Transcript ACD Bariatric Interdisciplinary Assessment Notes

The Implementation of Advanced Clinical
Documentation for Bariatric Services
at University Health Network:
Lessons From the Field
Vicky Ramirez, Giuseppe Cammisa
e-Health 2013: Accelerating Change
May 27, 2013
UHN Fast Facts
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Canada’s leading research and
academic hospital
4 Sites:
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Toronto Western Hospital
Toronto General Hospital
Princess Margaret Cancer Centre
Toronto Rehab Institute
$1.8B revenue
762 beds
1,400 physicians
12,000 employees
966,000 amb visits
$265M in research
4,465 OR visits
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UHN
Advanced Clinical Documentation
Strategy
In support of UHN’s ACD strategic goals…
UHN will be a global leader in
reporting on patient outcomes
Research hospital of the future
road map will be developed and
implemented
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ACD IP EPR
ACD OP EPR
ACD Bariatric
Assessment
Notes
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Program Overview
Nurse Practitioners
Social Workers
Registered Dietitians
Surgeons
Psychologists
Psychiatrists
Psychometrists
Support Staff
Endocrinologists
Internists
Data Analysts
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The Team
Project
Team
Mobility
Partner
Privacy
The Team
Clinicians
Security
Human
Factors
Technical
Teams
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Life before the iPad
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And the aftermath…
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Challenges
• Patients repeatedly answering the same
questions
• Clinicians’ persistent difficulties locating charts
or finding information in a chart
• Other challenges:
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Interdisciplinary rounds
Diminished productivity
Outcomes monitoring
Leveraging data for research
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The Solution
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Methodology
Where we started
Mapping the data flow
Focus on outcome
indicators
Device & usability
assessment
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Design Philosophy
Agile and responsive development
iOS design driving clear, standard documentation
Free-text to synoptic
Function (Human Factors) vs. flash
Multidisciplinary lens – enable the breakdown of care silos
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Common Framework Elements
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Benefits
Workflow: Before & After
Early results:
Summary report allows time at end of day to be used for
other purposes
~30 minutes saved per clinician per day!
The problem:
Back to back assessments resulted in charting being
stockpiled until the end of day
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Measuring Success:
An Outcomes Approach
• Baseline surveys and observations
• Post-implementation surveys and observations
Improving the ability to monitor and report on:
PreSurgery
Health
Status
Time to
Care
Patient
Errors
PostSurgery
Health
Sustainability
Patient &
Clinician
Satisfaction
Data
Collection &
Access
Cost
Measures
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The Bariatric Journey
Start small → gather learnings → grow access
Critical Success Factors
Leading edge technology; the
‘fun’ factor
End to end change management
Rapid prototyping/Agile
documentation
Improving data collection &
access
Sustainability model (leveraging
existing infrastructure, MDM
strategy)
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Bariatric Assessment Notes Demo
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