The Patient Information Exchange, or PIE, at McLaren Health Care is reducing data chaos and supporting clinician workflow by facilitating diagnostic and evaluation processes for physicians and nurses. This article addresses the use of the PIE portal within the hospital acute-care setting across the health system, and how this technology supports delivery of quality patient care and helps meet the American Recovery and Reinvestment Act of 2009 healthcare IT stimulus requirements.
The PIE is a bridging technology solution that connects disparate clinical patient-information systems (including paper) across the health system. The PIE portal provides single sign-on access and aggregates all the essential clinical information from the disparate systems into one location. The PIE portal is organized around “tabs” that indicate the type of clinical information housed within each tab, and supports a familiar intuitive process for clinical use (resembling paper chart tabs). This logical format facilitates the ongoing need to add more information over time. It can be added to the system with little clinician training.
By observing the workflow process that physicians use to assess, document, and prescribe patient interventions, it can easily be seen that the cognitive diagnostic process requires viewing multiple clinical variables simultaneously, without the interruption and distraction of navigating through many disparate clinical EMR modules or systems. Viewing these clinical variables and their relationship to the patient’s clinical context (multiple comorbidities) through one access point, facilitates the physician’s deductive reasoning and allows rapid patient intervention.
McLaren incorporated medical staff input concerning a standard physician workflow for “patient rounding”, “documentation” and “ordering”, and discovered many “workflow defects” within the current state. These defects found when collecting data from the current EMR disparate systems and paper charts included: interruptions, delays and dead-ends resulting in process failure and frustration.
Because of these findings, the IT department proposed a global solution for the health system resulting in the PIE solution model. The PIE model includes the following list of functionalities which is not all-inclusive:
- PIE is a browser-based user interface that provides a familiar environment for the end user. Training requirements and adoption cycles are reduced; users become productive with the functionality quickly.
- PIE allows physicians to share information “across the continuum of patient care.” Authorized physicians can share clinical results across medical specialty teams, significantly reducing duplicate testing, thus aiding in the reduction of overall healthcare costs.
- PIE interfaces with a hospital EMR system to present EMR functionality and data to the physicians’ desktop. As an interim step, physicians are using PIE as their documentation tool. PIE transfers current lab values, vital signs, I&O and automatically populates fields on the physician progress record. The physician prints this form, documents additional findings and places the form on the chart. Once again, the IT staff is looking at “task simplification” as they move toward the EMR solution for physician documentation.
Patient Snapshot provides a quick view of the patient’s clinical information for the past eight, 12, 24 or 48 hours. Vital signs, I&O and cumulative lab results, consults, and other clinical results, such as radiology images and transcribed reports are readily accessible. Graphing is available for trending purposes.
PIE will display all patient orders sorted with the most recent first. MHC believes this is one of many PIE functions that will be critical to successfully deploying computerized provider order entry.
Prior admissions to McLaren hospital facilities are accessible from PIE. The PIE model can reduce physician workflow steps for rounding by 50%-65% depending on clinical specialty. This improved process reduces time on task; it also improves the quality of time spent on properly determining patient intervention, therefore improving both quality and timeliness of care.
In closing, McLaren believes that PIE meets the EMR stimulus requirements as follows:
- Meaningful use has been demonstrated by the number of physician user “hits” on PIE, which totaled 629,358 last year. McLaren has validated that the functionality “fits” the dynamic operational needs of clinical end users.
- McLaren also believes aggregating all disparate system data in one location facilitates the use of CPOE. McLaren is taking the appropriate initial steps around “task simplification” to ease the effort of retrieving information prior to deploying the new CPOE functionality.
- The PIE functionality has proven to be a “usable” architecture by the clinical staff because of its open and interoperable nature. Interfacing may be eased in the future as more software products will be required to be interoperable.
- The PIE functionality is a certified architecture. The prevailing feeling is the government will look at not only whether a “software” program is certified, but that the certified software is being used by clinicians.
- The PIE functionality could offer decision support, but only after CPOE has been designed and deployed. This is done so as not to create conflict and unnecessary redundancy within the architecture and associated processes.
This PIE bridging technology is part of the overall IT services provided by McLaren’s outsourcing partner. PIE provides clinicians with patient care focused tools to improve quality and clinical productivity that typical EMRs do not provide.
