Transcript Slide 1

…the Premier Cardiovascular Information System for Improving Patient Healthcare
Surgical Op Note
Presented by
Nick Gawrit
March 4, 2008
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Written
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The Goal!
Tree Diagram
Starting With…
• Data Model Design Features
– Patient centric
– Longitudinal
– Integrated
• Retrospective data entry
• Enthusiastic Users
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Data Model
Design Features
• Patient centric
• Longitudinal
• Integrated
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DEMOGRAPHICS
HOSPITALIZATION
DRUG USAGE
CLINICAL
PRESENTATION
DRUG USAGE
OPEN HEART
SURGERY
(SURG)
CATH LAB VISIT
(CATH)
CLOSURE
DEVICES
(EQUIPA)
COMPLICATION/
OUTCOMES
PCI
(PROC)
SEGMENT
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EQUIPMENT
(EQUIPA)
DIAGNOSTIC
CATH SEGMENT
ANALYSIS
GRAFT
GRAFT
COMPLICATION/
OUTCOMES
Goals of Op Note Reporting
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Prepare an Open Heart Surgery Op Note
Interface with transcription
Collect data points for registries
Provide perfusionists with data they need
Reduce surgeon time needed for
preparing an Op Note
• Sync Up database with Op Note
• Improve Workflow
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Goals of Op Note Reporting
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Ease of Use
Create Consistency
Improve Data Accuracy
Ensure Completeness
Provide Data for Research
Improve Patient Satisfaction
Eliminate Data Redundancy
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Steps to create Op Note
• Receive the aid of a physician champion to
design a report for CABG only cases
• Meet with the perfusionists to review design
and get input into data entry
• Meet with transcription to review
requirements and set up automatic transfer
to transcription system.
• Meet with IS to insure proper implementation
• Utilize heartbase data administrator and staff
to coordinate all activities
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Surgical Op Note Workflow
Perfusionist
Reports
Referring
MD
O
pt
io
na
l
Perfusionist
Report System
Perfusionist
Real Time
Surgery Capture
Transcribing
Narrative
Reporting
Re
vie
w
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STS Data
Collection
Patient
Coronary
Tree
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MD Dictation
Surgical Op Note Workflow
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Transcribing
Button
Interface
Queue Folder
Interface scans for reports
that need to be sent
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Transcribing
Folder
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Back Up
Archive
Copy
Programming Issues
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Schema changes
Develop a Custom Data Entry Form
Interface hospital demographic and admission discharge data
Create custom paragraphs and CSV file in PQL.
Integrate SIR with Microsoft Word (macros)
Interact of hb generated op-note with hospital transcription
department(EHR)
Implement SIR in a wireless environment
Create a graphical representation of patient coronary tree
Interact with flash drives
Create a Patient pocket handout
Allow Surgeons to dictate of additional findings in the OR which in
turn become part of the EHR.
Prevent Op-notes from being completed unless key fields are
entered.
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Schema Changes
• Needed by:
– Surgeon
– Perfusionist
– heartbase
• Performed with Modify Schema
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Custom Data Entry Form
• Create a new data entry screen that
reflects the needs of the perfusionist, hb
data collector, surgeon, and transcription.
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ADT Data Interchange
DEMO
Brings in Demographic,
Hospitalization and ICD9
Information
HOSP
CLINPRES
DRUG USAGE
DRUG USAGE
OPEN HEART
SURGERY
(SURG)
CATH LAB VISIT
(CATH)
CLOSURE
DEVICES
(EQUIPA)
COMPLICATION/
OUTCOMES
PCI
(PROC)
SEGMENT
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EQUIPMENT
(EQUIPA)
CATHSEG
GRAFT
GRAFT
COMPLICATION/
OUTCOMES
Custom PQL
• Auto generate paragraphs from data entry
fields
• Creation of a CSV file to be used with Mail
Merge later.
– Be aware of SIR CSV Save File max limit
• Audit function
• Graphical tree creation with narrative data,
including wallet sized output
• Event Management
• Triggers
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MYINDr=9
IFTHEN(CRSMOKE=1 )myindr=myindr+1;compute ind(myindr)='current smoker';
elseif(smoke =1)myindr=myindr+1;compute ind(myindr)='history of smoking';
endif
if(FHXCAD=1)myindr=myindr+1;compute ind(myindr)='family history of coronary artery
disease'
if(DIAB=1)myindr=myindr+1;compute ind(myindr)='diabetes'
if(HYPCHOL=1)myindr=myindr+1;compute ind(myindr)='dyslipidemia'
if(HRENFL=1)myindr=myindr+1;compute ind(myindr)='renal failure'
if(HYPTN=1)myindr=myindr+1;compute ind(myindr)='hypertension'
if(HCVA=1)myindr=myindr+1;compute ind(myindr)='cerebrovascular accident'
if(INFEND=1)myindr=myindr+1;compute ind(myindr)='infectious endocarditis'
if(chrlungd GE 2)myindr=myindr+1;compute ind(myindr)='chronic lung disease'
if(IMMSUPRX=1)myindr=myindr+1;compute ind(myindr)='immunosuppressive treatment'
if(PVDIS=1)myindr=myindr+1;compute ind(myindr)='peripheral vascular disease'
if(PRCBVDIS=1)myindr=myindr+1;compute ind(myindr)='cerebrovascular disease'
ifthen(myindr=9)mysent=mysent+' Risk factors were not noted.'
else
mysent=mysent+' Risk factors include '
ifthen(myindr=10)
. mysent=mysent+''+ind(10)+'.'
elseif(myindr gt 10)
. for sdsd=10,myindr-1
. mysent=mysent+ind(sdsd)+', '
write ind(sdsd) mysent
. end for
. mysent=mysent+' and '+ind(myindr)+'.'
endif
endif
Risk Factor
Paragraph
Example
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CSV Save File
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CSV SAVE FILE FILENAME='surgnarr.dat'/HEADER/
VARIABLES=
PDATE
('SURGDATE')
LNAME
('LNAME')
FNAME
('FNAME')
MINT
('MINT')
APROC(1)
('APROC1')
APROC(2)
('APROC2')
APROC(3)
('APROC3')
APROC(4)
('APROC4')
APROC(5)
('APROC5')
APROC(6)
('APROC6')
APROC(7)
('APROC7')
APROC(8)
('APROC8')
APROC(9)
('APROC9')
APROC(10)
('APROC10')
SSNUM
('SSNUM')
BILLNUM
('BILLNUM')
PATSSN
('PATSSN')
WBDATE
('WBDATE')
WADMDATE ('WADMDATE')
WCWTLB
('WCWTLB')
wchtfi
('WCHTFI')
PRONOUN
('PRONOUN')
MYSENT
('ind12')
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Audit Program
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. IFTHEN(SEX =1)COMPUTE W9 ='1'
. ELSEIF(SEX =2)COMPUTE W9 ='2'
. ELSE COMPUTE W9 =''
. ENDIF
. IFTHEN(EXISTS(W9)=0 or w9='')
. valfield(9,2)=valfield(9,2)+1;WERR=1
. IFTHEN('<AUDITALL>' = 'Y' OR '<WW9>'='Y')
. WRITE (VALIDATE_STS_NAR.CSV)SSNUM MYC MYC MYC 'SEX'
MYC 'STS0150 GENDER' MYC 'DEMO' MYC
. WLUDEMO=WLUDEMO+'SEX ';WLUDEMOQ='Y'
. ENDIF
. ALINEA=TRIM(ALINEA)+'|'
. ELSE
. valfield(9,1)=valfield(9,1)+1
. ALINEA=TRIM(ALINEA)+TRIM(VALLAB(SEX))+'|'
. ENDIF
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Microsoft Word Integration
• Utilize Word to produce the narrative
letter by utilizing Mail Merge and
Macros
• Include header information for Softmed
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Transcription Electronic Health
Record
• Automatically
send the case to
transcription
when all required
variables are
entered
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Wireless
• Access heartbase via the hospital
wireless network
– Security
– Accessing SIR Master and heartbase
application
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graphical patient coronary tree
• Use database to
define grafts and
then map these
points graphically
(thanks Tom!)
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Flash drives
• Distribute information on flash drive
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Patient pocket handout
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Surgeon Dictation
• Surgeon needs to enter additional
findings in the OR
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Op-Note Completion Check
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Data Capture
Rules we follow:
• Optimize Workflow
• Eliminate Data Redundancy
• Offer Flexible Alternatives
• Reduce FTE costs
• Comply with Rules
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Real Time Data Capture
Customized data collection screens can be
tailored to the individual need
• Perfusionist
• Physician Specific
• Nurse/Tech
• In-Lab/In-OR
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Op Note
DEMO
HOSP
CLINPRES
DRUG USAGE
DRUG USAGE
OPEN HEART
SURGERY
(SURG)
CATH LAB VISIT
(CATH)
CLOSURE
DEVICES
(EQUIPA)
COMPLICATION/
OUTCOMES
PCI
(PROC)
SEGMENT
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EQUIPMENT
(EQUIPA)
CATHSEG
GRAFT
GRAFT
COMPLICATION/
OUTCOMES
Data Collection: Op Note
• Perfusionist
• Procedure MD
• Variables =
Sentences and
Paragraphs
• Graft Definition
= STS Data
Harvest Fields
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Op Note Preparation
• Run the Report
• See the Patient
Coronary tree
• See the Narrative
Report
• Send to Transcription
• Add Dictation
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Op Note Reports
Written
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Tree Diagram
Benefits of Op Note System
• Savings of 20-30 minutes of surgeon time per op
note
• Validation of data in Op Note to data in database
• Concurrent Data Collection
• STS data completion
• Perfusionist Report Preparation
• Integration into hospital electronic medical
record
• Transcription savings
• Physician ability to dictate additional findings
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Benefits of Op Note System(cont)
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Electronic Signature
Op Note speed up to referring MD by 1-2 days
Medical record interaction
Flash drive patient record
E-Mail to referring cardiologist
Optional customization of report for physicians
Coding Improvements for billing
MD bonus program
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Demonstration
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