HIS Product Design Handbook - Emergency System Design Essentials

Continuing with the article on emergency process transformation, let's sort out the design points of the core systems related to the emergency business as a whole.

Here we will put together a list of core design points, and then we will have the opportunity to cover each of them.

Of course, if you are a HIT expert, you may know what you want to do just by looking at the title, and you are welcome to discuss and add to it together.

1. Added the stop and enable control to the basic dictionary

Expand the availability of the two markers of emergency clinic and emergency observation in the system configuration and basic dictionary.

The system configuration includes basic system configuration items such as departments, consultation areas, and treatment types. Basic dictionaries include basic business dictionaries such as diagnosis, frequency, usage, diagnosis and treatment items, doctor's order packages, and medical record forms.

The deactivation marker I recommend is to separate the emergency room from the emergency room for observation. The emergency room and the emergency room are completely different business processes. For example, graded care, oxygen, surgery, anesthesia and other diagnosis and treatment items required for observation in the emergency department, but do not need to be used in the emergency department.

2. Patient list and patient information display

In the patient list and the patient information display area after selecting the patient, you need to add the level that shows the emergency pre-test triage, and it is best to click on the level to directly view the content of the pre-test triage. For patients with green channels, there is also a need for a clear marker.

The order of the patients to be seen and the order of the call queue in the emergency clinic should be sorted according to the level of pre-examination and triage, and the patients with a high degree of critical illness should be ranked first. Patients of the same triage level are then sorted according to the time of registration.

3. Rules related to medical records

3.1 Source Validity Period

In the outpatient clinic, the registration is valid on the same day, and the registration number registered today will be invalid even if you do not receive a visit the next day.

Generally, the system will mark the outpatient registration of the day as expired and invalid by the scheduled task at 24 o'clock. But this logic cannot be used in the emergency department, otherwise there will be an emergency number similar to 23:59, and it will be invalid at 24 o'clock, and the doctor will not be able to accept the loophole.

Therefore, the emergency department can be delayed until the next day. As for the postponement to the next day, it is recommended to make the system parameters, and different hospitals will have different requirements.

3.2 Observation record generation

For patients who are transferred from the emergency department to the emergency department for observation, the patient does not need to register and pay again.

However, for the system, these are two different types of medical data, and it is necessary to generate another medical record for observation, and the two medical records correspond to the same registration.

This can be done directly at the nurse triage desk, in which case the nurse will need to be re-evaluated.

3.3 Physician in charge

Patient visit records in the emergency room do not require the "registered physician" field from a business perspective.

The registration is all affiliated with the department, and then the doctor who received the appointment is added to the "Visiting Doctor" field when the doctor receives the consultation.

Emergency patients often need to stay for more than 24 hours, and the process will involve the change of doctors, which requires the system to be able to support the modification of the "responsible physician" of emergency patients, and at the same time, the electronic medical record needs to have the function of doctor shifts.

Fourth, the diagnosis of entry

Outpatient diagnostic functions can be reused in the emergency room.

Emergency observation needs to be expanded to a diagnosis function similar to hospitalization, which supports the entry of different diagnosis types such as admission diagnosis, supplementary diagnosis, and discharge diagnosis, and supports the addition of sub-diagnoses and other functions. The function of diagnostic entry is very complex, and we can explain it later.

5. Doctor's order function

The doctor's order function in the emergency room can be reused in the functional framework of the outpatient office.

The difference is that some medical insurance fee control and auxiliary diagnosis and treatment rules will be different between outpatient and emergency clinics.

Emergency observation requires support for the issuance of medical orders such as graded care, diet, oxygen, etc., and long-term medical orders can be issued in the same way as inpatient medical orders.

The process of using antimicrobial drugs for emergency observation also needs to be the same as that of hospitalization, and support the function of doctors with the corresponding level of antimicrobial prescribing authority to authorize doctors without authority to prescribe.

In addition, the doctor's order function for emergency observation needs to have the function of doctor's order change order and anesthesia prescription printing.

6. Billing of doctor's orders

In the emergency room, for patients who need in-hospital infusion, the system should be able to support the nurse to complete the process of infusion execution and billing.

In the emergency department, it is necessary to have a complete doctor's order review and execution billing function.

For nurses in the emergency department, the timely reminder of the new doctor's order and the dashboard that summarizes the doctor's orders and the doctor's orders to be executed by all patients in the emergency observation area are the upgrade functions with a relatively high priority after the doctor's order execution function.

One can assist in the timeliness of the execution of the doctor's order, and the other can greatly avoid the omission of the implementation of the doctor's order.

If the hospital does not use the system to record the execution of medical orders, it is recommended to evaluate whether this function is needed in conjunction with the relevant users of the pre-hospital based on the actual situation, and at the same time determine the configuration of some limited rules for the execution of medical orders.

In the emergency observation area, especially for the rescue patients, many times due to the critical condition, the nurses are busy with the treatment of patients, and it is difficult to ensure that the systematic execution of medical orders is completed in a timely manner.

In this case, the billing time point of the doctor's order needs to be appropriately moved forward to the time when the doctor's order is issued or the planned execution time to ensure that the expenses can be credited to the system in a timely manner.

7. Electronic medical records

The emergency clinic can adopt the functional framework of outpatient electronic medical records, and on this basis, appropriately supplement the required auxiliary functions such as medical record templates and consultations.

Emergency observation requires the use of inpatient electronic medical records. The electronic medical record editor can be used to define the content of the medical record form required for emergency observation, and the multi-day medical record can be viewed and written continuously.

In terms of nursing documents, it is necessary to support the entry of electronic temperature sheets, the writing of various nursing documents, and the handover of shifts.

8. Emergency triage

The emergency triage function of nurses is the core function of connecting emergency business processes.

Although the triage of emergency departments has relevant expert consensus and diagnosis and treatment guidelines as a reference, in the actual process of landing in each hospital, some evaluation content and rules will be adjusted according to the hospital's own processes and management norms.

Therefore, in the product design, the emergency triage module needs to be able to support the interface of delivery personnel to adjust the evaluation items and rules. Otherwise, every time a hospital goes online, it needs to be customized development, and the cost of pre-delivery and post-maintenance will be high.

9. Pharmacy dispensing medicines

The process for dispensing medication for patients in the emergency department is similar to that for outpatients.

Patients who are under observation in the emergency department need to support hospitalization to dispense drugs in batches, and the system operation process of dispensing drugs is similar to that of hospitalization.

If the inpatient medication delivery mode is adopted for emergency observation, then the system needs to support the establishment of a separate zero-break method for emergency observation. Because even if it is the same drug, the dismantling of the inpatient and the emergency department may be different.

Columnist

Wu Zhimao, WeChat public account: I don't know, everyone is a product manager columnist. Health management Xiaoshuo, medical and health products Wang + literary cat.

This article was originally published by @吴之猫 on Everyone is a Product Manager. Reproduction without permission is prohibited

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