Patient contact. EPR to PMS

Transcription

1 Patient contact EPR to PMS

2 Patient integration Scheduling E Handover ADT ORM,ADT Radiology ADT Pathology Blood bank QRY Rhapsody ADT EPR Out patients ADT ADT Pharmacy ADT ADT Alerts A&E PAS

3 EPR

4 EPR

5 Referral Process Referral management Concluded Assessment Planning Contact

6 PMS Pathway OP Episode OP contact OP contact IP Episode Diagnostic contact Theatres contact Diagnostic contact OP Episode OP contact OP contact Referrer summary

7 Business model Out patients In patients Referral Episode of care Episode of care Episode of care Admission Episode of care Procedures Procedures Procedures Episode of care Procedures

8 PMS model Pathway Out patient Spell Episode of care In patient Spell Episode of care Procedures Out patient Spell Episode of care Procedures Procedures Episode of care Episode of care Procedures Episode of care

9 From EPR

10 To PMS Referral T & O Pathway Out patient Episode T & O First attendance MRI investigation Pre op assessment In patient Episode Theatres Out patient Episode Discharged

11 Episodes of care Referral T & O Pathway Out patient Episode T & O First attendance MRI investigation Pre op assessment In patient Episode Theatres Out patient Episode Discharged

12 Refer to HL7 model ADT/ACK - update patient information (event A08) This trigger event is used when any patient information has changed but when no other trigger event has occurred. For example, an A08 event can be used to notify the receiving systems of a change of address or a name change. We recommend that the A08 transaction be used to update fields that are not related to any of the other trigger events. The A08 event can include information specific to an episode of care, but it can also be used for demographic information only. ADT ADT Message Chapter MSH Message Header 2 EVN Event Type 3 PID Patient Identification 3 [PD1] Additional Demographics 3 [ { NK1 } ] Next of Kin /Associated Parties 3 PV1 Patient Visit 3 [ PV2 ] Patient Visit - Additional Info. 3 [ { DB1 } ] Disability Information 3 [ { OBX } ] Observation/Result 7 [ { AL1 } ] Allergy Information 3 [ { DG1 } ] Diagnosis Information 6 [ DRG ] Diagnosis Related Group 6

13 Planning contacts / appointments Referral T & O Pathway Out patient Episode T & O First attendance MRI investigation Pre op assessment In patient Episode Theatres Out patient Episode

14 Refer to HL7 model Notification of new appointment booking (event S12) Notification of appointment rescheduling (event S13) Notification of appointment modification (event S14) Notification of appointment cancellation (event S15) Notification that patient did not show up for scheduled appointment (event S26) SCH - schedule activity information segment Chapter 10 says nothing about an attendance

15 Refer to HL7 model ADT/ACK - register a patient (event A04) An A04 event signals that the patient has arrived or checked in as a one-time, or recurring outpatient, and is not assigned to a bed. One example might be its use to signal the beginning of a visit to the Emergency Room. Note that some systems refer to these events as outpatient registrations or emergency admissions. PV1-44-admit date time is used for the visit start date/time ADT/ACK - admit/visit notification (event A01) An A01 event is intended to be used for Admitted patients only. An A01 event is sent as a result of a patient undergoing the admission process which assigns the patient to a bed. It signals the beginning of a patient s stay in a healthcare facility. Normally, this information is entered in the primary Patient Administration system and broadcast to the nursing units and ancillary systems. It includes short stay and John Doe admissions. For example, an A01 event can be used to notify: the pharmacy system that a patient has been admitted and may be legitimately prescribed drugs; the nursing system that the patient has been admitted and needs a care plan prepared; the finance system of the start of the billing period; the dietary system that a new patient has been installed and requires dietary services; the laboratory, pathology, and radiology systems that a patient has been admitted and is entitled to receive services; the clinical repository that an admission has taken place for the EMR (electronic medical record).

16 PMS Referral T & O Pathway Out patient Episode T & O First attendance MRI investigation Pre op assessment In patient Episode Theatres Out patient Episode

17 Pathway index Pathway Out patient Spell Episode of care identifier = App2 Episode of care

18 App2 Pathway Out patient Spell Episode of care PathwayID SpellIID EpisodeID ID Episode of care

19 Data registration PathwayID SpellIID EpisodeID ID Data registration EventID = 10 Code set = Pathway registration Date of referral = 01/Oct/2010 Pathway type = Direct access Priority = Routine Data registration EventID = 100 Code set = Patient contact Procedure = None Treatment started = Yes Registration complete = Yes

20 Data registration OBXID EventID SetIndex ValueType QuestionCode QuestionPrompt QuestionCodingSystem AnswerCode AnswerPrompt AnswerCodingSystem Units ObservationResultStatus CE PRIORITY Priority QPRIORITYTYPE 1 Routine APRIORITYTYPE NULL F CE SERVTYPE Service Type Requested QSERVICETYPEREQUESTED 1 Advice / Consultation ASERVICETYPEREQUESTED NULL F ST AREFRDAT Date Letter Received QREFRDATE 29/11/2010 NULL NULL NULL F ST AREFLDAT Date of Referral QREFLDATE 29/11/2010 NULL NULL NULL F CE PRIORITY Priority QPRIORITYTYPE 1 Routine APRIORITYTYPE NULL F CE SERVTYPE Service Type Requested QSERVICETYPEREQUESTED 1 Advice / Consultation ASERVICETYPEREQUESTED NULL F ST AREFRDAT Date Letter Received QREFRDATE 29/11/2010 NULL NULL NULL F ST AREFLDAT Date of Referral QREFLDATE 29/11/2010 NULL NULL NULL F CE PRIORITY Priority QPRIORITYTYPE 1 Routine APRIORITYTYPE NULL F CE SERVTYPE Service Type Requested QSERVICETYPEREQUESTED 1 Advice / Consultation ASERVICETYPEREQUESTED NULL F ST AREFRDAT Date Letter Received QREFRDATE 29/11/2010 NULL NULL NULL F ST AREFLDAT Date of Referral QREFLDATE 29/11/2010 NULL NULL NULL F CE PRIORITY Priority QPRIORITYTYPE 1 Routine APRIORITYTYPE NULL F CE SERVTYPE Service Type Requested QSERVICETYPEREQUESTED 1 Advice / Consultation ASERVICETYPEREQUESTED NULL F ST AREFRDAT Date Letter Received QREFRDATE 29/11/2010 NULL NULL NULL F ST AREFLDAT Date of Referral QREFLDATE 29/11/2010 NULL NULL NULL F CE PRIORITY Priority QPRIORITYTYPE 1 Routine APRIORITYTYPE NULL F ST AREFSITE Site QREFSITE BHH NULL NULL NULL F CE SERVTYPE Reason for Referral QREFREASON 1 Advice or Consultation AREFREASON NULL F ST AREFRDAT Date Letter Received QREFRDATE 29/11/2010 NULL NULL NULL F ST AREFLDAT Date of Referral QREFLDATE 29/11/2010 NULL NULL NULL F CE PRIORITY Priority QPRIORITYTYPE 1 Routine APRIORITYTYPE NULL F ST AREFSITE Site QREFSITE BHH NULL NULL NULL F CE SERVTYPE Reason for Referral QREFREASON 1 Advice or Consultation AREFREASON NULL F ST AREFRDAT Date Letter Received QREFRDATE 29/11/2010 NULL NULL NULL F ST AREFLDAT Date of Referral QREFLDATE 29/11/2010 NULL NULL NULL F CE PRIORITY Priority QPRIORITYTYPE 1 Routine APRIORITYTYPE NULL F ST AREFSITE Site QREFSITE BHH NULL NULL NULL F CE SERVTYPE Reason for Referral QREFREASON 1 Advice or Consultation AREFREASON NULL F ST AREFRDAT Date Letter Received QREFRDATE 29/11/2010 NULL NULL NULL F ST AREFLDAT Date of Referral QREFLDATE 29/11/2010 NULL NULL NULL F CE PRIORITY Priority QPRIORITYTYPE 1 Routine APRIORITYTYPE NULL F ST AREFSITE Site QREFSITE BHH NULL NULL NULL F CE SERVTYPE Reason for Referral QREFREASON 1 Advice or Consultation AREFREASON NULL F ST AREFRDAT Date Letter Received QREFRDATE 29/11/2010 NULL NULL NULL F ST AREFLDAT Date of Referral QREFLDATE 29/11/2010 NULL NULL NULL F CE PRIORITY Priority QPRIORITYTYPE 1 Routine APRIORITYTYPE NULL F CE SERVTYPE Service Type Requested QSERVICETYPEREQUESTED 1 Advice / Consultation ASERVICETYPEREQUESTED NULL F ST AREFRDAT Date Letter Received QREFRDATE 29/11/2010 NULL NULL NULL F ST AREFLDAT Date of Referral QREFLDATE 29/11/2010 NULL NULL NULL F CE PRIORITY Priority QPRIORITYTYPE 1 Routine APRIORITYTYPE NULL F CE SERVTYPE Service Type Requested QSERVICETYPEREQUESTED 1 Advice / Consultation ASERVICETYPEREQUESTED NULL F ST AREFRDAT Date Letter Received QREFRDATE 29/11/2010 NULL NULL NULL F ST AREFLDAT Date of Referral QREFLDATE 29/11/2010 NULL NULL NULL F

21 Data registration OBXID EventID SetIndex ValueType QuestionCode QuestionPrompt QuestionCodingSystem AnswerCode AnswerPrompt AnswerCodingSystem Units Status CE PRIORITY Priority QPRIORITYTYPE 1 Routine APRIORITYTYPE NULL F CE SERVTYPE Service Type Requested QSERVICETYPEREQUESTED 1 Advice / Consultation ASERVICETYPEREQUESTE D NULL F ST AREFRDAT Date Letter Received QREFRDATE 29/11/2010 NULL NULL NULL F ST AREFLDAT Date of Referral QREFLDATE 29/11/2010 NULL NULL NULL F

22 Events EventID EventCode ContactTypeCode ContactTypeName TypeName ScheduleAuthorityName StartDateTime BookingStatus SequenceTiming SIUS15 OPFUP Outpatient Follow-up attendance F-Up Cardiology OP Murray Robert Gordon Dr 12/08/ :10 CANCELLED 27/05/ : SIUS14 OPFUP Outpatient Follow-up attendance F-Up Cardiology OP Murray Robert Gordon Dr 12/08/ :10 MODIFIED 27/05/ : SIUS13 OPFUP Outpatient Follow-up attendance F-Up Cardiology OP Murray Robert Gordon Dr 12/08/ :10 REBOOKED 11/05/ : SIUS13 OPFUP Outpatient Follow-up attendance F-Up Cardiology OP Murray Robert Gordon Dr 01/07/ :50 REBOOKED 22/02/ : SIUS14 OPFUP Outpatient Follow-up attendance F-Up Cardiology OP Murray Robert Gordon Dr 27/05/ :40 MODIFIED 17/02/ : SIUS13 OPFUP Outpatient Follow-up attendance Migration - F-Up Cardiology OP Appt Murray Robert Gordon Dr 27/05/ :40 REBOOKED 08/12/ : SIUS12 OPFUP Outpatient Follow-up attendance Migration - F-Up Cardiology OP Appt Murray Robert Gordon Dr 18/03/ :00 BOOKED 19/09/ :16

23 Data event registration PathwayID SpellIID EpisodeID ID PathwayEvent Event Event Data registration ObjectID = 255 EventID = 10 Code set = Pathway registration Date of referral = 01/Oct/2010 Pathway type = Direct Access Priority = Routine Data registration ObjectID = 300 EventID = 100 Code set = Patient contact Procedure = None Treatment started = Yes Registration complete = Yes

24 Data persistence Pathway Out patient Spell Episode of care

25 Entensible data registration <xml> <objecttype> contact</objecttype> <objectid > 100 </objectid> <eventid> 101 </eventid> </xml> PMS Dendrite HL7 v2.3/4

26 Complex appointment sets PathwayID SpellIID EpisodeID New fracture OP appt 5d Radiology procedure 10d Follow up fracture OP appt 10d Occupation therapy appt 3d Occupation therapy appt 5d Follow up fracture OP appt PMS

27 PMS components CFH Choose and book Referral management Check in CAB DQ merge UltraGenda Enterprise Scheduler Pathway editor Issue management PMS Organiser PAS

28 PMS Referral T & O Pathway Out patient Episode T & O First attendance MRI investigation Pre op assessment In patient Episode Theatres Out patient Episode

29 Referral Discharged Time T & O Hip Pathway Duration 9 weeks, Referral to treatment 4 weeks, In patient stay 2 weeks, MRI wait 11 days, 12% rescheduled Weeks 1-3 Weeks 4-5 Weeks 6-9 Out patient Episode Dr A T & O First attendance MRI investigation Pre op assessment In patient Episode Dr B Theatres Out patient Episode Dr C

30 Time T &O Pathway Patients hip problem Status Open T &O Pathway Patients knee problem Status Closed Diabetic Chronic disease management pathway Status Persistent

31 Conditional routing

32 Choose and book integration

33 Average throughput messages per hour Peak throughput messages per hour

34 Referral Discharged PMS closing the loop T & O Hip Pathway Duration 9 weeks, Referral to treatment 4 weeks, In patient stay 2 weeks, MRI wait 11 days, 12% rescheduled Weeks 1-3 Weeks 4-5 Weeks 6-9 Out patient Episode Dr A T & O First attendance MRI investigation Pre op assessment In patient Episode Dr B Theatres Out patient Episode Dr C