Projects, designs, and writings on health IT

2016-07-14

ResultCast: A Tool For Reporting of Results

4:01 PM Posted by David Do, MD No comments


Introduction

For real-time reporting of long-term EEG results in our hospital, we have an extensive email listserv, through which brief reports are sent three times daily. Most email recipients have no patients on the list, and therefore users are forced to sort through the junk every day. 
In many cases the recipients of the messages are not the primary providers of the patients, and there are many degrees of separation between the patient, the providers, the interpreters of the data.

EEG machine <-> EEG technician <-> EEG fellow <-> Neurology consult team <-> Primary team <-> Patient

Such a system has limitations


  • Workflow burden - EEG interpreters have many hours of data to manually sift through to find important data
  • Delayed diagnosis (detection), and communication of conditions like subclinical status epilepticus 
  • Delayed feedback of adequacy of anticonvulsant therapy – there are many patients connected at a given time, routinely reported three times daily
  • Fragmented communication - Primary provider is often excluded from the primary conversation (when not a part of the listserv)
  • EEG interpreter is excluded from the clinical updates and the clinical context that helps with interpretation of data (medications given, changes in exam)
  • Email inbox clutter
  • Limited continuity – overnight usually by different MD and different EEG fellow (see next page)

Solution

I designed an EMR-integrated system for reporting and broadcasting the data. This system facilitates workflow of the EEG fellow and helps communicate to all relevant providers without cluttering inboxes.









Benefits

  • Earlier diagnosis
    • More clear triage of patients who need close EEG attention overnight
    • Offering Primary provider involvement in the conversation encourages them to contribute updated clinical status, to seek help at critical times, and to know what to look out for.
  • Reduced resource utilization
    • More clear indications that goals have been met and sooner discontinuation of EEG. Often a patient is connected to continuous EEG because of a poor mental status, and could be immediately disconnected once they show wakefulness. The primary team may be aware of wakefulness, but leaves the EEG on.
  • Streamlined communication
    • This system reduces cluttered email chains and allows EEG readers to leave more frequent updates on patients who need them without feeling like they are cluttering in boxes.
    • Handoffs – overnight person sees the conversation that occurred earlier in the day and vice versa



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