Communication & Tracking Technology

Customer Service

The PTTF considers elsewhere the Ideal Patient Experience. Currently PFF handles over 300,000 phone calls per year. There is a high level of dissatisfaction with these communications by patient and staff. There are hundreds of CRM products available. The PTTF is recommending the deployment of Epic prodcts for the EMR. An intergrated CRM product has many advantages. Therefore the PTTF evaluated the Epic products supporting CRM.

Epic's MyChart

MyChart is a web interface that permits patients secure access, allowing them to make appointments, view laboratory results, request prescription refills and communicate with their healthcare team. The Geisinger MyChart website describes the functionalities: click here. Gesinger had a very rapid registration of patients when MyChart was introduced.

MyChart allows patients to set alerts which are email messages that are sent based on user's selected options. The email directs them back to MyChart where the alerts are prominently displayed.

Patients can also look at their medical record, including:
  • Call Center Calls
  • Health Issues
  • Health Reminders
  • Hospital Visits
  • Immunizations
  • Lab Results
  • Medical History
  • Medications
  • Recent Visits
The PTTF request a quote from Epic. MyChart costs $2.35 per patient record accessed per year, which includes maintenance and, if the software is on its own server, InterSystems Cache. Records count only once per year. If users want to print wallet cards, they must have Adobe Acrobat (full version). MyChart carries a $20,000 annual minimum.



MyChart operates from a separate database which shadows the primary EMR record source. This design prevents patient accessions from degrading the functioning of the production database, sending only messages or requests back to the production database. The only direct queues are the high response queues required, if the design choice incorporates direct appointment scheduling by patients. MyChart employees a secure socket layer encryption (see Security document).

The MyChart Training Manual contains further information; it is a large (4 mB) file and will take some time to download.

Patient involved in their care is important for customer satisfaction and also for quality assurance and patient safety.
Epic's Nurse Triage
Nurse Triage is a set of Navigation Wizards that facilitate movement between patient record screens while processing patient communications. Protocols can be built and then called up during a call.



The Nurse Triage Training Manual contains further information; it is a large (1.7 mB) file and will take some time to download.


Paper vs. Electrons

CMH Health Infomation Management (HIM) maintains paper records, which typically have significant delays in filing or difficulty in being retrieved. Because of the difficulties with the HIM records, each division has created shadow systems. In transitioning to an EMR, careful consideration of these paper records is important. The problems with storage and retrieval may be minimized by converting paper records to electronic form (see illustration):


The Director of HIM indicated that HIM is currently evaluating external vendors who will scan all the paper records. The documents would be accessible via Epic and retrievable by physician and encounter. It is anticipated that this project would be completed as Epic is rolled out at the EMR. Thereafter, paper records would be retired.

Also, we frequently receive outside paper records which are useful in caring for our patients; some of these records must also be retained. Digital imaging systems are readily available which receive faxes in digital format. The digital files can be more readily stored, triaged, processed, and retrieved that their paper counterparts. CMH has very limited capacity for receiving digit images; this limitation should be eliminated by the development of advanced document image systems.

Tracking Technology

The healthcare industry has been far behind tollroads and supermarkets in applying bar coding and Radio Frequency Identification Tags (RFID) technologies. Bar codes will soon be an obsolete technology in supermarkets, yet healthcare is now embracing them for tracking. RFID tags are familiar to most in Illinois from the Tollway I-Pass box that sits in a car and registers a transit through the toll plaza. Within a few years we will exit the supermarket by pushing the cart through a tyag reader that will instantly total up the bill for the entire content of the cart.

It is a small stretch to visualize how this might work in a clinical setting. We will always know exactly where a patient is geographically located. We will also know where are inventory is located. We can automatically bill for a respirator in the patient's room. We can implement high level safety measures. If a drug enters the wrong patient room, an alert will sound just as it does when someone leaves a store without being properly checked out.

For a more information on RFIDs, see: Advanced Telephony

Current CMH phone systems have significant limitations. They are, however, highly reliable. The most advanced systems available are Automatic Call Distribution (ACD) lines. The application is, however, proprietary and access to data is restricted to the software licensed with the prodcuct. Thus, it is not possible to further analyse the data beyond the limited capabilities of our ACD software. Significantly more powerful systems are now available.

Improvements in telephone and paging technology are necessary to accomodate the demands required of them. The PTTF has explored several options, but these issues represent an arena where there is unfinished business and a need for further investigation. The PTTF identified the following for further evaluation:
  • IP Phones
  • Wireless environments
Items to include:

  1. Improved ACD
  2. Predictive dialing
  3. Interactive Voice Response (IVR)
  4. email; secure (SSL) email
  5. wireless
Telemedicine

CMH is currently a regional tertiary care center. Achieving a dominant role requires rapid access to consultation and easy transfer of data. High speed internet connectivity permits transmission of video and data for conferencing and consultations over great distances. Research scientists also rely on collaborative relationships that are often separated by great geographic distances. Developing video conferencing facilities will support both telemedicine consultation and the research enterprise. The participation of NUFSM in Internet2 may provide opportunities to be leaders in telemedicine.

Business EDI is also important for profesional billing, health plan benefits management, prescription refills & other CPOE, and numerous other business functions.

David A Stumpf, MD, PhD