T ECHNOLOGY : M EANINGFUL USE , M EANINGFUL COMMUNICATION L IZ F - - PDF document

1

TECHNOLOGY: MEANINGFUL USE, MEANINGFUL

COMMUNICATION

L IZ F AGAN, MD, F ACE P HE AT HE R ST IRNWE IS, RN

Date

ME ANINGF UL USE

• 1999 Institute o f Me dic ine ’ s “T
• E

rr is Huma n: Building a Sa fe r He a lth Syste m” – With this pub lic a tio n, o rg a niza tio ns b e g a n the initia l pro c e sse s o f a ddre ssing a nd pla nning

Page 2

initia l pro c e sse s o f a ddre ssing a nd pla nning fo r imple me nta tio n o f IT syste ms to he lp minimize the risk o f e rro rs re duc e c o sts a nd impro ve pa tie nt c a re

• 2001 Institute o f Me dic ine ’ s “Cro ssing the Qua lity

Cha sm, A Ne w He a lth Syste m fo r the 21st Ce ntury”

ME ANINGF UL USE

2009--T he Ame ric a n Re c o ve ry a nd Re inve stme nt Ac t. Me dic a re a nd Me dic a id E HR inc e ntive pro g ra ms pro vide a fina nc ia l inc e ntive fo r the me a ning ful use o f c e rtifie d E HR te c hno lo g y to a c hie ve he a lth a nd

Page 3

g y e ffic ie nc y g o a ls. By putting into a c tio n a nd me a ning fully using a n E HR syste m, pro vide rs will re a p b e ne fits b e yo nd fina nc ia l inc e ntive s–suc h a s re duc tio n in e rro rs, a va ila b ility o f re c o rds a nd da ta , re minde rs a nd a le rts, c linic a l de c isio n suppo rt, a nd e -pre sc rib ing / re fill a uto ma tio n.

2

WHATIS "ME

ANINGF ULUSE”?

• T

he use o f a c e rtifie d E HR in a me a ning ful ma nne r, suc h a s e -pre sc rib ing .

• T

he use o f c e rtifie d E HR te c hno lo g y fo r e le c tro nic e xc ha ng e o f he a lth info rma tio n to impro ve q ua lity o f

Page 4

g p q y he a lth c a re .

• T

he use o f c e rtifie d E HR te c hno lo g y to sub mit c linic a l q ua lity a nd o the r me a sure s.

• Simply put, "me a ning ful use " me a ns pro vide rs ne e d to

sho w the y're using c e rtifie d E HR te c hno lo g y in wa ys tha t c a n b e me a sure d sig nific a ntly in q ua lity a nd in q ua ntity.

WHAT ARE T HE CRIT E RIA F OR ME ANINGF UL USE ?

• The criteria for meaningful use will be staged in

three steps over the course of the next five years.

• Stage 1 (2011 and 2012) sets the baseline for

l i d d i f i h i

Page 5

electronic data capture and information sharing.

• Stage 2 (expected to be implemented in 2013)

and Stage 3 (expected to be implemented in 2015) will continue to expand on this baseline and be developed through future rule making.

• Me a ning ful use info rma tio n pa c ke ts in b a c k.

HOW DO I ME

E TME ANINGF UL USE R E QUIRE ME NT S?

• Adopte d: Ac q uire d a nd insta lle d c e rtifie d E

HR te c hno lo g y. (F

• r e xa mple , c a n sho w e vide nc e o f

insta lla tio n.)

• Imple me nte d: Be g a n using c e rtifie d E

HR te c hno lo g y.

Page 6

p

g g g y (F

• r e xa mple , pro vide sta ff tra ining o r da ta e ntry o f

pa tie nt de mo g ra phic info rma tio n into E HR.)

• Upgr

ade d: E

xpa nde d e xisting te c hno lo g y to me e t c e rtific a tio n re q uire me nts. (F

• r e xa mple , upg ra de to

c e rtifie d E HR te c hno lo g y o r a dd ne w func tio na lity to me e t the de finitio n o f c e rtifie d E HR te c hno lo g y.)

3

HOW DO I ME

E TME ANINGF UL USE R E QUIRE ME NT S?

• In it’ s fina l rule da te d July 13, CMS inc lude d

CPOE in its c o re se t o f me a ning ful use o b je c tive s.

• “CPOE

is a fo unda tio na l e le me nt in ma ny o f the

• the r o b je c tive s o f me a ning ful use , inc luding

Page 7

j g , g e xc ha ng e o f info rma tio n a nd c linic a l de c isio n suppo rt”

• F
• r e lig ib le ho spita ls a nd c ritic a l a c c e ss ho spita ls

(CAHs), the re a re a to ta l o f 24 me a ning ful use

• b je c tive s. T
• q ua lify fo r a n inc e ntive pa yme nt,

19 o f the se 24 o b je c tive s must b e me t, inc luding :

ME

ANINGF ULUSE SPE CIF ICAT ION SHE E T S

• 14 re q uire d c o re o b je c tive s—AND..
• 5 me nu se t o b je c tive s (c ho se n fro m a list o f 10)
• E

a c h she e t c o ve rs a sing le e lig ib le pro fe ssio na l c o re o r me nu se t o b je c tive :

Page 8

– Me e ting the me a sure fo r e a c h o b je c tive – Ho w to c a lc ula te the nume ra to r a nd de no mina to r fo r e a c h o b je c tive – Ho w to q ua lify fo r a n e xc lusio n to a n o b je c tive – In-de pth de finitio ns o f te rms tha t c la rify o b je c tive re q uire me nts – Re q uire me nts fo r a tte sting to e a c h me a sure

Inc e ntive T ime line

Page 9

4

BE

NE F IT S OF ME ANINGF UL USE

• 52 physic ia ns + Sta ff a t 26 pra c tic e s with E

HR in pla c e fo r a t le a st 2 ye a rs we re surve ye d b y Ce nte r fo r Studying He a lth Syste m Cha ng e – Imme dia te a c c e ss to E MR da ta e na b le d the m to fo c us o n the pa tie nt ra the r tha n g a the ring info rma tio n fro m a va rie ty

Page 10

the pa tie nt ra the r tha n g a the ring info rma tio n fro m a va rie ty

• f pa pe r so urc e s during visits

– E a se o f a c c e ss e nric he d pa tie nt e duc a tio n during visit – Sho wing pa tie nts po rtio ns o f the ir re c o rds c o uld fa c ilita te mo re a c c ura te do c ume nta tio n a nd jo int de c isio n ma king

• Struc ture d/ Co de d Da ta is se a rc ha b le

Can EMRs Lead to a Failure to Communicate? HealthLeaders Media, April 29,2010. Janice Simmons.

CASE E

XAMPL E

• Ne w Pa tie nt is b ro ug ht b a c k fo r b e dside tria g e

trig g e ring “pt ne e ds to b e se e n” ic o n. – Ic o n no te d b y physic ia n who re vie ws no te s, e xa mine s pt a sking CC fo c use d q ue stio ns

Page 11

p g q fo llo we d b y CPOE

• Nurse no te s/ c a rrie s o ut o rde rs o n pa tie nt

– Pro vide r no te s o rde r c o mple tio n a nd re c he c ks pt, e xpla ins re sults/ disc ha rg e pla n o f c a re —the n trig g e rs ic o n fo r d/ c

• Nurse se e s ic o n a nd d/ c pt with Rx/ instruc tio ns.

CASE E

XAMPL E DISCUSSION

• Pt re c e ive d time ly c a re fro m b o th nurse a nd

pro vide r, BUT …….. N d P id h d i t l

Page 12

• Nurse a nd Pro vide r ha d no inte rpe rso na l

c o mmunic a tio n re g a rding the pa tie nt.

• Do e s tha t ma tte r? .........

5

COMMUNICAT

ION CONCE RNS WIT H E HR

• Pro vide rs will re ly o n E

MR fo r info rma tio n g a the ring a t the e xpe nse o f re a l time c o mmunic a tio n with pa tie nts a nd o the r c a re pro vide rs

Page 13

• T

he we a lth o f da ta a va ila b le c a n lull c linic ia ns into b e lie ving the y ha ve a ll the info rma tio n ne e de d c a using the m to c o mmunic a te le ss with the ir pa tie nts

» Electronic Medical Records and Communication with Patients and Other Clinicians: Are we Talking Less? Issue Brief No. 131 April 2010 O’Malley, Cohen, Grossman.

COMMUNICAT

ION CONCE RNS WIT H E HR

• E

HRs ha ve e na b le d so me c linic ia ns to e ng a g e le ss with pa tie nts b e c a use so muc h mo re info rma tio n is a va ila b le b e fo re se e ing the pa tie nt

Page 14

the pa tie nt

– “…..My c o nc e rn no w is tha t we ’ re liste ning le ss b e c a use we ha ve mo re info rma tio n whe n we wa lk into the ro o m, a nd its no t a ll trustwo rthy” – “ T his is g re a t, I use d the E MR, a nd wa s a b le to write the no te s b e fo re I e ve n we nt into the ro o m”

– E le c tro nic Me dic a l Re c o rd s a nd Co mmunic a tio n with Pa tie nts a nd Othe r Clinic ia ns: Are we T a lking L e ss? Issue Brie f No . 131 April 2010 O’ Ma lle y, Co he n, Gro ssma n.

CASE R

E PORT

• 38 yo WM c o mpla ins o f “flu-like sympto ms” fo r o ne we e k—

inc luding sub je c tive fe ve r, dry c o ug h a nd pa in with de e p b re a thing .

• 98.6 97 18 145/ 90 100% sa t o n RA
• PMH/ PSH a re ne g a tive 1 ppd o c c a sio na l e to h de nie s

Page 15

• PMH/ PSH a re ne g a tive , 1 ppd, o c c a sio na l e to h, de nie s

drug use

• URI te mpla te c ho se n a nd do c ume nte d o n b y tria g e nurse
• Physic ia n e xa mine s pt, a sks fo c use d q ue stio ns, c o mple te s

URI te mpla te c he c kb o xe s a nd d/ c pt with sympto ma tic the ra py.

• Pt wa s fo und de a d b y spo use whe n she c a me ho me fro m

wo rk

6

CASE E

XAMPL E DISCUSSION

• Pt received timely care from both nurse

and provider, BUT……..

Page 16

p ,

• Nurse and Provider had no interpersonal

communication regarding the patient.

• Does that matter?...............YES IT DOES!

CASE R

E PORT WIT H COMMUNICAT ION Sa me pa tie nt….. URI te mpla te c o mple te d b y tria g e nurse a nd pt pla c e d in ro o m

• While a t sta tio n, nurse spe a ks with physic ia n a nd sa ys

“o n pa pe r he lo o ks fine , b ut the re ’ s so me thing a b o ut

Page 17

p p , g him tha t’ s just no t rig ht”.

• Physic ia n g o e s in a nd a sks o pe n e nde d q ue stio ns, pt

re luc ta ntly a dmits to DOE sinc e ye ste rda y a nd with furthe r pro b ing a dmits to using Co c a ine la st pm a nd ha s no t fe lt we ll sinc e . E K G a b no rma l, Initia l T ro po nin 15, pt a dmitte d to mo nito re d b e d whe re spo use fo und him whe n she g o t o ff wo rk.

COMMUNICAT

ION CONCE RNS WIT H E HR

• F
• r so me c linic ia ns inte rvie we d, the c he c kb o x fo rma t
• f the E

MR c re a te d a te mpta tio n to fo c us o n filling

• ut the b o xe s whic h re duc e d the a mo unt o f time

spe nt a sking o pe n e nde d q ue stio ns.

Page 18

• T

he risk o f fo c using o n c he c kb o xe s while ta king a pa tie nt histo ry is tha t “sub tle o r nua nc e d sympto ms mig ht g o unide ntifie d”.

• E

MRs ma y diminish the ne e d fo r inte rpe rso na l c o mmunic a tio n a s the q ue stio ns b e c o me mo re fo c use d. E

le c tro nic Me dic a l Re c o rds a nd Co mmunic a tio n with Pa tie nts a nd Othe r Clinic ia ns: Are We T a lking L e ss? O’ Ma lle y e t a l Issue Brie f No 131

7

WHY DO WE HAVE C OMMUNICAT

ION CONCE RNS IN T HE E

R,… . I ME

AN E

HR?

• He a lthc a re is typic a lly risky, c o mple x, unc e rta in a nd

time pre ssure d.

• De ma nds o n c linic ia ns fo r c a re a re unc e rta in, va ry

wide ly, a nd a re in a c o ntinua l sta te o f c ha ng e

Page 19

• Wo rk is pe rfo rme d o n c o mpro mise d syste ms (pa tie nts)

who se a fflic tio n a nd re spo nse to tre a tme nt is no t pre dic ta b le a nd c a n b e diffic ult to a sse ss a nd ma y va ry wide ly

• Pt c o nditio n, dia g no sis, a nd tre a tme nt a re hig hly

c o nte xt spe c ific a nd individua lize d.

– A he a lthc a re te a m c o mmunic a tio n re se a rc h a g e nd a . In: Ne me th CP, e d . Impro ving He a lthc a re T e a m Co mmunic a tio n:Building o n L e sso ns Fro m Avia tio n a nd Ae ro spa c e . Ha mpshire , E ng la nd : Ashg a te ; 2008:245-250

E

F F E CT IVE INT E RPE RSONAL COMMUNICAT ION

• T

he hig h sta ke s fa st pa c e d na ture o f the e me rg e nc y de pa rtme nt po se s sig nific a nt c ha lle ng e s to e ffe c tive c o mmunic a tio n (a nd this wa s b e fo re E HRs)

• E

D sta ff a tte mpts to fo c us o n ra pid re c o g nitio n (if t l t h b i d t tl

Page 20

wro ng te mpla te c ho se n, c a re c a n b e ina dve rte ntly g uide d do wn the wro ng pa th) Sta ff re spo nds to immine nt life thre a ts while a lso me e ting o the r impo rta nt pa tie nt ne e ds, suc h a s c o mpa ssio n, c o mfo rt a nd pro visio n o f de ta ile d info rma tio n to pa tie nt a nd fa mily—no t to me ntio n c o mplying with a ll b e st pra c tic e s a nd c o re me a sure s. E

xamining E me rg e nc y De partme nt Co mmunic atio n T hro ug h a S taff-base d Partic ipato ry Re se arc h Me tho d: I de ntifying Barrie rs and S

• lutio ns to

Me aning ful Chang e . Vo l 56 No 6, 614-622

E

F F E CT IVE INT E RPE RSONAL COMMUNICAT ION

• Additio na l stre sse s suc h a s c ro wding , inte rruptio ns,

a nd shift c ha ng e s ma y furthe r c o mplic a te re la tio nships a nd c o mmunic a tio n b e twe e n pt a nd the E D he a lthc a re te a m

Page 21

• Pt pe rc e ptio n o f c o mmunic a tio n pro b le ms in E

Ds ha ve b e e n a sso c ia te d with De c re a se d pa tie nt sa tisfa c tio n a nd c o mplia nc e with c a re pla ns

• T

he la te st studie s sho w tha t 75% o f pa tie nt c o mpla ints we re re la te d to c o mmunic a tio n issue s

– E xamining E me rg e nc y De partme nt Co mmunic atio n T hro ug h a S taff-base d Partic ipato ry Re se arc h Me tho d: I de ntifying Barrie rs and S

• lutio ns to Me aning ful Chang e . Vo l 56 No 6,

614-622

8

E

F F E CT IVE INT E RPE RSONAL COMMUNICAT ION

• T

he E D T e a m wo rks in a fa st pa c e d inte nse e nviro nme nt tha t c a lls fo r q uic k a c tio n a nd o ffe rs little time fo r e xte nsive disc ussio n.

• Impo rta nt Aspe c ts o f te a mwo rk inc lude e nsuring tha t

Page 22

p p g c ritic a l info rma tio n is no t lo st during ha ndo ffs

• A pra c titio ne r’ s risk o f ma lpra c tic e c a n b e pre dic te d

b y his (in)a b ility to c o mmunic a te we ll with his pa tie nts—spe c ific a lly whe n pts pe rc e ive : a la c k o f re spe c t, b e ing liste ne d to , a nd fe e db a c k.

E

F F E CT IVE INT E RPE RSONAL COMMUNICAT ION

• In mo re tha n 50% o f RCAs re vie we d, the inc iting

e ve nt wa s de sc rib e d a s e rro ne o us c o mmunic a tio n b e twe e n sta ff, a s ro o t c a use s o f

• r c o ntrib uting fa c to rs o f se ve re pa tie nt sa fe ty

Page 23

inc ide nts BMJ Qual S af do i:10.1136/ bmjqs.2010.040238

• Co mmunic atio n F

ailure has be e n c ite d by T JC as the mo st c o mmo n re aso n fo r se ntine l pt safe ty e ve nts that re sult in me dic al e rro r E

xamining E me rg e nc y De partme nt Co mmunic atio n T hro ug h a S taff-base d Partic ipato ry Re se arc h Me tho d: I de ntifying Barrie rs and S

• lutio ns to Me aning ful Chang e . Vo l 56 No 6, 614-622

E

F F E CT IVE INT E RPE RSONAL COMMUNICAT ION

• Re a l T

ime fa c e to fa c e o r pho ne c o mmunic a tio n a llo ws c linic ia ns to a c q uire sub tle o r nua nc e d info rma tio n fro m pa tie nts a nd o the r c linic ia ns tha t is no t e a sily c o mmunic a te d in the me dic a l

Page 24

re c o rd—so c ia l c o nte xt, no n-ve rb a l c ue s, e tc .

• Be tte r Co mmunic a tio n b e twe e n pa tie nts a nd

c linic ia ns is a ke y c o mpo ne nt o f c a re c o o rdina tio n a nd le a ds to impro ve d pt

• utc o me s.

– E le c tro nic Me dic a l Re c o rd s a nd Co mmunic a tio n with Pa tie nts a nd Othe r Clinic ia ns: Are We T a lking L e ss? O’ Ma lle y e t a l Issue Brie f No 131

9

COMMUNICAT

ION CONCE RNS WIT H E HR

• “I

llusio n o f c o mmunic a tio n” pro mo te s the b e lie f tha t e ntry o f a n o rde r into the syste m e nsure s tha t the pro pe r pe o ple will se e a nd a c t upo n it.

• Do c to rs/ Nurse s/ Othe r pro vide rs c o nsiste ntly

Page 25

/ / p y re po rt tha t c linic a l syste ms like CPOE c a n c a use unsa tisfa c to ry re duc tio ns in fa c e -to -fa c e c o mmunic a tio n re g a rding pa tie nt c a re whic h in turn ma y inc re a se the like liho o d o f a n e rro rs.

– POE T Re c o mme nda tio ns, T ype s o f Uninte nd e d Co nse q ue nc e s o f CPOE . OHSU Ja n 9, 2011

COMMUNICAT

ION CONCE RNS WIT H CPOE

• A Unive rsity o f Pe nnsylva nia study fo und tha t CPOE

use re sulte d in a de c re a se in the c o lla b o ra tio n b e twe e n nurse s a nd pro vide rs.

• By no t se e ing the pro vide r write the o rde r, the re ma y

Page 26

b e a de la y b e fo re the o rde r is se e n, a nd the nurse is no t a s like ly to c o nve rse with pro vide r a b o ut the

• rde r a nd o b ta in c la rific a tio n if ne e de d.
• At Ma yo Clinic in AZ, the # 1 c o nc e rn o f nursing sta ff

upo n imple me nta tio n o f the ir E MR wa s time ly no tific a tio n o f ne w/ c ha ng e d o rde rs.

– Ma inta ining E xc e lle nc e in Physic ia n Nurse Co mmunic a tio n with CPOE : A Nursing Info rma tic s T e a m Appro a c h. Wrig ht e t a l, Jo urna l o f He a lthc a re Info rma tio n Mg t Vo l 20, No 2. 65-70

COMMUNICAT

ION CONCE RNS WIT H CPOE

• In a no n-CPOE

e nviro nme nt, the nursing sta ff re lie s he a vily o n the unit se c re ta ry to ke e p the m info rme d o f o rde r c ha ng e s, pa rtic ula rly tho se tha t re q uire imme dia te o r sta t inte rve ntio ns b y

Page 27

nurse .

• L
• ss o f visua l c lue s a b o ut o rde rs (e x: no c ha rt in

the o rde rs ra c k)

• L

a c k o f visua l c lue s a nd de c re a se d pro vide r pre se nc e c a n le a d to re duc e d c o mmunic a tio n

• r fe we r inte ra c tio ns b e twe e n nurse / physic ia n

» Ma inta ining E xc e lle nc e in Physic ia n Nurse Co mmunic a tio n w ith CPOE : A Nursing Info rma tic s T e a m Appro a c h. Wrig ht e t a l, Jo urna l o f He a lthc a re Info rma tio n Mg t Vo l 20, No 2. 65-70

10

COMMUNICAT

ION CONCE RNS WIT H CPOE

• Sta ff do e s no t ha ve time to c o nsta ntly lo g in a nd

se e if a ne w o rde r ha s b e e n pla c e d.

• Within 2 we e ks o f the syste m g o -live , Ann Arb o r

nurse s c a lle d a me e ting . T he pro b le m? ........

Page 28

g p c o mmunic a tio n ha d b e e n la rg e ly a uto ma te d a nd inte ra c tio n with physic ia ns ha d b e e n sha rply c urta ile d.

» T he Bra ve Ne w w o rld o f e le c tro nic c o mmunic a tio ns Hi-te c h ve te ra ns de sc rib e the stra te g ie s tha t ma ke up a fo r fe w e r fa c e to fa c e inte ra c tio ns. Ha sso n, Judi T

• da y’ s Ho spita list F

e b 2009

COMMUNICAT

ION CONCE RNS WIT H CPOE

• T

he c o mpute r ha s a re ma rka b le a b ility to de c re a se the pra c tic a l ne c e ssity o f physic a l pre se nc e in the nursing sta tio n.

• A lo t o f inte ra c tio ns b e twe e n do c to rs a nd nurse s

d h d t t t d k i th

Page 29

• c c urre d whe n do c to rs sa t a t a de sk in the

nurse s sta tio n to write the ir no te s.

• Nurse s fo und the mse lve s wa nting mo re

info rma tio n to b e sure tha t the y kne w wha t the do c to r wa s thinking whe n the o rde r wa s pla c e d—wha t did yo u se e tha t I didn’ t? .

» T he Bra ve Ne w w o rld o f e le c tro nic c o mmunic a tio ns Hi-te c h ve te ra ns de sc rib e the stra te g ie s tha t ma ke up a fo r fe w e r fa c e to fa c e inte ra c tio ns. Ha sso n, Judi T

• da y’ s Ho spita list F

e b 2009

COMMUNICAT

ION CONCE RNS WIT H CPOE

• E

MR ma y le a d to fe we r info rma l c o nve rsa tio ns.

• Sta ff fre q ue ntly fe e l the y ne e d mo re de ta il fro m

do c to rs a b o ut pa tie nts. Nurse s ne e d a fo rum fo r pa ssing o n pa tie nt/ fa mily re q ue sts a nd nua nc e d

Page 30

p g p / y q info rma tio n tha t do e s no t e a sily fit into a c he c kb o x

• Antie me tic re q ue ste d witho ut c o nte xtua l info . RN

re po rts “Pt is na use a te d, ne e ds tre a tme nt”—b ut no t wha t pro mpte d the na use a , …i.e . it sta rte d a fte r: trying to e a t spic y fo o d, hitting he a d in fa ll, wa lking do wn ha ll, two diffe re nt me ds fa ile d.

• T

he a b o ve sc e na rio s e a c h ha ve diff c o nc e rns.

11

COMMUNICAT

ION CONCE RNS WIT H CPOE

• In so me wa ys, CPOE

re duc e s c o mmunic a tio n.

• T

he re is a pe rc e ive d lo ss o f c o ntro l fo r nurse s.

• Nurse s ha ve a lwa ys b e e n a t the c o re o f o rde r

ma na g e me nt a nd c o mmunic a tio n to o the r

Page 31

ma na g e me nt a nd c o mmunic a tio n to o the r de pa rtme nts/ se rvic e s.

• A nurse ma y no t e ve n kno w the o rde r ha s b e e n

issue d unle ss he / she lo o ks fo r it.

» Ho w to Avo id CPOE Pitfa lls E ra mo , L isa . F

• r T

he Re c o rd Vo l 22,No 15. P 10 Aug ust 16, 2010

.

L OCAL E D SURVE

Y ON INF ORMAT ION SHARING

• Ma ny surve ys a b o ut c o mmunic a tio n

b e twe e n do c to rs a nd nurse s ha ve b e e n c o mple te d. Mo st RN’ s fe lt the re wa s a de c re a se in c o mmunic a tio n with the

Page 32

de c re a se in c o mmunic a tio n with the Do c to r a fte r the imple me nta tio n o f CPOE .

• I

n this surve y, Nurse s a nd Physic ia ns we re a ske d a b o ut info rma tio n sha ring a t two diffe re nt style d Nursing Sta tio ns, a nd pre - E MR.

COMMUNICATION SURVEY

Page 33

12

L OCAL E D SURVE

Y ON INF ORMAT ION SHARING

Open Station Closed Station Before EMR/CPOE Share All Info 20 3 21

Page 34

Share Most Info: Ease of sharing affects amount 23 16 23 Batch Info for sharing 4 14 NA Share Urgent Info 23 23 23

ORDE R ING COMMUNICAT ION CONCE RNS

• Ve rb a l o rde rs a re b e ing stro ng ly disc o ura g e d

due to c o nc e rns fo r e rro rs. With CPOE , ve rb a l

• rde rs a re de c re a se d, b ut the re is a n inc re a se in

time to o rde r pla c e me nt.

Page 35

• T

he disruptive o pe ning a nd c lo sing o f e le c tro nic c ha rts fo r the pro vide r b e ing a ske d to multita sk a nd g ive a n o rde r o n a pa tie nt no t c urre ntly b e ing do c ume nte d o n, pre dispo se s pro vide rs to ma ke a no the r type o f me d e rro r—e nte ring the

• rde r o n the wro ng c ha rt.

» T he Bra ve Ne w w o rld o f e le c tro nic c o mmunic a tio ns Hi-te c h ve te ra ns de sc rib e the stra te g ie s tha t ma ke up a fo r fe w e r fa c e to fa c e inte ra c tio ns. Ha sso n, Judi T

• da y’ s Ho spita list F

e b 2009

CONCERNS WITH EHR

• Pro vide rs who do no t like to type te nd to use the

pre -pa c ka g e d te mpla te s tha t dra ma tic a lly c ut do wn o n the fre e te xt ne e d fo r typing (b ut ma y re duc e the pa tie nt spe c ific de ta ils inc lude d).

Page 36

• Cha rts tha t inc lude mo re de ta ils a re pa rtic ula rly

he lpful fo r the ne xt pro vide r who c a re s fo r the pa tie nt, o r no n-me dic a l pe rso nne l—like yo ur de fe nse te a m.

• Individua lize d de ta ils mo re e a sily suppo rt tha t

the pro vide r re a lly tho ug ht thro ug h the pt’ s c a re .

13

COMMUNICAT

ION CONCE RNS WIT H CPOE

• In sta nda rd pro c e dure s, the re is a lo t o f ma nua l

c he c king a nd do ub le c he c king ….b ut whe n the who le syste m b e c o me s a uto ma te d, the ma nua l c he c king g e ts re pla c e d.

Page 37

• Co mpute r g e ne ra te d o rde rs a re q ue stio ne d le ss
• fte n tha n ha nd writte n o rde rs.
• Yo u b e g in to re ly o n the a uto ma tio n. So me

a le rts ma y b e turne d o ff witho ut the pro vide r’ s kno wle dg e , o r c e rta in no n-fo rmula ry drug s ma y no t e ve n b e sub je c t to a le rt c he c ks.

E

L E CT RONIC COMMUNICAT ION

• T

e xt me ssa g ing a llo ws c a re te a ms to c o mmunic a te witho ut the fo rc e d inte rruptio ns o f re spo nding to o ve rhe a d pa g e s—c o st is ina tte ntio n to the pa tie nt while re a ding the te xt

Page 38

me ssa g e s—Pa tie nt pe rc e ive s yo u a re so c ia l ne two rking .

• Ale rt F

a tig ue o c c urs whe n pro vide rs a re inunda te d with a le rts to the po int tha t the y b e g in to ig no re the m---the nurse is muc h ha rde r to ig no re whe n the y ha ve a c o nc e rn.

AL

E RT F AT IGUE

Page 39

14

AL

E RT F AT IGUE

Page 40

AL

E RT F AT IGUE

Page 41

AL

E RT F AT IGUE

Page 42

15

AL

E RT F AT IGUE Duplicate med, check box, go on Duplicate med, check box go on (Oh, Oh, this duplicate is also an Allergy)

Page 43

RE COMME NDAT IONS

• Re vie w a ll pre -e xisting da ta with the pa tie nt fo r

a c c ura c y. T his fa c ilita te s a c c ura te do c ume nta tio n a nd the pe rc e ptio n o f jo int de c isio n ma king b y the pa tie nt.

Page 44

• T

he b e st wa y to e nsure g o o d c o o rdina tio n o f c a re is fo r two c linic ia ns to spe a k with e a c h o the r dire c tly.

• Se t c le a r e xpe c ta tio ns with sta ff o n wha t is

a ppro pria te fo r e le c tro nic ve rsus o ra l c o mmunic a tio n—inc o rpo ra te with wo rkflo w.

R

E COMME NDAT IONS

E HR tra ining sho uld inc lude inte rpe rso na l c o mmunic a tio n skills fo r pra c titio ne rs, a lo ng with ro unding re c o mme nda tio ns a nd te mpla te / wo rkflo w re c o mme nda tio ns.

Page 45

• In this e ra whe re da ta c a n b e tra nsfe rre d a t the

spe e d o f lig ht, c o nside r slo wing do wn fo r so me g o o d

• ld fa shio ne d fa c e time --Do n’ t le t CPOE

re pla c e tra ditio na l fa c e to fa c e c o mmunic a tio n.

16

R

E COMME NDAT IONS

• Do n’ t b e to o re lia nt o n the syste m.. E

xa mple , Pa tie nt is pe nic illin a lle rg ic b ut it wa s no t e nte re d into c o mpute r,

• r wa s e nte re d in no n tra ditio na l lo c a tio n. A pe nic illin

b a se d a ntib io tic wa s o rde re d a nd a dministe re d ith t b l t i d

Page 46

witho ut c o nc e rn--b e c a use no a le rt wa s issue d.

• CPOE

will ne ve r re pla c e huma n inte llig e nc e , do n’ t b e c o me so de pe nde nt o n te c hno lo g y tha t yo u

• ve rlo o k e rro rs yo u wo uld no rma lly ha ve c a ug ht.

Child we ig he d in po unds, b ut we ig ht mista ke nly e nte re d a s kilo g ra ms. We ig ht b a se d me ds o rde re d a nd a dministe re d.

R

E COMME NDAT IONS

• Add a n a c kno wle dg e me nt re q uire me nt fo r a ll

do c ume nta tio n se c tio ns, e spe c ia lly tho se a dde d a fte r initia l do c ume nta tio n fo r b o th physic ia ns a nd nurse s.

• Clinic ia n must c a ll/ spe a k with nurse whe n putting in a

Page 47

ST AT

• rde r (CPOE

g ive s the illusio n tha t the o rde r is c a rrie d o ut whe n in re a lity, o nly the “middle ma n” ha s b e e n no tifie d) RE COMME NDAT IONS

• Clinic ia n wo rk a re a sho uld b e c lo se ly inte g ra te d

with nursing sta tio n to fa c ilita te fa c e to fa c e dia lo g ue .

• At o ur ho spita l, we ha ve two diffe re ntly de sig ne d

Page 48

p , y g fa c ilitie s. At o ne , we wo rk in a c e ntra l a re a whe re nurse s a nd physic ia ns wo rk c lo se ly b o unc ing ide a s o ff o f o ne a no the r. At the o the r c a mpus, the physic ia ns sit in a mo re iso la te d a re a a nd o fte ntime s the nurse a nd do c to r do no t c o mmunic a te c o nc e rns with e a c h o the r.

17

TEAM BUILDING

• If pe o ple inte ra c t with e a c h o the r, the y a re mo re

like ly to c o mmunic a te b e tte r o ve ra ll--

• A T

e a m E nviro nme nt is impo rta nt, If yo u physic a lly re mo ve pe o ple fro m a c e ntra l

Page 49

p y y p p lo c a tio n, yo u risk lo sing c o mmunic a tio n, a nd tha t c a n b e a pro b le m/ pa tie nt sa fe ty issue .

BEST PRACTICES IN THE AUDIENCE?

Page 50

G E

NE SIS CUP

“Re c ognizing Cr

e ativity a nd Innova tion in the E me rg e nc y De pa rtme nt.”

• T

he y sa y, “Ne c e ssity is the Mo the r o f I ti ” T h i t lli h

Page 51

I nve ntio n”. T he re is no te lling ho w ma ny ing e nio us de vic e s o r pro c e sse s tha t ha ve b e e n de sig ne d b y o ur e me rg e nc y me dic ine pro fe ssio na ls. I t is time to c e le b ra te tho se suc c e sse s a nd ha ve so me fun in the pro c e ss!

18

G E

NE SIS CUP

• T

he Ge ne sis Cup is de sig ne d to re c o g nize a nd c e le b ra te c re a tivity a nd inno va tio n o f o ur e ve ry da y physic ia ns in o ur ne ve r e nding pursuit to impro ve the de live ry o f pa tie nt c a re in the

Page 52

E me rg e nc y De pa rtme nt. In a dditio n to re c o g nizing the inve nto r/ inno va to r, the Ge ne sis Cup re c o g nize s “the te a m” to inc lude , the e me rg e nc y de pa rtme nt a nd the Re g io na l Suppo rt o ffic e in suppo rting suc h e nde a vo rs.

G E

NE SIS CUP

• T
• b e c o nside re d fo r the a wa rd, e a c h

e ntry must b e : O i i l

Page 53

• Orig ina l
• Re pro duc ib le
• Use a b le in o the r E

me rg e nc y De pa rtme nts

ME ANINGF UL USE— ME ANINGF UL COMMUNICAT ION

• In c lo sing , the a pplic a tio n o f the E

MR ho lds a lo t

• f pro mise .
• With ta ps o n a ke yb o a rd, da ta o n pt’ s a lle rg ie s,

Rx use , pre vio us ho spita liza tio ns, o r c linic a l te sts

Page 54

, p p , a re insta ntly a va ila b le .

• But…surro unding o ne se lf with the e le c tro nic a lly

de rive d da ta , ma y c re a te a b a rrie r to e ffe c tive , re a l time , fa c e to fa c e c o mmunic a tio n b e twe e n pa tie nts a nd pro vide rs.