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Tag: EHR

Winter is coming…

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Birds migrate south for better climates.  Is it time to start re-evaluating your EHR climate?

Well known among clinicians are the challenges with many EHR systems, troubling user interfaces, difficulty navigating screens, and the number of mouse clicks required for even the most mundane tasks. As different EHR systems improve and provide more user-friendly interfaces, the challenges associated with choosing the best system for patient care should not be insurmountable.

Staff have finally gotten used to the existing system, so why change? Just because the current system is what everyone is used to, does not necessarily mean it is the best choice.

Health systems and physician practices have more choices than ever for EHR systems. Cloud based systems allow great flexibility and decreased infrastructure costs, traditional licensed software systems can offer more customized security and storage options. Practices may outgrow one EHR and have a need to move on to a new one, maybe the price has become prohibitive, maybe the nature of the practice itself has changed. The reasons for changing the EHR can be numerous.

Physicians, nurses, techs, and whole practices have likely spent countless hours customizing interfaces, connecting numerous devices and apps, and reducing their reliance on fax machines. Choosing a new EHR, for whatever reason, should not be a step backwards.

How do you choose a new EHR to begin with?

How do you handle the data migration?

What about all the existing patient data?

What about all the clinical workflows?

Where do you even start?!

Larger health systems may have an army of IT specialists at their disposal to help answer these questions, but even for large systems a migration of this size is a challenge. Are there the right people in place to begin with? What does the current infrastructure look like, can it even support a new system? For smaller hospitals or independent practices all these questions can seem overwhelming.

In 2016 the ONC published a guide to selecting EHR vendors, while published six years ago, the information is still relevant. For clinical and patient care staff one of the most important questions to be answered is whether or not the patient’s information will be present on day one. All patient data and information should be readily available to provide the continuity of care that everyone expects. All equipment used to enable patient care should be connected and functioning from day one.

Anyone who has been through systems and EHR implementations in healthcare is likely aware of the challenges and pain points that can occur. No matter how much training and testing has been completed, on day one, there will be questions and something will be missed. Clinical staff want systems that just work, and if something is broken, they want it fixed quickly so they can focus on their patients.

If you’ve experienced the challenge of implementing an EHR system, the thought of migrating to a new one might give you nightmares. Don’t let data migration, testing, and support be a barrier to implementing the best system for clinical staff and patients. Tido Inc. can help answer many of these questions with advisory services and assist with EHR migration and post go-live support.

B+ when transfusing blood.

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Blood Groups

Blood transfusions in hospitals are a common occurrence to treat a number of conditions and diseases, from traumatic events to sickle cell. They are becoming more and more common for a variety of conditions, it now a medical specialty called transfusion medicine. Blood must be matched, at a minimum by type (ABO compatibility) for emergencies, but as transfusions have become more common to treat other conditions, additional testing and matching will occur for various other antibodies. Transfusions are largely regarded as a last resort when other treatment methods have failed, and related critical events are rare, depending on source 0.2%-1%, but they are still common and necessary occurrences. Critical to the safety of transfusions is ensuring that right blood gets to the right patient.

Each blood component must be tracked to ensure that when a patient needs it, they are receiving blood that is compatible, from the blood type to different antibodies in the components. Information systems help ensure this safety by providing a means for tracking blood products, which go through multiple processing steps after donation and are often collected far from the recipient.

Once blood products arrive in the hospital, they will often undergo additional testing to further discriminate sub types and antibodies. Patients that have received multiple transfusions are more likely to have antibodies against certain bloods, increasing the risk of a transfusion, increasing the need for more checks. Within the hospitals ordering blood products follows a similar pathway to medication ordering and administration, which was discussed in last week’s blog.

Similar to pharmacies, blood banks (where the blood is stored and distributed) often have a dedicated system for testing and tracking blood products. These systems are connected to the hospitals EHRs for physician ordering, distribution, and finally administration by the nursing staff. At any point along the chain if a connection is broken there can be a safety consideration that is missed. Healthcare workers are extremely vigilant when ordering, dispensing, and administering blood products, each step along the way involves checks and double checks to ensure safety.  As complexity in matching grows, the risk for missing a critical element increases.  As a safety double check blood products will be electronically scanned at each step, including administration, to make sure the right blood is being administered.

As the utilization of blood products increases to treat more and more diseases and conditions, and more specific matching becomes ever more critical, there is always an increased likelihood that a break in one of these systems can cause a critical check or piece of information to be missed. Transfusion events are rare, but they do occur, and it is often because of an unknown on the patient side. Until a patient receives a transfusion, we may not know how they will react.

If a transfusion event does occur, there is a process that occurs to figure out why. Critical to this process is knowing what blood was administered, it’s components and sources, and why the patient had a reaction. All of this information is documented, not only in the EHR, but also in the blood bank systems, to ensure that the risk of future events can be minimized, not only for that patient, but for other patients as well.

Interconnected systems ensure the safety of the blood supply and the safe administration of life saving therapies for patients in need. Are we positive these systems are operating as they should be? Can we B+ that all critical information and safety checks are happening as expected?

Tido provides automated end to end monitoring solutions that will automatically alert your teams there is a disruption.

Blood donation and transfusions remain safe and effective treatments to help those in need. For more information on donating blood, please visit the American Red Cross.

Low visibility tech that has a high impact for clinical staff.

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Cath Lab Technology

How to avoid staff sentiment of “nothing works like it’s supposed to.”

Low visibility tech that fits so seamlessly into a workflow, we don’t know it’s there until it tells us it is.    Tech that actually saves clinical workers time and allows them to focus on patients, could it exist?

Absolutely.  There are so many systems healthcare is reliant upon, when they fail to connect, big problems arise that will have a big impact on clinical workers.  This can be such a problem that many clinical areas within hospitals will dedicate a person to check information is flowing where its supposed to.  They are not IT, they are patient care professionals taking time to check these systems because they know the problems that arise when patient information doesn’t flow.

Consider a Cardiac Catheterization Lab, the simplest lab might have 3 different systems, the most complex, maybe 10 or more.  A typical solution to checking systems within a lab:

  • Everyday, or every week, a Cath Technician or Nurse may spend 3 – 5 hours checking reports to make sure they went to the EHR, and images to make sure they went from the local system to the PACS/VNA/EHR/DICOM.  At best any interruption in transfer is caught before the patient leaves the procedure area, at worst, it is not caught until someone is looking for the results.
  • Once the interruption is caught a staff member will check operations on their end to make sure it wasn’t an issue with what they did.  Then they reach out to the IT help desk to report the problem.  IT will ask several questions and have the staff member perform checks manually to make sure everything was done correctly on the user end again.  
  • At this point the IT help desk will forward the ticket to another area or vendor if needed.  In a serial manner, the issue will get passed until the proper team or vendor is found that controls the part of the feed that was interrupted.

This is what happens during normal operating hours.  Most interruptions to connections occur when upgrades to one of the systems happen, most often during the night or weekends when staffing is lightest.  Cath labs have staff that are on call for emergencies, but not on site during those times.  If they are called in for an emergency they may discover the problem when they arrive and have a ‘network failure’ message on one of the systems, or it may not be discovered until after they have left the building and someone is looking for more information.  This will result in the physician or staff being called at home to provide the missing information.

Systems that don’t connect will inhibit the flow of patient information, and frustrate staff trying to provide patient care, this often leads to the sentiment “nothing works like it’s supposed to.” 

Low visibility tech that monitors these feeds can save staff time when things are operating normally, and can save frustration when its not by alerting the right people; often before the issue is even noticed by the user.

Imagine a Cath Lab solution with such a technology in place:

  • Cath Lab Technologist or Nurse is providing patient care, not checking different systems.
  • Feed from the imaging system is interrupted and a message alerts the appropriate IT team and/or Vendor as well as the Cath Lab.  In an ideal world this will be done on a hospital’s secure messaging platform so everyone can communicate a problem or resolution instantly.
  • All teams are checking for a problem on their end simultaneously.
  • Cath lab calls IT, confirms they have checked systems on their end, they are told that problem is known about and all teams are looking into it at the same time.
  • From experience we know that by the time the Cath Lab team finishes checking systems on their end, the other teams will have too.  The problem is often resolved by the time the Cath Lab is calling the help desk.

Since most interruptions occur during an upgrade, if the problem is found immediately, the IT team is notified immediately, likely before they are even finished with the upgrade and have left for the night.  

Implementing such a solution means you have freed up 3-5 hours per week of a highly trained patient care worker, and eliminated a major source of frustration for caregivers when systems don’t connect.  Low visibility tech that ensures smooth and hassle free operations for your staff, allowing them to focus on what really matters, the patient. 

Talk to Tido about their end to end monitoring packages to let your staff focus on their patient.

 

How to keep healthcare uninterrupted; staffing challenges

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healthcare applicationsAll health systems, no matter if they are small, medium, or large are dealing with increasing number of applications. The COVID-19 pandemic has accelerated digital transformation in every major sector, vastly increasing our reliance on technology to meet many of our daily needs. And healthcare is no exception! Our health systems have greatly expanded their digital footprint to better serve our patients, empowering them to perform routine tasks without leaving the comfort of their home—such as paying bills, requesting medication refills, and even receiving personal health updates digitally.

More than 30 percent of health systems are reporting that they can’t locate enough candidates to fill open positions, and all are feeling the effects of staffing shortages. Beyond recruiting, retention is even more difficult with the increase in turnover and employee burnout.

On top of this the applications that health system IT deals with are becoming increasingly complex. Most if not all applications whether it’s a desktop application, web, or mobile, integrate with each other to transfer information in real-time.  There are very few standalone applications in today’s integrated environment.

So we have increasing number of complex and integrated applications in a health system with fewer people to manage and support them. This presents a significant challenge for IT departments and can also impact patient care. Helpdesk ends up relying on end-users to report production application issues to start the process of diagnosing and resolving the issues. Reliance on manual identification and reporting causes significant delay in diagnosing and fixing issues. This interruption can impact patient safety and outcomes.

Currently, most healthcare organizations have basic monitoring in place for their digital assets, such as operating system errors and breaks in connectivity. However, typically there is no active end-to-end monitoring of the production environment that would catch issues in real-time and alert the appropriate staff proactively. To keep healthcare uninterrupted, we recommend using end-to-end monitoring of applications and interfaces in your production environment.

At Tido, we realized that there had to be a better way to proactively monitor applications and interfaces in production, to make IT staff aware of the issues immediately; before the end-users are even aware that there is an issue with the system. To address this ongoing problem, we have developed high-quality automated monitoring services for healthcare systems.

  • Tido’s monitoring framework uses Microsoft Azure Monitor to reduce reliance on manual reporting—helping to detect 95% of application and integration issues automatically in the production environment.
  • Tido’s end-to-end monitoring framework automates application, interfaces, and data checks in EHR and all downstream applications in the production environment: PACS, Pharmacy, LAB, Cardio, Ambulatory, and more.
  • Tido’s monitoring solution sends automated notifications to responsible parties and the IT help desk within seconds, alerting them about live application or interface issues to avoid unscheduled downtime and reduce patient safety issues.

Contact us to find out more about how your healthcare organization can subscribe to Tido’s end-to-end monitoring packages, to proactively maintain the quality of all the applications and interfaces in your digital health system and keep healthcare uninterrupted.