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Surgical Op NotePresented by

Nick Gawrit

March 4, 2008

…the Premier Cardiovascular Information System for Improving Patient Healthcare

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The Goal! Written Tree Diagram

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Starting With…

• Data Model Design Features– Patient centric– Longitudinal– Integrated

• Retrospective data entry

• Enthusiastic Users

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Data Model

Design Features

• Patient centric

• Longitudinal

• Integrated

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DEMOGRAPHICS

HOSPITALIZATION

CLINICALPRESENTATION

DRUG USAGE

DRUG USAGE

CATH LAB VISIT(CATH)

OPEN HEART SURGERY

(SURG)

CLOSURE DEVICES(EQUIPA)

COMPLICATION/OUTCOMES

PCI(PROC)

DIAGNOSTIC CATH SEGMENT

ANALYSIS

GRAFT GRAFT COMPLICATION/OUTCOMES

SEGMENT

EQUIPMENT(EQUIPA)

heartbase Data Model™

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Goals of Op Note Reporting• Prepare an Open Heart Surgery Op Note• Interface with transcription• Collect data points for registries• Provide perfusionists with data they need• Reduce surgeon time needed for

preparing an Op Note• Sync Up database with Op Note• Improve Workflow

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Goals of Op Note Reporting

• Ease of Use

• Create Consistency

• Improve Data Accuracy

• Ensure Completeness

• Provide Data for Research

• Improve Patient Satisfaction

• Eliminate Data Redundancy

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Steps to create Op Note

• Receive the aid of a physician champion to design a report for CABG only cases

• Meet with the perfusionists to review design and get input into data entry

• Meet with transcription to review requirements and set up automatic transfer to transcription system.

• Meet with IS to insure proper implementation• Utilize heartbase data administrator and staff

to coordinate all activities

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Surgical Op Note Workflow

Perfusionist Real Time

Surgery Capture

Perfusionist Report System

Transcribing

STS Data Collection MD Dictation

Patient Coronary

Tree

Referring MD

Narrative Reporting

Perfusionist Reports

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Review

Optional

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Surgical Op Note Workflow

Transcribing Folder

Interface Queue Folder

Transcribing Button

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Interface scans for reports that need to be sent

Back Up Archive Copy

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Programming Issues• Schema changes• Develop a Custom Data Entry Form• Interface hospital demographic and admission discharge data• Create custom paragraphs and CSV file in PQL.• Integrate SIR with Microsoft Word (macros)• Interact of hb generated op-note with hospital transcription

department(EHR)• Implement SIR in a wireless environment• Create a graphical representation of patient coronary tree• Interact with flash drives• Create a Patient pocket handout• Allow Surgeons to dictate of additional findings in the OR which in

turn become part of the EHR.• Prevent Op-notes from being completed unless key fields are

entered.

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Schema Changes

• Needed by:– Surgeon– Perfusionist– heartbase

• Performed with Modify Schema

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Custom Data Entry Form• Create a new data entry screen that

reflects the needs of the perfusionist, hb data collector, surgeon, and transcription.

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DEMO

HOSP

CLINPRES

DRUG USAGE

DRUG USAGE

CATH LAB VISIT(CATH)

OPEN HEART SURGERY

(SURG)

CLOSURE DEVICES(EQUIPA)

COMPLICATION/OUTCOMES

PCI(PROC)

CATHSEGGRAFT GRAFT COMPLICATION/

OUTCOMES

SEGMENT

EQUIPMENT(EQUIPA)

heartbase Data Model™ ADT Data Interchange

Brings in Demographic, Hospitalization and ICD9Information

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Custom PQL• Auto generate paragraphs from data entry

fields• Creation of a CSV file to be used with Mail

Merge later. – Be aware of SIR CSV Save File max limit

• Audit function• Graphical tree creation with narrative data,

including wallet sized output• Event Management• Triggers

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Risk Factor Paragraph Example

• MYINDr=9• IFTHEN(CRSMOKE=1 )myindr=myindr+1;compute ind(myindr)='current smoker';• elseif(smoke =1)myindr=myindr+1;compute ind(myindr)='history of smoking';• endif• if(FHXCAD=1)myindr=myindr+1;compute ind(myindr)='family history of coronary artery

disease'• if(DIAB=1)myindr=myindr+1;compute ind(myindr)='diabetes'• if(HYPCHOL=1)myindr=myindr+1;compute ind(myindr)='dyslipidemia'• if(HRENFL=1)myindr=myindr+1;compute ind(myindr)='renal failure'• if(HYPTN=1)myindr=myindr+1;compute ind(myindr)='hypertension'• if(HCVA=1)myindr=myindr+1;compute ind(myindr)='cerebrovascular accident'• if(INFEND=1)myindr=myindr+1;compute ind(myindr)='infectious endocarditis'• if(chrlungd GE 2)myindr=myindr+1;compute ind(myindr)='chronic lung disease'• if(IMMSUPRX=1)myindr=myindr+1;compute ind(myindr)='immunosuppressive treatment'• if(PVDIS=1)myindr=myindr+1;compute ind(myindr)='peripheral vascular disease'• if(PRCBVDIS=1)myindr=myindr+1;compute ind(myindr)='cerebrovascular disease'• ifthen(myindr=9)mysent=mysent+' Risk factors were not noted.'• else• mysent=mysent+' Risk factors include '• ifthen(myindr=10)• . mysent=mysent+''+ind(10)+'.'• elseif(myindr gt 10)• . for sdsd=10,myindr-1• . mysent=mysent+ind(sdsd)+', '• write ind(sdsd) mysent• . end for• . mysent=mysent+' and '+ind(myindr)+'.'• endif• endif

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CSV Save File• CSV SAVE FILE FILENAME='surgnarr.dat'/HEADER/• VARIABLES=• PDATE ('SURGDATE')• LNAME ('LNAME')• FNAME ('FNAME')• MINT ('MINT')• APROC(1) ('APROC1')• APROC(2) ('APROC2')• APROC(3) ('APROC3')• APROC(4) ('APROC4')• APROC(5) ('APROC5')• APROC(6) ('APROC6')• APROC(7) ('APROC7')• APROC(8) ('APROC8')• APROC(9) ('APROC9')• APROC(10) ('APROC10')• SSNUM ('SSNUM')• BILLNUM ('BILLNUM')• PATSSN ('PATSSN')• WBDATE ('WBDATE')• WADMDATE ('WADMDATE')• WCWTLB ('WCWTLB')• wchtfi ('WCHTFI')• PRONOUN ('PRONOUN')• MYSENT ('ind12')

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Audit Program• . IFTHEN(SEX =1)COMPUTE W9 ='1'• . ELSEIF(SEX =2)COMPUTE W9 ='2'• . ELSE COMPUTE W9 =''• . ENDIF• . IFTHEN(EXISTS(W9)=0 or w9='')• . valfield(9,2)=valfield(9,2)+1;WERR=1• . IFTHEN('<AUDITALL>' = 'Y' OR '<WW9>'='Y')• . WRITE (VALIDATE_STS_NAR.CSV)SSNUM MYC MYC MYC 'SEX'

MYC 'STS0150 GENDER' MYC 'DEMO' MYC• . WLUDEMO=WLUDEMO+'SEX ';WLUDEMOQ='Y'• . ENDIF• . ALINEA=TRIM(ALINEA)+'|'• . ELSE• . valfield(9,1)=valfield(9,1)+1• . ALINEA=TRIM(ALINEA)+TRIM(VALLAB(SEX))+'|'• . ENDIF

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Microsoft Word Integration

• Utilize Word to produce the narrative letter by utilizing Mail Merge and Macros

• Include header information for Softmed

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Transcription Electronic Health Record

• Automatically send the case to transcription when all required variables are entered

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Wireless

• Access heartbase via the hospital wireless network– Security– Accessing SIR Master and heartbase

application

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graphical patient coronary tree• Use database to

define grafts and then map these points graphically (thanks Tom!)

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Flash drives

• Distribute information on flash drive

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Patient pocket handout

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Surgeon Dictation

• Surgeon needs to enter additional findings in the OR

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Op-Note Completion Check

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Data CaptureRules we follow:

• Optimize Workflow

• Eliminate Data Redundancy

• Offer Flexible Alternatives

• Reduce FTE costs

• Comply with Rules

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Real Time Data Capture

Customized data collection screens can be tailored to the individual need

• Perfusionist

• Physician Specific

• Nurse/Tech

• In-Lab/In-OR

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DEMO

HOSP

CLINPRES

DRUG USAGE

DRUG USAGE

CATH LAB VISIT(CATH)

OPEN HEART SURGERY

(SURG)

CLOSURE DEVICES(EQUIPA)

COMPLICATION/OUTCOMES

PCI(PROC)

CATHSEGGRAFT GRAFT COMPLICATION/

OUTCOMES

SEGMENT

EQUIPMENT(EQUIPA)

heartbase Data Model™ Op Note

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Data Collection: Op Note

• Perfusionist• Procedure MD• Variables =

Sentences and Paragraphs

• Graft Definition = STS Data Harvest Fields

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Op Note Preparation

• Run the Report• See the Patient

Coronary tree• See the Narrative

Report• Send to Transcription• Add Dictation

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Op Note Reports Written Tree Diagram

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Benefits of Op Note System• Savings of 20-30 minutes of surgeon time per op

note• Validation of data in Op Note to data in database• Concurrent Data Collection• STS data completion• Perfusionist Report Preparation• Integration into hospital electronic medical

record • Transcription savings • Physician ability to dictate additional findings

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Benefits of Op Note System(cont)• Electronic Signature• Op Note speed up to referring MD by 1-2 days• Medical record interaction• Flash drive patient record• E-Mail to referring cardiologist• Optional customization of report for physicians• Coding Improvements for billing• MD bonus program

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Demonstration