Abstract
The authors will demonstrate a web-based outpatient clinic whiteboard application that has been embedded into an existing enterprise-wide electronic medical record (EMR). The whiteboard integrates real-time scheduling information with room movement and tracking capabilities and EMR linkages to enhance outpatient clinic workflows and serve as a hub of clinical information activities.
Problem Addressed
In busy clinics, and especially those that administer therapies such as chemotherapy or dialysis, complex workflows involve the tracking of patients, labwork, orders, and clinical flowsheets. Integrating these workflows into a central electronic whiteboard can provide visual cues and quick access to relevant data, reducing potential administrative and clinical errors.
System Description
The outpatient clinic white-board application, created in PHP4 with Javascript enhancements, receives HL7 messages in real-time from an institutional, commercial scheduling system which handles appointments for over 400 distinct clinic and provider schedules. Approximately 21,000 messages daily are processed, representing appointment creations, cancellations, and arrivals. A MySQL database containing all relevant appointment and demographic information is updated in real-time.
A concurrent process queries the EMR’s knowledge of the status of lab specimens (received, pending, complete) and asynchronously updates the white-board database with the latest information.
Additional links within the whiteboard application have been developed to launch previously-developed EMR functions, including the display of vital signs, immunization records, growth curves, problem and medication lists, intake forms, lab results, flowsheets, a prescription writer, and a documentation tool.
Room-movement capabilities allow for the assignment of patients to exam rooms, procedure rooms, or any other previously-specified location. These movements are timestamped to provide data for subsequent room and staff utilization reports. Levels of acuity and nurse assignments are among additional whiteboard items that can be entered and displayed.
The resulting outpatient clinic whiteboard application provides a one-stop hub to not only track patient movements and appointment status but also perform multiple clinical information tasks and display a ‘dashboard’ of workflow events.
Because the whiteboard application captures appointment information throughout the Vanderbilt enterprise, longitudinal views of patient visits across multiple clinics are available, including cancellations and no-shows. A patient-centered calendar view of appointments has also been created, including a bar-coded medical record number for prototyping clinic sign-ins using barcode readers.
System Deployment
Use of the outpatient white-board application in a production environment began in May, 2005 at the Pediatric Cancer Center which contained multiple provider and clinic schedules that were grouped into a common physical location. The adult Cancer Center followed in September, 2005. Additional clinics currently using the whiteboard include Peds Primary Care, Peds Acute Care, Peds GI, Peds Dermatology, Adolescent, and Adult Hematology and Stem Cell Transplant.
In the six months since September 12th when logging functionality was added, there have been 466 distinct users of the whiteboard application. Since February 27th, 2006, there have been consistently more than 100 distinct users on each weekday, for an application which has not yet been officially ‘rolled-out’.
Future Work
Adding clinical decision support to the whiteboard application will reduce missed opportunities for providing necessary interventions. For example, a link to quickly display an immunization record can be enhanced by an alert that signals an overdue status. Chronic disease management can be improved with electronic reviews of relevant chart data and appropriate alerts for clinical workups. Preventive health care screening recommendations can be applied with clinical reminders.