Work
Emergency Medicine Charts (emchart.app)
Optimizing charts with comprehensive and accurate details of patient
encounters helps justify the level of care provided, ensuring fair
reimbursement for the services rendered by emergency physicians.
The site features an extensive list of conditions, management options,
vital signs, lab values, and clinical scenarios to assist emergency
physicians in determining if a critical care condition exists.
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Patient Navigator Program
The patient navigator program is tasked with reducing structural
barriers to make it convenient for patients to access effective care
and augmenting clinician practices. Patient navigators are well-positioned
to bridge gaps inherent in health systems and provide a closed feedback
loop with patients after specific interventions.
Interventions designed to reduce these barriers may facilitate timely care
by addressing several key priorities. These include reducing no-shows or
missed appointments, minimizing the time or distance between service
delivery settings and target populations, decreasing inpatient admissions
and emergency department visits, and eliminating or simplifying administrative
procedures such as scheduling assistance, transportation, and translation
services. Additionally, coordinating between different departments and members
of the healthcare team is crucial, such as ensuring a patient needing an MRI
can see the orthopedic surgeon within a short period and possibly undergo
surgery. Understanding the patient experience with services and improving
upon the interaction is also a priority.
There is a clear need for this program because patients are often left to
navigate the healthcare system on their own, especially under the increased
stress of illness. They lack medical knowledge and understanding of the
healthcare landscape, which can leave them stranded on the road to health.
This issue is most pronounced in acute care settings, such as emergency
departments or urgent care clinics, but also affects surgical patients
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Automatically Log Procedures
Emergency Medicine residents will attest to the fact that their shifts are
already busy taking care of patients, following up on laboratory and
imaging results, speaking with families, and performing procedures. It
should come as no surprise that some of these procedures don’t make it
back into your residency’s procedure log and at the end of 3 or 4 years
you find yourself a few short.
At Maimonides Medical Center, we have been using an electronic medical
record (EMR) for the past decade but it wasn’t until the Spring of 2011
that we began to integrate key pieces of technology around it. As a means
to simplifying the lives of the residents and provide a more accurate
attestation of procedures performed, I wrote software to automatically
log procedures found in our EMR (Allscripts) and upload them to New
Innovations, an integrated software solutions for medical education programs,
with the residents receiving an email detailing the procedures that were
uploaded and attendings receiving an email to confirm the procedures.
The software was implemented on June 18, 2011 with great success and an overall
increase in the number of procedures logged by residents. The residents are
also very happy to have one less task to worry about after a long and tiring
shift with an average of 10-15 minutes saved per resident per shift.
Since the implementation of the software, bedside ultrasounds have now been
accounted for within the software in 2013 and are now counted towards ultrasound
procedures performed by the resident.
You can find the source code at GitHub.
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Custom Reporting System
We aimed to develop an automated graphical dashboard for key performance metrics,
which was distributed daily to clinical and administrative leadership.
Additionally, we created automated, dynamic reports to support quality assurance
and improvement activities. Furthermore, we automated the process of managing
physician and nursing sign-offs for the Incomplete Board. These objectives had
practical applications, including the Emergency Medicine Dashboard, automated
dynamic reports, and managing the incomplete charts board.
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ED Physician Communication
As an Emergency Medicine resident at Maimonides Medical Center, I quickly recognized
that communication between emergency physicians, primary care physicians, and
specialists was often disorganized. This disorganization was partly due to patient
non-compliance and untimely follow-ups with primary care physicians and specialists,
and partly due to the chaotic nature of the emergency department. Consequently, there
was frequently a breakdown in communicating a patient’s history, presentation, and
diagnosis to other physicians, hindering further care.
Timely and informative communication is crucial for patient safety, coordination of care,
and optimal resource utilization. To address this issue, I developed a stateful service
using Perl, CPAN, and Microsoft SQL Server (though it is database-agnostic) to send
automated and directed internal emails to physicians within the hospital system.
The stateful nature of the system allows us to contextualize the patient’s care in the
emergency department and apply dynamic rules to coordinate their care through various
programs, including congestive heart failure and total care management. It also
leverages outpatient resources such as case management and social work.
While the emergency department initiated this project, we have observed adoption by
most specialties, including internal medicine, OB/GYN, general surgery, and cardiology.
Physicians now primarily contact the emergency department only when they have not
received emails regarding their patient’s emergency department encounter, indicating
the system's effectiveness and integration into the broader hospital workflow.
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Emergency Medicine Dashboard
The impetus to create the dashboard originated from requests by the department chairman
and hospital executive board for insights into operational and performance metrics. These
metrics included daily and monthly volume, admission rates, re-admissions, the frequency
of patients boarded in the ED, bed status on inpatient floors, and overall patient flow
and throughput.
Initially, simpler metrics were compiled daily by the Director of Operations, who ran a
SQL query through the Cognos query tool to obtain the data. This data was then parsed
manually or through an Excel spreadsheet. As expected, this process was tedious and
time-consuming, diverting the Director’s attention from other important projects.
As a medical student with a background in engineering and system administration, I recognized
that I could help create a dashboard to consolidate all these metrics into a single email.
While finding the data within the Allscripts EMR was challenging and tedious, I was able to
create SQL functions and procedures for efficient retrieval through extensive notes and trial
and error. The results (graphs) were generated using Perl to efficiently parse through the
generated results and were piped through queries against Google chart images.
The idea, brainstorming, and implementation for the dashboard occurred during the winter of 2010,
and the product went into production in March 2011. Successive iterations have been made
following constructive feedback from stakeholders, informing us about "what works and what
doesn’t work."
A second version of the dashboard was developed to accommodate future metric requests while
simplifying and refactoring the code to meet these and other needs. This newer version has
improved the presentation of the data, making it cleaner and more understandable.
