Trade.Information

A new electronic approach to documenting patient care : Duke University Hospital (DUH)

Duke University Hospital (DUH) is collaborating with Duke Health Technology Solutions (DHTS) to develop a new electronic approach to documenting patient care.

The project involves developing a single, integrated clinical system to support patient care across the continuum. This includes a plan for standardization and collaboration among clinicians, as well as support for medication safety and primary patient safety initiatives.

The system is being designed to increase operational efficiencies and will eventually be inclusive of Computerized Physician Order Entry (an electronic system that replaces hand-written physician orders with a computerized system), Pharmacy and Ambulatory systems.

This project, which will be implemented over the next two years, will replace the existing documentation system and extend electronic documentation into most inpatient nursing units. It will also have a significant impact on all four quadrants of the DUH Balanced Scorecard (BSC).

Mary Ann Fuchs, chief nursing and patient care services officer for Duke University Health System (DUHS) and DUH, says this project was developed in alignment with the DUHS strategic plan. The project further advances the health system’s commitment to having a patient-centered approach to care, she says.

“Development of a new electronic medical record will facilitate the flow of patient information,” Fuchs says. “By building this resource into the fabric of our operations, we will fundamentally change and improve the way patient information moves throughout the institution, thereby enhancing our ability to care for our patients. This truly promotes our goal as a health system to continue to develop innovative ways of providing patient-centered care. This is also reflected by the targets we have set on our Balanced Scorecard.”

News Inside News;

The new electronic patient care documentation system’s impact on the BSC is multifaceted. The following are some examples of the project’s alignment with DUH Balanced Scorecard initiatives:

Quality and Patient Safety
• Patient safety: medication, legibility of orders and availability of medical record

• Increase organizational efficiency: Streamline communication, documentation, potential for operations and patient outcomes research processes

• Customer: Increase patient satisfaction through a user-friendly, readily available patient care record

• Work Culture: Increase staff satisfaction and communication

• Finance: Enhanced coding through legible, available clinical documentation, accurate capture of workload and potential predictor of workload.

The project had a kick-off meeting in January 2007 and work is under way with input from staff nurses and other disciplines to begin building the system. The initial phase will include roll-out to the intensive care units and extend to the intermediate areas. Phase two will include the ancillary areas. Phase three will incorporate medication administration and bar coding into the system.

The Executive Committee, which leads the 10-committee team formed to work on a project to develop a new electronic approach to documenting patient care, includes leaders from Duke University Health System, Duke University Hospital and the Duke School of Nursing.
Proposed Changes in Promotion and Tenure Policies for Clinical Departments
Ross McKinney, MD
Vice Dean for Research
A Committee appointed by Dean Williams (Ross McKinney, MD; Sal Pizzo, MD, PhD; Tony Means, PhD; Michael Frank, MD; Danny Jacobs, MD) has reviewed the promotion pathways and proposed changes. The document is long and available at the link below for review. The document has three sections: an introduction describing the changes, a brief analysis of MD faculty entering tracks I and II to see whether they are comparable, and the full description of the new pathways.

Briefly, if the proposal is approved:

We will have 5 tracks -
I - Clinical Academic [also for career educators and administrators] - standard (for us) 11 year tenure clock
II - Clinical Research - standard 11 year tenure clock [evaluates both clinical and research metrics]
III - Pure Research - standard 11 year tenure clock, with no clinical metrics
IV - Clinical, Non-clocked - Equivalent to our old "Clinical" track, but we remove the word "Clinical" from the faculty rank. Dropping the word "clinical" is becoming a national norm, since the words "Clinical" or "Research" in a faculty title are increasingly viewed as detriments to grant funding and because they seem to declare 2nd class citizenship. Since clinical and research faculty are part of our bedrock, we need to upgrade these two categories. There is now the possibility for tenure on Tracks IV or V for individuals selected for excellence from among full professors.
V - Research, non-clocked - Equivalent of our old "Research" track
We explicitly value team work/ team science - grants involving other departments, for example, are to be recognized for having greater worth than the dollars per se.
We explicitly value certain "community" functions, like IRB and IACUC (one year's full-time service is roughly equivalent to one first authored paper)
We rename the "associate of the department" rank to "instructor"

Release link: http://inside.duke.edu/article.php?IssueID=175&ParentID=16596