The Patient List. Methods of Making Patient Lists More Like Facility Boards. Marc Palter, MD, CMIO

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1 The Patient List Methods of Making Patient Lists More Like Facility Boards. Marc Palter, MD, CMIO Gordon Tait, Application Architect January 6, 2012

2 Hartford Healthcare Acute Care Hartford Hospital Hospital of Central Connecticut Windham Hospital Midstate Medical Center Institute of Living Behavioral health Natchaug Hospital Rushford Center Institute of Living Home Care VNA Healthcare VNA of Central Connecticut Physical Medicine Eastern Rehabilitation Network Central Connecticut Physical Medicine Diagnostic Services Clinical Lab Partners Physician Practices Alliance Occupational Health Hartford Medical Group Hartford Specialists Midstate Medical Group 2

3 Hartford Healthcare Sunrise Clinical Manager Sunrise Record Manager Sunrise Patient Flow Sunrise EPSi Care Management Allscripts ED Allscripts Homecare Alscripts Enterprise Allscripts MyWay 3

4 Overview of Penn Medicine Penn Medicine is a $4.07 billion health care provider organization consisting of over 2,000 physicians providing services to the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Pennsylvania Hospital and the health system network that serves the city of Philadelphia, the surrounding five county area and parts of southern New Jersey. Hospital of the University of Pennsylvania (HUP) 749 Beds, 1,674 Physicians Penn Presbyterian Medical Center (PMC) 317 Beds, 832 Physicians Pennsylvania Hospital (PAH) 515 Beds, 888 Physicians Clinical Practices of the University of Pennsylvania (CPUP) Clinical Care Associates (CCA) Penn Medicine at Rittenhouse Penn Homecare and Hospice Services 4

5 Overview Status Board Background / Challenges Clinical Need Penn Background Challenges Where Could We Display On A Higher Level? Where Could We Save Info On A Higher Level? Why Choose Custom Columns? What Would You Want To Display? What Might It Look Like? 5

6 Status Board Background / Challenges 6

7 Status Board Background / Challenges 7

8 Clinical Need Do an Orthopedic Surgeon and a Pulmonologist want to see the same view? 8

9 Clinical Need Clinical Summary Clinical Data Viewer Tracking Board Columns on the patient list? 9

10 Penn Background Challenges Needed to do queries on detailed information to determine our beginnings of our Sepsis sniffer. Thank you RWJ, AMH, UK, and others for sharing your ideas! What we found: Clinical Document observation-level data is horrid to work with. Results are quite a bit better but the tables can still be enormous. Queries on Active patients alone (~30,000 rows) = 4+ minutes. Useless for any real-time tool for a user to wait on. WHY can t such critical info be kept on a visit or higher level?! THEN it would be SO much quicker to get to! Maybe it can... 10

11 Where Could We Display On A Higher Level? Patient Header Info: Can Be Seen Across Tabs. Can Be Bolded, Made Red, etc. Can Show Long Text. Patient Header Info Can Be Seen Across Tabs. Custom Columns Enable Quick Glances Across Sets of Patients. Can Be Hidden By User Preference. Patient List Custom Columns: Less Intrusive, Can Be Shifted Around Or Removed By User Quickly. Can Be Forced On Users As Often As Needed IF You Push It. Can Display a Red Flag, Green Flag, or Text Up To 60 Characters. Sortable With a Quick Column Header Click. Often Underutilized and can have a custom Application behind it. Custom Tabs: This offers a clean slate to operate from. 11

12 Where Could We Save Info On A Higher Level? When custom data needs to be saved so it can be later used: Can be put into a custom column data field. 50 per visit. 50 per chart. 50 per patient. Can be put into a field that the patient headers can use. Patient Comment Type (CV3PatientCommentDeclaration) Health Issue Type (CV3HealthIssueDeclaration) Can be saved into a custom database. In a custom database on Sunrise DB server. In a custom database on another server as an SQL Linked Server. In our discussion we will choose the use of custom columns. The other methods may suit your organization. 12

13 Why Choose Custom Columns? The Patient List is the first thing most users see when they login. Facility Boards are widely used in efficient manners by (other) vendors. Proven technology in other columns previously presented. Columns are convenient for users to add to lists where they want it. Do not need to be ever-present: can be on all, any, or no lists. Since all 50 per-level fields are kept in a single row in a table, they are quick to access. HID and PCD tables can have millions of rows. Can ultimately make up to 150 custom columns. Can have custom applications a double-click away: blank slate also. 13

14 Need More Convincing? There are many MLM trigger points that can be used to update them. Since other MLMs could be redirected to use these quicker data points, you could feasibly even reduce your MLM load on the system. Since columns are so easy to build lists with and sort across a provider s assigned patients, a unit census, orders, AVLD, facility, etc: Can help with compliance. Could reduce report requests. Could be a launching point for future tools that need speed: Critical clinical alerts. Admission assessments. Okay, you can even make that Custom Tab if you really wanted and have it pull its data from these columns. 14

15 What Would You Want To Display? Latest: Heart Rate* Respiratory Rate* Blood Pressure* Temperature C (or F)* White Blood Cell Count* Other Critical Lab Results* Last Pneumovax Given Date (or reason not to give: Egg allergy, etc) Pulled from latest Epic ambulatory data. Pulled from prior Sunrise visits. Last Influenza Vaccination Given Date (or reason not give) Pulled from latest Epic ambulatory data. Pulled from prior Sunrise visits. [* = with other column(s) for date/time as wanted] 15

16 What might it look like? 16

17 What might it look like? 17

18 What might it look like? 18

19 Questions? Suggestions? Marc Palter, MD, CMIO, Hartford Healthcare Gordon Tait, Application Architect, Penn Medicine 19

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