How a small hospital is overcoming the hidden challenges of EHR - - PowerPoint PPT Presentation

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Jan 07, 2023 255 likes •448 views

How a small hospital is overcoming the hidden challenges of EHR alerts and RNA reflex testing implementation: A presentation from Kingsbrook Jewish Medical Center Neil Allen Pasco MD H H H Initial Patient KJMC ED KJMC Acute Care

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How a small hospital is overcoming the hidden challenges of EHR alerts and RNA reflex testing implementation: A presentation from Kingsbrook Jewish Medical Center

Neil Allen Pasco MD

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Initial Patient Engagement

Testing Criteria
Between the ages fo 13-64 years old.
Last test >6 months.

EHR Registration Waiting Area

Pre-Test Info

Triage

Forced prompt within EMR to document patient's

refusal or acceptance of the HIV test.

RN Blood Draw MD Lab

 KJMC ED  KJMC Acute Care Hospital Admission  KJMC Ambu Clinic /PT Family Health Center

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21 96 199 27 101 109 25 70 93 40 89 378 7 46 125 19 41 56 3 42 33 10 42 165 14 50 74 8 60 53 22 28 60 30 47 213 5 13 5 13 1 7 2 1 10 32 50 100 150 200 250 300 350 400 09/2015 09/2015 09/2015 10/2015 10/2015 10/2015 11/2015 11/2015 11/2015 12/2015 12/2015 12/2015 174A- Kingsbrook: Emergency Department 174B- Kingsbrook: Inpatient 174C- Kingsbrook: Outpatient 174A- Kingsbrook: Emergency Department 174B- Kingsbrook: Inpatient 174C- Kingsbrook: Outpatient 174A- Kingsbrook: Emergency Department 174B- Kingsbrook: Inpatient 174C- Kingsbrook: Outpatient 174A- Kingsbrook: Emergency Department 174B- Kingsbrook: Inpatient 174C- Kingsbrook: Outpatient

Hepatitis C Screening Q4 2015

Number Eligible for HCV Testing Based on Local Criteria Number of Clients Born Between 1945-1965 (Birth Cohort) Tested for HCV Ab Number of Clients Born Outside of the Birth Cohort Tested for HCV Ab Number HCV Ab Positives Linear (Number of Clients Born Between 1945-1965 (Birth Cohort) Tested for HCV Ab) Linear (Number of Clients Born Outside of the Birth Cohort Tested for HCV Ab ) Linear (Number of Clients Born Outside of the Birth Cohort Tested for HCV Ab )

Date Partnership was awarded Date EMR modification was created

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20 175 78 39 110 35 26 122 42 14 87 16 48 132 102 10 129 32 55 126 29 50 130 58 4 16 14 1 9 6 7 11 9 1 8 2 20 40 60 80 100 120 140 160 180 200 01/2016 01/2016 01/2016 02/2016 02/2016 02/2016 03/2016 03/2016 03/2016 04/2014 04/2014 04/2014 174A- Kingsbrook: Emergency Department 174C- Kingsbrook: Outpatient 174B- Kingsbrook: Inpatient 174A- Kingsbrook: Emergency Department 174C- Kingsbrook: Outpatient 174B- Kingsbrook: Inpatient 174A- Kingsbrook: Emergency Department 174C- Kingsbrook: Outpatient 174B- Kingsbrook: Inpatient 174A- Kingsbrook: Emergency Department 174C- Kingsbrook: Outpatient 174B- Kingsbrook: Inpatient

HCV Ab Screening Q1 2016

Number of Clients Born Between 1945-1965 (Birth Cohort) Tested for HCV Ab Number of Clients Born Outside of the Birth Cohort Tested for HCV Ab Number HCV Ab Positives

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500 1000 1500 2000 2500 3000 3500 4000 01/2016 02/2016 03/2016 04/2014 174C- Kingsbrook: Outpatient 174C- Kingsbrook: Outpatient 174C- Kingsbrook: Outpatient 174C- Kingsbrook: Outpatient

Testing Penetration in Outpatient Setting

Total Tests Performed Individual Patients Seen

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2 4 6 8 10 12 14 16 18 01/2016 01/2016 01/2016 02/2016 02/2016 02/2016 03/2016 03/2016 03/2016 04/2014 04/2014 04/2014 174A- Kingsbrook: Emergency Department 174C- Kingsbrook: Outpatient 174B- Kingsbrook: Inpatient 174A- Kingsbrook: Emergency Department 174C- Kingsbrook: Outpatient 174B- Kingsbrook: Inpatient 174A- Kingsbrook: Emergency Department 174C- Kingsbrook: Outpatient 174B- Kingsbrook: Inpatient 174A- Kingsbrook: Emergency Department 174C- Kingsbrook: Outpatient 174B- Kingsbrook: Inpatient

HCV Ab Positive and Reflex Testing

Number HCV Ab Positives Number HCV RNA Positive Number of HCV RNA Negatives Number of HCV RNA Invalid/ Indeterminate/ Tests that Did Not Yield a Result Number of Individuals Testing HCV RNA Positive Linked to Care

Where is the Reflex Testing?

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Multidisciplinary RCA revealed several issues: Lab orders not properly placed in ED setting Nursing/Tech Education on which tubes to use Difficulties in off site RNA reflex testing

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Hepatitis C September, 2015 - December, 2016 September, 2015 - March, 2016 April, 2016 Cumulative Data through April, 2016 HCV Ab Tests Performed 2,559 356 2,915 HCV Ab Positive Patients Identified Through Testing 167 9 176 HCV Ab Seropositivity 6.5% 2.5% 6% HCV RNA Tests Performed 112 9 121 HCV RNA Positive Patients Identified Through Testing 52 3 55 HCV RNA Positive Patients (identified through testing) Attended First Appointment 34 3 37