This image was attained near Smokey Hill Road in The George W. Mead Wildlife Area. “The Mead” consists of approximately 30,000 acres, bordering both sides of the Little Eau Pleine River in northern Wood and Portage Counties and southern Marathon County. It is managed by the DNR as a mixture of habitats for plants, animals and birds, especially those associated with water. Parts of the wildlife area are open for hunting and fishing during regular seasons.
We implement electronic health records in an effort to improve care. If we simply turn on a computer instead of using a paper record, why would we expect care processes to improve? To achieve improvement, we have to redesign our care processes to take advantage of the EHR.
A common practice within medicine’s paper based world is to never document a procedure or administration of a medication prior to actually doing it. EHRs give us an opportunity to utilize decision support to prevent errors, but they only work if a certain amount of document takes place prior to administration to a patient.
A workflow of vaccine administration typically has documentation following administration. In a paper based world, this work flow may make sense since documentation does not in itself prevent administration errors. In a smart EHR or vaccine registry, vaccine lot numbers are entered into a database as they are placed into inventory. Lot numbers identify the specific type of immunization. If the lot number is documented prior to administration, decision support can provide alerts that the wrong immunization is being given, the immunization is being given too early or the immunization has already been provided. Without recording the lot numbers first, these errors are not prevented.
Changing of long established workflows is a difficult but necessary function if one is to achieve improvements in quality and patient safety.
The Buena Vista Grasslands, south of Plover, uses a variety of methods to prevent overgrowth of woody plants. Without attention, the grasslands will slowly convert to woody vegetation further reducing prairie chicken habitat. Activities including periods of grazing and cutting for hay are all part of the management plan aimed at maintaining our population of native prairie wildlife.
Our EHR Project is now officially underway with the Kickoff off at our Pilot. There are so many tasks needed to allow the Pilot to be successful but one in particular will be preloading important data. Many organizations have choosen not to preload data, the philosophy seems to be that care teams learn how to use the EHR through the process of entering baseline data. We believe the EHR should be of value to our care teams from the very first day. Entering data should be a by-product of patient care, not preparation for patient care.
We have initiated a large project aimed at identifying what data from our paper chart, lab systems and hospital information systems should be loaded into CattailsMD before the EHR is used for patient care. We are building interfaces that once established, will load current labs, reports, dictations, x-ray reports and links to x-ray images into CattailsMD. There are historical results that will be necessary to track essential preventive and disease management services. We will identify and load these items into CattailsMD before Go-Live.
In addition, we will identify types of historical paper documents we will routinely scan and load into CattailsMD. Care providers will also be able to identify those special documents unique to a patient that should be scanned and loaded.
Part of the pre-Go-Live process at each site will be to preload the current medication and allergy lists. The more accurate the paper lists, the more accurate the initial EHR list will be.
From the very first use of CattailsMD, our clinicians will have access to all the documents and data loaded since the interfaces went live plus all the data we have preloaded. Our efforts will be rewarded when our clinicians open a patient’s record for the first time and have a WOW moment because they see the value of EHR with their own eyes.
The Mackinac Bridge is a suspension bridge spanning the Straits of Mackinac connecting the Upper and Lower peninsulas of Michigan. It connects the city of St. Ignace on the north end with the village of Mackinaw City on the south and is the longest suspension bridge between anchorages. This image was captured from Mackinac Island.
Our decision to use Marshfield Clinic’s CattailsMD was featured in a story on AMNews (July 21, 2008), the newspaper of the American Medical Association.
http://www.ama-assn.org/amednews/2008/07/21/bisb0721.htm
CattailsMD was attractive to us for a number of reasons including the development of what the newspaper is calling a private RHIO. There is also a State of Wisconsin effort to develop a data exchange linking information from multiple health care providers. Our use of CattailsMD will make it easy for us to participate. Patients are best served when health information is avialable to their health care providers.
New Hopes Pines is a Wisconsin State Natural Area. Located just to the east of Rosholt, it is the largest northern dry-mesic forest remaining in central Wisconsin. The vast forests found in the region prior to settlement have been logged with a precious few undisturbed tracts remaining.
Once embarked on an EHR journey, Ministry needed to develop supporting corporate infrastructure, tasks such as finding a Chief Information Officer (CIO) and Chief Medical Information Officer (CMIO). While those efforts were underway, we pulled together a team of clinicians and staff who were using or had used an electronic medical record in the past. This team gathered virtually on a regular basis to develop a joint vision of what practicing clinicians need in an EHR.
I have found clinicians who have used EMRs in the past possess unique insights as to how an EMR can be used to improve provision of care. Clinicians who have not used an EMR, tend to develop workflows duplicating their paper flows rather than finding new processes to leverage the technology.
We gathered over the noon hour once a week via a telephone conference. We generally talked about a topic and flushed out our functional specification. Offline, we developed representative screen shots depicting the functionality we desired. Screen shots and functional requirements were shared using PowerPoint Presentations sent via our internal e-mail server. Today we would collaborate using WebEx as the communication tool.
By the time Ministry had hired a CIO and CMIO, the clinicians had formed a very clear vision of our functional specifications.
In a previous post, I stated there are there three common structures for EHRs.
A data exchange provides a mechanism where information from disparate data systems is collected and then presented for viewing. The data, while useful as a reference source, is of limited value because of a restricted ability to package the information in meaningful ways or be used as a driver of decision support. Patients are often not uniquely identified in the database resulting in duplicate records. Some entities maintaining data exchanges do not adhere to the same patient confidentiality standards as the organizations that contribute the data. These exchanges are expensive and ongoing funding to support continued use has been problematic. A data exchange can be useful when regional providers of care use either different electronic medical records or EMRs where the database can be unilaterally altered. It’s value will be high in the short term when entities merely wish to view data, but will be limited in the future when those same entities wish to use the data to provide decision support at the point of care.
A few EMR vendors offer a standard data base across their user base. Separate health care entities can utilize these records and have an identical database structure allowing alignment of patient records. The resulting structure can allow the data to drive decision support or common determination of clinical benchmarks. Since the database has a standard format, custom programs for decision support can be easily shared between users. Though more useful than an data exchange, this format is limited in that patients may not be uniquely identified in aligned systems.
A single common medical record with a single patient database used by independent regional health care entities provides the most robust structure to share medical data and drive decision support. Governance can be a real issue but the improvement in patient care is worth the effort. Data can be packaged and presented to meet the needs of each individual user.
Opinions expressed do not necessarily reflect the views of my employer.
