|
Center Activities
In/Out: Web-Based Continuity Improvement Projects:
- Signout/Discharge Summary System:We have completed development
of a World Wide Web (WWW) based signout and discharge summary system
for medical housestaff that captures and stores information about
a patient’s hospitalization during the hospitalization. The system
is currently in operation for all Care Centers staffed by Medicine
housestaff. Upon discharge an interim discharge summary is generated
which supplies the names of the inpatient health care providers (with
beeper numbers) provides a means for the outpatient primary care physician
to contact the inpatient attending and/or housestaff. The system is
now being redesigned as a funded IT project with an an assigned programmer.
The new system will have an improved feature set and a three tier
architecture. The three-tier architecture will allow us to develop
and deploy this system for any physician-based service.
- IMA Provider Database-We have created a web based provider
database. This database permits provider identification for individual
patients and patient panels by provider.
Provider identification is a mandatory requirement of the
Resident Review Committee and is a necessity for Managed Care. IBAX
had no method for adequately recording housestaff providers. IDX will
remedy many of the existing deficiencies, but it remains to be
seen how easily this system will be used in the inpatient setting by
inpatient providers to identify outpatient providers correctly. There
also exists no mechanism to identify or correct misidentifications of
providers.
We have constructed a Web-ased form linked to a database that
will allow retrieval (and eventually entry) of IMA Provider Information.
The patient information is stored in a Microsoft Access 2.0 database.
This database is frequently updated and contains information on names,
unit numbers, and other demographics. It has limited information on
diagnoses. Provider information has been obtained to date through a
retrospective analysis and prospective process.
- Provider Identification/Notification System. This system
will notify both Medicine housestaff and IMA attending providers that
their patients have been hospitalized. This notification will be accomplished
by linking the information in the above two systems (IMA provider
database and the new signout Signout/Discharge Summary System. Additionally
this linkage will allow outpatient providers to identify the inpatient
housestaff and attendings.
- Disease Management. Details to follow.
- Remote Consultation Project. In planning stages.
- SOS is a General Medicine SignOut System designed
to improve communication between housestaff and attendings.Presently
udner development.
- PINS. Planning Stages
- PDA. Planning Stages
Other Ongoing Projects:
- Outpatient Electronic Medical Record Research Initiative (OEMRRI).
Goal is to conduct a study of a physician-designed EMR (i.e.,
iTrust) to be implemented in the ambulatory environment. The study
will determine what factors are critical to success in our environment.
Workflow will be analyzed. This study draws from prior work
done by The Ambulatory Computerized Chart Committee (Dept. of Medicine)
which identified, organized, and prioritized physician needs
based on want list and the science of medical informatics as well
as the needs of the ongoing Ambulatory EMR-Team Effort. Research Description
on Intranet Only site.
- CITE. Planning Stages
- PharmFree. We have completed prototype development of a
Web site for obtaining medicines for indigent patients and are in
the process of designing a clinical trial. Our objective is to determine
if a comprehensive database of medication assistance programs, available
to health care providers via the World Wide Web (WWW), is an effective
mechanism for increasing access to medications for indigent patients.
Dr. Carlton Moore has been funded by NLM's Applied Informatics Fellowship
to continue work on PharmFree.
- Med JAAM. Web-based EBM (Evidence Based Medicine System).
Under development.
- Patient Survey. Computer Literacy, Phobia, Numerical
Probability-Determining if a computer-based format for patient
decision support is an effective methodology for communicating the
potential benefits of a medical intervention to patients. We are constructing
a survey for our patient population. This survey will assess the level
of computer literacy, computer anxiety, and the ability to use risk-reduction
information correctly.
- Automation of Patient Recruitment for Clinical Trials. Clinical
Trial Recruitment Tool
Part 1:
We are obtaining reports from the Mount Sinai’s outpatient legacy billing
system, HBOC, and the outpatient registration system, IBAX. These reports
identify patients seen in the Internal Medicine Associates (General
Medicine) Practice of Mount Sinai. Each day these reports are automatically
generated and imported into a relational database to create a General
Medicine Outpatient database. The database includes patient name, identifier,
patient demographics, ICD-9 CM billing codes, and appointments. To date
we have 15,716 patients in the repository. Depending on the trial, queries
are run each day identifying eligible patients two days in advance of
their visit date, which gives sufficient time for recruitment day of
visit. The limiting factors are the accuracy and reliability of diagnostic
billing and race data. 20-30 patients have been successfully recruited
for Salt Substitute Trial. We are now actively recruiting for two more
clinical trials.
Part 2:
Web-based Solution: CITE.
- Outcomes research in hypertension at the Mount Sinai Health
System. We have provided a tool to physicians that facilitates
the identification and management of hypertensive patients in a way
current practice does not support. We have identified the MessagePad
2000 as our test platform. We have completed programming and are now
in the prototype testing stage.
- Office of Student Research Opportunities. We have developed
a web-based solution for providing an up-to-date list of research
opportunities for medical Students. This work was made possible by
work study money from both Mount Sinai and NYU Medical Schools.
- DOES (Departmental Order Entry Sets):Selecting A Subject Diagnosis.
In our study we are compared and contrasted four different approaches
for selecting subject diagnoses for DOES:
1) Departmental/Institutional Need
2)Admitting Diagnosis
3)Discharge Diagnosis
4)Physician Opinion
The latter three approaches are measures of real and perceived incidence.
DOES can save money, standardize care by influencing management choices,
and educate housestaff (as well as attendings) by indicating preferred
treatments. For DOES to realize its full potential, a methodological
basis for selecting subject diagnoses needs to be identified. Our
study found that housestaff are a good starting
point for selecting subject diagnoses.
- Ambulatory Care Policies and Procedure Manuals
We are currently building aWeb-based version of the HCVA Medicare Managed
Care Policies & Procedures. We are also compiling the Ambulatory
Care Department Policies & Procedures. We will soon add other administrative
documents. Ambulatory Care Department Policies and Procedures Manuals
will be available for review, searching and printing.
Increased regulatory and market pressures make it very important that
health care be delivered appropriately and according to established policies
and procedures. Making the most current policies and procedures easily
available through an Intranet service within the hospital promotes more
efficient and consistent decision making. The Intranet was chosen as means
of distribution because it offers:
1. Centralized update of changes in one place instead of trying
to manage multiple paper copies throughout the system.
2. Faster updates. There is no delay for printing, binding and distribution.
3. Searching by index or text matching enhances ability to review all
sections of interest.
4. Sections can be copied and printed locally whenever and wherever
needed.
5. Dissemination, review, discussion.
|
