Kevin S.Hughes, MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center Massachusetts...
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Transcript of Kevin S.Hughes, MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center Massachusetts...
Kevin S.Hughes, MD, FACSCo-Director, Avon Comprehensive Breast Evaluation Center
Massachusetts General Hospital
SurgeonThe Newton-Wellesley Hospital Breast Center
Beyond the EHR
EHR and productivity varies by specialty100 internists, pediatricians and family practitioners
• Initial implementation – 25 to 33 percent drop in MD productivity
• Over time– Internists
• Slightly above original productivity– Pediatricians and family practitioners
• Remained below original productivity
• Explanations– Internists review data entered by others
• EMRs more efficient– Pediatricians/family practitioners data entry and
documentation
• EMR more time-consuming
Hemant Bhargava, UC Davis Graduate School of Management
• Quote from a breast surgeon recently on a new EHR
• …our productivity is down 28%• Everyone attributes this to the learning curve of xxxx EHR.• I am the highest paid transcriptionist in the state• Each cancer patient chart takes me apprx 1 hour • For the first time in my career, I turned down an add-on patient
from one of my outside referrers because I just could not spend one more hour putting a new patient into the computer
• I spent 5 hours on Saturday and 4.5 on Sunday catching up on charts from Thurs and Friday and backloading charts of return patients for Tuesday
EHR
Generic InterfaceDatabase
Filing CabinetOr
Document Management System
The EHR is a filing cabinet, not a database. The interface is the same for a pediatrician, a neurosurgeon, a cardiologist, and everyone else, as if every specialist wanted data presented the same way.
EHR
Mammography Interface
Pathology
Interface
Generic Interface
Filing CabinetOr
Document Management System
AnesthesiaInterface
Anesthesia, pathology and breast imaging have set up their own databases and interfaces to deal with their unique needs. They send free text reports into the EHR as the EHR lacks the ability to accept data.
HughesRiskAppsBreast Surgery Module
Free software available at:
HughesRiskApps.net
Less work + CDS = Higher Quality
Reviews Report & Pedigree
Reviews suggestedmanagement Documents and
Orders
Patient educatio
nal material
s
Clinical Decision Support
Patient enters data :
Tablet PCiPad
Website
Clinical Decision Support
EHR
Breast Surgery Module as the prototypeCan be adapted to other disciplines and other cancers easily
• Designed to decrease clinician workload• Increase quality by facilitating appropriate course of action
– Examples:• Risk algorithms run real-time• Referral letters generated real-time
• Improve patient satisfaction– Provide educational materials real-time
• Store data needed for certification by NAPBC, ACoS, QOPI, and others– Easily retrieves most data needed for certification with minimal work
• Decrease cost– Per above, savings in staff and workload– Decrease in transcription costs of $6000 or more per clinician per year
HughesRiskApps modules follow a simple workflow
Existing data Patient data entry
Clinical Decision Support (CDS)
Printout with suggested actions
Clinician editing/enhancing
Clinical Decision Support (CDS)
Generate orders and documents
Choose how much data you want the patient to enter via the Tablet
by choosing the type of survey• Standard
– Basic risk information• MGH Standard
– Basic risk information plus an extended medical history
Using the HughesRiskApps Tablet questionnaire (With added questions for the Surgery Clinic), a patient can enter her own data
• Requiring little or no help from the staff, patients enter their own data.
• 5th Grade Reading Level• Available in English, Spanish and Italian
Sample screenshots follow
Patient data is downloaded from the LMR (MGH home grown EMR) allowing correlation with patient entered data
• Problem List• Medications• Allergies• Procedures
Upload of data being developed. Interfaces with other EMRs in development.
Patient data is downloaded from the LMR (MGH home grown EMR) allowing correlation with patient entered data
Upload of data being developed. Interfaces with other EMRs in development.
Patient data is downloaded from the LMR (MGH home grown EMR) allowing correlation with patient entered data
Upload of data being developed. Interfaces with other EMRs in development.
Patient data is downloaded from the LMR (MGH home grown EMR) allowing correlation with patient entered data
Upload of corrected data being developed. Interfaces with other EMRs in development.
Entered by patient via tablet, Clinician/Staff can edit and enhanceSubTabs for Risk Factors, Family History (As Table), Pedigree, and Risk Analysis under Tab for specific disease
Entered by patient via tablet, Clinician/Staff can edit and enhanceCan view/edit Family History via table or pedigree(See next slide)
Entered by patient via tablet, Clinician/Staff can edit and enhanceCan view/edit Family History via pedigree or table (See Prior slide)
If the Impression includes surgery, Surgical Scheduling screen opens with appropriate procedure pre-chosen.Clinician can edit or change procedure as needed
Table (Above gray area) shows the procedures and a pathologic summary of the resultsThe more detailed pathology view (Below gray area) relates to the SELECTED procedure
Future timelineWill soon also include Timelines for Breast Imaging, Chemotherapy, RT, and Hormonal Therapy
In development
Not yet available
Breast Surgery Module as the prototypeCan be adapted to other disciplines that treat breast cancer, as
there is significant overlap of data collected
The source of this data can be seen at the procedures tab
When the final surgery is completed, the cancer summary is derived from the pathology of the individual procedures that had been entered by MD
After the final surgery, letters are generated to PCP summarizing care, and to Med and Rad Onc, asking for consultation/opinion
Summary of surgery is sent to primary and as part of referral letters to Medical Oncology and Surgical Oncology
Breast Surgery Module as the prototypeCan be adapted to other disciplines that treat breast cancer, as
there is significant overlap of data collected