New York Presbyterian Hospital

New York Presbyterian Hospital, like many medical facilities, found it needed to have information flow freely. Information is gathered from the moment the patient is admitted in the hospital until discharge. This information needs to be accessible to all interested parties that come in contact with the patient. The survey pointed out that both the physician and the nursing staff needs to know certain patient specific information. Lab results and other test results are cited by both the physician and nurses as important patient specific data.

Because physicians required more information to make a proper diagnosis, they required more patient specific information than the nurses. Physician need to have access to: *Allow them to connect directly with laboratory and radiology facilities. *Allow them to have abnormal laboratory results flagged automatically, alerting them to issues which need to be addressed immediately. *Allow them to incorporate findings from ‘ancillary’ equipment, such as ‘scopes’, EKG, Ultrasound etc. , directly into the chart. *Minimize or eliminate duplication of documentation from other medical equipment, such as cardiac catheterization, etc.

*Allow them to connect directly with Pharmacies *Assist them with HIPAA compliance Nurses are more reactionary, so they cited a need for more Institutional and Domain information than physicians Nurses require access to: *Allow them to connect with census reports *Allow the to review current drug information *Assist them with diagnostic definitions *Allow them to review education material In the survey there were other difficulties regarding sharing information and communication. Let’s take a closer look at specific information needs and the possible solutions.

Problem list

Physicians identified problem list as a critical need for proper patient care. The problem list can be generated in the admission office or the Emergency Room. During the initial triage, the information is written in a chart or typed into a computer data base. Take for example a Health History form where a patient fills out a Past Medical History and any Family Medical History. This could be important information on the problem list. How is it going to get into the EMR is an important question. One of the solutions is to have the registration in the admittance and E. R. to be electronic.

This will allow the problem list to be populated correctly. Diagnostic definitions The nursing staff cited diagnostic definitions as an important component for patient treatment. It is clear that the nursing staff might need to have access to a very thorough, but comprehensive list of diagnosis definitions and codes. There is the issue of clinical vocabulary, which has a huge impact on information sharing. There simply is no single universally used medical vocabulary. For example, a cardiologist might refer to a condition as hypertension, whereas another physician in the same hospital might refer to it as high blood pressure.

The concepts are virtually identical, but they will not show up as such when the contents of the medical record system searched unless some form of synonym mapping is carried out. Thus, when a patient’s record is searched for “hypertension,” references to “high blood pressure” will be missed. It’s unrealistic to expect medical staff to search an EMR for multiple synonyms. So the solution to make sure the diagnostic information is shared information reliably with the rest of the world. Identifying and contacting other healthcare professional

Both Physicians and Nurses indicated that is was often difficult to identify the attending staff. Surprisingly enough they can’t seem to find each other. This shows that the information is not flowing in both directions. The reason could be that the physicians and nurses don’t have a system to notate the information and they don’t have an efficient procedure to retrieve the information. Traditional paper charts all have the same flaw: they can only be in one place at a time and frequently are not where they are supposed to be.

When an electronic system is introduced into a medical facility, it is important to have workflow rules. Workflow rules embedded in the system permit information to flow properly as the patient transitions to different care stages. This will definitely improve the quality of medical care for the patient while reducing the possible confusion between the medical staff. Integration of IT systems also means inpatient physicians, nurses, and outpatient physicians can share a complete view of the patient record and discuss options regarding diagnosis, treatment, and discharge.

The system will also encourage communication between medical staff by simplifying the referring process and the reporting process. The survey taken at the New York Presbyterian Hospital pointed out certain areas that improving. There certainly is room to improve the overall efficiency of the system, but there also seems to be a need for more participation by the physicians. With increased participation in the review process, more areas of difficulty can be addresses. Reference: Ursula Pennell and Eric Fishman, M. D. Known Pitfalls and Proven Methods for a Successful EMR Implementation. Retrieved from www. EMRConsultant. com

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