Implementing a Medical Device Module
in the EHR
A Critical Patient Safety Enhancement
Robert E. Watson, Jr., M.D., Ph.D., Cradick, Connie M., P.M.P., Samanthie Epps, M.B.A., William D. Mauck, M.D., Patrick Luetmer, M.D.
American College of Radiology Annual Conference May 2015
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Disclosures
Purpose / Introduction
•
Implanted medical devices (IMD)
are becoming increasingly
common.
•
Failure to identify the presence of
some IMD can lead to serious injury
or death in MRI.
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Purpose / Introduction
In contrast to the widely accepted need to reliably access a patient’s
• allergies
• current medications in a unique and defined site in the electronic health record (EHR), information about a patient’s
• Implanted medical devices
is frequently incomplete and fragmented across multiple locations in the EHR, clearly posing a patient safety risk.
allergies
medications
???
Purpose / Introduction
•
We report the successful implementation of a
Medical Device Module
in the EHR at our tertiary
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Purpose / Introduction
•
A key facet of the
Medical Device
Module
is a
multi-tiered
blaze alert
system
highlighting
the presence of “high
risk” implanted devices
in MRI to
•
ordering providers
•
MRI schedulers
•
MRI radiologists
and technologists
Example of one type of Blaze alert, notifying radiologist and MRI staff of the presence of an MRI “high risk” device
Device Module
•
Implanted medical device data collection
•
Implanted medical device data storage
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Device Module
•
Implanted medical device data collection
•
Implanted medical device data storage
Device Module
IMD data collection
Automatic Feed From Surgery (SIMS)
Manual Updates via Intake Process
Automatic Feed From Pre-Visit
Questionnaires
Electronic Health Record
3 tiered approach to collecting IMD data
• SIMS (Surgical Information Management System • Manual uptake at patient encounters
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Device Module
•
Implanted medical device data collection
•
Implanted medical device data storage
IMD information is housed in a central repository,
the Medical Device Flowsheet. This is available
at a common location in the EHR for all staff
Easy Navigation to Flowsheet from
Devices tab
Medical Device Flowsheet
Device Module
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Device Module
•
Implanted medical device data collection
•
Implanted medical device data storage
Patient’s IMD information can also be
accessed through different portals that
converge on the single site
“Synthesis” Viewer
Device Module
IMD data access
“LastWord Flowsheet” Viewer
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Devices Module // MRI
•
Ordering
•
Scheduling
Devices Module // MRI
•
Ordering
•
Scheduling
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Devices Module // MRI
Ordering
During ordering process, if a device is
present in the implanted devices module,
it will be carried over, prepopulating the
order screen for the provider
Devices Module // MRI
•
Ordering
•
Scheduling
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Devices Module // MRI
Scheduling
Passive Alert Lists High Risk Devices
Passive alert permits Scheduling office to confirm with service that they are aware of the presence
of the device, and wish to continue with scheduling so that the patient can be scanned at
the proper site with special precautions
Presence of MRI high risk devices is highlighted on MRI scheduling screens
For example, a patient with a deep brain stimulator system can be safely scanned provided a transmit / receive head coil is used and the specific
absorption rate is restricted. But, it is essential to know of the presence of the system. Severe patient injury could result if the presence of the device is not recognized and the patient is scanned improperly.
Devices Module // MRI
•
Ordering
•
Scheduling
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Radiology “Blaze” Alerts
Quickly Identify Patients With
High Risk Devices
Orange Passive Alert Indicates High Risk
Device Present
Orange Passive Alert Indicates High Risk
Device Present
New Tab for Notes and Communications Specific
to the Devices
Devices Module // MRI
Devices Module // MRI
MRI Safety check and exam
protocoling Orange flag in MRI patient list identifies presence of “high risk” device
When protocoling MRI exam, again alerts that a “high risk” device is present.
Clicking on this tab brings up screens below; in this case, identifying presence and type of an implanted aneurysm clip.
Devices module
provides alerts to
the presence of
MRI high risk
devices with
and
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Results
•
Manual intake process takes only 1-2 minutes
:
•
During 2 week pilot, 24% of 6261 outpatient visits in clinics
with high device utilization (CV, Pain, Neurologic Surgery)
required intake assessment. IMD information was gathered at
760 visits, average time of 1-2 min with 21% of IMDs
identified as high risk.
•
IMD commonly encountered in MRI
•
Over 1 month, 900 of ~5130 (17.5%) patients at MRI check in
had an IMD, more granular IMD documentation took 2-3 min
and research of a single IMD averaged 6 min.
Results
•
60% of IMD in SIMS tracked in EHR
•
Of 150,000 items within Surgical Information System,
~90,000 were identified as devices to track in the EHR.
•
Significant level of EHR alert generation
•
After a load of historic data from 1995 forward and full
implementation, 82 alerts/week (60%) are generated at time
of inpatient MRI order and 106 alerts/week (8.3%) at
in/outpatient MRI protocol/check in
•
Moderate frequency of over alerting at MRI order and MRI
protocol and checking after SIMS interface activated
•
Over-alerting reduced after SIMS corrected to identified and
exclude temporarily implanted devices in ORs
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Results: Implanted Device Data
Based on this initial data, the device list being captured was amended. Very low risk devices such as clips and suture/staples were removed due to their frequency and relative lack of clinical significance.
Total patients = 1,049,351
Results: Dramatic Reduction in MRI
Appointment Delays, Cancelations and
Reschedules
Initial results indicate approximately a 53% reduction in MRI appointment delays, cancellations, and reschedules related to devices over a 3 month sample.
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Results:
Implanted Device Reconciliation User Impact
A Team-Based Solution – Impacts Entire Institution
Area Frequency
Outpatient First appointment for an episode of care
Primary Care Once per year
Hospital Inpatient Admission and discharge
Emergency Department Every visit
Surgical Specialties First appointment for an episode of care
Outpatient Procedural/Surgical Areas Admission
Regional Lab PAC Varies based on appt.
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Conclusions and Lessons Learned
• An implanted medical device module is feasible and can provide critical patient safety information at time of MRI ordering and check in.
• In a short amount of time, this has produced initial significant decreases in appointment delays, cancellations, and rescheduled exams in MRI.
• An initial rollout of the devices module involved areas associated with many high risk implanted devices: Cardiology, Pain Medicine, Neurology, and Neurosurgery. A staged roll out subsequently expanding to other areas was valuable in that it allowed initially identified shortcomings to be
addressed before going forward.
• While not specifically measured, it is anticipated that there are significant gains in efficiency in that this critical patient information can now be located in a single reliable location in the EHR.
• Compliance with data collection has been excellent, and other clinical areas are now benefitting by having ready availability to this essential patient information.