electronic medical records: using cutting edge technology to improve care in std clinics in new york...
TRANSCRIPT
Electronic Medical Records: Using Cutting Edge Technology to Improve Care in STD
Clinics in New York City
2006 National STD Conference
Kate F. Washburn, MPH1
Maushumi Mavinkurve, MPH1
Rachel Paneth-Pollak, MPH2
Stephen Giannotti1
Susan Blank, MD, MPH2,3
1Bureau of Informatics and Information Technology, New York City Department of Health and Mental Hygiene
2Bureau of Sexually Transmitted Disease Control, New York City Department of Health and Mental Hygiene
3Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta GA
Background
• NYC’s Bureau of Sexually Transmitted Disease Control (BSTDC) – 10 clinics throughout the 5 boroughs of NYC– Over 100,000 visits/year– Clinics offer a range of free services including:
STD evaluation, Emergency contraception, anonymous and confidential HIV counseling and testing, PAPs, Hepatitis immunization, and Hepatitis C testing
STD Electronic Medical Record Timeline
Spring 2002 – Summer 2004
• Application built internally by DOHMH and pilot tested by several clinic staff
• Joint effort between BSTDC and Bureau of Informatics and Development
August 2004 – September 2005
• Implemented in 10 STD clinics throughout NYC
• Web-based and accessible from all DOHMH workstations
STD Electronic Medical Record Cost
• In-kind salaries for 1 project manager, 1 project specialist, and 2 computer programmers
• $240,000 in hardware and stipends for 4 training consultants
STD-EMR Functionality• Registers confidential patients (with electronic signature)
and anonymous HIV clients• Medical record modules include:
– Reason for visit– Chief complaint– Medical, sexual and medication history– Physical exam– Labs (stat, referral and HIV)– HIV counseling and testing – Hepatitis vaccines– Counseling and referrals
• Other features include label printing, missing results queue, supervisor and medical chart review queues, and record search
Objectives
• Provide examples of how STD-EMR increases productivity and generates quality assurance measures
• Demonstrate how EMRs can guide programmatic decisions and improve decision-making regarding patient care
Increase Productivity
• STD-EMR reduced time taken to fill out and file paper
– Consolidation of HIV counseling and testing forms
– Easy search of records for registration and provision of results
Increase Productivity
• Daily/Hourly Monitoring (by Clinic or Central office)– Patient Wait Times– Number of patients seen per physician and
counselor
Increase Productivity
• Monthly Reports– Physician Productivity report
• Shows the actual number of patients seen per physician and the average number of patients/day across all clinics
– Counselor Productivity report• Ad-hoc reports of the number of HIV pre-tests
done per counselor in a particular clinic
Improve Quality of Data Collected
• Completeness, readability and uniformity of medical records– STD-EMR modules include radio buttons,
drop down lists, and pre-formatted data fields to ensure medical information is accurate and quantifiable
– Built in alerts for required questions
Improve Quality of Data Collected
• Accuracy of diagnosis and treatment– Built in logic prompts if patient is eligible for
emergency contraception– Recommended treatments pop-up when
diagnosis is selected– Link to PDF of the latest CDC STD Treatment
Guidelines (2002)
Improve Quality of Data Collected
• STD-EMR creates a user-friendly summary of every chart for review by PIC and FLS. The system:
– Differentiates charts by lab result (positive, non-negative, negative)
– Permits electronic request for action – sending letters, routing charts to Supervisor, filing charts
Guide Programmatic Decisions
• Reallocation of Resources– 3 staff assigned to manual scanning of forms
(HIV) redeployed to clinics or other duties– Physical space used to store paper charts in
clinics now used for other purposes– With electronic transfer of lab results, clerks
will assist patients and provide results over the phone rather than manually enter results
Guide Programmatic Decisions
• STD-EMR data used to evaluate the cost effectiveness of specific lab tests
– Oral and anal GC cultures – Cervical and urethral gram stains
Conclusions
– Continuity of care across clinics– Identify bottlenecks in the clinic– Readily assessable compliance with policies
and procedures– Free-up clinic space and redeploy staff– Enhance completeness and quality of data
collected at each patient visit– Improve customer service and quality of care
Next Steps
• Patient print outs for personal records– Date and result of previous PAPs– Serology history
• Reminder letters automatically generated and printed– Next Hepatitis A/B vaccine– Follow-up or repeat test needed
• Additional prompts to remind physicians/counselors of necessary medical care
Acknowledgements
Julia Schillinger
Preeti Pathela
Steve Rubin
Hadi Makki
All BSTDC Clinic Staff
Contact Information
Kate Washburn
Deputy Director, Informatics and Development
Bureau of Informatics and Information Technology
New York City Department of Health and Mental Hygiene