By Suzi Birz, principal, HiQ Analytics
The goals are simple: improve patient care, patient safety and
documentation at the point of care, all while decreasing medical malpractice
risk. Sound good? That’s what E&C Medical Intelligence set out to do with the
Intelligent Patient Record for Obstetrics (IPRob).
Eyal Ephrat, M.D., chief executive officer of E&C Medical
Intelligence, summarized the objective of the package as producing a
“quantifiable, statistical reduction in errors and better quality indicators.”
Intelligent Patient Record for Obstetrics
There are three components to the IPRob: the obstetrics chart,
the best practices knowledge base and the risk management service.
The chart allows workflow of the multidisciplinary team and
results in the official chart with information entered throughout the entire
stay. By addressing the continuum of care in obstetrics, the collaborative
effort is enhanced with one common place for the documentation of care. The
system is used in the inpatient setting and in the prenatal, ambulatory setting
from the first visit through the last post-partum visit six weeks after
delivery. It accepts data from fetal surveillance systems and appropriately
exchanges information with enterprise and ancillary clinical systems eliminating
double entry.
The best practices knowledge base is customized to a specific
hospital. The knowledge base includes published guidelines, information from the
American College of Obstetricians and Gynecologists (ACOG) and regulations from
the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO),
as well as required practices in support of clinical activities and risk
management.
“These two components combine to create a chart that
understands the state of the patient and what we need to do in real time,”
Ephrat explained, calling this the “best care, best documentation, best risk
management approach.”
The system is used by obstetrics staff members, including
physicians, nurses and midwives. Documentation is facilitated by menus, which
are arranged based on the kind of documentation being entered, easing the
navigation.
The system generates prompts, alerts and suggestions in a
number of ways. While a clinician is documenting, the system reacts and presents
to the clinician suggestions on what should be done from a care and
documentation perspective. Throughout the day, information from monitors such as
fetal heart rate or blood pressure is sent to the system. If the system detects
changes requiring action, a prompt will be sent to the workstations on the unit.
If a response is undetected by further documentation, the prompts escalate and
can be programmed to page a physician. Similarly, if a patient protocol requires
documentation at a particular time, prompts will be generated.
The third component is the risk management service. Before
turning the system on at a hospital, E&C analyzes a statistically relevant
sample of written charts to identify deficiencies and weak points. Once the
system is in use, E&C returns at the end of each quarter to show areas of
improvement, areas in need of continued improvement and new opportunities for
improvement.
Data is entered into structured fields providing hospital
staff the opportunity to use this information for quality, risk management and
performance improvement. Standard reports are available on the system to respond
to daily, weekly or monthly needs. In addition, report-writing tools are used to
query the database for special studies or reports.
A Case in Point
Two years ago, administrators at Flushing Hospital Medical
Center, in Flushing, New York, made the decision to implement the intelligent
patient record for obstetrics. Since that decision, nursing staff have played a
key role on committees and in quarterly reviews and updates. Nursing is
essential, providing input on policy changes and staff requests.
Maria Demarinus Smilios, RNC, BSN, CCE, represents
nursing in these meetings in her role as clinical nurse manager for the
inpatient perinatal unit.
The system has impacts on day-to-day activities of nurses, as
well as research and management responsibilities, Smilios said. One of the
biggest benefits is the elimination of illegible notes and orders, preventing
errors and promoting patient safety. Smilios added that having access to the
prenatal portion of the chart eliminates the paper chase to get the data from
clinic visits. For her management role, Smilios pointed out that the data is
available post-discharge for questions that arise or for use in gathering data
across the patient base.
Take-away Messages
Ephrat would like nurses to remember two things when thinking
about an electronic chart: “This system understands what nurses have to document
and customizes the data entry to mirror the workflow,” he said. “And the system
can assist the nurse to provide better care by understanding the current
situation and bringing forth the right information at the right time regarding
relevant clinical actions and documentation.”
Smilios encouraged: “Do not turn away from the new and
innovative. Be open to systems; give it a chance and it can be of benefit.”
Resources
E&C Medical Intelligence
Flushing Hospital Medical Center
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