TrakCare Solution Guide

2.2 TrakCare Clinicals (CIS)

Consider the problems that arise when an elderly, confused patient presents for treatment and is unable to recall his past medical experiences. Imagine if the doctor could immediately access that patient’s complete medical history at that facility, all from a single screen. Diagnosis and treatment could be carried out much faster and far more accurately. This is what TrakCare Clinicals offers.

All TrakCare functionality is built on the Electronic Patient Record (EPR) and allows the capture, display, and analysis of patient-centric information, facilitating better patient care.

TrakCare Clinicals provides functionality to review and document patient care, and as a by-product automates the ordering of treatment and procedures. TrakCare Clinicals can be implemented as a stand-alone product integrated with existing systems, or in parallel with one or more modules of TrakCare.

TrakCare Clinicals allows authorised healthcare professionals to document care and enter treatment, exploratories, and procedures directly into the patient’s EPR using a connected computer located in a ward, clinic, consulting room, home, or office. Orders can be sent to the provider of the service electronically, by e-mail or fax, or they can be printed to enable the clinician to sign and verify an order if required.

Functionality

All clinical functionality starts with the TrakCare Clinicals ? Foundation module. The following add-on modules can be implemented in parallel with TrakCare Clinicals ? Foundation or as part of a phased implementation plan:

• Nurses Workbench
• Clinicians Workbench
• Prescribing
• Pharmacy Workbench
• Radiology or Departmental Workbench
• Active Decision Support

Clinical Applications

2.2.1 TrakCare Clinicals - Foundation

In addition to the TrakCare Core Components (see previous section), TrakCare Clinicals ? Foundation includes the following components:

• Patient Lists
• Questionnaires
• Orders
• Clinical Summary

Example: EPR

• Patient Lists includes:
  • Patient and Patient Episode allows healthcare professionals to define a list of regularly accessed patients or specific, regularly accessed patient episodes.
  • Care Provider Patient List allows clinicians to build lists of current patients according to their specifications based on various filtering criteria, such as specialty, care provider, patient type, and patient location.
• Questionnaires allows healthcare providers to capture assessment or other relevant information about the patient. Features include:
  • Intuitive Assessment and Information-Gathering Process can be defined by the clinical speciality to suit individual requirements and attached to workflows in the system. Answers from previously completed questionnaires can be used as defaults for faster entry.
  • Unique Decision-Tree Assessment Tools are triggered by the selection of a category of consultation generating decision-tree questions that can result in the selection of the appropriate clinical pathway/care plan.
  • Flexibility of Workflow Location allows questionnaires to be entered directly from the EPR or defined as an integral part of a clinical workflow, allowing healthcare professionals access at the right time and ensuring all required information is collected. Current processes with Questionnaires include: order entry, order administration, diagnosis, clinical pathways, and patient assessment.
  • EPR View makes all completed questionnaires available in the EPR for review and can be defined against the patient’s episode of care or an individual order item.

• Orders provides the foundation for recording and communicating information about the tests, results, and treatments for each patient. Features include:
  • Order Entry
  • Frequently Requested Items can be set up by healthcare professionals to enable these items to be quickly selected.
  • Questions can be defined for display at various points in the order entry workflow, ensuring relevant clinical information is collected.
  • Order Sets enables healthcare professionals to quickly order a group of order items, rather than selecting each item individually.
  • Order Entry Alerts are triggered for combinations of events.
  • Security Restrictions are a standard feature throughout TrakCare. Security group restrictions limit the user’s ability to order items and view sensitive orders and results.
• Clinical Summary provides a summary of clinical and administrative activity when a patient is discharged or transferred to another service. This document is used to communicate to consulting physicians and other caregivers involved in the patient’s treatment. Clinical Summary is comprised of the following features:
  • Configurable Format and Content can be designed (using Business Objects Crystal Reports or Microsoft Word) to meet a range of clinical settings. Patient information provided in the report can include principal diagnosis, other conditions and complications, procedures, medications, clinical opinion, and management plan. ? Multiple Document Types supports different types of summaries. For example, an inpatient discharge summary, an inpatient or aged-care transfer, or a nursing discharge summary.
  • Multiple Episode Summaries can be produced for one or more episodes, including nondischarged episodes, statistical discharges, and statistical readmissions. Episodes can also be identified as not requiring a summary.
  • Automated Distribution of the Clinical Summary supports electronic transfer, automatic faxing, printing, and e-mailing to the recipients selected by the user. The distribution list can include external healthcare professionals or organisations.
  • Security Features ensure only authorised users can modify the Clinical Summary. Flexibility exists to retain previously created discharge/transfer/ clinical summaries and produce a new version, which can then be updated.

2.2.2 TrakCare Nurses Workbench

In addition to the clinical functionality available in TrakCare Clinicals ? Foundation, TrakCare Nurses Workbench helps nurses track and manage their daily workload, improving their task efficiency and patient care.

TrakCare Nurses Workbench includes the following functionality:

• Workload Tracking enables nurses to build patient-centric worklists according to various filtering criteria such as specialty, care provider, patient type, patient location, orders and results status, and priority.
• Scanning and Image Association allows document and image files to be placed directly against a patient’s episode of care or selected order items.

Nurses Workbench clearly defines the daily nursing interventions and tasks, facilitating the recording of information such as:

• Drug Administration makes medication and fluid that are ordered for the patient visible in the Nurses Workbench. The workbench displays what is required to be administered to the patient and then provides a streamlined process to register the administration of those medications.
• Observations allows the recording of a patient’s clinical observations throughout the episode of care. TrakCare allows clinicians to enter patient measurements such as weight, heart rate, and blood pressure directly into the EPR. Measurements can be graphed to show changes over a period of time and can be printed for inclusion in the patient’s record. Abnormal results can be highlighted when they fall outside hospital-determined reference ranges. The observations may be defined to suit the clinical requirements of the site or users and can be accessed from the EPR or from the nurses’ worklist or other functional workflow.
• Specimen Collection allows the viewing and collecting of specimens as required for ordered laboratory tests.
• Clinical Pathways allows the clinician to define the tasks required for the care of a patient with a particular admission diagnosis or referral reason.
• Care Plans supports the planning of care tailored for the individual. Interventions derived as a result of care planning are matched and scheduled into the clinician’s diary. Standard Care Planning templates can be created.

2.2.3 TrakCare Clinicians Workbench

TrakCare Clinicians Workbench provides further advanced functionality to locate and view patient details and manage the electronic charting of the patient’s progress. It allows authorised healthcare professionals to document care and enter treatment and investigational requests directly into the patient’s EPR.

TrakCare Clinicians Workbench includes:

• Doctor’s Patient List allows healthcare professionals to define a list of regularly accessed patients or specific, regularly accessed patient episodes.
• Orders and Results Worklists deliver current laboratory, radiology, and medication data to the point of care. The worklist allows the clinician to access a list of patients’ results online and review orders according to specified defaults and sort criteria. A clinician’s own specific defaults and preferences can be defined and saved.
• Patient Assessments and Consultation includes:
  • Patient History
  • Subjective Findings for the entry of chief complaint and additional easy lookup fields
  • Objective Findings for the entry of observations and questionnaires
  • Assessment for the entry of diagnosis and clinical notes
  • Plan for the generation of orders
• Clinical Pathways allows the clinician to define the tasks required for the care of a patient with a particular admission diagnosis or referral reason.

Example: Clinicians Workbench

2.2.4 TrakCare Prescribing

The addition of the Prescribing module to TrakCare’s core functionality provides healthcare professionals with the additional safety of a clinical review system that offers medication checks and patient alerts when generating and capturing medication management plans.

With TrakCare Prescribing, the EPR includes the Medication Profile as well as standard EPR functionality.

Prescribing includes the following functionality:

• Generic or Brand
• Frequently Requested Items can be setup by healthcare professionals to enable these items to be quickly selected.
• Priority Assignment
• Questions can be defined for display at various points in the order entry workflow, ensuring relevant clinical information is collected.
• Order Sets enables prescribers to quickly order a group of items, rather than selecting each item individually.
• Prescribing Checks and Alerts are integrated into the prescribing process. TrakCare can be integrated with a third-party pharmaceutical drug knowledge database to provide checks and alerts for concerns including:
  • Allergies provides an alert when current medications prescribed have the potential to create an allergic reaction. The patient’s allergy history can be viewed showing the severity and the nature of the reaction recorded. Where a previous severe reaction was recorded, a mandatory override can be configured as part of the ordering process. Medication allergies can be configured to provide the following alerts:
    • Ordering of the same brand
    • Ordering an item that includes an allergy-related ingredient
    • Ordering an item from the same generic group
    • Ordering an item from the same allergy group (e.g., penicillin)
    • Ordering an item from an allergy group likely to give a cross-sensitivity reaction (e.g., cephasporins)
  • Duplicate Checking is available at a number of levels including:
    • Therapeutic Duplication Alerts
    • Order Item Duplication Alerts
• Interaction Alerts display when current prescribed medications interact.
• Drug Information can be displayed as an order entry message or links provided to thirdparty online or offline drug monographs.
• Therapeutic Substitution creates sets of medications or single medications to recommend to clinicians as alternatives to the placed orders.
• Formulary Management designates medications as formulary or nonformulary items. Ordering can then be restricted via security group dependent on formulary status.
• Security Restrictions are a standard feature throughout TrakCare. Security group restrictions limit the user’s ability to order items and view sensitive orders.

2.2.5 TrakCare Pharmacy Workbench

TrakCare Pharmacy manages safe prescription dispensing and inpatient dispensing. Additional tools are available to support clinical pharmacist activities such as medication review, patient counselling, and education.

Pharmacy Workbench includes the following functionality:

• Dispensing Workbench
• Electronic Format receives pharmacy prescriptions in electronic format, directly into the dispensing system.
• Full Prescription Dispensing
• Unit Dose Dispensing
• Configurable Dispensing Process
• Queuing of Medication Orders with verification, dispensing, and dose reconciliation
• Clear Display of prioritised patient lists with current clinical information
• Patient Alerts
• Drug Manufacture records the manufacturing process and the product formula, specifies the quantity for manufacture, and deducts the quantity of items used automatically when the process is started. The product is also added to the inventory at the conclusion of the manufacturing process.
• Medication Review Reporting includes the following features:
  • Configurable Format and Content can be designed (using Business Objects Crystal Reports or Microsoft Word) to meet a range of clinical settings. Patient information provided in the report can include principal diagnosis, other conditions and complications, procedures, medications, clinical opinion, and management plan.
  • Multiple Document Types can be configured to support different types of medication review reports.
  • Automated Distribution of the medication review reports summary can be carried out by electronic transfer, automatic faxing, printing, and e-mailing to the recipients selected by the user. The distribution list can include external healthcare professionals or organisations.
• Pharmacist Clinical Workbench includes the following features:
  • Prioritised Worklist
  • Single Entry, including therapy notes
  • Review and Actioning
  • Access to all relevant patient information and results
• Security Features ensure only authorised users can modify the medication review reports. Flexibility exists to retain previously created medication review reports and produce a new version, which can then be updated.

Example: Patient Alerts

2.2.6 TrakCare Radiology/Departmental Workbench

TrakCare Radiology/Departmental Workbench streamlines the entire work process of the medical imaging department, allowing for easy and efficient order placement, authorisation, and scheduling. The module can also be used to support other departments, including physical therapy and cardiology.

The capture of pre- and post-examination data and integrated dictation, transcription, and result verification functionality completes the Imaging Facility functionality. Authorised healthcare professionals can review treatment and investigational requests, documenting care/results directly into the patient’s EPR. Results can be sent electronically, printed, e-mailed, or faxed to the requesting healthcare professional.

With TrakCare Radiology/Departmental Workbench, the EPR includes basic workbench functionality including:

• Scanning and Image Association and the recording of patients’ clinical observations are available throughout the episode of care. The observations can be defined to suit the clinical requirements of the site or users and can be accessed from the EPR or from the nurses’ worklist or other functional workflow.
• Appointment Management allows authorised staff to schedule an appointment, place the patient on a waiting list, or perform a procedure immediately once an order has been approved. The system provides the facility to display available time slots at a resource or departmental level, making the task of scheduling both simple and efficient.
• Departmental Workload Manager provides a prioritised worklist of patients and orders, displaying the essential clinical and administrative information for efficient workload management. This is available in standard, diary, and split screen views.
  • Order Authorisation allows authorised staff to review, authorise, or reject requests. Request information or procedures can be updated or changed by authorised staff when required.
• EPR View makes all completed questionnaires available in the EPR for review. They can be defined against the patient’s episode of care or an individual order item.

Radiology Workbench comprises the following additional functionality:

• Pre- and Post-Examination Details allows authorised staff to record more information on the execution of investigations, including material used and the degree and intensity of the investigation.
• Result Reporting (Dictation, Transcribing, and Verification) allows results of investigations to be recorded through simple entry by authorised staff. Alternatively, results can be entered in discrete steps from digital dictation to transcription to result verification.
• Images can be accessed and annotated directly from the Departmental Workbench or through the EPR via the TrakCare Clinical Viewer or an interfaced third-party viewer.

2.2.7 TrakCare Active Decision Support

TrakCare Active Decision Support provides targeted information about critical patient risk factors to assist clinicians in decision making. In addition to the Active Decision Support messages provided in TrakCare Clinicals, such as interaction and duplicate checking, this module provides the unique functionality of creating user-defined rules that drive decision support actions.

Actions can be as diverse as sending a pop-up message to the user, sending an e-mail or fax to the referring doctor, sending an internal message to the laboratory, or even changing the status of an order to “On-hold,” or a waiting list status to “Cancelled.”

The rules can be set across the conventional therapy and patient condition (e.g., issuing an alert if warfarin is ordered for a patient who is just three days out of post-op).

Designed with uncluttered screens, TrakCare Active Decision Support ensures that the desired information is readily and clearly available, avoiding the pitfall of multiple, confusing alerts.

Active Decision Support comprises the following functionality:

• Rules and Events functions at the simplest level by having a rule take two different fields and build a ready reckoner reference. Rather than query the database directly each time a decision support condition needs to be evaluated, this index can be referenced, dramatically reducing query times. Events are the triggers set in TrakCare. For example, an event may be as simple as one condition such as, “If the current patient is ordered aspirin,” with only one condition to satisfy this event. Complex events can also be created by attaching multiple conditions: for example, “If the current patient is ordered atenolol” AND “the ordered date is in the last two days” AND “for a patient with an active diagnosis of heartblock.”
• Actions are what we would like to happen if the conditions of our event have been met. For this reason, the action screen offers a broad range of options. Action types include:
  • Alert (pop-up) can be configured to display:
    • Error Message will not allow the user to proceed
    • Warning Message offers the user the choice of proceeding or aborting the intended event, by way of a pop-up message with “OK” and “Cancel” options
    • Information Message offers an “OK” button only, but will not affect the intended workflow
  • Messages can be directed to users, groups, or allocated care providers. The message can be standard or dynamic so that variables can be inserted into the message. They can take the form of e-mails, faxes, or TrakCare Message or Pager.
  • Set Field Action allows direct manipulation of database fields. For example, the order status could be changed for a particular order from “Verified” to “On-hold” by use of this action.

 

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