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To Study The Functioning Of VistA CPRS
Project OverviewJune 2012
Dr. Amit Kumar Srivastava
Dr.Garima Malik
MARSH 2
Country’s leading comprehensive provider of standardized, seamless and international class healthcare services
It is committed to the highest standards of medical and service excellence, patient care, scientific and medical education
Max Healthcare operates eight facilities in Delhi & NCR, offering services in over 30 medical disciplines
Max Healthcare has a base of over 1600 leading doctors, 4300 employees and 13,00,000 patients with number of beds growing to over 1900 in the next two years
Organizational Overview
MAX HEALTHCARE
MARSH 3
GENERAL OBJECTIVE:
To Study the functioning of VistA CPRS
SPECIFIC OBJECTIVES:
To study the workflow involved in the module CPRS
To identify the relationship of the CPRS with other modules of VistA
To reach a comprehensive training plan to the hospital customers
MARSH 4
SCOPE OF STUDY:
To study CPRS in depth, so that will be able to assist end users ( nurses & physicians) while giving hands on training
Study can be used for creating user manual, training plan and schedule
Observational
Interview of end users with close ended structured questionnaire
METHODOLOGY:
MARSH 5
CCPRS/BCMA HANDS ON TRAINING
TO DESIGN AND PLAN SCHEDULE FOR TRAINING PROGRAM
TRAINING END USERS
REFRESHER SESSIONS
PROJECT REPORT DRAFT
APRIL 9TH-13TH
APRIL 16TH- 20TH
APRIL 23RD-27TH
APRIL 30TH-MAY 4TH
MAY 7TH- 11TH
MAY 14TH- 18TH
MAY 21ST-25TH
MAY28TH-31ST
JUNE 1ST- 13TH
SUMMER TRAINING PROJECT TIMELINE
MARSH 6
VistA
The Veterans Health Information Systems and Technology Architecture (VistA)
It is an enterprise-wide information system built around an electronic health record, used throughout the U.S. Department of Veterans Affairs (VA) medical system, known as the Veterans Health Administration(VHA)
VistA, is an integrated system of software applications that directly supports patient care
It has various modules, some of them include laboratory, pharmacy, radiology, Bar Code Medical Administration and CPRS
MARSH 7
VistA CPRS
It is graphical user interface for clinicians known as the Computerized Patient Record System (CPRS), which was released in 1997
It allows health care providers to review and update a patient's electronic medical record
It includes the ability to place orders, including those for medications, special procedures, X-rays, nursing interventions, diets, and laboratory tests
It provides electronic data entry, editing, and electronic signatures for provider-patient encounters as well as provider orders
MARSH 8
VistA CPRS in Detail
VistA – Veterans Health Information Systems and Technology Architecture computer application
CPRS – Computerised Patient Record System
MARSH 9
CPRS
To enter Patient
Information
To review Patient
Information
Continuously Update
Information when
connected.
Supports Clinical
Decision Making
Analyze Patient Data
PURPOSE OF CPRS
MARSH 10
Record Patient History
Enter Problems
Enter Diagnosis
Enter Treatment Plan
Enter Progress Notes
Record Allergies
Record Adverse Events
Request and track Consults
Order Lab Investigations
Order Medications
Order Diets
Order Radiology tests
Order Procedures
Enter Discharge Summaries
CPRS Helps To
MARSH 11
COMPUTERISED PHYSICIAN ORDER ENTRY ( CPOE )
CPOE decreases :-
1. Delay in order completion
2. Reduces errors related to handwriting or transcription
3. Allows order entry at point-of-care or off-site
4. Provides error-checking for duplicate or incorrect doses or tests
5. Simplifies inventory and posting of charges
Salient Features of VistA CPRS
MARSH 12
BENEFITS OF CPOE
a. Enables doctors to enter prescription, lab test and other orders for patient care straight into a hospital information system
b. CPOE decision support includes: automated medication checking, drug dose, allergy, and interaction checking; duplicate order notification; recommendations for pre- or post-administration tests etc
Adverse Reaction Tracking
a. Documents patient allergy and adverse drug reaction data
b.Alerts the Pharmacy and Therapeutics Committee each time the signs/symptoms are modified for a patient reaction
Clinical Reminders
a. Allows clinicians to resolve reminders through dialogs within the CPRS GUI (graphical user interface). Using point-and-click techniques, a clinician can generate text for progress notes, update current and historical encounter data in Patient Care Encounter (PCE), update vital signs, update mental health test results/scores, and place orders
MARSH 13
Difference in Workflows before and after EHR Implementation in Client’s Hospital
Orders are sent manually
Billing – Pre Consultation Billing
Patient gets Prescription from Physician
Manual Medication Administration to IP patients
Trade Names of Medicines Prescribed
Orders will be send electronically
Billing – Post Consultation Billing
Patient will collect the Prescription from the front
desk after making the payment for consultation
Bar-coded Medication Administration
Generic Names of Medicines Prescribed, New Concept of Cart fill and Unit Dose to be
introduced
Before EHR Implementation After EHR Implementation
MARSH 14
TRAINING – PLAN AND SCHEDULES
MARSH 15
TRAINING NEED ANALYSIS
To get the information of number of end users to be trained
To know who are to be trained in which module that is CPRS, Radiology, Lab and Pharmacy and what will be the staff number for the training
MARSH 16
ROLES AND RESPONSIBILITIES OF THE TRAINING TEAM AND THE USERS
End User• They should be familiar with the working of the system
• They should be able to access, retrieve and enter data in VistA
• They shall be well versed with the module
Training Coordinators• They will coordinate the entire training process
• They will check availability of trainers , staff , training material and infrastructure
MARSH 17
BASIC METHODS OF DELIVERY
1. Individual hands-on Instructor
An instructor walks to each user individually to help in performing common tasks and clear their doubts.This is the most expensive method, although potentially the most effective.
2. Hands on class room style instructor-led training
An instructor shows users how the software works and how to perform common tasks, with users performing the tasks themselves in a classroom/lab setting. Each user or pair of users will have a system to practice the software. Classes of 12-15 are often effective.
MARSH 18
3. Seminar Style Group Demonstration
An Instructor shows users how the software works and how to perform common tasks in a live demonstration. Groups of 20 to 50 are often effective.
4.Computer Based Training
CD-based or online ( Web Based )
Self-placed training allows end-users to complete interactive lessons, as per their comfort and this makes them efficient in performing common tasks . The software tests them on their performance and understanding.
MARSH 19
4. Most of the providers were not happy with the amount of data entry and the time consumption
3. Problem was faced regarding time management as a lot of physicians were not able to come on time during the training
2.There were issues of change management as some providers felt that paper based system was better
1. The senior physicians were not co-operative and were not satisfied with the new system
CHALLENGES FACED
MARSH 20
RECOMMENDATIONS
The senior physicians should be counseled again and advantages of the paper less system should be explained to them to develop a positive attitude
Training should be scheduled such that during that time they don’t have to see any patients and there duties are taken care of by some other person
Location and time of the program should be such it is comfortable for the people who have to attend
MARSH 21
CASE STUDY (1)
Physician Perception on Electronic Health Record
MARSH 22
OBJECTIVE:
To Study the Physician’s Perception on EHR
METHODOLOGY:
A sample size of 30 Physicians were taken to evaluate their perception of the CPRS/ EHR
Only the physicians who have undergone 16 hours of hands on training were considered
Out of them 30 were randomly selected
A well structured questionnaire in english was used for the purpose of primary data collection
The questions were related to computer awareness as well as EHR
Physician team covered were : Junior Residents, Senior Residents, Specialists, Consultants
MARSH 23
OBSERVATIONS
64.7% of the Physicians who were sound with the computers felt that the new EHR will increase workload and entering data will consume time
100% of the Physicians are aware that the EHR implementation will reduce medication errors and agree that EHR supports effective communication among team members.
66.7% of the Physicians were not satisfied with the training they received on CPRS
66.7% of the Physicians feel that the EHR is not user friendly
8 Physicians who were sound with computer skills felt that the EHR application is not user friendly
MARSH 24
RECOMMENDATIONS
More change management efforts should be made so that the physicians develop a positive attitude
The templates for entering case history can be made simpler
Free text option can be given for entering case history
Before initiating the CPRS training an orientation process should be carried out regarding the entire EHR process
MARSH 25
Comparative Study Of Paper Medical Records & Electronic Medical Records
CASE STUDY (2)
MARSH 26
OBJECTIVE :
To do a comparative study of the Paper medical records and the Electronic Medical Records
METHODOLOGY:
Observational & Discussion method
The information is collected primarily by observation of the software and making a comparison between paper medical records & electronic medical records.
Focus points of discussion are:
• Disadvantages of PMR
• Advantages & EMR over PMR
• Disadvantages of EMR
• Also some information is collected using secondary data sources
MARSH 27
OBSERVATION: PMR VS EMR
• Patient is identified by name, medical record number & other identifier
• Progress notes might be produced by dictation, free handwriting or form completion
• Consists of office or progress notes in chronological sequence. These are browsed by literally flipping through pages, until the desired entry is located
• Prescription is written on paper. It is manually checked for interactions & allergies. It is then taken by the patient to the pharmacy .It takes time & can also result in errors
• Patient can be identified by any identifier i.e. Name, SSN, Date of birth, phone number
• Progress notes are produced as the visit is produced
• Stores progress notes and provides quick access by date of visit, provider and the ability to browse by diagnosis and prescription
• Prescription is written in the system. It is checked for interactions & allergies by the system & then it is sent to the pharmacy by the system directly where it is verified & drug is dispensed. There are rare chances of errors.
PMR EMR
MARSH 28
DISADVANTAGES OF PMR
1. Needs lot of space for storage
2. No centralization of records & collection of records is a tedious task
3. More chances of medical errors caused by poor legibility on paper forms
4. Less in efficiency as compared to EMR
5. Data cannot be easily exchanged or transferred
6. They are not eco-friendly
MARSH 29
ADVANTAGES OF EMR
1. Increasing storage capabilities for longer periods of time
2. Is accessible from remote sites to many people at the same time
3. Retrieval of the information is almost immediate
4. The record is continuously updated and is available concurrently for use everywhere
5. Information is immediately accessible at any unit workstation whenever it is needed
6. Provides medical alerts and reminders
7. Supports accountable autonomy, collecting and disseminating information to assist the medical professional in decision making
8. Allows for customized views of information relevant to the needs of various specialties
9. Provide information to improve risk management and assessment outcomes
.
MARSH 30
1. Start-up cost is high
2. Lack of Technical knowledge
3. Inability of the provider to adapt
4. Usability is a major issue
5. Placement of hardware is an issue
6. Crashing of computer & loss of data
7. Change in workflow of the department after the implementation of an EMR
8. Lack of standardized terminology, system architecture, and indexing
9. Lack of flexibility and lack of capacity for the diverse requirements of the different healthcare disciplines
DISADVANTAGES OF EMR
MARSH 31
RECOMMENDATIONS
• The robust back up methods, sophisticated protection mechanisms & advanced data recovery methods should be developed
• Decisions regarding the portability of the equipment must also be considered
• Documentation forms must be revised in order to accommodate the changes in the workflow
• Development of standard language is required
• A unique health identifier must also be developed
• Well planned training must be given to the end users
MARSH 32
THANK YOU
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