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An HIT Moment with … Chuck Demaree

February 14, 2010 Interviews 2 Comments

An HIT Moment with ... is a quick interview with someone we find interesting. Chuck Demaree is vice president of product development with Access of Sulphur Springs, TX.


With all the talk about EMRs, is there still a strong business case for electronic forms solutions?

Absolutely. The focus of an EMR is to provide an electronic collection of medical information that can be used real-time during the clinical episode and historically as an archive. Generally, not all information will be fed electronically into an EMR. Forms provide a tool for the organized collection and presentation of information that will not be collected electronically.

In supporting the EMR, EHR and LHR, an electronic forms solution provides:

  • Consistency in form quality, format and delivery.
  • Accuracy in correct filing information through the use of patient-specific bar codes.
  • Efficiency through the use of business rules by assuring that all the correct forms are generated (collecting ALL of the needed data).
  • A standardized and structured presentation of data in the EMR, especially if COLD feed information is passed through the forms solution to provide a standard presentation.

Describe the typical workflows associated with using access-related electronic forms.

The most common entry point for Access EFM is in the registration area. A typical workflow would start with the registration of a patient. The resulting information generated by the registration system passes to the business rules engine in the Access EFM server where data elements are evaluated. The rules engine then determines what forms are required, what data needs to be applied to each form, and where and how those forms need to be distributed.

For example, a customer being registered as an inpatient would have a complete registration packet that is customized to them for this particular clinical event printed in the registration area, with bar codes and demographics applied. The only documents that would print there would be documents that the patient (or their family) needed to take with them or that needed to be electronically signed, such as consents. The bar codes on each form enable HIS staff to interface forms into the EMR with less effort, as the ECM/EDM system uses bar code recognition to auto-index the forms with the patient record. 

Electronic workflow would then route any other documents needed by the nursing unit, laboratory, pharmacy, patient finance and other departments directly to their location (or application) at the time of registration. Electronic notifications (via fax or email) would be sent to the primary care physician notifying them of their patient’s admission. 

In more advanced forms management projects, registration staff send forms to a monitor without printing. The patient reviews them, applies their electronic signature on an LCD pad, and the nurse submits the forms. They’re then interfaced into the ECM/EDM system, a paperless process that eliminates the financial and environmental costs of forms printing.

What is the Universal Document Portal?

The Universal Document Portal (UDP) is an interesting and exciting product. The purpose is to provide a method to feed the EMR electronically from systems or medical devices that do not have the ability to COLD feed today.

Some examples of how this is being used by our customers are:

  • Passing medication orders which used to be faxed, from one vendor’s HIS system to a competing vendor’s pharmacy system.
  • Providing an electronic import capability for clinical documentation from one vendor’s HIS system to another vendor’s EMR. This particular customer has well over 50 different feeds running through UDP
  • Indexing the output from a 12-lead EKG system directly into the proper patient’s chart in an EMR.
  • Migrating historical medical record information from a system that is being discontinued into the customer’s current EMR.

The uses for UDP are only limited by the output abilities of the system or device and the IT/IS team’s imagination.

How can electronic forms support patient safety?

The Access EFM system impacts patient safety both directly and indirectly.

Every form outputted from Access EFM has patient identification bar codes on it, enabling positive patient ID throughout the encounter. Bar coded wristbands are generated at registration and reconciled with bar coded medication labels also printed by the Access system, facilitating accurate bedside medication verification (BMV).

Documents that are passed into the EMR have a consistent structure which reduces search time for information. Because of patient and form specific bar codes on every form, all forms are accurately filed in the EMR
Notification of printed bar coded forms are sent to the EMR for the purpose of creating automatic deficiencies, which are resolved when the form is scanned in.

The indirect impact is the time saved by the use of the business rules engine and the staff efficiencies it produces. The business rules take the guesswork out of what forms need to be pulled and what data needs to be collected. If it needs to be done based upon the data entered for the patient, it gets done because of Access EFM.       

How common is it for hospitals to capture patient signatures electronically and how are they using them?

Electronic signature capture is becoming more common every day. The most common uses are obviously in the signing of consent forms, whether in registration or at the bedside. Other uses are the signing of discharge or patient teaching instructions, financial responsibility documents, and any other document that provides legal protection for the facility during the care delivery process.

The most important factor in choosing an electronic patient signature solution is how well those signatures will stand up in court. Basic electronic signatures like those used in a grocery store (TIFF on TIFF) are hard to defend if legally challenged as they could be copied, forged, or altered after signing. Access e-Signature creates a biometrics file that becomes part of the patient’s record and proves that the original signature was not forged or changed, positioning hospitals well for audits and e-discovery.

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Currently there are "2 comments" on this Article:

  1. Wonderful presentation, but:

    “Every form outputted from Access EFM has patient identification bar codes on it, enabling positive patient ID throughout the encounter. Bar coded wristbands are generated at registration and reconciled with bar coded medication labels also printed by the Access system, facilitating accurate bedside medication verification (BMV).”

    Reliance on Bar Coding is a problem. Erroneous reports of mismatches are common when the correct medication at the correct dose at the correct time is being given to
    the correct patient in the correct room in the correct hospital. This wastes time and is disruptive to the care of other patients. Who approved these defective sytems?

  2. Nurse Manager Flora,

    While I agree that BMV can be challenging and disruptive to the patient, it has been a major focus of hospitals and vendors for at least five years. The FDA is recommending implementation by September of 2013.

    Utilization of bar codes on wristbands (different from those on forms) is one methodology to accomplish BMV. The use of RFID technology can accomplish the BMV task without disturbing the patient to access the barcode, although it is typically more expensive. The availability of RFID is something that should be explored with any electronic forms vendor you are considering.

    Obviously the focus of BMV is the reduction of medication errors resulting in an increase in patient safety. The challenge is accomplishing this without increased delays or complications in quality patient care.

    If your current BMV solution is creating errors or mis-matches, or unduly disrupting the patient care process, this is a serious matter that should be addressed. Hopefully these issues can be resolved by exploring some of the options available and create a safe and
    efficient process.

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