“We began by stealing time, and we got a little bit more scope to have our own server,” says Cucina, a physician. “Over the course of three or four years, we've turned it into a pretty neat physician documentation tool that we thought was more feature-rich than we ever thought it would be.”
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The application has a built-in, computer-aided correction system based on the Joint Commission's list of “do not use” abbreviations. Improper abbreviations appear in red and their suggested substitutions in green.
While the medical center eventually will replace NoteWriter with the new vendor-developed system, work on it may not be lost. The hospital is considering making the software available through an open-source license, Cucina says.
Cucina also managed development of a reconciliation tool for discharging patients that accounts for medications patients were taking before admission, during their hospital stays, and what are prescribed when they leave. The Web-based system, first deployed in December 2007, is being rolled out throughout the hospital and remains a work in progress.
The application helps guide physician decisionmaking and records those decisions in the EHR as well as on a single, printed prescription form. It also creates a patient-friendly version listing medications the patient is to keep taking at home at their previous dose, medications the patient is to keep taking at home at a different dose, new medications, and medications the patient was taking at home that they should stop taking after discharge.
“We're continuing to develop it even now,” Cucina says. “We've scaled back because we know Epic is coming in.” The medication reconciliation software also will be made available via an open-source license, Cucina says.