I’m working on an Emergency EMR prototype, currently focused on the user interaction front-end than the infrastructure/backend.
Because of the early stages of this, I’m contacting different communities to know their opinions about what is needed/required, by users (clinicians, nurses, technicians), and also by other roles (might be indirect users), like directors of emergency medicine, chief medical officers, chief nursing officers, medical managers, non-medical managers, etc.
Any input would be very valuable for us (we are a small team).
I got some really great feedback from other communities.
I can think of nurses would value having a well organized set of tasks (orders, instructions, procedures), prioritized correctly, and tools to manage transferring tasks on shift changes.
Some colleagues suggested to be able to track readmissions, to evaluate causes and allow to react faster, e.g. knowing problems with high readmission probability before hand, and be prepared to handle the readmissions faster in case those happen, like having a plan of treatment before the readmission.
I’ve heard of this in a different form (I’m a techie and tend to hear of the use cases second/third/etc hand from business people).
I think in the UK the idea is to send a discharge notification to the GP. Which sounds to me as the Emergency Encounter diagnosis would be sent to the GP to manage?
I believe in these cases a CarePlan would exist in with the GP.
Is the discharge notification to the GP sent for follow up purposes after an emergency episode? I’m not sure how that works in the UK.
The topic about readmissions, and the value I can see on that area is that there are many conditions that have high probability of readmission to the ED in the next 30 days. And there is no way around that, no system can prevent readmissions to happen. But, if the system keeps the high probability readmission cases flagged, and the rendering clinician creates a plan of care in case of readmission, and leaves a summary of the current ED episode ready, if the patient is readmitted to the ED, with all that info available, that patient can be correctly prioritized and a plan will be already in place. Even quick communication with the previous rendering clinicians could be done to provide a good quality and fast service to the patient, and hopefully minimizing the risks.
Currently I don’t know how readmission cases are managed, or if are even detected besides asking the patient.
In the UK a digital ED discharge summary is sent to the GP via a messaging system called MESH, which integrates with the document ‘inbox’ workflow of the GP system.
I can’t speak for other countries, but in the current state of the NHS it is unrealistic that any clinician would have time to discharge someone and create a hypothetical ‘in case of readmission’ plan.
Firstly, I would not presume to be able to predict what the patient would be readmitted with or why. The patient needs fully reassessing on the second admission, preferably without coloration of one’s thought by a preceding plan. Thinking you know the future is one of the most dangerous parts of medicine. Technology can only cause harm here.
Secondly, there is no available spare clinician time in which to do this additional work of creating a readmission plan. It’s simply impossible in the current NHS.
Sorry to be so despondent and negative, but I’ve got to be realistic.
One of the (UK) projects I’m aware of, will have a CarePlan defined in primary care. So it’s similar but the expectation is the GP would manage the readmission plan.
The notification from ED to GP would request either an re-evaluation of meds or plan. It may be in addition to the letter Marcus refers to (a task or request).
I’m currently an emergency medicine provider near New York City and soon matriculating to a school for health IT. This is right up my alley!
The mainstay I believe for effective charting is highly influenced by time management. With that being said, the current accepted model for medical note writing is sometimes redundant. For example when writing in the HPI, this can automatically include or exclude things in the review of systems. In the physical examination, this can support a diagnosis which can support autosuggestion. Imaging results typically return with wording which highly influences a diagnosis as well, for example “acute appendicitis” on CT scan. This, can influence autosuggestion when typing in the diagnosis. When selecting the diagnosis in the medical chart, it typically requires the user to not only type it, but also go to a separate portion of the chart to select this diagnosis, this too is redundant.
User interaction is crucial in the emergency department given there is usually a high volume of patients requiring large resources, and the provider has very little time. Therefore, i believe the key to making a large impact is eliminating redundancy, and outputting a beautiful effective note.
Thanks John, it seems you have experience with some EMR software that has some issues. The initial question was focused on getting input on the requirements, but also on the pains current emergency clinicians are having and you gave a good idea of your own pains.
This week we are going to put the system that we are developing online for public test and getting feedback from the community. It’s a prototype and work in progress with many things to improve, but will love to hear what you have to say to consider it into the design.
I’ll share the link when the app is online and a google form to provide feedback.