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Jim King



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    OS23 - Looking Through the Data Lens (ID 38)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Executive
    • Presentations: 1
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      OS23.01 - Using the EMR to Rapidly Respond to Product Recalls (ID 394)

      Jim King, Paediatric, Children's Hospital of eastern Ontario; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Drug and consumer product recalls are fortunately rare in healthcare. When a recall occurs timely response to identify, remove and provide an alternative are crucial. A voluntary recall was issued in September 2018 by Abbott (for certain liquid nutrition products due to possible bacterial contamination) and in October 2015 by Sanofi-aventis (for Allerject?, epinephrine injection, for potentially inaccurate dosage delivery). The purpose of this presentation is to highlight how CHEO used the analytic capability of an integrated EMR to rapidly respond to these product recalls.


      Methodology/Approach:
      Following the announcement of each recall a product based report was generated for all the potential order ids (ERX) for both the inpatient and outpatient departments identifying both the patient and provider. The report was generated for the current order (day of) for the inpatient department and the order within the last year (time - 1 year) for the outpatient department. Relevant information for these orders including ordering provider, ordering date, and the patient address, name, phone number were extracted. An alert was then developed within the EMR and presented to the provider when ordering the recalled product. The alert provided information about the recall with hyperlinks to the Health Canada or the Canada Food Inspection Agency websites along with prescription information and a recommended alternative when attempting to order the recalled product.


      Finding/Results:
      The following table outlines the number of unique patients that were identified as having an order for the recalled product. The report was generated the same day as notification of the reporting team of the product recall. Orders Sanofi-aventis (Allerject?) Abbott Formula Inpatient N/A 94 Outpatient 21 18 Total 21 112 An alert for the recall and an alternative for the recalled product were built within the order entry system.


      Conclusion/Implications/Recommendations:
      Managing product recalls may be challenging. While it is a responsibility of the dispensing pharmacy to notify patients when there is a recall it is equally important for the ordering physician to identify and notify patients and prescribe an alternative course of therapy. In the hospital setting we have used the analytic capability of our EMR to rapidly respond to two product recalls. This allowed a quick and reliable means to identify patients and their providers and communicate quickly with our families. Also, we were able to notify prescribers with the EMR of the recall in the context of their ordering and to offer an alternative to the recalled product.


      140 Character Summary:
      Using our EMR we rapidly responded to two product recalls, identified affected patients and providers and offered alternatives to the recalled product.

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    RF04 - The Power of EHR's! (ID 47)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Rapid Fire Session
    • Track: Clinical and Executive
    • Presentations: 1
    • Coordinates: 5/29/2019, 08:30 AM - 10:00 AM, Room 201 A
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      RF04.06 - SK and CHEO; Living in the Instance  (ID 78)

      Jim King, Paediatric, Children's Hospital of eastern Ontario; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      In 2016 SickKids & CHEO agreed to work together on a single instance of Epic for closer organizational partnership, technical efficiency and optimized care through clinical alignment. The purpose of the presentation is to provide an overview of the governance structure for decision making and the outcome of the clinical workflow and content sharing between the organizations.


      Methodology/Approach:
      While sharing the same instance of Epic, SK and CHEO have had different enterprise wide implementation staregies. CHEO has been engaged in a rolling implementation startegy since 2012 while SK went live with a 'big bang' implementation in 2018. Both institutions are live with EpicCare Enterprise 2017 edition. CHEO has obtained HIMSS EMRAM Stage 6 and SK has obtained HIMSS Outpatient EMRAM Stage 6. A mixed-methods review of the shared workflows and clinical content across 12 integrated clinical information system applications took place in April 2018. Descriptive statistics are presented for for both the workflow and clinical content shared within each application.


      Finding/Results:
      Workflow and Clinical Content were reviewed across 12 applications. The percentage of build shared between the two organizations is presented in the table. Further to the information shown there was complete sharing between organizations for MyChart patient portal, Medication records, Dosing Rules, eCTAS, Synopsis views in Endocrine, ENT, Orthopedics and Standardized views of I&O and vital signs. Application WorkFlow (%) Clinical Content (%) Inpatient Orders 75 30 Inpatient Clin Doc 50 15 Emergency 70 15-20 Ambulatory 45 15 Surgery 45 15 Oncology 25 10-15 Pharmacy 70 10-15 Reporting N/A 80 HIM N/A 20 Lab N/A N/A Radiology N/A 20 Patient Access and Revenue Cycle N/A 20


      Conclusion/Implications/Recommendations:
      Overall, given the complexity of the partnership, the initial results are encouraging. We identified more workflow overlap (45-70%) than content overlap (10-30%) with less content overlap overall. In many cases, less sharing is due to the nature of the application itself rather than the install. As expected, the level of overlap is higher in those areas where we have had a closer working clinical relationship (ED, Pharmacy, Inpatient and Ambulatory Care). The initial analysis occurred early in the content review process; now that both organizations have stabilized post go-live we believe that the shared workflows and clinical content has increased and we are planning to repeat the analysis. Further, we have started to align the application leadership teams at both organizations to further enhance the partnership and sharing of information.


      140 Character Summary:
      In a single instance of Epic, shared by SK and CHEO, we explore the shared workflows and clinical content of 12 integrated clinical information system applications.

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