learning objectives emr vs. ehr - jdevents.com · 8/17/2011 7 history & medication px consults...
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8/17/2011
1
EHR’s Impact On Nursing Care And The Patient
September 20, 2011 10:00am
Presenters
M. Terry Miller, BSEE
Victoria L. (Vicki) Bechet, BSN, RNC
Executive Vice President , GBA
Project Manager, GBA
Learning Objectives
• Identify the types and variations of information captured in the medical record – the types of information, where gathered, where entered.
• Assess physical, operational, privacy and safety
challenges f fWhy should you aschallenges typically faced in both newer and older facilities.
• Determine where integration with other medical technologies such as monitoring, pumps, beds, etc. may streamline EHR capture and accuracy.
• Evaluate the impact of EMR roll-out on nursing workflow, training and orientation, overtime during “go-live”, and follow-up activities
Why should you as an architect care?
EMR vs. EHR
EMR EHR
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EMR Mandate
Background:• Passed by Congress in 2006 • Signed into law the same year • No funding provided• ARRA Act (Stimulus Bill) of 2009 provided $40B• Must achieve “Meaningful use” by Jan 1, 2015, or:
• Reduced reimbursements• Possible fines
2015
Seven levels of Compliance
ARRA - Federal Mandates
20132011
Notable US Commitments:
• VA – started 1970, now piloting NHIN• Kaiser – implementation complete 2010 • CHI – committed $1.5B in 2009 • CHW – committed $1B February 2010• US Military – partial completion 7/11
Comparison to other countries
• Canada – established a national health database 1950’s
• Estonia was the first EU 100% EHRD k 2009• Denmark – 2009
• Britain – target 2010 – not there yet• France – target 2012• Germany, Australia, New Zealand…
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What does this mean to the Nurse?
Nurses
Cornerstone of hospital care delivery
Nurses
21 35 50 65
AvgAge: 48
47%
Nurse’s Time Spent Per Shift
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Current Work Environmentsnurse
burnout
decreased recruitment and
retention gaps in technology
infrastructure
inefficiencies and stress
retention
increased morbidity &
mortalityunsupportive organizational
cultures
work processes and physical design
Reduce Med Errors
Decrease Paper Mountain Decrease Travel Distances
Supply and equipment management
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Physical Assessment Data Collection Devices
Impact of EMR on Nursing Patient Chart
History & PX ConsultsMedication
Nurses Notes
Progress Notes
Advanced Directives
PhysicianOrders
Admission Data
Misc.DietaryGraphic
ChartEKG/EEGX-Ray
ReportsLab
ReportsReport of Operation
It’s not just the nurse
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History & PX ConsultsMedication
Nurses Notes
Progress Notes
Advanced Directives
PhysicianOrders
Admission Data
You must design for all these clinicians to access the EMR.
Misc.DietaryGraphic
ChartEKG/EEGX-Ray
ReportsLab
ReportsReport of Operation
g
The Good News
You won’t have to design for these anymore!
EMR Rollout
So what happens when we go from the paper chart to the EMR?
Barriers to EMR
• Cost• Interoperability issues• Conversion of historical documents• Privacy and Security Concerns• End user adaptation
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Preparing for Roll-out
• Months to years of preparation
• Operational/Cultural shift
Construction project causes• Construction project causes additional stress
Training Modalities
• Team-based• Role-based• Simulation Training = Overtime• Super-Users
Training = Overtime
Data Collection Devices Three types of information
• Quantitative – vital signs, numerical values, quick observations
• Qualitative – physicians progress t i t d tnotes, nursing notes, order entry
• Collaborative – care plan assembly and updates, discharge planning
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Three locations
• In the room – at the bedside• Near the room – quieter, more
private – less distractionC t l Ch ti / R t R• Central Charting / Report Room –multi-disciplinary care team collaboration (not the “nurse station”)
In-room Challenges and Solutions
Ideal solution?• Wall mount• WOW• Tablet • Wall cabinet
Wall Cabinet Options Is a Tablet the Answer?iPad
Motorola Xoom
Samsung Galaxy
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Handheld PC? Are WOW’s the Answer?
Are Wow’s the Answer?
• Wireless device will never perform like a wired device
• Require charging • Require power/data outlets too low• Require power/data outlets - too low• Hallway clutter - require a garage• Trip hazard• One more big, clunky thing to push • Infection control
“Near” room Solutions
• Charting Alcoves
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Central Charting/Report Workstation
• Close to patient rooms• Private – care team only• Set up for individual (solitary) or
ll b ti kcollaborative work
Combination of individual and collaborative charting stations
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Will I remember BP 142/71 in the time it takes me to get from the bedside to the charting station?
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It’s Not Just Nurses…
Devices use the EMR too
Sources of Information from inside the Patient Room
• Vital signs monitor• Physiological Monitor• Bed-Exit alarm• Bed (position, protocol reminders)• IV Pump• Patient fall detection• Diagnostic set• Scale• Nurse call System• ITV system• Fetal Monitoring• Neuro Monitor / Seizure Monitoring• Ventilators• Telemetry• EKG/EEG• BMS - Temp Monitoring – Light Control• Staff / Visitor Presence• Hand-washing detection
Why Integrate?
• Improve accuracy• Save time • Improve clinician workflow• Improve patient care , safety, and
satisfaction• Improve outcomes• Reduce readmissions
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“We want the wireless integration option”
Simple, right?
Project Impact
Types of “Technology Integration”
• Physical – independent function connecting through IT infrastructure
• Logical – independent function connecting through the IP networkconnecting through the IP network
• Software – sharing data – requires:– Format coordination – data cells & types– Custom interface software – both sides– May require middleware
Full Interoperability
• Capsule• Hill-Rom• Nuvon• Nurse Call• BMS• Others?
- Wireless / RFID / RTLS?
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Sources of Information from outside the Room
• ADT information – family & professional contacts, insurance
• Lab test results and reportsR di l i d t• Radiology images and reports
• Surgery images, video and reports• Cardiology information and reports• Pharmacy record
Technology Integration – 1980IT
HIS/Cable
Telecom
Telephone /Cable
Comm Syst
Nurse CallPublic Address
Equipment
RadiologyUltrasoundNuc MedSurgical LightsPat MonitorsSterilizersLab
Owner
DictationTime & AttenTV / MATVSecurityEduc TVIntercomA / VLab A / V
Technology Integration – 1991IT Tech
HISNetworkLISRISSISPhIS
Telecom Tech
Telephone /CableTelemedicineTeleradiologyWireless Tele
Comm Tech
Nurse CallPublic AddressIntercomStruc CablingSecurity
Equip Tech
RadiologyUltrasoundNuc MedSurgical LightsPat MonitorsSterilizersLab Analyzers
Owner Tech
DictationTime & AttenTV / MATVSatellite TVInteractive TVEduc VideoA / VLab Analyzers
PACSCRPrint MgmtPharm DistSpecial Procs
A / V
“Medical Technology”
Technology Integration – 2001IT Tech
HISNetworkLISRISSISPhISEHR
Telecom Tech
TelephoneTeleconferenceTelemedicineWireless Tele
Comm Tech
Nurse CallPublic AddressIntercomStruc CablingSecurity
Equip Tech
RadiologyUltrasoundNuc MedSurgical LightsPat MonitorsSterilizersLab
Special Tech
DictationTime & AttenTV / MATVSatellite TVInteractive TVEduc VideoA / VEHR
CPOEPayroll / HREduc Track(many more)
Lab PACSCRPrint MgmtPharm DistSupply DistSurgical VideoSpecial Procs(many more)
A / V(many more)
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Technology Integration- 2011 Contractor’s Responsibility
It’s more than just data drops• Adequate IT support spaces?• Data center redundancy?
Infrastructure
• Redundant connectivity?• Redundant network?• Electrical redundancy - UPS?• Building systems redundancy?
Integration Management
• Recent Project examples– IT mandate for Cerner compatibility– Quadrupling of wireless infrastructure
Wireless bed option– Wireless bed option– In-room display
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Why should you care?
Technology Planning:•Operational Analysis•Needs Assessment•Recommendations•List, Narrative & Estimate
Technology Project Management•Critical Path on-site dates•Final site-specific vendor drawings•Pre-installation coordination•Site-readiness review•Receiving, storage, transportation, security•Installation, completion, testing, certification•Final inspection and punch-list
TechnologyIntegration•Integration matrix•Physical, logical, software •Vendor-user interface•Vendor-vendor interface•Coordinate configurations•Schedule connection and testing•Track and manage process
100% CDs
TechnologyDesign•Drawings & Specifications•User Review and Sign-off•A/E and Utility coordination•100% CD Books, Specs, Estimates•Response to AHJ comment
Technology ProcurementManagement•Procurement schedule – Grps 1, 2, 3 and Critical Path•Group by procurement method•Assist w RFP’s / RFQ’s as needed•Proposal evaluation / analysis•Track and manage process
TechnologyCommissioning•Operational testing•O&M manuals•Coordinate training
EquipLV
Architect’s CA Responsibility
Summary
• Every new hospital must be designed to support EMR
• Many existing facilities will require renovation to support EMRrenovation to support EMR
• EMR requires a new workflow – new workflow means new charting locations
• “If nurses ain’t happy, ain’t nobody happy”
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