990 / Implementation of a Parameterized Electronic Health Record

SPAIN
Classification of the PSP
Type of Patient Safety Practice Not Proven Effective
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Health IT
Patient identification There is no specified text here
Topic of the reported practice
Quality improvement project
Aim and the benefit of the Patient Safety Practice
 
Clinical history not parameterized, this storage format has problems related to the availability and accessibility, confidentiality, format and content.
Description of the Patient Safety Practice
 
Implementation of a Parameterized Electronic Health Record, improving the availability, for all the health providers, of information on health status and clinical course throughout the continuum of care. All this information supports the clinical decision making.

The key issues addressed during implementation are related to the identification of individuals, interoperability, use of standards, clinical information display, usability, security, privacy, confidentiality and the management of change.
The key issues addressed during implementation are related to the identification of individuals, interoperability, use of standards, clinical information display, usability, security, privacy, confidentiality and the management of change.

The implementation of the parameterized electronic medical record has been performed in the Oncology Unit of the University General Hospital of Valencia for the management of cancer patients. This implementation was developed on the following 4 phases:

A.    Database adaptation and creation of integrations with other systems.
Starting date: January 2013
Duration: 5 months

This initial phase was analyzed and the following critical points were detected in the integration of patient information:

1.    Admission. Administrative patient data are synchronized with the hospital Admission software, keeping the information updated in the two systems.

2.    Clinical analysis laboratory. It allows real-time reception of the lab results of the patient to ensure that the doctor has the analytical values before the consultation. Additionally the system maps the laboratory data of the patient with the Common Terminology Criteria for classification Adverse Events (CTCAE), classifies the adverse effect and saves this information in the treatment history of patients by cycle and date.

3.    Calendar. Synchronization of appointments with the hospital manager requests. Information of appointments from patient is recorded and available for other medical services.

4.    Clinical Platform PANGEA. As a result of patient care in medical oncology service, parameterized reports are sent to PANGEA software that acts as a centralized document repository allowing it to be queried from any primary care center or functional unit involved in the patient care process.


Moreover, the critical fields for parameterized record oncology patient history are analyzed and classifications used for it, concluding with the following:

- Medical history.
- General overview of patient evolution
- Current status of the patient.
- Diagnosis.
- Treatment Plan.

Revision in the specific case of chemotherapy protocols is performed by diagnosis, keeping as actives only the one approved by the Pharmacy and Therapeutics Committee of the hospital. They are highly parameterized allowing standardization and customization of treatment that will receive the patient. Related to the protocol is support medication that is dispensed for home administration, toxicities to monitor them and the prevalence or severity caused in patient. Normalized documents containing the recommendations and counseling for the patient about their treatment are inserted in each protocol.

B.    Pilot test.
Start date: June 2013
Duration 2 months

Initially the workflow for the care of cancer patients is defined and two medical consultations for the pilot phase are selected.

Programming a patient-type, for example, the first day of a cycle of chemotherapy entail, according to the proposed circuit:

1.    Lab test

2.    Medical consultation. Registration and clinical evaluation of the patient. Creation of the clinical episode and order the treatment. All the information is given to the patient if required in the hospital. The prescription of pharmacotherapeutic protocols is facilitated by the filter based on patient episode, that is, by default the system provides the protocols indicated for patient diagnosis and approved by the hospital. This prescription automatically includes all information from outpatient and inpatient treatment that will receive the patient, the nursing cares and recommendations (patient counseling). The patient is informed about the details of the treatment by giving written information.

    The outcome of medical consultation is sent to Pangea software     platform making it available to the rest of the hospital medical     service and primary care centers.

3.    Scheduling. Allocation of date on which the treatment is administered. After the prescription, prescriber indicates the cycle, day and date of start of treatment and the number of expected cycles. From this information, the system automatically sets the dates available for patient treatment administration respecting the frequency between cycles of the protocol. In addition, on that date, it searches the availability in the Calendars, informing the professional about the time, duration and place reserved. In case there is no availability for the dates selected, the system generates a notice informing of the situation. The prescriber may choose to look for another date or force the appointment if an urgent situation. To do this the user will need the appropriate permissions, which are customizable for each group of professionals.


C.    Starting and monitoring.
Start date: August 2013
Duration: until today.

Incorporation into process the entire Medical Oncology Unit.

D.    Evaluation.

At present the evaluation phase is running. On it are establishing indicators to measure the implementation of the system. This phase will conclude with proposing improvements and review of the circuit.

Current issues in the health environment:


Clinical history not parameterized, this storage format has problems related to the availability and accessibility, confidentiality, format and content.

Different studies have revealed the relationship between errors and transition assistance. The U.S. Pharmacopeial Convention (USP) in 2004 adds 3 sources of error related to the healthcare system transition to web communication of medication errors (MEDMARX). In July 2005, 2.022 conciliation errors are recorded corresponding to 66% transitions , 22% admissions and 12% discharges.

The database of Joint Commission: Accreditation, healthcare, Certification (JCAHO) on fatal errors or serious medication: 63% related to communication failures.

In short they all conclude that more than 50% of medication errors are related to the transition of care (Rozich et al. Q ManagHealtCare, 2001; 8 (10): 27-34).

Benefits:

Implementation of parameterized clinical history of the Farmis_Oncofarm software as an integrated information system to improve continuity of care.

The integration of all healthcare information systems allow to citation and admission, the control the flow of patients and efficiently coordinate all actions required in the diagnosis and treatment of each process: consultations, diagnostic tests, therapeutic procedures, hospital admissions.

Parameterized reports in response to standards available encryption (ICD-9; TNM, CTCAE ...) generated in oncology are available from any primary care center or medical unit involved in the patient care process through clinical platform PANGEA. Additionally a copy of this report is given to the patient at each medical visit.

All information generated is integrated into a SINGLE MEDICAL RECORD that provides professional support system clinical decision both individual and population levels.



Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
There is no specified text here
There is no specified text here
There is no specified text here
Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
Effect not known or the intervention has not yet been evaluated
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Health care assistants
Pharmacists
Technical support / technician
Administrative support (secretary, clerk, receptionist etc.)
Clinical manager
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Sharing of progress information among involved staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Carlos Camps Herrero
Country: SPAIN
Organisation: Consorcio Hospital General Universitario (Valencia)
E-mail: camps_car@gva.es
Phone: +34 961 972 184
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