IAIMS Clinical focus Area
Team
Members
Process
Findings/Conclusions and Recommendations
Members
Martha D. Mullett, MD, Team Leader
Kevin Halbritter, MD
Danielle Tran, MD
Cliff Wolfe
Elaine Nailler
Norton Smith, DDS
Process
The Clinical Focus Area committee members participated inthe conference
in November 1997 led by the consultant from Vanderbilt University, Ann
Olsen. Approximately 40 people from across all areas of the Health Sciences
Center participated. The committee took the suggestions which arose out
of those meetings as a starting place and grouped the suggestions pertaining
to clinical care into logical groups with additions and clarifications.
Each committee member was then assigned an area to seek out more information
about and report back to the committee. This information was presented
to the committee in January and February 1998. Clarification was added
to the report and the report was then circulated via the web page with
requests to respond with additions. This report is available on the web
page at http://www.hsc.wvu.edu/iaims/ifocus/
Findings/Conclusions and Recommendations
A-1. Delivery of care
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Delivery of care is made difficult by access to medical records. The medical
record is split among multiple sites and information is difficult to find.
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CHIP, the present order entry system, facilitates the speed of orders reaching
the laboratory and pharmacy and decreases errors but it does not have logic
and therefore allow algorithms for quality control. CHIP screens are 45
characters across and therefore it takes many screens to enter large order
sets.
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At present there is no system for tracking or automatic reminders that
would help to ensure consistent quality in the hospital and OPD.
A-2. Conclusions
A-3. Recommendations
-
Implement the data repository.
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Purchase a new order entry system.
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Develop intraweb sites that facilitate guidelines, track, and mesh with
order entry.
B-1. System support for flow of care
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Registration is not well coordinated between the clinic and hospital.
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Managed care options are difficult to understand for each patient.
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Scheduling of tests in the hospital for out-patients is still difficult
for some procedures.
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Clinic schedules are not generally accessible in the HSC therefore faculty
cannot check anything about clinic from their offices.
B-2. Conclusions
-
Registration needs to become one time only with accurate information for
any location without redundancy.
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Insurance coverage needs to be more accurate with managed care options
accessible when needed and an efficient system for managed care referrals
and approvals.
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Scheduling of tests and procedure needs to be efficient especially in OPD.
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Clinic schedules need to be accessible by secretaries and physicians in
their offices. An improved ability to annotate a clinic visit on the scheduling
system to facilitate outcomes and preventive health measures needs to be
possible.
B-3. Recommendations
-
Evaluate problems with registration.
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Evaluate and implement managed care support options.
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Improve test scheduling.
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Implement access to clinic schedules using IDX.
C-1. Communication / Documentation
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Charting and communication need improved. It is difficult for faculty to
remain efficient when they have to hand-write every note. Our dictation
costs are high and slow. Preformatted notes are generally not available.
-
Communication with referring physicians is at times difficult. The phone
numbers are not the private lines. Fax alternatives are not available.
-
Communication with patients/family presently is by phone when available.
Brochures on topics or information regarding follow-up is improving but
still has room for improvement.
-
Home health prescriptions are very time consuming. They come weeks after
the patient is discharged and require pulling information from charts or
discharge summaries, which delays the prescription. This information is
known to the team at the time of discharge but is not communicated to the
specific company.
-
Medication prescriptions, which are hand-written or called in, could be
facilitated.
-
Communication between residents, attendings, and students requires paging
presently and is cumbersome when trying to schedule a group meeting.
-
Obtaining a consult at present requires special knowledge by each clerk
on how to communicate with that service about the consult. Delays occur
at times.
C-2. Conclusions
-
Efficient, multiple options for documentation by attendings and houseofficers
need to be available for in-patients and out-patients.
-
Accurate data on referring or off-site physicians to allow efficient transmission
of information back to them and efficient approval of referrals.
-
Methods that facilitate processes of communication with Patient/Family
need to be improved.
-
Accurate data on Pharmacies, Home Health, etc. should be available to efficiently
process requests or prescriptions.
-
Email or intraweb bulletin boards for communication with resident and student
teams would facilitate care and teaching.
-
Communication of consults via web base might facilitate the process.
C-3. Recommendations
-
Obtain and support a state of the art dictation system for documentation
on in-patients and out-patients.
-
Maintain on web browser lists of physicians, home health agencies, and
pharmacies with an accurate address, phone, fax, and email address.
-
Develop better health information for families.
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Develop e-mail/web browser communication for houseofficer/student teams
as well as consults.
D-1. Education / Information
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Although theoretically professional resources are available in many sites
of the HCS and hospital, the interfaces are cumbersome and few attendings
use them. Guidelines are not accessible in any practical manner.
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Information for patients on topics is rare.
-
Most faculty do not know how to use the IS we presently have because of
barriers to the process. These barriers include access codes which are
numerous, unfriendly screens, and inadequate education.
D-2. Conclusions
-
Professional resources including Medline, Internet searches, and our own
guidelines need to be available in a manner that encourages use by attendings
and houseofficers.
-
Patients/Families need information by phone, web site, pamphlet, and video
on multiple topics to encourage understanding of health issues.
-
Implementation of IS for new users of these systems need improved orientation
and training in a timely, convenient way for physicians.
D-3. Recommendations
-
Information systems across the schools of the Health Sciences Center, the
hospitals, and the clinics should be organized into one department with
one person in charge.
-
Develop structures to ensure appropriate easy access across the enterprise
to information.
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Educate physicians in a manner appropriate to physicians to information
systems.
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Provide common screens across all access sites with a simple single secure
access code.
E-1. Research
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At present little data is available for clinical research that is automated.
Chart review or hand filling of data sheets at the time of service is expensive.
E-2. Conclusions
-
Patient data needs to available without identifiers for clinical research
from the hospital and OPD.
E-3. Recommendation
-
Implement the data repository.
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