Originally presented in 2011, this talk gives an overview of informed consent, do not resuscitate, and electronic medical record issues for anesthesia providers. This talk may be interesting for doctors and nurses that work in the operating room as well as hospital administrators and those working in health care informatics .
Billing Transition in Medical Imaging - a 2010 presentation by Rob MaroszekRobert P. Maroszek
Billing Transition in Medical Imaging - a 2010 presentation by Rob Maroszek
- Trends in Patient Bulk-Billing in Australia
- Viability of Billing Scheme
- Cost vs. Revenue of Radiology Service Providers
- Value vs. Pricing Strategy
- Implications
- Education & Embracing Change
- Outcomes
- Presentation and discussion by MEDIMCO www.medimco.com.au
VIRTUAL HOSPITALS OF FUTURE IN DEVELOPING COUNTRIESLutfi Abdallah
A review article ppt presentation on telemedicine and virtual communication within and outside the hospital while data is encrypted and decrypted advantage ...
Automated Post-Discharge Care: An Essential Tool to Reduce ReadmissionsPhytel
Readmissions are a major problem in U.S. healthcare. Nearly one in five Medicare patients that are discharged from the hospital returns there within 30 days, and between 50 percent and 75 percent of those readmissions are considered preventable. Medicare pays about $17 billion annually for 2.5 million rehospitalizations of its beneficiaries and other payers spend roughly the same amount every year for all readmissions of non-Medicare patients.
Billing Transition in Medical Imaging - a 2010 presentation by Rob MaroszekRobert P. Maroszek
Billing Transition in Medical Imaging - a 2010 presentation by Rob Maroszek
- Trends in Patient Bulk-Billing in Australia
- Viability of Billing Scheme
- Cost vs. Revenue of Radiology Service Providers
- Value vs. Pricing Strategy
- Implications
- Education & Embracing Change
- Outcomes
- Presentation and discussion by MEDIMCO www.medimco.com.au
VIRTUAL HOSPITALS OF FUTURE IN DEVELOPING COUNTRIESLutfi Abdallah
A review article ppt presentation on telemedicine and virtual communication within and outside the hospital while data is encrypted and decrypted advantage ...
Automated Post-Discharge Care: An Essential Tool to Reduce ReadmissionsPhytel
Readmissions are a major problem in U.S. healthcare. Nearly one in five Medicare patients that are discharged from the hospital returns there within 30 days, and between 50 percent and 75 percent of those readmissions are considered preventable. Medicare pays about $17 billion annually for 2.5 million rehospitalizations of its beneficiaries and other payers spend roughly the same amount every year for all readmissions of non-Medicare patients.
Workflow & Business Process Automation Opportunities in the Healthcare MarketY Soft Corporation
Wouter Koelewijn, Y Soft Vice President and Managing Director of Y Soft Scanning Division, talked about opportunities in workflow and business process automation for healthcare market in USA.
YSoft SafeQ is a leading print management and document capture solution currently uses by more than 14 000 companies in more than 100 countries.
If you want to find out more about YSoft SafeQ, contact us at www.ysoft.com/contact-us or schedule your Live Demo at www.ysoft.com/demo.
Dear all,
Recording & Reporting are very important in the nursing profession. As a nurse, we have to be very conscious of it to prevent further complications.
Railhealth EMR encompasses the information and capabilities required to support healthcare service delivery, where the information is captured in a computer-readable form that supports interoperability and clinical decision support.
In this presentation, you will know regarding the features, objectives and benefits by using our Railhealth EMR
The Communiqué is a publication dedicated to bringing articles and advice, specific to the anesthesia and pain management community, that are practical and tangible. ABC is happy to provide The Communiqué electronically as well as hard-copy versions. The Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Tony Mira, President & CEO, explains, “The Fall 2014 issue features several experts in anesthesia practice management providing helpful advice, starting with Danielle Reicher, MD, an Anesthesiologist from San Diego, CA. Dr. Reicher describes a specific and very important application of EHR technology in Making Meaningful Use More Meaningful: communicating with patients." Dr. Reicher states, “While we may not be a daily fixture in the medical lives of our patients, our role is critical and the information we gather can be extremely vital to the electronic medical record. Let’s make Meaningful Use even more meaningful!”
Another author we are proud to feature is Steven Dale Boggs, MD, MBA, Director of the OR and Chief of the Anesthesia Service at the James J. Peters VA Medical Center in Bronx, NY as well as Associate Professor of Anesthesiology at The Icahn School of Medicine at Mount Sinai in Manhattan, NY. One of Dr. Boggs’s areas of particular interest is GI sedation. For the past several years, Dr. Boggs has been working closely with endoscopists at Mount Sinai in New York and elsewhere, evaluating turnover time and safety metrics. He will be presenting at The ANESTHESIOLOGY™ 2014 annual meeting in New Orleans with a Point-Counterpoint session on Monday, October 13th and on a panel Tuesday, October 14th, and he gives us a detailed preview of his arguments in Computer-Assisted Personalized Sedation (CAPS): Will It Change the Way Moderate Sedation is Administered? ABC was pleased to have the opportunity to provide Dr. Boggs with claims data showing that the cost of anesthesia and anesthesia providers may be quite competitive with cost of CAPS.
For these and past Communiqué articles, please log on to ABC’s web site at www.anesthesiallc.com and click the link to view the electronic version of The Communiqué online. To be put on the automated email notification list, please send your email address to info@anesthesiallc.com. We look forward to providing you with compliance, coding and practice management news through The Communiqué.
An electronic health record is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings.
Railhealth Electronic Medical Record encompasses the information and capabilities required to support healthcare service delivery. This presentation gives you the information regarding the features, objectives and the benefits what doctor gets by using our EMR.
Railhealth EMR encompasses the information and capabilities required to support healthcare service delivery, where the information is captured in a computer-readable form that supports interoperability and clinical decision support.
In this presentation, you will know regarding the features, objectives and benefits by using our Railhealth EMR
Health Information Exchange ( usage and benefits )Htun Teza
Presentation for RADS 601 ( Health Informatics and Health Information Technology ) - 20/11/19
Student of Master of Science in Data Science for Healthcare ( International Program ) ( Clinical Epidemiology and Biostatistics, Mahidol University, Thailand )
Given well-publicized data breaches nationally and the spread of health information exchange (HIE), the issue of privacy and security of patient data shared through HIE networks is one of the most complex and sensitive issues in establishing and maintaining trust among consumers, physicians, and other major community stakeholders. In this presentation, we discuss the privacy and security challenges the New Mexico Health Information Exchange (NMHIC) has encountered in its HIE development history and the lessons it has learned concerning them.
Federal and state privacy law compatibility: beyond HIPAA and HITECH
Privacy approaches: opt-out, opt-in, hybrid
Educating consumers and providers about HIE benefits & risks
Privacy policies needed to support interstate information exchange
Engaging consumers, providers, and other community stakeholders about uses of HIE data & other privacy decisions
Workflow & Business Process Automation Opportunities in the Healthcare MarketY Soft Corporation
Wouter Koelewijn, Y Soft Vice President and Managing Director of Y Soft Scanning Division, talked about opportunities in workflow and business process automation for healthcare market in USA.
YSoft SafeQ is a leading print management and document capture solution currently uses by more than 14 000 companies in more than 100 countries.
If you want to find out more about YSoft SafeQ, contact us at www.ysoft.com/contact-us or schedule your Live Demo at www.ysoft.com/demo.
Dear all,
Recording & Reporting are very important in the nursing profession. As a nurse, we have to be very conscious of it to prevent further complications.
Railhealth EMR encompasses the information and capabilities required to support healthcare service delivery, where the information is captured in a computer-readable form that supports interoperability and clinical decision support.
In this presentation, you will know regarding the features, objectives and benefits by using our Railhealth EMR
The Communiqué is a publication dedicated to bringing articles and advice, specific to the anesthesia and pain management community, that are practical and tangible. ABC is happy to provide The Communiqué electronically as well as hard-copy versions. The Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Tony Mira, President & CEO, explains, “The Fall 2014 issue features several experts in anesthesia practice management providing helpful advice, starting with Danielle Reicher, MD, an Anesthesiologist from San Diego, CA. Dr. Reicher describes a specific and very important application of EHR technology in Making Meaningful Use More Meaningful: communicating with patients." Dr. Reicher states, “While we may not be a daily fixture in the medical lives of our patients, our role is critical and the information we gather can be extremely vital to the electronic medical record. Let’s make Meaningful Use even more meaningful!”
Another author we are proud to feature is Steven Dale Boggs, MD, MBA, Director of the OR and Chief of the Anesthesia Service at the James J. Peters VA Medical Center in Bronx, NY as well as Associate Professor of Anesthesiology at The Icahn School of Medicine at Mount Sinai in Manhattan, NY. One of Dr. Boggs’s areas of particular interest is GI sedation. For the past several years, Dr. Boggs has been working closely with endoscopists at Mount Sinai in New York and elsewhere, evaluating turnover time and safety metrics. He will be presenting at The ANESTHESIOLOGY™ 2014 annual meeting in New Orleans with a Point-Counterpoint session on Monday, October 13th and on a panel Tuesday, October 14th, and he gives us a detailed preview of his arguments in Computer-Assisted Personalized Sedation (CAPS): Will It Change the Way Moderate Sedation is Administered? ABC was pleased to have the opportunity to provide Dr. Boggs with claims data showing that the cost of anesthesia and anesthesia providers may be quite competitive with cost of CAPS.
For these and past Communiqué articles, please log on to ABC’s web site at www.anesthesiallc.com and click the link to view the electronic version of The Communiqué online. To be put on the automated email notification list, please send your email address to info@anesthesiallc.com. We look forward to providing you with compliance, coding and practice management news through The Communiqué.
An electronic health record is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings.
Railhealth Electronic Medical Record encompasses the information and capabilities required to support healthcare service delivery. This presentation gives you the information regarding the features, objectives and the benefits what doctor gets by using our EMR.
Railhealth EMR encompasses the information and capabilities required to support healthcare service delivery, where the information is captured in a computer-readable form that supports interoperability and clinical decision support.
In this presentation, you will know regarding the features, objectives and benefits by using our Railhealth EMR
Health Information Exchange ( usage and benefits )Htun Teza
Presentation for RADS 601 ( Health Informatics and Health Information Technology ) - 20/11/19
Student of Master of Science in Data Science for Healthcare ( International Program ) ( Clinical Epidemiology and Biostatistics, Mahidol University, Thailand )
Given well-publicized data breaches nationally and the spread of health information exchange (HIE), the issue of privacy and security of patient data shared through HIE networks is one of the most complex and sensitive issues in establishing and maintaining trust among consumers, physicians, and other major community stakeholders. In this presentation, we discuss the privacy and security challenges the New Mexico Health Information Exchange (NMHIC) has encountered in its HIE development history and the lessons it has learned concerning them.
Federal and state privacy law compatibility: beyond HIPAA and HITECH
Privacy approaches: opt-out, opt-in, hybrid
Educating consumers and providers about HIE benefits & risks
Privacy policies needed to support interstate information exchange
Engaging consumers, providers, and other community stakeholders about uses of HIE data & other privacy decisions
Similar to Gerancher: Informed Consent, DNR, and EMR issues in Anesthesia (20)
This presentation described features of a custom OR information system used to ensure timely administration of the correct antibiotics prior to surgery. The custom software (John Galt Systems) has since been replaced by an off-the-shelf product (Epic).
Cell Analog Blind Kid's Seventh Grade Project: A cell is like a krispy kreme ...John Gerancher
This is the powerpoint presentation my son completed for a cell analogy school project. Classmates help play act the organelles and doughnuts were provided to all as yummy "proteins."
Building a Better Regional Anesthesia Note (on paper or in an EHR)John Gerancher
The author, JC Gerancher MD discusses the principals that add value to an electronic (EHR) or paper regional anesthesia note. See also:
http://www.raadvantages.com/wp-content/uploads/Helping-Patients-Understand.pdf
John Charles Gerancher has held medical licenses in Washington, California, and North Carolina. Furthermore, JC Gerancher recently served as a professor of anesthesiology at the Wake Forest University School of Medicine.
Residency Training in Anesthesiology at Wake Forest University John Gerancher
A former professor of anesthesiology at the Wake Forest University School of Medicine, Dr. John Charles Gerancher served the school for more than a decade. Between 1999 and 2011, Dr. John Gerancher created and introduced a regional anesthesia program to the University's Baptist Medical Center that includes clinical care as well as a teaching curriculum.
NC Organization Supports Parents with Visually Impaired ChildrenJohn Gerancher
Physician John Charles Gerancher is an active contributor to the community in which he lives and works. Dr. JC Gerancher maintains affiliation with the North Carolina Association for Parents of Children with Visual Impairment (NC-APVI). Affiliated with the National Association for Parents of Children with Visual Impairments, the NC-APVI provides education, resources, and emotional support to families with children who are visually impaired or blind.
this presentation reviews basic information on adjuncts to local anesthetics and peripheral nerve blockade. it was last undated and used for anesthesiology resident education in 2011. hope you find this information helpful. John Gerancher JC Gerancher MD
Different types of anesthesia by john gerancherJohn Gerancher
Recognized as a pioneer in the field of anesthesiology, Dr. John Gerancher was responsible for developing the clinical care area, teaching program, and regional anesthesia section at Wake Forest Baptist Medical Center. Dr. John Gerancher also designed and implemented a computer information system for the operating room called the John Galt. Otherwise known to his peers as J.C., Dr. John Charles Gerancher was licensed to practice medicine in Washington, North Carolina, and California.
Wake forest professor john gerancher developed school’s anesthesiologyJohn Gerancher
Located in Winston-Salem, North Carolina, the Wake Forest University School of Medicine was founded in 1902 and its Department of Anesthesiology has received national recognition for excellence in research, teaching, and patient care.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Disclosures
• I have no financial relationships to disclose.
• I am a speaker for Teleflex.
• It will be obvious that I am not a speaker for the big
name commercial EMR manufacturers.
3. Overview
• Informed Consent
-Definition of a Process
• Overview of anesthesia documentation issues related to
Patient Autonomy and Informed Consent
-Universal Protocols
-Do Not Resuscitate
• Anesthesia Documentation: Paper or Plastic?
-Why the current big-name commercial EMR’s aren’t
yet good enough for regional anesthesiologists.
4. Informed consent is required
• Ethics: required under the doctrine of patient
autonomy.
• Legal: required else regional anesthesia providers
are subject to accusation of battery in the absence of
complications or responsibility for complications
despite no breech of standard of care clinically.
• Regulatory Compliance: Joint commission and
ASA.
• Billing Compliance: CMS conditions of participation
5. The Process of Informed Consent:
• Disclosure of Information
• Understanding (or competency)
• Mutual decision making
6. Disclosure of Information
Legal
Ethical
•
•
•
Since 1980’s most states have
adopted a ‘reasonable patient’
approach to disclosure information
that a reasonable person would
deem pertinent to make his or her
decision.
At the same time the ‘professional
rule’ might be a secondary
consideration—i.e. those things
that are common and those that
are very bad but uncommon.
•
Regional Anesthesia providers
have a duty to know their patients
, surgeons, surgeries,
perioperative course, and
anesthetics well enough to provide
appropriate disclosure.
We perform regional anesthesia
and analgesia in the clinical
setting where the incidence of risk
versus the true benefit is not
currently known.
7. Understanding or Competency
•
•
•
•
•
Inability to express choice or preferences.
Inability to understand one’s situation.
Inability to understand disclosed information.
Inability to give a reason.
Inability to give a rational reason, though having
some supporting ones.
• Inability to give a risk-benefit supported reason,
though having some supporting ones.
• Inability to give a reasonable decision as judged by
the reasonable patient.
-Beauchamp, Childress 1989
9. Good Pro-Con Discussions about
Written Informed Consent
• SAMBA Newsletter
January 2009
Nitsun
• ASRA Newsletter
August 2006
Green,Brull
• ASA Newsletter
July 2006
Domino,O’Leary,Bierstein,Sanford,Cheney
10. Including written consent in the
process of informed consent will
not..
• increase patient anxiety
• prevent lawsuits
• substitute for the process of informed consent
-Gerancher, 2007
11. Including written consent in the
process of informed consent
may..
• increase patient recall of information
--provided the form is understandable to a seventh grader
--provided the form is given to patients
--despite the stress of medical situations (including labor)
• provide legal protection
• improve the process of consent
-Gerancher, 2007
14. A little bit high tech is
sometimes a good thing….
15. Better Patient Care?:
“The only way computers improve care is when
humans document as part of the process of
providing care. ”
16. Paper or Plastic?
“The electronic record, in most institutions, has progressed
while most anesthesia departments have stayed with paper.
I believe the most compelling reason to implement an AIMS
is that ..we (the field known for its advances in technology)
should not be left out of the electronic age”
-Kevin Tremper Ph.D, MD,
49th annual Rovenstine Lecture,
Anesthesiology 2011
18. Paper or Plastic?
“We have been documenting on paper anesthesia records
for about the last hundred years and we have made it pretty
near perfect…Problem is, perfect is pretty damn hard to
improve on!”
- Randy Calicott MD, Vice Chair of Clinical
Operations WFUBMC Anesthesiology,
comment to the developer of our ORIS 2006.
23. DNR history and the growth of
patient autonomy
• 1974: AMA recommended that decisions to forgo
resuscitation be formally documented.
• 1976: First DNR Order at MGH
• 1983 After a Presidential Commission, CPR became
a standard of care and became the only medical
therapy to require a physician’s order to be withheld.
• 1990: Patient Self-Determination Act provides that
any patient who enters an institution receiving
Medicare or Medicaid funds must be advised of his or
her right to execute advanced directives, including a
request for a DNR order.
24. DNR today
• Prior to 1991, it was widespread practice to routinely
suspend DNR orders during the intraoperative and
postoperative periods.
• ASA developed Guidelines for the Anesthesia Care
of patients with DNR orders. These were revised in
1993, 1998, 2001, and last reaffirmed in 2008.
• As many as 15% patients with DNR orders will
undergo surgery
-Margolis JO, Anesth Analg 1995.
• As few as 7% of MGH physicians correctly addressed
DNR issues during patient simulation.
-Waisel , Simulation in Healthcare, 2009.
28. Why current big-name Commercial EMR‟s aren‟t
good enough:
A tale of two „applet‟s
• This one allows data to
be entered and saves it to
the database.
• This one allows data to
be entered and saves it to
the database, plus
• This one will only allow
numbers and letters to be
saved.
29.
30.
31.
32.
33. A “fully functional” field needs 15
more powerpoint slides of code to:
•
•
•
•
•
Provides for drop down choices, plus
The ability to choose multiple choices at times, plus
Free text choices in addition to these, plus
Error checking of what is entered, plus
Rules ensuring the field is not left blank after making
an entry but before it becomes part of the EMR.
• Other applications to modify the content of the drop
downs in the field, create reports of the field, and
view the field within a different application or field.
35. Health Information Technology
for Economic and Clinical Health
Act of the American Relief and
Recovery Act of 2009
• Around $20 billion to aid the development of a robust IT systems
• Large -sized hospitals implementing EMR could get $10 million
• Eligible Medical professionals who show meaningful use of
EMR’s will receive $44,000 in incentives per professional
• The ASA has recommended to CMS that ARRA will impede
EMR’s in the Operating Room unless CMS acts to:
37. Why current big-name Commercial EMR‟s aren‟t
good enough:
• Lack of specificity for anesthesiologists work flow and
processes.
• Reliance on electronic data recorded as narrative text
from dictation software or keystroke text by humans.
• Reliance on unity of data in the database and data in
the electronic medical record.
• Companies exist to support a cycle of sales,
installation, sales…….and you are not their customer.
• EMR’s do not automatically changes processes.
39. Why current big-name Commercial EMR‟s aren‟t
good enough:
• Lack of specificity for anesthesiologists work flow and
processes.
• Reliance on electronic data recorded as narrative text
from dictation software or keystroke text by humans.
• Reliance on unity of data in the database and data in
the electronic medical record.
• Companies exist to support a cycle of sales,
installation, sales…….and you are not their customer.
• EMR’s do not automatically changes processes.
• EMR’s do not automatically change people.