RESUMEN
PURPOSE: The pharmacist-led implementation of a smart pump-electronic medical record (EMR) interoperability program at a hospital within a regional health system is described. SUMMARY: Smart pump-EMR interoperability involves a wireless, bidirectional connection by which infusion information transmitted by the EMR prepopulates infusion devices, reducing keystokes and opportunities for manual programming errors. The smart pumps transmit time-stamped infusion data to the EMR for nurse documentation. Use of interoperability technology forces the use of dose-error reduction software so that 100% of prepopulated infusions and dosage adjustments are protected. To improve i.v. medication safety and documentation at a 286-bed hospital within an 8-hospital health system, pharmacists led an initiative to implement smart pump-EMR interoperability as a first step toward systemwide implementation. The hospital's smart pump-EMR interoperability initiative resulted in patient safety and revenue-generation gains in the first 8 months after implementation. The mean number of keystrokes needed to program an infusion was reduced from 15 to 2 (an 86% decrease). Pump alerts, alert overrides, and reprogrammed or cancelled infusions were decreased. In addition, the program improved outpatient charge capture, resulting in $370,000 in incremental revenue. CONCLUSION: A pharmacist-led implementation of smart pump-EMR interoperability led to measurable, data-based improvements in i.v. medication safety and improved accuracy, timeliness, and efficiency of i.v. infusion documentation. Revenue was increased due to improved charge capture for outpatient i.v. infusions.
Asunto(s)
Registros Electrónicos de Salud/organización & administración , Bombas de Infusión , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Tecnología Inalámbrica , Registros Electrónicos de Salud/economía , Seguridad de Equipos , Humanos , Seguridad del Paciente , Farmacéuticos/economía , Servicio de Farmacia en Hospital/economía , Factores de TiempoRESUMEN
We report the findings of a big data nursing value expert group made up of 14 members of the nursing informatics, leadership, academic and research communities within the United States tasked with 1. Defining nursing value, 2. Developing a common data model and metrics for nursing care value, and 3. Developing nursing business intelligence tools using the nursing value data set. This work is a component of the Big Data and Nursing Knowledge Development conference series sponsored by the University Of Minnesota School Of Nursing. The panel met by conference calls for fourteen 1.5 hour sessions for a total of 21 total hours of interaction from August 2014 through May 2015. Primary deliverables from the bit data expert group were: development and publication of definitions and metrics for nursing value; construction of a common data model to extract key data from electronic health records; and measures of nursing costs and finance to provide a basis for developing nursing business intelligence and analysis systems.
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Economía de la Enfermería/estadística & datos numéricos , Registros Electrónicos de Salud/economía , Costos de la Atención en Salud/estadística & datos numéricos , Modelos Económicos , Modelos de Enfermería , Enfermeras y Enfermeros/economía , Registros Electrónicos de Salud/estadística & datos numéricos , Enfermeras y Enfermeros/estadística & datos numéricos , Escalas de Valor Relativo , Estados UnidosAsunto(s)
Registros Electrónicos de Salud/economía , Uso Significativo/economía , Cirugía Bucal/economía , Costos y Análisis de Costo , Personal de Odontología/economía , Administración Financiera/economía , Humanos , Gestión de la Práctica Profesional/economía , Salarios y Beneficios/economía , Administración del Tiempo/economía , Flujo de TrabajoRESUMEN
OBJECTIVES: the aim of this study was to report a ten years experience in the electronic medical record (EMR) use. An estimated 80% of healthcare transactions are still paper-based. METHODS: an EMR system was built at the end of 1998 in an Italian tertiary care center to achieve total integration among different human and instrumental sources, eliminating paper-based medical records. Physicians and nurses who used EMR system reported their opinions. In particular the hospital activity supported electronically, regarding 4,911 adult patients hospitalized in the 2004- 2008 period, was examined. RESULTS: the final EMR product integrated multimedia document (text, images, signals). EMR presented for the most part advantages and was well adopted by the personnel. Appropriateness evaluation was also possible for some procedures. Some disadvantages were encountered, such as start-up costs, long time required to learn how to use the tool, little to no standardization between systems and the EMR technology. CONCLUSION: the EMR is a strategic goal for clinical system integration to allow a better health care quality. The advantages of the EMR overcome the disadvantages, yielding a positive return on investment to health care organization.
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Servicio de Cardiología en Hospital/organización & administración , Registros Electrónicos de Salud/organización & administración , Centros de Atención Terciaria/organización & administración , Adulto , Actitud hacia los Computadores , Capacitación de Usuario de Computador , Registros Electrónicos de Salud/economía , Humanos , Italia , Satisfacción del Paciente , Integración de SistemasRESUMEN
SummaryObjectives:the aim of this study was to report a ten years experience in the electronic medical record (EMR) use. An estimated 80% of healthcare transactions are still paper-based.Methods:an EMR system was built at the end of 1998 in an Italian tertiary care center to achieve total integration among different human and instrumental sources, eliminating paper-based medical records. Physicians and nurses who used EMR system reported their opinions. In particular the hospital activity supported electronically, regarding 4,911 adult patients hospitalized in the 2004- 2008 period, was examined.Results:the final EMR product integrated multimedia document (text, images, signals). EMR presented for the most part advantages and was well adopted by the personnel. Appropriateness evaluation was also possible for some procedures. Some disadvantages were encountered, such as start-up costs, long time required to learn how to use the tool, little to no standardization between systems and the EMR technology.Conclusion:the EMR is a strategic goal for clinical system integration to allow a better health care quality. The advantages of the EMR overcome the disadvantages, yielding a positive return on investment to health care organization.
ResumoObjetivos:o objetivo deste estudo foi relatar uma experiência de 10 anos de utilização de registro médico eletrônico (EMR). Estima-se que 80% das transações na saúde ainda são feitas em papel.Métodos:um sistema de EMR foi implementado ao final de 1998, em um centro italiano de cuidados terciários, com o objetivo de alcançar uma total integração entre diferentes recursos humanos e instrumentais, eliminando registros médicos em papel. Médicos e enfermeiros que utilizaram o sistema EMR relataram suas opiniões. Foi analisada a atividade hospitalar amparada eletronicamente relacionada a 4.911 pacientes adultos hospitalizados, no período de 2004 a 2008.Resultados:o produto final do EMR integra documentos com recursos de multimídia (texto, imagens, sinais). O EMR apresentou predominantemente vantagens e foi bem adotado pelos profissinais. A avaliação de adequação também foi possível em alguns procedimentos. Algumas desvantagens foram encontradas, como os custos de instalação, longo período de aprendizado para uso, pouca ou nenhuma padronização entre os sistemas EMR. Conclusões: o EMR é um objetivo estratégico para a integração do sistema de clínica e para permitir uma melhor qualidade de cuidados de saúde. As vantagens do EMR superam as desvantagens, produzindo um retorno positivo desse investimento para a instituição de saúde.Conclusões:o EMR é um objetivo estratégico para a integração do sistema de clínica e para permitir uma melhor qualidade de cuidados de saúde. As vantagens do EMR superam as desvantagens, produzindo um retorno positivo desse investimento para a instituição de saúde.
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Adulto , Humanos , Servicio de Cardiología en Hospital/organización & administración , Registros Electrónicos de Salud/organización & administración , Centros de Atención Terciaria/organización & administración , Actitud hacia los Computadores , Capacitación de Usuario de Computador , Registros Electrónicos de Salud/economía , Italia , Satisfacción del Paciente , Integración de SistemasAsunto(s)
Registros Electrónicos de Salud , Internado y Residencia , Medicina , Academias e Institutos/organización & administración , Argentina , Registros Electrónicos de Salud/economía , Registros Electrónicos de Salud/normas , Humanos , Agencias Internacionales/organización & administración , Internado y Residencia/organización & administraciónRESUMEN
BACKGROUND: Belize deployed a country-wide fully integrated patient centred health information system with eight embedded disease management algorithms and simple analytics in 2007 for $4 (Cad)/citizen. OBJECTIVES: This study evaluated BHIS uptake by health care workers, and pre and post BHIS deployment mortality in selected areas and public health care expenditures. METHODS: BHIS encounter data were compared to encounter data from required Ministry of Health reports from licensed health care entities. De-identified vital statistics death data for the eight BHIS protocol disease domains and three non-protocol domains were compared from 2005 to 2011. Belize population data came from the Statistical Institute of Belize (2005-2009) and from Belize census (2010) and estimate (2011). Public health system expenditures were compared by fiscal years (2000-2012). RESULTS: BHIS captured over 90% healthcare encounters by year one, 95% by year two. Mortality rates decreased in the eight BHIS protocol domains (each 2005 vs. 2011, all p<0.02) vs. an increase or little change in the three domains without protocols. Hypertension related deaths dropped from 1st cause of death in 2003 to 9th by 2010. Public expenditures on healthcare steadily rose until 2009 but then declined slightly for the next 3 years. CONCLUSION: For modest investment, BHIS was well accepted nationwide and following deployment, mortality in the eight BHIS disease management algorithm domains declined significantly and expenditures on public healthcare stabilized.
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Registros Electrónicos de Salud/economía , Registros Electrónicos de Salud/estadística & datos numéricos , Costos de la Atención en Salud/estadística & datos numéricos , Sistemas de Información en Salud/economía , Mortalidad/tendencias , Atención Dirigida al Paciente/economía , United States Public Health Service/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Belice , Niño , Preescolar , Sistemas de Información en Salud/estadística & datos numéricos , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Atención Dirigida al Paciente/estadística & datos numéricos , Integración de Sistemas , Estados Unidos , Adulto JovenAsunto(s)
Registros Electrónicos de Salud/tendencias , Cooperación Internacional , Programas Informáticos/tendencias , Países Desarrollados , Países en Desarrollo , Registros Electrónicos de Salud/economía , Registros Electrónicos de Salud/normas , Humanos , México , Programas Informáticos/economía , Programas Informáticos/normasRESUMEN
We systematically reviewed PubMed and EBSCO business, looking for cost indicators of electronic health record (EHR) implementations and their associated benefit indicators. We provide a set of the most common cost and benefit (CB) indicators used in the EHR literature, as well as an overall estimate of the CB related to EHR implementation. Overall, CB evaluation of EHR implementation showed a rapid capital-recovering process. On average, the annual benefits were 76.5% of the first-year costs and 308.6% of the annual costs. However, the initial investments were not recovered in a few studied implementations. Distinctions in reporting fixed and variable costs are suggested.