There is no dedicated space to see vital signs and MAR data. Clinicians have to correlate the timing of medications and the change in vital signs manually. Answering questions like, " Is the patient perfusing well? what kind of shock is the patient in? Is the patient's blood pressure low because he is receiving too much sedation?" can be answered very easily if there was a dedicated view/space for such.
Establish a View that displays both MAR data and vital sign data all in one dashboard.
All ICU Units and All StepDown Units.
The accordion print group was used to create the View. Labs from multiple sources, flowsheet rows from nursing documentation and medications from comprehensive formulary were imported into the view. Exhaustive lists of medications were created by using the Comprehensive Flowsheet as a starting point. I worked with the Director of Critical Care at Kennestone Hospital, Dr. Saberi, to fine tune the output of this tool.
Navigate through the accordion print group horizontally for time.
West Georgia Medical Center and Kennestone Medical Center are using these dashboards to make critical clinical decisions on a daily basis.
Increase awareness and expand use of this report to all Wellstar Facilities.
Covid-19 season prompted an immediate need for a visualization of all Covid-19 data. There was no central location to view all things covid-19.
Establish a View that displays all things covid-19 on 1 screen.
All Covid-19 Units
Using Dr.Saberi's guidance, we designed an accordion print group view that contained all the desired elements: vitals, labs, medications. Analyst Kalya Brown built the original version. As new clinical evidence is introduced the dashboard has been changed accordingly per Dr. Saberi's requests.
Navigate through the accordion print group horizontally to view data over time.
All of Wellstar facilities used this tool during covid-19 to make critical clinical decisions.
Use the Tool as needed if another signifcant Covid-19 Season occurs.
Given how important and large the topic of Sepsis is, there is no dedicated space for looking up sepsis related information. Initially I was tasked to build an Inpatient Sepsis BPA that was sensitive and specific enough to pick up on truly septic patients and alert for treatment. The work helped me realize that there needs to be a dedicated EHR space for all things sepsis.
The Infectious Disease Dashboard was born out of a necessity to help clinicians: identify time zero for inpatient sepsis, comprehend a patients history of infections over a 1 year period of time and understand the current state of a patient's sepsis course.
All Inpatient clinicians, Sepsis Monitoring Committees
The dashboard comprised of several tools.
Navigate through the sepsis navigation at the top right through the links and see all the different views.
West Georgia Medical Center and Kennestone have been exposed to these tools.
Get Infectious Disease invested in using this dashboard across all Wellstar Facilities
There is no dedicated view for Nephrologists
Establish a view dedicated for all things nephrology
All nephrologists
The accordion print group was used to create the View. Labs from multiple sources, flowsheet rows from nursing documentation and medications from comprehensive formulary were imported into the view. Exhaustive lists of medications were created by using the Comprehensive Flowsheet as a starting point. I worked with the Dr. Vijay Nath- Director of Nephrology Kennestone Hospital and Dr. Ashwin Kamath, to fine tune the output of this tool.
Navigate through the accordion print group horizontally for time.
Kennestone Nephrologists are using this dashboard.
Increase awareness and expand use of this report to all Wellstar Facilities.
Hospitalist notes can be long, bloated and involve a lot of copy and pasting of results etc. Also, LTAC, outpatient physicians recieving these discharge summaries felt that the reports were not adequate for clinical consumption.
The goal was to create a note structure that automatically pulled in key sections of information:unique labs, cultures, radiology, cardiology, pathology, other ( eeg), wound summary, blood products, ancillary staff recommendations ( pt,ot, speech), dispo planning.
Anyone writing discharge summaries. Mostly hospitalists.
Several custom print groups were created to address the information curation challenge for the sections mentioned above. These print groups were then integrated into a smartphrase used for discharge summaries.
Use the smartphrase ".DischargeSummaryWSTest" to start using it.
The project was tested at West Georgia Medical Center and Spaulding Medical Center. Compliance rate of use of the tool was near 80% amongst hospitalists after 4 months. Impact of tool on primary care still being measured. Physicians have liked the structure of the tool so much that they have imported key sections of the note into their own progress notes.
Discuss with leadership to see if they would want to implement parts or all of this note structure into future established notes smartphrases.
Interdisciplinary Rounds involve Nursing, Pharmacy, Clinicians, other ancillary staff to meet together to make key clinical decisions, increase communication with the patient, and solve disposition related challenges. The conversation that happens during the meeting is probably the most important conversation that can happen for the patient throughout the day. Preparing for such a meeting consumes a lot of time and can sometimes get in the way of efficient clinical work. The EHR chart review process consumes the most time since relevant data is scattered.
Create a Dedicated space for viewing all things IDR. Create an Activity Tab nested with 3 subdashboards: Nursing, Pharmacy, Care Coordination. Each sub-dashboard is dedicated to showing commonly viewed information and offering the ability to react and place orders from the dashboard.
All inpatient nursing, pharmacy, care coordination teams and physicians involved in IDRs
The build will be split into 3 stages:
Currently the tool is in testing phase.
Currently the tool is in testing phase
Launch a draft version of this tool silently for administrators and key clinicians/team members to use and offer feedback.
Prepartion for IDR Rounds takes a long time.
Help Nurses prep efficiently for shift report and IDR rounds
Inpatient Nursing Staff
Custom smarttexts containly commonly reported information were created for easy consumption of information.Existing and custom print groups were organized in a report for easy consumption.
Click on the IDR Tab and click Nursing
Still being tested
Get more feedback from nursing staff.
Prepartion for IDR Rounds takes a long time.
Help Pharmacists prep efficiently for shift report and IDR rounds
Inpatient Pharmacy Staff
Multiple key medication sections were created. Each section shows labs/vital sign/nursing documentation combined with relevant medications. The exhaustive medication lists were compiled from UpToDate and then cross referenced with Wellstar's formulary.
Click on the IDR Tab and click Pharmacy
Still being tested
Get more feedback from pharmacy staff.
Prepartion for IDR Rounds takes a long time. All the important documentation care coordintion saves is often inadquately shared with the rest of the team.
Help Care Coordination prep efficiently for shift report and IDR rounds. Help them also share all their information about a patient's dispo to the rest of the team.
The Entire IDR Team
Custom print groups were created to illustrate data relevant to common discharge barriers: Home Circumstances, Mobility barriers, Respiratory barreiers, Ancillary Services challenges, Medication Barriers, Wound Barriers.
Click on the IDR Tab and click Care Coordination
Still being tested
Get more feedback from care coordination staff.
While building records as an analyst, finding correct labs is not an easy task. Some don't have common names, base names etc. Some labs are named unconventionally and are difficult to identify. There are many duplicate labs which are not ordered. All these inadequacies make building quickly a significant challenge.
Offer a search tool that can identify relevant result components very quickly.
All EPIC Analysts
With TS Help, I got a chronicles based report of complete list of result components. The excel file was then integrated into a bootstrap data tables css/js framework for easy consumption/use.
search by lab, common name, base name. It will show how many times a lab was ordered and all the other relevant information
Analysts across the board are using this tool to help build their records.
Increase Awareness amongst all the analysts.
While building records as an analyst, finding the correct medications is not an easy task. Its hard to identify pharmacy classes, subclasses etc.
Offer a search tool that can identify relevant medications very quickly.With a searchable database its very easy to identify key information and help form medication lists/groupers.
All EPIC Analysts
With TS Help, I got a chronicles based report of complete list of result components. The excel file was then integrated into a bootstrap data tables css/js framework for easy consumption/use.
Search Medication name or class, subclass, or therapeutic class.
Analysts across the board are using this tool to help build their records.
Increase Awareness amongst all the analysts.