Status, location and… favorite color?

John from EMR and HIPAA and I were recently discussing the notion of  the ‘status’ of a patient in an EMR application and it got me to thinking… Is there another aspect of tracking a patient that has been overlooked?  So far, we have two concepts to describe  a patient while she is visiting the office:  Location and Status.  These are pretty comprehensive but in this post I want to brainstorm about other possible descriptions of a patient during her visit. Maybe keeping track of her favorite color will bring us a step closer to EMR paradise!

The two existing aspects that describe a patient’s place in the workflow are currently:

Status (“Waiting for”): What is the next action that needs to happen with this patient?    Is she waiting in an exam room? Is she receiving an infusion?

and

Location: Where, physically, is this person?

I have obtained a list of the possible locations specific to my client’s office. This list is modifyable but i am concerned with the possibility of some serious tunnel-vision.  Let’s say if I were to take this product, plug in the correct locations and statuses for a different office, would they still be able to march through their workflow by simply changing states?  Probably, but I want to take a few shots in the dark. Feel free to let me know how ridiculous they are.

Urgency: How urgently does this patient need to move along the workflow? With status and location, we have ideas of position and direction, what about velocity? You can’t describe a play in baseball very accurately without some notion of the speed of the ball.  I’m sure this is a given in emergency room EMR products.

Let’s continue with the baseball analogy. When a pitcher pitches the ball, the rotation of the ball also determines what course it takes throughout the play. What in the world could we force into that analogy?

“Patient Spin”: What about a patient’s disposition? This could almost be an analogue for urgency (I am sure the two are not orthogonal). If the staff knows how happy/disgruntled a patient is, can we make something better or more effective with that information?

“Urgency” sounds promising, but I’m not sure sure about “patient spin”.It’s probably just a neat idea.  We must tread carefully, however. We don’t want to get mixed up into patient string theory!

5 Responses to “Status, location and… favorite color?”

  1. John Lynn Says:

    Nice discussion orlowski and welcome to the EMR blogging world!

    We use a combination of status and room (essentially location) to do most of our work. For example, one status means they’re ready for the nurse. Then, once the nurse adds the room to the patient, then the doctor knows that the patient is ready for them and where they’re at. Has worked out quite well.

    As far as urgency, we have a field that’s called “Acuity” which can be used however you want. We’ve chosen not to use it. Haven’t really had a need, but in other settings I could see where this might be needed.

    We also have a generic field called “Appointment Note” It’s mostly updated by the front desk, but has been a really useful field (basically a freetext box) to put all sorts of comments about the visit or a patient’s preferences.

  2. orlowski Says:

    Thanks for the comment. I am hoping to make this discussion about technical aspects of implementing an EMR for the improvement of not just my project, but others’ as well.

  3. Marcia Orlowski Says:

    What you are talking about, it seems to me are the dimensions of assessment of the status of the patient to make the decision of what is next. Where in the system are the nurses, PAs or docs responding to blood test results, need for transfusions, need for hospitalization, need to change medication, etc.

  4. orlowski Says:

    Marcia, I’m not sure what you are saying. Are you emphasizing the difference between the patient and the system?

  5. Joy Hester Says:

    Nick
    Acuity is something I have considered in patient asignment and scheduling. The problem in the treatment area rises when we have a lot of high acuity patients on one day and low acuity patients on another day. it seems it is very hard to even it out. Parients expect to be treated on the day they see their doctor. When one doctor sees a lot of patient on one day that puts most of the treatments on that day. It is hard to even out.

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