT Clinical Care Delivery and Documentation (84)Printed medication administration records(MARs) Description 1. Pharmacy departmental system creates printed document that is used by nursing to document whether a medication has been administered 2. Updated Medication allergies are printed on the document 3. Reasons for not giving a medication are indicated 4. Medication name(both generic and trade) is easily legible 5. Dosage formulation is designated(e.g. two 50 mg capsules) Primary Users 1. Nurses 2. Physicians 3. Pharmacists Rationale 1. Handwritten MARs are subject to transcription errors 2. Handwritten MARs are time inefficient for the nurses 3. Medication allergies are available for review at time of medication administration 4. Electronic MARs are even better but are in a later phase Dependencies 1. Pharmacy Departmental Functions Barriers 1. Requirement for collaboration between nursing and pharmacy departments 2. Requirement for timely printing and distribution 3. Multi-day MARs are often out-of-date because of medication changes 4. Single day MARs obscure the trend of medication usage (15)Transcription Description 1. Transcribed reports of the specified types on patients who received care at a CHW facility will be available for review on-line within a reasonable period of time(i.e. <24 hours) a) Transcription(H&P, Consults, D/C Summary, Procedure Reports, ER Visits, Pathology), cardiac cath reports b) Echocardiogram transcription Page 14 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  15. 15. DRAFT c) Noninvasive vascular transcription d) Treadmills 2. Text of EKG report 3. Reports should be available on-line for no less than two years after creation, preferably indefinitely 4. It should be easy to determine what types of reports are available 5. There should be regular reporting on turnaround time from dictation to on- line availability 6. Some discrete coded data elements should be captured from studies with quantitative results 7. EKG graphics stored and viewable on-line Primary Users 1. Physicians 2. Nurses 3. Medical Records staff 4. Billing staff Rationale 1. Increases availability of clinical data because paper chart often unavailable 2. Easier to find on-line than in paper chart 3. Easier to create duplicate reports for inter-facility transfers and record requests 4. Improves availability of information for Billing Office Dependencies 1. Interface to Transcription system/vendor Barriers 1. Ability to store and display text documents 2. Workflow to update manually signed documents (59)Physician patient list Description 1. Report or display that lists all patients a physician is interested in 2. Includes all roles a physician may have, such as Attending, Consulting, Referring or simply covering for another physician 3. Patients can be added or removed, patient location is displayed with basic descriptive information such as medical record number, age, sex. Patient location is updated by the ADT application for transfers, discharges Page 15 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  16. 16. DRAFT 4. Display identifies patient for access to clinical information on-line Primary Users 1. Physicians Rationale 1. Streamlines access to clinical data 2. Enhances efficiency of physician rounds by giving correct patient location 3. Information is used to facilitate report distribution to treating and Referring physicians Dependencies 1. ADT Barriers 1. Flexibility to accommodate complex physician needs Departmental Operations (1)Laboratory departmental functions Description 1. Automates internal operations of department 2. Electronic connection to instruments and HIS reduces errors and improves response time 3. Quality assurance measures are automated ensuring quality and regulatory compliance 4. Manages tracking of send-out specimens 5. Results of send-out specimens are viewable by caregivers Primary Users 1. Lab technicians and managers Rationale 1. Standard capability for high volume laboratory Dependencies 1. ADT and order entry interfaces to HIS Barriers 1. Instruments that don’t support standard electronic connection (34)Pharmacy departmental functions Description Page 16 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  17. 17. DRAFT 1. Automation of the workflow within the pharmacy for tasks such fill lists for patient cassettes, labels for iv infusions, piggybacks and injectables. 2. Mechanism for charging for medication usage 3. Duplication, drug-drug, drug-food interaction checking 4. Reporting on drug utilization for real-time decisions and retrospective analysis 5. Supports appropriate allocation of tasks between pharmacist and pharmacy technicians Primary Users 1. Pharmacists 2. Physicians(medication list) 3. Nurses 4. Infection Control (via reporting of TB drug usage) Rationale 1. The high volume, expense, and risk of medication usage make pharmacy applications essential and highly productive Dependencies 1. ADT Barriers 1. Integration with core system (10)Radiology departmental functions Description 1. Automates internal operations of department 2. Creates requisitions, flashcards, jacket labels, transporter slips and other documents 3. Exact procedure performed(which may vary from that ordered) is logged into system 4. Charges captured and sent downstream 5. Displays worklists 6. Produces departmental work and quality statistics 7. Scheduling of outpatient exams Rationale 1. Reduces administrative burden of department 2. Improves turnaround time Page 17 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  18. 18. DRAFT Dependencies 1. ADT and Order Entry interfaces Barriers 1. Integration with core system Administrative Procedures (83)ADT(Admission, Discharge, Transfer) system focused on the needs of the acute care setting (hospital, attached ambulatory clinics, attached ambulatory surgery). Description 1. Demographic and insurance information is expeditiously gathered 2. Encounter history is readily available, showing a patient’s prior encounter registrations 3. Screen designs increase the likelihood that valid data is collected 4. Available beds are displayed and assigned Primary Users 1. Admitting office 2. Administrative staff Rationale 1. All subsequent computer-based activities with a patient record require valid information, collected as early in the process as possible. In different areas, the type and volume of information will vary and the system should accommodate this variability. Dependencies 1. Adequate patient volume Barriers 1. Needs of Patient Accounting system (53)Order entry to all departments Description 2. Communicate need for all patient-related orderable items in a facility 3. Ensures timely delivery of orders, fully specified with all information needed for timely and complete fulfillment 4. Captures charges and allows analysis of utilization 5. Permits review of order status Page 18 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  19. 19. DRAFT Primary Users 1. Clerical staff 2. Nursing 3. Departmental staff implementing orders Rationale 1. More efficient and accurate than paper-based ordering Dependencies 1. ADT interface Barriers 1. Ability of downstream systems to accept transactions Page 19 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  20. 20. DRAFT Phase IB Results Retrieval (57)Physician Rounds Report Description 1. Display a substantial fraction of the information that physicians wish to review during patient care rounds in an effective format , organized by patient 2. Report should include all data available electronically 3. Minimum data set would be labs performed or reported since “yesterday’s rounds” and medication list 4. In more advanced form, would include vital signs, intake and output, medication charting and microbiology and blood gas results Primary Users 1. Physicians 2. Nurses 3. Pharmacists Rationale 1. Enhanced efficiency of physician rounds 2. Thorough evaluation of clinical information more routinely done due to ease of access to the data Dependencies 3. Lab Results Review by encounter 4. Clinical Documentation Barriers 1. Availability of essential data 2. Varying physicians’ clinical requirements and preferences 3. Coded laboratory values (5)Longitudinal lab results review Description 1. Lab results are viewed over multiple registrations by use of a unique identifier, such as medical record number 2. User can easily review all prior results 3. Data is displayed such that review for trends is facilitated Page 20 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  21. 21. DRAFT 4. User can control amount of prior data displayed 5. Prior data kept on line no less than 2 years Primary User 1. Physicians 2. Nurses 3. Quality Coordinators Rationale 1. Prior abnormal values more likely to be noticed 2. Prior values establishes expectations for current results 3. Review of computer-based data vastly faster and more available than review of paper-based chart Dependencies 1. Lab results review by encounter 2. Common patient identifier across encounters for the data sources involved Barriers 1. Capacity for large volume data storage (11)Longitudinal radiology results Description 1. Radiology transcribed reports are viewed over multiple registrations by use of a unique identifier, such as medical record number 2. Sorting or filtered by report type 3. Reports should be available on-line for no less than two years after creation, preferably indefinitely Primary Users 1. Physicians 2. Nurses 3. Radiologists 4. Radiology Techs Rationale 1. Displays radiologic history to ensure comprehensive understanding of patient status 2. Reduces unnecessary repetition of imaging studies Dependencies 1. Radiology transcribed results Page 21 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  22. 22. DRAFT 2. Common patient identifier across encounters for the data sources involved Barriers 1. Capacity for large volume data storage Clinical Care Delivery and Documentation (20)Bedside numbers Description 1. Quantitative measures of patient status that are routinely obtained will be entered into the computer in a timely fashion and available in a variety of display formats wherever computer access is available 2. Vital signs, height, weights, oximetry are entered 3. Point of care testing such as fingerstick glucose and stool occult blood is captured 4. I&O are entered and total and net values are calculated 5. Devices for Point Of Care data entry are available Primary Users 1. Physicians 2. Nurses 3. Quality Coordinators 4. Pharmacists 5. Dieticians Rationale 1. Quantitative measures are universally obtained on patients regardless of nursing theory. 2. Data acquisition and codification is much more straightforward than for textual information 3. There is a tremendous amount of secondary usage of this information in various reports Dependencies 1. Routine physician utilization for Results Retrieval 2. Simultaneous availability of (57) Physician Rounds Report 3. See Assumptions Barriers 1. Major change in workflow for nearly all caregivers Page 22 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  23. 23. DRAFT (35)Medication allergies, height, weight Description 1. Each patient’s medication allergies should be available on-line for use by pharmacist, nurse, and physician 2. It should be printed on reports, such as medication administration records 3. Allergies should be coded so that drug-allergy checking may be done electronically 4. Height and weight are captured and available for use by pharmacist 5. Updates done by pharmacist should display on screens used by caregivers Primary Users 1. Pharmacists 2. Physicians 3. Nurses Rationale 1. Adverse drug events occur in 10% of hospital admissions and many of these are preventable and due to known allergies Dependencies 1. Pharmacy departmental functions Barriers 1. Simultaneous availability of information on remaining paper-based documents limits utility of on-screen display (33)Medication profile Description 1. Active and PRN medications are listed with dose, frequency, order date 2. Inactive medications are listed separately Primary Users 1. Physicians 2. Nurses Rationale 1. Drug therapy is a fundamental treatment modality and is expensive and has high potential for harm. When the medication list is not readily available, sub-optimal therapy commonly occurs Dependencies 1. Pharmacy departmental functions Page 23 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  24. 24. DRAFT Barriers 1. Display flexibility (82)Medication vending machines Description 1. Hardware device maintains inventory of commonly used or controlled medications and dispenses and documents unit doses 2. Receives ADT from external systems 3. Receives medication profile from external systems 4. Handles reporting for controlled substances 5. Documents medication administration to Clinical Documentation system Primary Users 1. Pharmacists 2. Nurses Rationale 1. Reduces access to controlled substances 2. Improves documentation of medication usage 3. Improves available of medications in inventory 4. Reduces lost charges for floor stock drugs Dependencies 1. Pharmacy departmental system 2. Interfaces Barriers 1. Interfaces 2. Requires restocking Inpatient Care Management (38)Drug utilization evaluation studies Description 1. Flexible reporting permits assessment of drug utilization patterns for improvements in concurrent care 2. Flexible reporting permits assessment of drug utilization patterns for retrospective analysis Page 24 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  25. 25. DRAFT Primary Users 1. Pharmacists Rationale 1. Cost and quality control Dependencies 1. Pharmacy Departmental Functions Barriers 1. Availability of a Clinical Pharmacist to act on the findings (44)Case finder reports Description 1. Contemporaneous Reports identify patients for whom defined data is outside the expected range and these Reports are used to guide some form of intervention in patient care 2. Reporting that maximizes value of already captured data elements to improve care 3. [Example: charge nurse uses Actionable Abnormal Labs report to identify labs warranting clinical intervention] 4. [Example: house supervisor/charge nurse uses Unstable Patients report to identify those patients who might benefit from increased staffing, clinical oversight ] 5. [Example: respiratory therapist uses Marginal Respiratory Status report to identify those patients who are having trouble with their breathing] Primary Users 1. Physicians 2. Nurses 3. Quality Coordinator Rationale 1. Prevents patients from “falling through the cracks” Dependencies 1. Clinical Documentation 2. Lab Results Review by encounter Barriers 1. Availability of necessary data elements Page 25 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  26. 26. DRAFT 2. Adjustment of work processes of those with responsibility for dealing with the findings Administrative Procedures (63)Electronic and printed Order Sets for common clinical pathways/standard orders Description 1. Multiple orders may be placed with a smaller number of keystrokes than when placed individually 2. Complicated order details are pre-filled 3. Standard orders for procedures and periods of care can be printed for signature Primary Users 1. Nurses 2. Patient Care Unit clerks 3. Recipients of previously erroneous orders Rationale 1. Expedites placement of repetitive or urgent orders 2. Reduces error rate for unusual studies 3. Concretely implements clinical paths Dependencies 1. Order Entry Barriers 1. Consensus on clinical pathways/order sets 2. Workflow to make them available Page 26 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  27. 27. DRAFT Phase IC Clinical Care Delivery and Documentation (39)Medication charting Description 1. Medication profile is updated by electronic transactions from pharmacy departmental system 2. Nurses identify pending medications 3. Nurses document administration of medications as well as reasons why medications are not given 4. Physicians have reports indicating which medications have been administered 5. Information is recorded in format that makes it available to other reports 6. Medication cost is automatically charged when administration is documented Primary Users 1. Physicians 2. Nurses 3. Pharmacists Rationale 1. Speeds identification of next medication due 2. Reduces likelihood a medication dose will be missed 3. Eases analysis of medication usage Dependencies 1. Pharmacy departmental functions Barriers 1. Major change in workflow 2. Clarifies deficiencies in paper charting (21)Clinical management flowsheets Description 1. Reports that integrate data of different types, such as lab, clinical observations, and medication administration, are displayed together to facilitate the optimal analysis of a clinical problem for patient care 2. Reports show the relationships between the data, such as the response in clinical terms of the usage of a medication Page 27 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  28. 28. DRAFT 3. Both primary effects and potential adverse effects are shown 4. Reports show effects over varying periods of time, which can be easily altered 5. [Examples: Anticoagulation, Antibiotic Usage, Diabetic Control, Mechanical Ventilation, Potassium and Magnesium Replacement] 6. [Note: is usually not used for capture of data] Primary Users 1. Physicians 2. Nurses 3. Quality Coordinators Rationale 1. Greater efficiency since data needed is expeditiously gathered and displayed in integrated fashion 2. Optimal analysis of clinical problems 3. Elevates sophistication of analysis for more naïve clinicians Dependencies 1. Extent of Clinical Documentation determines richness of flowsheets Barriers 1. Major change in workflow Inpatient Care Management (22)Discharge planning screens Description 1. Screens capture and display the information needed for the patient care team to share estimated discharge date, destination, and needs as well as contacts with Significant Others Primary Users 1. Physicians 2. Nurses 3. Case Managers 4. Home Health 5. Chaplains Page 28 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  29. 29. DRAFT Rationale 1. Enhances coordination of the discharge planning team by increasing the availability of the information and the number of staff who can ensure its validity Dependencies 1. Utilization of system for other functions Barriers 1. Lack of integration with any other Case Management system that might exist Administrative Procedures (55)Electronic communication among all clinical caregivers Description 1. E-mail is pervasively available and commonly used by caregivers to share clinical information about patients 2. Confirmation that message has been received is available Primary Users 1. Physicians 2. Nurses 3. All caregivers 4. Executive team 5. All clinical managers Rationale 1. Phone calls and faxes are less efficient Dependencies 1. Pervasive utilization Barriers 1. Concern about confidentiality Page 29 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  30. 30. DRAFT Phase IIA Results Retrieval (6)Lab order status available on HIS Description 1. User can use the HIS to identify the status of a lab order i.e. whether a specimen has been obtained, has a preliminary or final result available Primary Users 1. Nurses 2. Clerical staff 3. Physicians Rationale 1. Reduces calls to lab trying to verify status Dependencies 1. Departmental lab computer system 2. Interface from Departmental lab computer system to HIS Barriers 1. Ability of Order Entry to accept two way interface to Lab Departmental system (7)Blood bank product availability Description 1. User can look on HIS to identify whether blood is available in the blood bank for a particular patient 2. User can use computer to identify number of units of different types that have been transfused to a patient 3. Blood utilization review is aided by reports that integrate clinical results with transfusion information Primary Users 1. Operating Room 2. Nurses 3. Physician Rationale 1. Reduces calls to blood bank by nurses and physicians Page 30 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  31. 31. DRAFT 2. Expedites review of transfusion status Dependencies 1. Interface to HIS Barriers 1. Timely data entry on BB system Inpatient Care Management (28)Microbiology/antimicrobial therapy alerts Description 1. Based on results of coded Microbiology results from Lab system, current antimicrobial therapy is evaluated based on rules 2. System identifies potentially significant cases of ineffective therapy(bug resistant to current therapy) 3. System recommends alternate therapy to optimize antimicrobial therapy 4. Effective notification system for distribution of alerts to users Primary Users 1. Pharmacists 2. Physicians Rationale 1. Optimizes effectiveness of antimicrobial therapy with potential for shortened length of stay, reduction in drug costs Dependencies 1. Pharmacy departmental functions 2. Coded Microbiology data from Lab 3. Coded Medication in Pharmacy system Barriers 1. Few Lab systems generate coded Microbiology results 2. Physician community needs to agree on “preferred” therapy 3. Physician community needs to be willing to change therapy in response to alerts, alert-prompted suggestions Departmental Operations (16)Electronic report distribution Description Page 31 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  32. 32. DRAFT 1. When hard copies are prepared, their distribution should be electronically facilitated in some way e.g. sorting, remote printing, electronic distribution, faxing Primary Users 1. Administrative staff 2. Physician offices Rationale 1. Improves report availability, especially to off-site areas 2. Reduces report turnaround time 3. Reduces manpower applied to report distribution Dependencies 1. Transcription 2. Radiology Transcription Barriers 1. Multiple systems generating reports via different mechanisms (36)Alerts to Pharmacist Description 1. System identifies potential adverse drug events 2. System checks for potential dose/weight appropriateness Primary Users 1. Pharmacists 2. Nurses Rationale 1. Reduces adverse drug events 2. Improves adverse drug event reporting Dependencies 1. Pharmacy departmental functions Barriers Administrative Procedures (60)Physician phone directory Description Page 32 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  33. 33. DRAFT 1. Physician office address, phone number, fax number, email address, pager number(with permission) are available 2. Physicians may be selected by specialty Primary Users 1. Physicians 2. Nurses 3. Administrative staff Rationale 1. Obviates need to publish paper directories 2. More likely to be valid since only needs to be updated in one place Dependencies Barriers 1. Additional MD database to be maintained (56)Web access for caregivers Description 1. Web browsers are generally available throughout the facility 2. Reference material and medical literature searches would be available 3. Internal documents such as Nursing Standard Practice and Continuing Education Class Schedules would be posted and available on internal network 4. Access to external Internet 5. Icon access to Pubmed for Medline searching Primary Users 1. Physicians 2. Nurses 3. Pharmacists Rationale 1. Advances in web technology can be used to simplify workflow problems at vastly lower cost than traditional healthcare applications 2. Expeditious access to vast array of clinical knowledge Dependencies 1. Use of PC as end user device, not dumb terminal Page 33 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  34. 34. DRAFT Barriers 1. Concern about time wasted “surfing the Web” Page 34 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  35. 35. DRAFT Phase IIB Results Retrieval (12)Images of digital modalities(CT, MRI, Ultrasound, Nuclear Medicine) Description 1. Digital images of these modalities are captured directly from the imaging device, without use of a scanner 2. Images are interpreted without printing of film 3. Prior images are available for side by side comparison 4. Images available outside Radiology department over the network Primary Users 1. Physicians 2. Operating Room 3. ER 4. Neurosurgeons at home Rationale 1. Reduction in lost images 2. More efficient film reading 3. Images distributed electronically so they may be read by domain expert Dependencies 1. High speed LAN Barriers 1. Image resolution concerns Clinical Care Delivery and Documentation (32)ICU/OR/OB monitor to computer download Description 1. Critical care devices such as pressure monitors, infusion pumps, urimeters feed clinical documentation system 2. Clinical data in clinical documentation system is integrated with non- ICU/OR documentation systems Primary Users 1. Nurses 2. Physicians Page 35 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  36. 36. DRAFT Rationale 1. Large volume of data entry simplified by electronic entry, so long as accuracy is validated Dependencies 1. Clinical documentation system in ICU/OR Barriers 1. Large number of artifacts generates spurious and potentially misleading data 2. Process efficiency difficult to achieve 3. Non standard device interfaces 4. Identification of patient, datatype (23)Nursing physical assessment Description 1. Multiple screens used by nursing staff to document patient’s physical status 2. Shift reports created for permanent medical record 3. Data available for review on multiple other reports 4. Data coded, minimal freetext 5. Displays focus attention on abnormal or changing values Primary Users 1. Physicians 2. Nurses 3. Quality Coordinators Rationale 1. Increases availability of information 2. Permits rules to be based on such information Dependencies 1. Bedside numbers Barriers 1. No established standard for nomenclature (19)Remote access from MD home, office Description 1. All capabilities used by the physician within the hospital should be available remotely—either by dialup, Internet, or extension of the network. Page 36 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  37. 37. DRAFT 2. Measures in place to ensure confidentiality standards are met Primary Users 1. Physicians 2. Physician office staff Rationale 1. Improved communication with reduction in telephone calls and faxes 2. If system is effective, there will be substantial demand for remote access Dependencies 1. Routine physician utilization Barriers 1. Security concerns 2. Offsite support burden Inpatient Care Management (37)Drug-lab alerts Description 1. System identifies potentially significant drug-lab, interactions Primary Users 1. Physicians 2. Nurses 3. Pharmacists Rationale 1. Reduces adverse drug events Dependencies 1. Pharmacy departmental functions 2. Lab results review by encounter Barriers Administrative Procedures (65)Electronic file cabinet for protocols, schedules, standard documents, policies and procedures Description 1. Documents are available electronically Page 37 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  38. 38. DRAFT 2. Documents may be printed as needed Primary Users 1. Nurses 2. Nursing Administration Rationale 1. Ensures adequate inventory of current reports wherever needed 2. Permits updating entire “inventory” of reports by a single electronic change Dependencies 1. Device availability Barriers 1. Large volume of documents in different formats (64)Review of OR, Cath Lab, PT, Endoscopy (et al.) schedules Description 1. Schedules for patient activities that are used by many others besides those performing the activity are available for review by others Primary Users 1. Physicians 2. Nurses 3. Therapists Rationale 1. Obviates need for distribution of paper schedules 2. Improves patient confidentiality by avoiding bulletin board posting of schedules 3. Enhances planning for patients’ other care activities Dependencies 1. ADT interface 2. Scheduling system for involved areas Barriers 1. Integration with existing scheduling systems (54)Cross-continuum patient registration system Description Page 38 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  39. 39. DRAFT 1. Patient registration system tailored to meet the needs of each provider environment (hospital, ambulatory surgery, home health, DME, long-term care, birthing centers, etc.) across the entire continuum of care. 2. Demographic and insurance information is expeditiously gathered from patients with maximum sharing of information from site to site. 3. Encounter history is readily available, showing a patient’s prior encounter registrations with site of care, diagnosis 4. Screen designs increase the likelihood that valid data is collected Primary Users 1. Physician office administrative staff 2. Admitting office 3. Administrative staff Rationale 1. All subsequent computer-based activities with a patient record require valid information, collected as early in the process as possible. In different areas, the type and volume of information will vary and the system should accommodate this variability. Dependencies 1. Master Patient Index Barriers 1. Varying needs (61)MPI across >1 site of care Description 1. Patients are identified on-the-fly using match-and-tag logic by interface transactions from systems that have a separate registration function Primary Users 1. Physicians 2. Billing office staff 3. Administrative staff Rationale 1. Allows consolidation of registration, billing, and clinical information from multiple sites of care Dependencies 1. Linkage to ADT systems Barriers Page 39 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  40. 40. DRAFT 1. Absence of data from non-owned entities (58)Housestaff sign-out cards/Problem List Description 1. Patients being cared for by physicians who are going off duty are “signed- out” to the covering physician. This document summarizes the care concerns of the departing physician. 2. Document lists all of a patient’s active problems 3. Document should be viewable by other physicians and nurses also Primary Users 1. Physicians 2. Nurses 3. Housestaff Rationale 1. Enhances continuity of care 2. Expedites signout process 3. Permits more comprehensive signout Dependencies 1. Pervasive housestaff physician usage Barriers 1. Data entry Page 40 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  41. 41. DRAFT Phase IIC Results Retrieval (18)Pathology transcribed results Description 1. Transcribed results of cytologic and histologic examinations are available electronically for clinician review Primary Users 1. Physicians Rationale 1. Results of pathologic studies are needed for clinical decision making and for informing patients and their families Dependencies 1. Anatomic pathology laboratory system Barriers 1. Anatomic pathology transcription formats are often different from standard transcription formats Clinical Care Delivery and Documentation (24)Patient careplans/pathways Description 1. Documents describing the intended treatment plan for a variety of different diseases and treatments are available 2. Screens facilitate the capture of such information 3. Reports indicate progress over time and variances from expected careplan/pathway Primary Users 1. Nurses 2. Physicians Rationale 1. Standardizes care, with consequent improvements Dependencies 1. Routine clinician usage Barriers Page 41 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  42. 42. DRAFT 1. Standardization of pathways (25)Documentation of patient care activities and interventions by nursing Description 1. Multiple screens used by nursing staff to document patient care activities and interventions 2. Significant clinical and psychosocial events are documented for review by subsequent caregivers 3. Shift reports created for permanent medical record 4. Data available for review on multiple other reports 5. Data coded, minimal freetext Primary Users 1. Physicians 2. Nurses 3. Other caregivers Rationale 1. Increases availability of information 2. Permits rules to be based on such information Dependencies 1. Agreement on level of detail to be documented Barriers 1. Consensus development (26)Documentation of all ancillary caregiver interventions Description 1. Multiple screens used by ancillary staff to document all ancillary caregivers’ patient care interventions 2. Shift reports created for permanent medical record 3. Data available for review on multiple other reports 4. Data coded, minimal freetext Primary Users 1. Ancillary staff 2. Physicians 3. Nurses Page 42 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  43. 43. DRAFT Rationale 1. Increases availability of information 2. Permits rules to be based on such information Dependencies 1. Agreement on level of detail to be documented Barriers 1. Consensus development Inpatient Care Management (8)Critical lab alerts Description 1. When the result of a test exceeds a previously specified value, automatically notify key users such as nurses, physicians 2. Site controls the tests and the trigger points 3. Control duplicate alerts within a defined time period Primary Users 1. Nurses 2. Physicians Rationale 1. Reduces time until clinical decision-makers are aware of critical circumstances Dependencies 1. Discrete, coded lab data Barriers 1. Routine computer use by caregivers is required for alert delivery to be timely Departmental Operations (17)Electronic Signature Description 1. Transcribed Reports that are available on-line may be validated by the physician 2. List of reports pending signature is available 3. User can review and edit reports Page 43 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  44. 44. DRAFT 4. On-line viewing and hard copies indicate preliminary or finalized nature of status Primary Users 1. Physicians 2. Medical records staff Rationale 1. Reduces trips to medical records department 2. Reduces chart pulls 3. Reduces number of incomplete charts Dependencies 1. Transcription Barriers 1. Security concerns 2. Need to sign other documents that are not in electronic form 3. Workflow to manage updating and signature of Preliminary on-line documents when they are signed manually Page 44 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  45. 45. DRAFT Phase III Clinical Care Delivery and Documentation (31)Anesthesia record Description 1. Key clinical events are concurrently captured into an electronic record, including vital signs, medications, fluids, operative events 2. Data captured is integrated with data from Recovery Room, ICU, and med- surg patient care area Primary Users 1. Anesthesiologist 2. Recovery Room, ICU, med-surg patient care area staff 3. Physicians providing peri-operative care Rationale 1. Complex care administered in OR is difficult to sort out post-operatively 2. Heavy burden of intra-operative documentation can produce incomplete records Dependencies 1. Non-OR documentation systems Barriers 1. Linkages are complex because of need for matched coding schemes 2. Fast pace of care intolerant of slow process or poor data displays (13)Telemedicine:CME Description 1. CME (a) Videoconferencing across >1 region for purposes of interactive education of any caregiver group Primary Users 1. Physicians 2. Nurses 3. Other caregivers Rationale 1. Enhances availability of services Page 45 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  46. 46. DRAFT 2. Reduces expenses of travel, non-productive travel time Dependencies 1. WAN or alternate high speed connection Barriers (73)Telemedicine: Remote diagnostics Description 1. Remote diagnostics (a) Diagnostic equipment such as stethoscopes, cameras obtaining diagnostic quality information, which is analyzed by a remote clinician for the purpose of diagnosis or therapy Primary Users 1. Physicians 2. Nurses 3. Patients Rationale 1. Enhances availability of services 2. Reduces expenses of travel, non-productive travel time Dependencies 1. WAN or alternate high speed connection Barriers 1. Patient acceptance Inpatient Care Management (27)Alerts to RNs and MDs Description 1. System processing of manually entered and interfaced data identifies conditions that warrant notification of caregivers or alterations in care 2. Alerts are delivered within the caregiver’s normal workflow 3. Changes that are needed based on the alert are facilitated Primary Users 1. Nurses Rationale 1. Reduces likelihood that important events go unnoticed Page 46 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  47. 47. DRAFT Dependencies 1. Clinical Documentation 2. Lab Results Review 3. Routine utilization of system Barriers (81)Physician order entry Description 1. Physician directly enters orders into system, which are executed electronically 2. Information is provided to the ordering physician to promote selection of optimal diagnostic or therapeutic measures 3. Warnings about potentially dangerous conditions are provided in the course of order entry 4. Assistance is ordered to make ordering easier such as displaying prior values that are germane to the order or calculations Primary Users 1. Physicians Rationale 1. Ordering is a key time in clinical decision making 2. Prospective assistance is much less intrusive to workflow than after-the-fact alerting Dependencies 1. Physician utilization 2. Prospective Alerting infrastructure Barriers 1. Cultural 2. Requirement for enhanced efficiency 3. Complete Orders require capture of much information that does not add value to physicians’ analysis process(e.g. mode of transportation to Radiology) Departmental Operations (14)Digital radiography including PACS Description Page 47 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  48. 48. DRAFT 1. All images including fluoro, angiograms, and plain radiography are captured digitally 2. Images are interpreted without printing of film 3. Prior images are available for side by side comparison 4. Images available outside Radiology department over the network Primary Users 1. Physicians Rationale 1. Reduction in lost images 2. More efficient film reading 3. Images distributed electronically so they may be read by domain expert Dependencies 1. Images of digital modalities(CT,MR, US, NM) Barriers 1. Image resolution concerns Page 48 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  49. 49. DRAFT Assumptions Support Related 1. Security measures protect confidentiality of patient information 2. Users receive adequate training 3. Policies and procedures needed to support these applications and the inherent changes in work processes will be in place 4. Manual fallback procedures and materials are available Technical Related 1. Response time of system meets users needs 2. Adequate number and types of devices for intended users and technical resources for installation and support 3. Devices are positioned close enough to normal work area to improve workflow 4. User interface is acceptable Page 49 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  50. 50. DRAFT Page 50 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  51. 51. DRAFT Index by Functionality Name FuncNum Functionality Name Page 83 ADT(Admission, Discharge, Transfer) system focused on the needs of the acute care setting (hospital, attached ambulatory clinics, attached ambulatory surgery). 17 36 Alerts to Pharmacist 32 27 Alerts to RNs and MDs 46 31 Anesthesia record 45 20 Bedside numbers 22 7 Blood bank product availability 30 4 Blood gas results review 12 44 Case finder reports 25 21 Clinical management flowsheets 27 8 Critical lab alerts 43 54 Cross-continuum patient registration system 38 14 Digital radiography including PACS 47 22 Discharge planning screens 28 26 Documentation of all ancillary caregiver interventions 42 25 Documentation of patient care activities and interventions by nursing 42 38 Drug utilization evaluation studies 24 37 Drug-lab alerts 37 63 Electronic and printed Order Sets for common clinical pathways/standard orders 26 55 Electronic communication among all clinical caregivers 29 65 Electronic file cabinet for protocols, schedules, standard documents, policies andprocedures 37 16 Electronic report distribution 31 17 Electronic Signature 43 58 Housestaff sign-out cards/Problem List 40 32 ICU/OR/OB monitor to computer download 35 12 Images of digital modalities(CT, MRI, Ultrasound, Nuclear Medicine) 35 6 Lab order status available on HIS 30 2 Lab results review by encounter 10 1 Laboratory departmental functions 15 5 Longitudinal lab results review 20 11 Longitudinal radiology results 21 35 Medication allergies, height, weight 23 39 Medication charting 27 33 Medication profile 23 82 Medication vending machines 24 3 Microbiology results review 11 28 Microbiology/antimicrobial therapy alerts 31 61 MPI across >1 site of care 39 23 Nursing physical assessment 36 53 Order entry to all departments 17 18 Pathology transcribed results 41 24 Patient careplans/pathways 41 34 Pharmacy departmental functions 15 81 Physician order entry 47 59 Physician patient list 14 Page 51 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  52. 52. DRAFT 60 Physician phone directory 32 57 Physician Rounds Report 20 10 Radiology departmental functions 16 9 Radiology transcribed results 11 19 Remote access from MD home, office 36 64 Review of OR, Cath Lab, PT, Endoscopy (et al.) schedules 38 73 Telemedicine: Remote diagnostics 46 13 Telemedicine:CME 45 15 Transcription 13 56 Web access for caregivers 33 Page 52 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  53. 53. DRAFT Index by Functionality Number FuncNum Functionality Name Page 1 Laboratory departmental functions 15 2 Lab results review by encounter 10 3 Microbiology results review 11 4 Blood gas results review 12 5 Longitudinal lab results review 20 6 Lab order status available on HIS 30 7 Blood bank product availability 30 8 Critical lab alerts 43 9 Radiology transcribed results 11 10 Radiology departmental functions 16 11 Longitudinal radiology results 21 12 Images of digital modalities(CT, MRI, Ultrasound, Nuclear Medicine) 35 13 Telemedicine:CME 45 14 Digital radiography including PACS 47 15 Transcription 13 16 Electronic report distribution 31 17 Electronic Signature 43 18 Pathology transcribed results 41 19 Remote access from MD home, office 36 20 Bedside numbers 22 21 Clinical management flowsheets 27 22 Discharge planning screens 28 23 Nursing physical assessment 36 24 Patient careplans/pathways 41 25 Documentation of patient care activities and interventions by nursing 42 26 Documentation of all ancillary caregiver intervention 42 27 Alerts to RNs and MDs 46 28 Microbiology/antimicrobial therapy alerts 31 31 Anesthesia record 45 32 ICU/OR/OB monitor to computer download 35 33 Medication profile 23 34 Pharmacy departmental functions 15 35 Medication allergies, height, weight 23 36 Alerts to Pharmacist 32 37 Drug-lab alerts 37 38 Drug utilization evaluation studies 24 39 Medication charting 27 44 Case finder reports 25 53 Order entry to all departments 17 54 Cross-continuum patient registration system 38 55 Electronic communication among all clinical caregivers 29 56 Web access for caregivers 33 57 Physician Rounds Report 20 58 Housestaff sign-out cards/Problem List 40 59 Physician patient list 14 60 Physician phone directory 32 61 MPI across >1 site of care 39 63 Electronic and printed Order Sets for common clinical pathways/standard orders 26 Page 53 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential
  54. 54. DRAFT FuncNum Functionality Name Page 64 Review of OR, Cath Lab, PT, Endoscopy (et al.) schedules 38 65 Electronic file cabinet for protocols, schedules, standard documents, policies and procedures 37 73 Telemedicine: Remote diagnostics 46 81 Physician order entry 47 82 Medication vending machines 24 83 ADT(Admission, Discharge, Transfer) system focused on the needs of the acute care setting (hospital, attached ambulatory clinics, attached ambulatory surgery). 17 Page 54 of 54 CLINT Functionalities 1/27/15 © CHW 1999 Proprietary and Confidential

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