A system implements a JCAHO/CMS compatible monitoring, compliance and documentation process for AMI, for example, using a Workflow Management System integrated with (or part of) a Healthcare Information System (HIS). Acute myocardial infarction (AMI), or heart attack, refers to necrosis (death) of myocardial tissue that results from ischemia (deprivation of oxygen) associated with sudden, prolonged diminished blood flow. The compliance and documentation process identifies patients with ANI, notifies clinicians of actions needed for maximum compliance with JCAHO/CMS AMI measures and captures documentation of these actions while they are taking place. Although embodiments herein are described in the context of AMI, this is exemplary only and the embodiments are applicable to other medical conditions and treatments. A workflow processor (comprising a Workflow Management System) supports documentation of actions (for compliance) and performance of the actions by prompting a clinician to perform an action at the correct time and concurrently capture the documentation. The Workflow processor also escalates action to acquire missing information while a patient is still in a hospital and continuously improves care by evaluating degree of compliance using captured documentation and identifying care actions needing improvement. In operation, the system alerts a nurse or physician that a patient just admitted with an AMI should receive aspirin and concurrently captures documentation indicating a clinician administered the aspirin or alternatively concurrently captures documentation indicating a clinically valid reason why the action was not performed, thereby supporting compliance. The system supports completion of documentation on-line in real-time and avoids a need to refer to historical patient charts and reduces time taken by an abstractor to collect data for documentation by providing on-line forms that track patient AMI treatment.
The Workflow processor is integrated with a Healthcare Information System and tracks relevant patient data and provides access to the patient data to multiple clinicians associated with patient care. The Workflow processor implements JCAHO/CMS Acute Myocardial Infarction (AMI) National Hospital Quality Measures, for example. The system moves a JCAHO measurement process from a retrospective after the fact process, to a concurrent process that occurs contemporaneously with change in patient condition associated with treatment of AMI and while improvements can still be made.
A processor, as used herein, operates under the control of an executable application to (a) receive information from an input information device, (b) process the information by manipulating, analyzing, modifying, converting and/or transmitting the information, and/or (c) route the information to an output information device. A processor may use, or comprise the capabilities of, a controller or microprocessor, for example. The processor may operate with a display processor or generator A display processor or generator is a known element for generating signals representing display images or portions thereof. A processor and a display processor may comprise a combination of, hardware, firmware, and/or software.
An executable application, as used herein, comprises code or machine readable instructions for conditioning the processor to implement predetermined functions, such as those of an operating system, a context data acquisition system or other information processing system, for example, in response to user command or input. An executable procedure is a segment of code or machine readable instruction, sub-routine, or other distinct section of code or portion of an executable application for performing one or more particular processes. These processes may include receiving input data and/or parameters, performing operations on received input data and/or performing functions in response to received input parameters, and providing resulting output data and/or parameters.
A user interface (UI), as used herein, comprises one or more display images, generated by a display processor enabling user interaction with a processor or other device and associated data acquisition and processing functions. The UI also includes an executable procedure or executable application. The executable procedure or executable application conditions the display processor to generate signals representing the UI display images. These signals are supplied to a display device which displays the image for viewing by the user. The executable procedure or executable application further receives signals from user input devices, such as a keyboard, mouse, light pen, touch screen or any other means allowing a user to provide data to a processor. The processor, under control of the executable procedure or executable application manipulates the UI display images in response to the signals received from the input devices. In this way, the user interacts with the display image using the input devices, enabling user interaction with a processor or other device. The activities herein may be performed automatically or wholly or partially in response to user command. An automatically performed activity is performed in response to machine instruction or operation without direct user interaction in initiating the activity.
Configuration processor 29 executes a configuration application enabling a user to configure a process definition and associated trigger events employed by workflow task processor 15 in implementing processes comprising sequences of process steps for performance by a device and or worker, for example. Workflow processor 15 (a Workflow Management System or Workflow Engine), processes data to determine tasks to add to a task list, remove from a task list or modifies tasks incorporated on, or for incorporation on, a task list. A task list is a list of tasks for performance by a worker or device or a combination of both. Workflow processor 15 executes in response to predetermined process definitions that implement processes responsive to events and event associated data. Workflow processor 15 implements processes in sequence and/or concurrently, responsive to event associated data to determine tasks for performance by a device and or worker and for updating task lists of a device and a worker to include determined tasks. A process definition is definable by a user and comprises a sequence of process steps including one or more, of start, wait, decision and task allocation steps for performance by a device and or worker, for example. An event is an occurrence affecting operation of a process implemented using a process definition.
Workflow processor 15 includes a Workflow Management System, a software system that manages processes. It includes a process definition function that allows users to define a process that is to be followed for treating AMI, for example. An Event Monitor in processor 15 captures events from Healthcare Information System 35 and communicates the results to Workflow processor 15. Such events include patient admission to a hospital, start of documentation of an activity or ordering a medication to be administered to a patient, for example. A processor in the Management System tracks which processes are running, for which patients, and what step needs to be executed next, according to a process definition. The Management System includes a procedure for notifying clinicians of a task to be performed, through their worklists and a procedure for allocating and assigning tasks to specific users or specific teams. The Management System provides a process that manages clinicians in execution of tasks and documenting performance of tasks or reasons for non-performance of tasks.
The system 10 devices are interconnected and bidirectionally communicate via network 21 such as a LAN (Local Area Network) or other type of network. A client device (workstation) 12 or 14 includes processor 26 and memory unit 28 and may comprise a personal computer, for example. A user is able create, maintain and manage a process definition and associated trigger events using configuration processor 29 via one or more user interface images displayed on client device 12 or 14. Compliance monitoring system 10 may be used by a healthcare provider that is responsible for monitoring the health and/or welfare of people in its care. Examples of healthcare providers include, without limitation, a hospital, a nursing home, an assisted living care arrangement, a home health care arrangement, a hospice arrangement, a critical care arrangement, a health care clinic, a physical therapy clinic, a chiropractic clinic, and a dental office. Examples of the people being serviced by the healthcare provider include, without limitation, a patient, a resident, and a client.
Workflow processor 15 is linked (or integrated with) clinical information system (a Healthcare Information System) 35. Workflow processor 15 operates in response to a Process Definition that defines actions to be taken for a patient with an AMI according to JCAHO/CMS guidelines, for example, to optimize measurements and compliance with the guidelines. Clinical information system 35 is a software system that acquires and stores patient clinical data, provides access to clinical information to healthcare workers of a healthcare provider organization such as nurses and doctors and allows workers to order tests, medications or treatments for a patient. Clinical information system 35 presents forms to users via workstation 12 or 14 enabling a user to enter documentation for the patient indicating data identifying which tests were ordered, the medical condition of the patient, reasons for ordering medications or not ordering medications etc.
Workflow processor 15 in response to a Process Definition determines actions to be taken for a patient with an AMI and optimizes measurements, documentation and compliance with JCAHO/CMS guidelines. Workflow processor 15 implements a process that identifies candidate patients admitted to a hospital/clinic with an AMI (Acute Myocardial Infarction). Processor 15 identifies candidate patients by evaluating a chief complaint of a patient, specific patient laboratory test values, admitting diagnosis, previous patient history information, or a combination of this information. Processor 15 provides an early identification of candidate patients and initiates a process of tracking performance and documentation of JCAHO/CMS compatible AMI measurements for a patient. Processor 15 notifies clinicians to perform specific actions for a patient, according to the JCAHO/CMS AMI measurement specifications. These include, for example, administering aspirin on day of admission, administering beta blockers on day of admission, providing smoking cessation counseling if a patient is a smoker, etc. in accordance with a definition of an AMI measurement set provided by JCAHO. Further, processor 15 adaptively and dynamically updates the process for tracking performance and documentation of JCAHO/CMS compatible AMI measures in response to updates or changes to the JCAHO/CMS AMI measures and new versions of the measures.
Processor 15 captures documentation such as a form completed by a clinician that performs an AMI treatment action (e.g., a nurse or physician) substantially at the time the action is performed. Processor 15 prompts a clinician to perform a task and to access and complete a documentation form that is already automatically partially filled out (pre-populated) with previously collected information indicating characteristics associated with the action performed. For example, a clinician is prompted to document a treatment action such as indicating the clinician provided aspirin on the first day of admission and smoking cessation counseling and if it was not provided, to indicate why not (patient allergic etc.). Documenting why actions were not taken is a valid response and indicates compliance with JCAHO/CMS metrics (unlike an undocumented decision which does not count toward compliance in a measurement).
System 10 optimizes and collates data concurrently with clinician performance of treatment actions for a patient while the patient is in a hospital which results in better performance (doing the right thing for the patient, and better documentation). System 10 acquires the documentation from clinicians who provide care and perform the treatment actions and not from an abstractor after a substantial delay following treatment or after the patient is discharged. System 10 advantageously employs a clinical information system to accelerate and facilitate acquiring compliance documentation at the point of care. Workflow processor 15 manages the process and allows the system to track and monitor patient treatment in relation to a best practice, e.g., JCAHO guideline. Processor 15 identifies treatment steps to be completed, notifies clinicians responsible for the steps and identifies and escalates alerts identifying treatment variances from the guidelines to supervisory staff. Processor 15 manages the process by determining which patients to track, identifying staff to be notified and given tasks to perform for particular patients and also identifying steps that are completed and those needing completion and escalation if necessary.
In contrast, known systems provide retrospective, labor intensive, and after the fact compliance documentation. System 10 advantageously supports flexible compliance documentation acquisition that adapts to existing localized hospital organization processes and dynamically adapts to changing JCAHO/CMS AMI treatment guidelines, for example. System 10 advantageously reduces need for full-time staff presence and the associated cost involved in an inflexible hard-coded software application supporting compliance documentation involving manual documentation and human tracking. System 10 in other embodiments employs other guidelines for the treatment of Acute Myocardial Infarction, for example, guidelines provided by other regulatory bodies, or the regulatory bodies of other countries. System 10 in other embodiments employs other measurement sets and clinical treatments and guidelines for different medical conditions (other than AMI) from JCAHO/CMS and other bodies. System 10 is employed where a pre-defined process is to be followed in treatment of a patient involving coordination and management of various members of a healthcare worker team. Workflow processor 15 is advantageously integrated with a Healthcare Information System (including a clinical information system) 35 to support implementation of JCAHO/CMS compatible guidelines. Workflow processor 15 initiates necessary clinical treatment actions for patients and capture of documentation indicating that the actions were completed, or if not, reasons why the actions were not completed. System 10 is used in hospitals, as part of (or in conjunction with) a Healthcare Information System and Workflow processor.
Processor 15 prompts a clinician via a display image presented on workstation 12 or 14 to provide documentation indicating treatment actions in compliance with guidelines and to enter data indicating reasons for not monitoring other care measures (real-time ECG data and discharge orders may not be available in the system).
Workflow task processor 15 in step 904 provides a healthcare worker with information indicating treatment activity to be performed for the patient that is in conformance with recommended guidelines for treating the medical condition. Processor 15 in step 909 prompts the healthcare worker (e.g., via a message in a displayed image) to complete documentation indicating an action taken by the healthcare worker in treating the patient and documenting compliance with the recommended guidelines for treating the medical condition. The action taken by the healthcare worker comprises an AMI treatment action comprising at least one of, (a) providing Aspirin and (b) smoking cessation counseling, for example. Processor 15 initiates sending a data collection form (automatically pre-populated by the system with previously acquired patient information) to the healthcare worker to document performance of a treatment action taken by the healthcare worker in treating the patient and documenting compliance with the recommended guidelines for treating the medical condition. The previously acquired patient information indicates characteristics associated with the action taken by the healthcare worker. In addition, processor 15 prompts the healthcare worker to complete documentation indicating a treatment action was not taken.
Processor 15 executes in response to a predetermined process definition in order to add a task to a worker task list, remove a task from a worker task list or to modify a task on a worker task list by determining a sequence of process steps including, start, wait, decision and task allocation steps. Specifically, processor 15 executes in response to a predetermined process definition determining a sequence of process steps including a wait step before sending the data collection form to a healthcare worker to document performance of a treatment activity for a patient. The healthcare worker is prompted to complete the documentation (e.g., the form) at a time substantially close to the time of the action being taken by the healthcare worker (or concurrently with attendance to the patient for performing the treatment action) in response to received data identifying the medical condition of the patient. The time substantially close to the time of the action being taken by the healthcare worker comprises at least one of, concurrently with the action being taken, within an hour of the action being taken, within a day of the action being taken and prior to discharge of the patient. In step 914 processor 15 tracks different concurrent documentation processes for corresponding different patients as well as steps to be executed next in response to a process definition. The process of
The system, processes and image displays of
This is a non-provisional application of provisional application Ser. No. 60/747,215 by H. J. Scherpbier et al. filed May 15, 2006.
Number | Date | Country | |
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60747215 | May 2006 | US |