Transcript Electronic Medical Record Advantages

Health Informatics –
Electronic Medical
Record Advantages
Garret Smith, Pharm.D. BCPS
Pharmacy Informatics Program Manager
Boise VA Medical Center
Brian McCullough, PharmD, BCPS
Formulary Lead - Inpatient
St Luke’s Health System
Lisa Thoroughman, PharmD
Pharmacy Operations Manager, Chief Pharmacy Informatics Officer
Saint Alphonsus Regional Medical Center – Boise
Richard Marrott, Phar.D.
Informatics Pharmacist
Eastern Idaho Regional Medical Center
3/5/2016
Disclosures
• None
Learning Objectives
• Describe Health Informatics as it relates to the electronic
medical record.
• Recognize the utility of regional business intelligence tools
related to health care metrics and patient outcomes.
• Identify different ways technology can enhance antimicrobial
stewardship.
• Understand the general impacts of converting to electronic
clinical documentation.
• Explain how electronic medical records contribute to quality
measures and patient safety.
What is Health Informatics?
• The fundamental theorem:
• “A person working in partnership with an information resource is
‘better’ than that same person unassisted.”
Friedman CP. J Am Med Inform Assoc. 2009;16:169-170
What is Health Informatics?
• More about people than technology:
• Resources are ultimately built for the benefit of people
• Not concerned with the development of “oracles”
Friedman CP. J Am Med Inform Assoc. 2009;16:169-170
What is Health Informatics?
• The resource must offer new information:
• Most challenging aspect of designing effective information
resources
• The interaction between person and resource cannot be
predicted in advance:
• Whether the theorem holds depends on this interaction
• Poor resource design
• Person lacks sufficient knowledge of domain
Friedman CP. J Am Med Inform Assoc. 2009;16:169-170
Assessment
The Fundamental Theorem of Health Informatics states that:
A. Information resources are more efficient that humans
B. All information resources have intuitive human interfaces
C. Working with an information resource elicits better
results than working unassisted
D. Informatics is all about technology, people play an
insignificant role
Learning Objectives
• Recognize the utility of regional business intelligence tools
related to health care metrics and patient outcomes.
Business Intelligence Tools
• Process large amounts of raw data into meaningful
information:
• Create Dashboards –
• Interactive collection of information to help make informed decisions
• Monitor Performance –
• Scorecards track progress towards goals
• More easily identify areas requiring attention
• What are some examples of BI tools at your site?
CDW. Business Intelligence Center. Accessed: 1/13/15. Available at:
https://vaww.dwh.cdw.portal.va.gov/TechTeam/BISLProjectCoordination/Pag
es/Default.aspx
High Risk Opioid Registry
VDW. VISN 20 HRR. Accessed: 1/13/15
High Risk Opioid Registry
VDW. VISN 20 HRR. Accessed: 1/13/15
BI Benefits
• Provider/Performance feedback has led to improved
outcomes in all of the following practices:
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Tobacco cessation
Anesthesia guidelines
Hypertension management
Treatment of cirrhosis
Bentz CJ, et al. Nicotine Tob Res. 2007 Mar;9(3):341-9
Loy V et al. Am J Med Qual. 2014 Oct 27 [ePub]
Luders S et al. Eur J Cardiovasc Prev Rehabil. 2010 Jun:17(3):271-9
Other VA Initiatives
Assessment
Business intelligence tools provide an efficient method for
achieving which of the following:
A. Reporting performance indicators to providers to
improve health care metrics
B. Providing real time clinical decision support to ensure
guideline adherence
C. Enhancing usability of existing EMRs
D. Ensuring existing decision support reflects the most
current evidence
Antimicrobial
Stewardship and the
EHR
Brian McCullough, PharmD, BCPS
Formulary Lead - Inpatient
St Luke’s Health System
March 2016
Learning Objectives
• Identify different ways technology can enhance antimicrobial
stewardship.
Using the EHR for
antimicrobial stewardship
• Many systems developed for clinical decision support (CDS)
• Initiatives include:
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Bug-drug mismatch
De-escalation opportunities
IV to PO conversion
Length of therapy
Guideline adherence
Many others
• May be within an electronic health record (Epic, Serner,
Meditech, etc.) or interfaced (Theradoc, MedMined, etc.)
Differences between systems
Forrest GN, et al. Clin Infect Dis 2014;59(S3):S122–33.
AMS Dashboards
Accessed from http://wolterskluwer.com/binaries/content/assets/wkhealth/pdf/company/newsroom/case-studies/texas-health-arlington.pdf 17 Jan 2015
Setting criteria for antibiotics
HAI reporting
• Real time
• Can be used to share
data internally
• May be used to
report outcomes
to NHSN
Accessed from
http://www.hpnonline.com/
inside/2013-08/1308-IPTracking.html 17 Jan 2016
Improvements in outcomes:
TREAT study
Survival
Paul M, et al. J Antimicrob Chemother 2006; 58:1238–45.
Leibovici L, et al. J Antimicrob Chemother 2013; 68:2664–6.
Barriers to electronic reporting
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Expensive!
Need training and buy-in from front-line pharmacists
Often needs interfacing
Not all are real-time
Each system has limitations (multiple clicks for one
intervention, poor data mining, etc.)
Assessment Question
Which of the following are antimicrobial stewardship initiatives
that can be enhanced by electronic clinical decision support?
A. Bug-drug mismatch
B. Early identification of inappropriate antibiotic drug levels
C. Unit-specific antibiogram reporting
D. Antimicrobial use reporting
E. All of the above
Learning Objectives
• Understand the general impacts of converting to electronic
clinical documentation.
Electronic Clinical
Documentation and
Communication
Lisa Thoroughman, PharmD
Pharmacy Operations Manager, Chief Pharmacy Informatics
Officer
Saint Alphonsus Regional Medical Center - Boise
March 2016
Electronic Clinical
Documentation
• Learning objective: Reviewing impacts of electronic clinical
documentation as it relates to communication
• Benefits
• Challenges
• Various forms of documentation
• Progress Notes
• Forms
• H&Ps
Benefits
• Improved visibility of documentation between disciplines
• Documentation retrieval
• Timeless
• Access from multiple locations
• Access for multiple users simultaneously
• Documentation creation
• Remote access for providers
• Legibility
• Real-time Automated Alerts to Providers
• Pre-built templates and macros for standardization
• Scanning documents – Delay in access
• Documents not achievable electronically
• Code Blue/Procedural/Signatures
• Impact to care
• Information in multiple locations
• Paper + electronic = breaks in continuity of care
• Verbal communication is still required
• Retirement of the almighty sticky note creates communication
challenges
• System requirements/options limiting accessibility
• Pharmacy Progress Note vs Pharmacy Consult
• Specialized programs lacking integration
• Cathlab, oncology
• Real-time documentation not always real-time
• Still find napkin type documentation styles
• Retrospective charting
• Ad Hoc forms populate data fields
• Various forms pre-populate with previous data
• Multi-Patient Activity List
• Allowing pharmacy users ability to pass information
• Various shifts
• Various sites
Ad Hoc Form
Multi-Patient Activity List
MedMined Surveillance
Advisor
• Alerts, Metrics and Reporting
• Rule generated, integrated with Cerner data
• Standard rule sets build for Alerts
• Health system standards
• Local standards
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Antimicrobial stewardship
Renal Dosing
Anticoagulant monitoring
Lab value rules – toxicities, contraindications
Reportable Intervention tracking
MedMined Dashboard
MedMined Alerts
Assessment
Which of the following is NOT a benefit in converting to
electronic clinical documentation?
a) Improves all levels of communication
b) Improves visibility to other health care disciplines
c) Improves efficiencies with pre-completed templates
d) Improves access to information from remote locations
Using EMRs to
Enhance Patient
Safety
Richard Marrott, Pharm.D.
Informatics Pharmacist
Eastern Idaho Regional Medical Center
03 March 2016
Learning Objectives
• Understand how EMRs can contribute to Quality
Measures/Patient Safety
Pharmacist Safety & Quality
Responsibilities
• I will apply my knowledge, experience, and skills to the best of
my ability to assure optimal drug therapy outcomes for the
patients I serve. (Oath of a Pharmacist)
• Drug/Drug Interactions
• Drug/disease interactions
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Renal dosing
Hepatic dosing
Heart failure
Asthma
• Pediatric/Neonatal weight based dosing
• Weight verification (Kg vs. lb.)
• Medication Reconciliation
Medication Reconciliation
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Omissions
Duplications
Correct dose/frequency
Reducing errors through discharge medication
reconciliation by pharmacy services
• Am J Health Syst Pharm September 1, 2015 72:S120-S126;
• http://www.ajhp.org/content/72/17_Supplement_2/S120.long?h
w-tma-check=true
• Improving medication safety with accurate preadmission
medication lists and postdischarge education.
• The Joint Commission Journal on Quality and Patient Safety,
Volume 38, Number 10, October 2012, pp. 452-458(7)
Pharmacist Safety & Quality
Responsibilities
• Best Practice Initiatives
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Starting Abx in a timely manner Pneumonia/Sepsis
Vaccinations – Flu and Pneumococcal
ASA after MI
Proper maintenance anticoagulation after MI
VTE prophylaxis
Antibiotic Duration after Surgery
• Meaningful Use Initiatives
• Financial Incentives for Hospitals/Physicians to comply with
guidelines.
• Change on the horizon to: Medicare Access & CHIP Reauthorization
Act of 2015.
How do we handle these issues?
• Go to the Chart
• Missing charts
• Handwriting
• Run a report
• Good for compiling data for multiple patients.
• Helps narrow your search for clinical changes.
• May not have the most up-to-date information.
• i.e. reports run in the morning will not contain labs/micro/radiology
reports done throughout the day.
• Look on the computer
• Talk to the Nurse/Physician – get order to change.
What is Up and Coming?
Health Information Exchange
• Current/Future uses for Med Rec
Dynamic “Real Time” Monitoring
• Wouldn’t it be nice if:
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Lab
Microbiology
Radiology
Nursing
Even Physicians!
Called you with current results that were pertinent to your
practice?
% of Hospitals using Health Information Exchange
http://dashboard.healthit.gov/dashboards/hospital-health-it-adoption.php
Clinical Decisions Support Software
(CDSS) systems.
• Integrate data from different systems and are frequently used by
stewardship programs.
• CDSS systems are often used to target patient populations and offer
'real-time' alerts. These alerts are customized to the targeted patient
populations or targeted medications.
• CDSS systems also allow for ongoing monitoring after initial order
entry. After healthcare professionals intervene as a result of an alert,
outcomes can be documented in the system.
Examples:
• Theradoc® (Hospira)
• Quantifi® (Pharmacy Onesource)
• Vigilanz® (Vigilanz Corp).
• http://www.medscape.com/viewarticle/755822_10
Clinical Decisions Support Software
Dynamic Monitoring System
VTE Prophylaxis Rule in real time
Shows the rule, why it fired and the guidance for that particular rule. The pharmacist can
then document what was done and either leave it open for follow up or complete it. Still
need to document electronically in patient’s chart for physician/others to see.
How will this help you?
• Less leg work – tools to help you do your job
more efficiently
• Reports are good to list or summarize data so that you
spend less time looking for it.
• Having electronic medical records means that you
don’t need to decipher handwriting.
• Don’t need to look for a chart to find
Physician/Nursing notes, radiology and lab reports
• Less time looking for the information and more
time using the information to make clinical
decisions to help you patients.
Assessment Question
• How has EMR helped with patient safety/Quality
Measures?
a) Made it easier to acquire necessary data to make clinical
decisions.
b) Eliminated medication errors now that physicians enter orders
electronically.
c) Takes the “human” element out of the practice of medicine.
d) Tells us when the patient is wearing his/her SCDs.
Questions