Re: Critical Results Processes
Posted by: "Hogan, Pauline M." hogan.pauline@mayo.edu hoganpauline
Wed Jul 28, 2010 5:57 pm (PDT)
I think we are focusing on the same outcome - a closed loop
communication process - I sent it, you received it. I've recently been
asked to assist with this process - the team has already been working
for almost a year. We have an EMR - results are already sent
electronically as soon as the result is available. If critical - it's
currently a phone tag follow up process. Date/Time stamps are entered
into the EMR from the lab/rad/card sending the result, the nurse
receiving the result and the provider receiving the result - these are
manual entries. Our policy specifies time expectations at each phase of
this loop. This time data is used to measure compliance with TJC
standard as well. There's a lot of variation in staffing patterns and
individual clinic processes making it difficult to measure compliance
with the process vs compliance with the documentation component of the
process. Do we have a documentation problem, a communication problem, a
compliance problem or a combination of the all of the above? There are
software packages out there claiming to assist in closing the loop
(Veriphy and Notifi are the two products they've looked at so far) and
the team has already participated in one demo. They've almost concluded
they need an IT solution. I'm still not convinced, so right now I'm
just gathering ideas from my colleagues out here to see how they
approach this process.
Thanks for the feedback - looking forward to continuing this thread of
discussion!
Pauline M Hogan, MBA, DSHS, FHIMSS
Performance Improvement Engineer
Franciscan Skemp-Mayo Health System
700 West Avenue South
La Crosse, WI 54601
office: 608-392-4514
cell: 608-769-0803
fax: 608-392-9780
hogan.pauline@mayo.edu <mailto:hogan.pauline@mayo.edu>
________________________________
From: drbradhill@aol.com [mailto:drbradhill@aol.com]
Sent: Tuesday, July 27, 2010 12:48 PM
To: Hogan, Pauline M.; hme@yahoogroups.com
Subject: Re: [Healthcare ME] Critical Results Processes
Hello Pauline,
In my efforts that date clear back to Dr. Michael O'Sullivan and more
recently Dr. Les Wold (both retired Chairs of Pathology at Mayo Medical
Laboratories) and in efforts at Stanford University Medical Center and
many more labs across the country, we in the laboratory medicine in have
worked diligently to provide timely and accurate diagnostic information
to the patient care teams in all settings. Successfully developing and
communicating diagnostic information are the lab's only reasons for
existence. I know you are quite aware that most laboratory information
systems have provisions to automatically send digital reports of routine
and critical lab values. However, on teams of laboratorians and direct
care providers of which I have been a member, we have sometimes had a
sinking feeling that what happens after sending the reports is not
always reliable and consistent. Our responsibility in the lab can not
stop just because we have sent the results - we would also like to know
that the information has been received by the decision makers in direct
patient care and that something is happening. Timely follow up testing
may be indicated. It sounds like you are trying to automate the
documentation of critical human next steps (whether on the floor and/or
in the lab) that should develop after the digital sending/receipt of
laboratory diagnostic information. A reliable feedback loop would be
great for all involved. How well this process and feedback loop works
could become a new quality metric for the lab and the patient care
teams. Better patient care and potentially reduced length of stay could
result. I would be happy to discuss this with you and am very
interested in everyone's critical thinking around this.
Regards,
Brad
Bradford Hill
Director
GroupHILL Management Consulting
Grouphill.com
720-985-1164
-----Original Message-----
From: Hogan, Pauline M. <hogan.pauline@mayo.edu>
To: hme@yahoogroups.com
Sent: Mon, Jul 26, 2010 9:06 am
Subject: [Healthcare ME] Critical Results Processes
Anyone out there working on processes related to communication and
follow up documentation for critical test results in lab, cardiology and
imaging? Are you using a software package to automate this
communication and documentation? I'd like to talk more about this topic
- if interested, please contact me...thanks!
Pauline M Hogan, MBA
Performance Improvement Engineer
Franciscan Skemp-Mayo Health System
700 West Avenue South
La Crosse, WI 54601
office: 608-392-4514
cell: 608-769-0803
fax: 608-392-9780
hogan.pauline@mayo.edu
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Messages in this topic (4)
1b.
Re: Critical Results Processes
Posted by: "Steven Davidson" davidson@pobox.com sjdavidson
Wed Jul 28, 2010 5:59 pm (PDT)
You are correct to be concerned. Merely transmitting information does not
assure its receipt, let alone digestion and consequent launch of an action.
"The problem with communication is the illusion that is has occurred."
--George Bernard Shaw
A number of companies have gotten into the "Critical Test Results
Management" (CTRM) business including Nuance (Veriphy), SecuReach and 10 or
so others. These companies began providing services focusing on imaging
results follow-up but have broadened their businesses into lab and other
diagnostic studies.
These businesses have developed because of the unfortunate reality that
radiologists and other physicians interpreting diagnostic studies don't have
the time to both generate (dictate, whether to a recording medium for human
transcription or to speech-recognition software) a report and communicate
the report's key findings to the ordering physician. Or, if the diagnostic
physician (radiologist, pathologist, other) takes the time to communicate,
that practitioner loses time to perform additional billable
readings/interpretations.
Hospitals and large group practices spend about $2-3K/radiologist/year to
provide this CTRM service while neglecting maintenance of their in-house
telecommunication directories and telecommunication services which could
perform the same function for similar or less expense. Software vendors sell
communication "middleware" for $20-40K (plus integration and maintenance
costs) that links laboratory information systems (LIS) to paging and
messaging systems that push the messages out and depending upon the
messaging device/path may confirm receipt by the device, but generally not
reading by the practitioner (Blackberry in some custom implementations does
confirm reading on the device.).
Regards to the list./Steve
--
Steven J. Davidson, MD, MBA, FACEP, FACPE
Chief Medical Informatics Officer
Maimonides Medical Center, 4802 10th Ave
Brooklyn, NY 11219-2916
Office/Fax: 718-283-6030/6042
http://www.linkedin.com/in/sjdmd
On Tue, Jul 27, 2010 at 13:47, <Drbradhill@aol.com> wrote:
>
>
>
> Hello Pauline,
>
> In my efforts that date clear back to Dr. Michael O'Sullivan and more
> recently Dr. Les Wold (both retired Chairs of Pathology at Mayo Medical
> Laboratories) and in efforts at Stanford University Medical Center and many
> more labs across the country, we in the laboratory medicine in have worked
> diligently to provide timely and accurate diagnostic information to the
> patient care teams in all settings. Successfully developing and
> communicating diagnostic information are the lab's only reasons for
> existence. I know you are quite aware that most laboratory information
> systems have provisions to automatically send digital reports of routine and
> critical lab values. However, on teams of laboratorians and direct care
> providers of which I have been a member, we have sometimes had a sinking
> feeling that what happens after sending the reports is not always reliable
> and consistent. Our responsibility in the lab can not stop just because we
> have sent the results - we would also like to know that the information has
> been received by the decision makers in direct patient care and that
> something is happening. Timely follow up testing may be indicated. It
> sounds like you are trying to automate the documentation of critical human
> next steps (whether on the floor and/or in the lab) that should develop
> after the digital sending/receipt of laboratory diagnostic information. A
> reliable feedback loop would be great for all involved. How well this
> process and feedback loop works could become a new quality metric for the
> lab and the patient care teams. Better patient care and potentially reduced
> length of stay could result. I would be happy to discuss this with you and
> am very interested in everyone's critical thinking around this.
>
> Regards,
>
> Brad
>
> Bradford Hill
> Director
> GroupHILL Management Consulting
> Grouphill.com
> 720-985-1164
>
>
> -----Original Message-----
> From: Hogan, Pauline M. <hogan.pauline@mayo.edu>
> To: hme@yahoogroups.com
> Sent: Mon, Jul 26, 2010 9:06 am
> Subject: [Healthcare ME] Critical Results Processes
>
>
> Anyone out there working on processes related to communication and
> follow up documentation for critical test results in lab, cardiology and
> imaging? Are you using a software package to automate this communication
> and documentation? I’d like to talk more about this topic – if interested,
> please contact me…thanks!
>
> *Pauline M Hogan, MBA*
> *Performance Improvement Engineer*
> *Franciscan Skemp-Mayo Health System*
> 700 West Avenue South
> La Crosse, WI 54601
> office: 608-392-4514
> cell: 608-769-0803
> fax: 608-392-9780
> hogan.pauline@mayo.edu
>
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发表于 2010-8-14 16:10:07