|
The VisualMED System
The VisualMED Clinical Information System (CIS) is a scaleable enterprise-wide Electronic Medical Record with CPOE decision support at its core whose development is based on 10 years of experience with our first generation physician order entry system, still in continuous use at a tertiary care university-affiliated healthcare institution. The VisualMED Clinical System seamlessly integrates physician order entry and alerts / decision support with nursing clinical functions, including an automatically generated medication administration record (MAR), as well as with doctors’ and nurses’ notes. Given the need to access clinical and laboratory data for the purpose of decision support, results reporting and clinical data entry are integrated as well. Designed by clinicians with more than 20 years hands-on experience in the tertiary care environment, the VisualMED Clinical System is modular in concept and responds to the unique needs of each of the medical and surgical specialties.
The VisualMED Clinical System is compatible with existing legacy systems and communicates with them through HL7 interfaces. User-defined data fields can be created, and the system allows ad hoc generation of requisition forms similar in appearance to an institution’s existing requisitions for those services not on-line. Data can be accessed off-site in secure, read-only mode through VisualMED-Web, using Citrix Server for secure, encrypted, off-site data transmission.. VisualMED security uses biometric logon and order sign-off throughout, clearly superior to traditional ID/Password systems. All data access is audited, and our software adheres to HIPAA proposed regulations of September 2000. Our legacy product was reviewed by Health Canada staff in 1995, and formally approved for medication and narcotic medication prescription. The system’s integrated DICOM viewer allows users to review image test results in the context of clinical patient findings, is interface ready, and is compatible with existing commercial PACS.
1. Complete electronic expert order entry with more than 30 levels of decision support, including pathology and image tests.
2. Clinical Information System that contains a CPOE component supplying the complete Electronic Medical Record.
3. Conceived for the practice of evidence-based medicine, the VisualMED system writes electronic prescriptions faster and more securely than traditional paper-based prescriptions.
4. Innovative graphical user interface designed in a hospital setting by clinicians.
5. Laboratory and imagery results are always available.
6. Laboratory and image test results reporting with built in graphic display.
7. PACS images may be reviewed directly from within the VisualMED DICOM screen in the clinical context of each case.
8. All clinical information is available through the VisualMED screen – no need to access multiple computer applications for information coming from different hospital systems.
9. Enhanced communication with nursing staff.
10. Radiology contrast intolerance notification
11. Image test alternatives suggestion based on quality of care and/or cost considerations
12. Renal failure dose modifications.
13. Drug – drug interaction notification.
14. Drug – allergy notification.
15. Clinical warnings with alternative therapy recommendation
16. Automatic replacement of expensive IV with PO medication where appropriate, if installation hospital chooses this feature.
17. Complete pediatric dosing modalities and safety ranges.
18. Insulin sliding scales.
19. Automatic dose tapers, for example prednisone.
20. Automatic notification of abnormal and STAT results.
21. Context-sensitive therapeutic order entry protocols (ordersets) defined by the client, including laboratory examinations and image tests.
22. Cosign responsibilities clearly defined.
23. All decision support and table content may be modified to suit local practice.
24. May be used in-hospital or in ambulatory setting.
25. Patient chart may be reviewed at a distance (in clinic, in the office) through a Citrix server technical solution.
26. Clinical data saved from all patient encounters are available for subsequent patient encounters.
27. Multiple users access patient information at the same time.
1. All prescriptions are legible, including those for pathology and image tests.
2. Seamless integration of physician orders with the Medication Administration Record (MAR).
3. Medication Administration Record generates itself automatically.
4. No transcription of any prescriptions to a paper record.
5. No duplicate charting occurs.
6. Nursing data entries feedback immediately on all new physician prescriptions.
7. Clinical signs data entries are all validated for age, sex, weight and height of patient.
8. Bedside data entry available, including wireless vital signs data entry.
9. Automatic calculation of drip rates based on physician prescription.
10. Enhanced communication with physician staff.
11. Physicians enter their own orders.
12. Automatic notification of specimen-obtain times.
13. Automatic notification for administration of all medications and examinations.
14. Multiple users can access patient information at the same time.
15. Prescriptions are automatically transmitted to pharmacy.
16. Tremendous time efficiencies in the area of prescription validation.
17. Prescriptions transmitted automatically to pharmacy, lab, and RIS.
1. A turnkey solution suitable for CIS or modular implementation.
2. Mission critical application with three-tiered client server architecture. This system integrates all Oracle based clinical data involving prescriptions and care, and also allows access to all laboratory results.
3. Interfaces with any existing hospital laboratory, ADT, pharmacy, laboratory, radiology or PACS systems through bi-directional HL7 interfaces.
4. Citrix server systems can link ambulatory sites at a distance with patient records stored at hospital sites.
1. Diagnoses and procedures:
· All diagnoses and procedures coded by ICD9-CM nomenclature.
· Captures primary diagnoses entered by physician.
· Captures admission procedures entered by surgeon.
· Automatically captures all secondary and laboratory diagnoses.
2. Costing:
· All costs displayed to prescriber during order entry activity.
· Cost-per-case and savings-per-case can be linked to any admitting diagnosis or procedure.
· System can be configured to suggest equivalent cost-effective alternative medications.
· Avoids the generation of duplicate or unnecessary laboratory and image test orders.
· Contractually-guaranteed reduction in historical drug and image test costs
3. Audit:
· All charted activities related to patient care may be audited for the purposes of quality assurance.
4. Security:
· Secure biometric logon and electronic signature for all activities
(with an ID and password backup).
· Unique consent module manages patient consent issues in ambulatory environment across multiple clinic and hospital sites.
· Conforms to HIPPA requirements for confidentiality of patient record.
1. Reduction in the annual incidence of adverse drug effects, with resultant decrease in morbidity and mortality in the population seeking medical treatment.
2. Improved safety in the provision of complex modern therapies to sick patients.
· Reduction in the medical malpractice risk for healthcare providers.
· Decrease in the length of stay for hospitalized patients.
· Improvement in the delivery of health care at all installed sites (allows nurses to spend more time caring for their patients).
· Improved morale of health care providers at installation site.
· Improved access to existing health care resources and maximization of use of existing resources (especially in the emergency department).
· Improved quality of hospital-based as well as ambulatory practice on the basis of the inclusion of best-practice care protocols included in the system.
· Advance the development of a practical regional patient medical record available at whatever hospital or clinic the patient attends in his or her region.
VisualMED CIS modules come in four broad classes – administrative/support, nursing, clinical, and the electronic medical record.
Administrative module:
VisualADMIN is the principal administrative module. It allows users with the appropriate security rights to access screens that may be used to define and modify architectural “seed data;” define the business rules for the clinical order entry for the 6 general order entry types – drugs, labs (pathology), IV solutions, image tests, nursing orders, dressings, as well as the special order entry types – sliding scales, drug tapers, transfusions, TPN; create and modify decision support algorithms that are called at multiple levels in the order entry sequence; create and modify decision support algorithms that operate as background processes; maintain the ward/bed configuration of the institution as represented inside the system; maintain the set of diagnoses represented inside the system; maintain any sets of system requisitions as may be required by the system; maintain the set of system user groups and user group rights, and maintain the set of system parameters that are used to determine the system configuration. The functionality that may be accessed though VisualADMIN is of a clinical-administrative nature. The company supplies all of the content required for full function of the system at the time of installation. The client may modify any of the content at any time in plain language. VisualADMIN is a required module in the setting of a minimal VisualMED installation.
Nursing module:
The VisualMED nursing module (VisualNURSE) integrates all physician / nursing clinical functions at the order entry and clinical data entry levels. VisualNURSE contains the Medication Administration Record, which is automatically generated by the VisualMED system according to a rules engine, which “translates” the physician’s prescription into the date-times for prescription administration. These rules are supplied by VisualMED at installation time, and may vary for each individual clinical module. VisualNURSE also contains the Care Plan and screen sets that allow for the recording and (graphic) display of clinical information including vital signs, glucometer-insulin record, input and output, and pain scale. Additional screens exist for the recording of the nursing history. The System Administrator through VisualADMIN manages the seed content of VisualNURSE. All clinical modules (see below) access VisualNURSE. VisualNURSE is a required module in the setting of a minimal VisualMED installation.
Clinical Modules:
The VisualMED clinical modules broadly correspond to the individual clinical specialty services of medicine and surgery, and are used by prescribers to order medications as well as pathology and image test examinations. All results, both text and image-type, are reviewed directly through VisualMED screens. All order entry activity is supported by more than 24 levels of real-time expert decision support (CPOE). Patients in a particular census may be linked to a single module – the patient is hospitalized on an Internal Medicine ward, for example – or patients in a given census may each be attached to different modules – a hematology / oncology ward, for example. Each clinical module may have its own set of available drug listings, laboratory examinations, image test examinations, its own table of order sets, and unique decision support algorithms. The look and feel of each clinical module is constant, though modules may contain unique screens, which may not be available elsewhere in the VisualMED Clinical System. For example, VisualER uses unique patient tracking screens; VisualICU, CCU, and ER contain unique results reporting screens. The System Administrator through VisualADMIN manages the seed content of the clinical modules. At least one clinical module is required in the setting of a minimal VisualMED installation.
The system includes a DICOM viewer embedded in the clinical signs and results reporting screens so that PACS images may be viewed directly within the clinical context of individual patient cases.
Note that all clinical modules come with a complete electronic patient record (EPR) used by physicians, consultants, nursing staff, and paramedical staff to record their admission and progress notes in a coded, menu-driven or free-text format, depending on the preference of the individual user. Clinicians can access all date related to their patient through the EPR, and can, as well filter the content to view only those notes relevant to the query at hand. Clinical data entered into the EPR is available to review for the purposes of quality assurance by both the clinical and staff and administration.
A VisualMED implementation responds to the potentially conflicting needs for efficient access to local data by clinicians taking care of patients, with the need for access to cumulative clinical information which can be put to use by health care planners. The proposed architecture allows for scaleable implementations given the range of requirements of the participating healthcare institutions. The VisualMED System is compatible with Citrix server which can be implemented if clinicians associated with a given institution require secure access to the application off-site.
Some key aspect of the VisualMED System are outlined below, under the following headings:
VisualMED applications modules include an expert electronic physician order entry system integrated with results reporting an electronic nursing tool to capture all clinical nursing functions, a complete electronic clinical patient record, an integrated Discharge Summary, a complete hypertext-linked integrated clinical guide, a graphic interface that allows integration of hospital data sources and customization of clinical settings, an integrated teaching tool, and expert order entry facilities for Pediatrics, Obstetrics and Gynecology, the Emergency Department, and other key hospital functional areas.
For more detail on individual modules, click here.
VisualMED connects legacy systems via HL7 to the Clinical Data Repository (CDR). Information transfer is seamless and bidirectional. VisualMED is DICOM-enabled, with the capacity to display medical imaging within the clinical context of the individual patient record. To date, VisualMED has been successfully interfaced to informatics solutions from Meditech, CPSI, Medisolutions, MetaPharmacy, Medquist, Pyxis/CardinalHealth and Siemens, and serves as a unique biometric portal to clinical data stored in those systems. VisualMED can also be implemented with its own fully-integrated pharmacy, laboratory, and ADT components, as a complete informatics solution.
VisualMED displays medical imaging in the context of the clinical record through a transparent link with the institution’s Digital Imaging and Communications System. More...
VisualMED delivers a powerful set of tools that reduce Adverse Drug Events and alert the physician to important changes in patient status. More...
VisualMED is a mission-critical application with hardware and software configured for 24 x 7 uptime. The three-tiered client server architecture is scaleable and can support any number of concurrent users. More...
|
