Technological Resources & Personnel Costs Required to Implement an Automated Alert System for Primary Care Physicians when Patients Transition from Hospitals to Home FIELD
Similaire à Technological Resources & Personnel Costs Required to Implement an Automated Alert System for Primary Care Physicians when Patients Transition from Hospitals to Home FIELD
E-Scribe: Centralized Electronic Healthcare Record Management SystemNilabja GhoshChowdhury
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Technological Resources & Personnel Costs Required to Implement an Automated Alert System for Primary Care Physicians when Patients Transition from Hospitals to Home FIELD
1. Terry Field, Lawrence Garber, Shawn
Gagne, Jennifer Tjia, Peggy Preusse, Jennifer
Donovan, Abir Kanaan, Jerry Gurwitz
Funding: AHRQ R18 HS017203 and R18 HS017817
2. Problems with continuity of care
High risk transitions
Poor communication between physicians
caring for patients in and out of the hospital
Existing methods to overcome these
problems:
◦ from the hospital side
◦ labor intensive
◦ or based on integrated EMR for out-patient
clinics and hospitals
3. 1. Can out-patient medical group EMRs be
used to provide information to PCPs when
patients are discharged to home?
2. What are the technological resources and
personnel costs needed to develop an
automated system providing information
about patient transitions to PCPs?
4. Medical group practice
330 clinicians
Approximately 180,000 patients
Epic ambulatory EMR
In-house medical informatics team
5. Automated system to facilitate information
flow to PCPs about patients discharged to
home from hospital or SNFs
Includes information about:
• new drugs added during hospital stay
• warnings about drug-drug interactions
• recommendations for dose changes and lab
monitoring
• reminders to support staff to schedule an
office visit
6. Admission, discharge,
Discharge transfer registration
notification (ADT) interface
Scheduling EMR integrated
Information is linked to
Info scheduling system
data in the EMR
database.
Program applies rules to
New construct messages and
EMR pre-discharge
Meds direct their flow.
Claims post-discharge
Lab
Monitoring Lab results interface
7. Primary Care
Provider
Locally produced
interface engine Support
distributes Staff
messages
8.
9.
10. Category Hours Cost ($) % of Total
Cost
Physicians 614 55,340 47
Operations research analyst 370 12,561 28
Research assistant 202 3,885 16
Nurse 58 1,873 4
Computer software engineer 40 1,692 3
Database administrator 17 597 1
Pharmacist 7 367 1
Total 1,308 76,314
11. Linkages to hospitals, SNFs, outside labs
Scheduling system integrated within the EMR
Real time access to claims for dispensed
drugs
Locally written interface engine application
EMR with a flexible database
Internal informatics expertise
HIT-experienced physician leader
12. Linkages to hospitals and labs through ADT
and ORU interfaces
Information about dispensed drugs through
Surescripts
Internal message delivery through
commercially available interface engine
13. Feasible
Requires strong internal informatics expertise
Cooperation from hospitals and SNFs
Electronic linkages to external facilities
Extensive physician time