Clinician Dashboard

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• Clinician Dashboard

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PATIENT
The Doctor is
Type stuff here
REAL SICK
Here
Not Here
SICK
To Internet (push button)
NOT SICK
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• Goal
• To provide the clinician with ready access to
• patient information
• the medical knowledge base
• communication tools
• decision-support and problem-solving tools
• quality improvement information
• practice management tools
• educational materials.

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• Two basic elements of the dashboard
• Clinician Practice Information
• QI profiles
• CME offerings credits
• Hospital news and alerts
• Favorite links and resources
• Todays hospital cafeteria menu
• Patient Care Activity
• Patient list with search option
• Off-hours patient activity (ER visits,
  admissions, incoming reports values)
• Alerts, emails, phone messages
• Needed documentation, signatures, bills
• Todays patient schedule
• Call list

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• Individual patient view
• Demographics
• Acute issue/chief complaint
• Problem list
• Medications
• Allergies
• Immunizations
• Patient-specific disease management alerts
• Most recent clinical documentation preceding
  current encounter
• New labs, reports, communications
• Current status vital signs, nursing notes
• Consult request form
• Linkages EMR components, outside facilities,
  other caregivers, information resources

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• Components of the System
• Electronic Medical Record
• Clinical documentation
• Medication management
• Diagnostic studies
• Billing
• Patient handoff
• Decision management
• Computerized physician order entry
• Patient scheduling
• Quality improvement

• Personal Tools
• Library/Education Function
• Decision Support Function
• Hardware
• Portable Assistance Laptop (PAL)
• Communication
• Email
• Pager
• Cell phone
• PDA
• Patient Portal
• Internet Access

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• Functionalities - EMR
• secure access - combination of RFID technology
  with other (biometric, random number, password)
  validation
• secure wireless linkage
• fully regulatory compliant
• Clinical documentation function
• automated alerts re newly-available documents,
  diagnostics and reports
• voice recognition capability
• dictations ? email or wireless transmission
• custom forms to facilitate coding, billing,
  information transfer
• automated forwarding of documents to treatment
  team members

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• Functionalities - EMR
• medication management function
• automated drug interaction checking
• automated med/dose checking
• dosing outside usual parameters
• neonatal, pediatric, geriatric, ethnic dosing
• genetic considerations
• recommendation of alternate medications or
  dosages based on patient Dx(s) and practice
  guidelines
• prescriptions are electronically transmitted to a
  centralized prescription database
• similar to airline e-ticketing
• link to BCMA system

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• Functionalities - EMR
• Diagnostic studies function
• graphic trending
• recommendations (including patient-specific
  genetic testing and profiling)
• links to PACS images, other digitized results
• auto-alerts re critical values via
  pager/cellular function of PAL
• Billing function
• clinical document forms are designed to allow
  computerized calculation of CPT4, ICD?, DRG
  coding
• billing data, including duration of visit,
  automatically transmitted to billing department

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• Functionalities - EMR
• Patient handoff function
• off-hours coverage
• Disease management function
• alerts clinician re
• needed workup
• health screening recommendations
• prescription renewals
• immunizations
• auto-generation of health reports for patients
• compares patient parameters to norms in national
  database

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• Functionalities - EMR
• Computerized physician order entry function
• screening for
• errors
• omissions
• recommendations
• automated reporting to QI, medication management,
  billing
• Patient scheduling function
• auto-updates to and from server

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• Functionalities - EMR
• Quality improvement function
• automated, anonymized reporting of adverse
  outcomes
• automated data collection and reporting of
  selected quality indicators
• Facilitated compliance with national goals -
  JCAHO, NPSG, CMS
• eg, surgical time-out popup

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• Functionalities - Library/education
• on-disk online texts and references
• automatic literature searches, links and
  recommendations based upon
• current patients
• clinicians top-ten and bottom-ten diagnoses
• identified interests
• automated delivery of CME based upon clinician
  practice patterns (both common practices and
  unused/underutilized practices)
• automated delivery of e-subscriptions to selected
  journals, searches, RSS
• the usual links to online resources

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• Functionalities - Decision support tools
• on-disk and online medication database access
• automatic medication updates, formulary updates
• integrated with medication management function of
  EMR
• InfoButtons and popups to pt-specific information
  via Medline Plus/GoLocal, UpToDate, DynaMed,
  PubMed, genetic dbs, Micromedex et al
• AI/expert systems re DDx, workup, treatment,
  genetic profile
• automated, auto-updating comparison of
  individual clinician trends with local and
  national peer groups
• statistical tools, clinical calculators

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• Functionalities - Miscellaneous
• utilization of location monitoring and clinician
  schedule to automatically select and load patient
  EMR or other appropriate task
• wireless access to video library of
  informed-consent videos
• followed by digitized signature of patient on
  form via tablet-pc functionality
• auto-encrypting email
• auto-encryption of on-disk document files
• automated information synchronization to desktop
  computer and servers (USB or wireless)

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• Implementation
• Multidisciplinary design team
• Preserve data independence from applications
• Design structure validation usability test
  simulated walk-throughs
• Small pilot projects
• Field function study
• Larger roll out
• SWAT teams
• Anticipation of failure with rapid, graceful
  recovery
• Field user effect study
• Problem impact study ? Corporate partnership
• Present at Woods Hole

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• Individual Clinician Hardware (PAL)
• Each clinician will be provided with a personal
  computing device with the following
  specifications
• 8x10x0.75 form factor
• 10 hour lithium ion battery life
• 20 GB flash RAM drive
• digitizing screen (for tablet PC functionality)
• 3x5 touchscreen on reverse side of full screen
  (PDA and cellphone screen)
• 2 GHz dual core processor
• DVD-R/W-CD-R/W drive
• three USB-2.0 ports

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• Individual Clinician Hardware (PAL)
• built-in camera (videophone and
  video-conferencing, patient documentation)
• microphone
• infrared port
• internal modem
• modem port
• Ethernet port
• SD card slot (or similar)
• microdrive slot
• 802.11n wireless
• Bluetooth 2.0

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• Individual Clinician Hardware (PAL)
• cellular telephone with text-messaging
• pager
• instant-on previous state maintained in RAM
• downsized (PDA) capability, using a limited
  portion of the screen, for rapid access to a
  limited function set
• location monitoring
• secure-area access
• combination of RFID technology with other
  (biometric, random number, password) validation
• auto-diagnosis and notification of impending
  failures or problems, need for backup

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