The MAGIC of Clinical Review: A logical progression toward CPOE

By: Donna Carroll, VP, Systems Personnel

A must-read article for all MAGIC sites considering the use of Clinical Review

MEDITECH's Clinical Review application can be a wonderful tool for your healthcare providers. Using Clinical Review can result in higher physician productivity, improved patient safety, and better preparation for CPOE. But, does your staff have the time and expertise to implement it properly?

A Primer on Clinical Review:

Clinical Review is an application used by MEDITECH MAGIC sites that provides physicians with a real-time, dynamic view of patients’ clinical information. It displays data based on pre-defined, standardized data mappings which format the data into easy-to-read panels organized by type, specifically:

• Laboratory, Microbiology, Blood Bank, Pathology
• Medications
• Radiology exams
• Reports from Departmental or Physician Documentation
• Notes and Assessments from NUR and EDM
• Vital Signs and Intake & Output queries
• Other queries that are part of a Special Panel

Clinical Review has a similar layout to the Client Server EMR application with interactive panels. The display of data allows providers to easily review a patient's clinical data sorted by department, date, time, or data item, making it easier to navigate through and to analyze data.

Additionally, Clinical Review is utilized by the following applications:

• Physician Desktop and Workload Management (PWM): The Clinical Review and Physician Desktop applications work together in providing the physicians with improved workflow from sign-on, rounding, to viewing data, as well as from electronic ordering to discharge.
• Physician Documentation (PDOC): The clipboard functionality of Physician Documentation copies results from Clinical Review directly into patient documentation.
• Emergency Department Management (EDM): Assessments, tests, products, orders, procedures, notes and reports entered in EDM are transferred directly to Clinical Review.
• Internet Access for Doctors (IAD): Physician Internet Gateway relies on Clinical Review to display results in an XML format

How do we know if we’re ready for Clinical Review?

The fact that you’re asking the question probably means that you are ready. If you have any plans to utilize MEDITECH’s Physician Desktop and Workload Management (PWM) or Provider Order Management (POM, a.k.a. CPOE) applications in the future, then implementing Clinical Review is a logical progression toward that goal. Getting your physicians accustomed to navigating MEDITECH to access patient data will help prepare them for the transition to the Physician Desktop or CPOE.

If your organization is LIVE with the 5.6 update or currently have the PCM or EDM suites installed, then you are eligible to install Clinical Review. All sites on release 4.9 or later should already have the EPS (Extra PCI Source) database which is used to populate the Clinical Review application.

Installing Clinical Review requires that the EPS module be on a server-class machine and should be the only application on the server. Clinical Review also runs on fairly large memory structures, so this machine may require significant disk space and an ample supply of RAM. It is recommended that the server should be a fast OSAL machine with 8kb blocks. Additionally, utilizing Clinical Review will require use of the 4.x workstation.

How will we benefit from using Clinical Review?

There are many benefits to using the Clinical Review application, including:

• Real-time dynamic views of patients' clinical data
• Data standardized with pre-defined EMR ID mappings
• A Windows look-and-feel with ability to use mouse navigation
• Streamlined navigation and integration with Advanced Clinical modules
• Clinical Review is a non-purging application which actually stores the data

The above benefits are directly related to the day-to-day use of the Clinical Review application, but it’s equally (if not more) important to take a look at the big picture. It’s a fact: the ability to gain physician adoption of CPOE is directly related to the state of organizational readiness for the deployment. Many variables factor into physician acceptance of CPOE, including the communication plan, end-user training, and go-LIVE support. However, one of the easiest ways to prepare your physicians for CPOE is to get them accustomed to the daily use and navigation of the system to access detailed patient data, such is available to them via the Clinical Review application.

In addition, when Physician Desktop is used in conjunction with Clinical Review, the applications can have a significant impact on patient safety and quality. Physicians are able to see critical values through Clinical Review, and receive notifications immediately upon signing into Physician Desktop. Together these applications consolidate access to most commonly-used functions onto a single screen, enabling providers to manage their patient populations more efficiently and to prioritize tasks.

This all translates into a more rapid return on investment (ROI) on your CPOE implementation, more efficient and productive physicians, and improved patient safety.

How can our EPS mapping be accomplished more efficiently?

The display of data in the Clinical Review application depends upon data mappings from EPS to specific data items, called EMR IDs. Every single data item must be mapped in order for that data to flow to Clinical Review. This mapping process requires not only a considerable amount of time to complete, but also takes a certain degree of ramp-up time to get started.

If you’re like most facilities today, you understand that time is a precious commodity. With one more project on your plate, you may be wondering, “What is the most efficient way to accomplish our EPS mapping?” One thing you should carefully consider is whether the time your in-house staff spends on this project is an acceptable trade-off for the time stolen from other critical tasks. A typical application analyst spends their average day evaluating issues and re-prioritizing items in order to focus their attention on the most critical needs. This constant juggling of tasks will inevitably push Clinical Review lower and lower on their task list. Before you know it, the Clinical Review project has found its way back on the shelf waiting for the rainy day that never comes.

This is where we can help! We have a team of consultants with extensive EPS mapping experience who have refined the mapping process to establish a proven method for success. Due to this prior experience, we’ll be able to complete the mapping in far less hours than your in-house staff would be able to. Also, utilizing our team of consultants helps to ensure data consistency throughout the mapping process.

In addition, the EPS mapping process does not require our consultants to be at your site to perform the job. This translates into cost-savings for you since there will be no travel required. In fact, working remotely actually boosts productivity since there are none of the typical distractions of a hectic office environment.

After an initial consultation and dictionary review, we will provide you with an approximate time estimate to complete the mapping process. This will allow you to budget the project more accurately, and to plan your end-user training accordingly. We provide you with status reports on the mapping progress so that you can track the project effectively. When you consider all of the benefits, outsourcing your EPS mapping to our team of experienced professionals just makes great sense!

To learn more about how Systems Personnel can assist with your Clinical Review implementation, please give me a call at 413-569-1111. We look forward to working with you! Regards, Donna.