Miami Children's Hospital
Miami Children's Hospital developed a web-based medical record that is linked to their laboratory systems and point of care testing devices that allow them to visualize data obtained at the bedside, almost instantaneous, from any location, and in graphic form. This was done in association with a small software company (www.Teges.com) and the i-Stat corporation.
Situation
A pediatric cardiac tertiary care center is responsible for children with complex heart problems often referred from great distances. During the course of their hospitalization, a substantial amount of critical data is accumulated, it needs to be evaluated by the experts in the center in real-time, despite the fact that those experts may not have the opportunity to be present at the patient's bedside. All of the data must also be available to the referring physicians, who will ultimately assume responsibility for these children.
Solution
The most pressing problem was overcome over three years ago when the cardiac team decided a web-based medical record could be the solution they were looking for. Unfortunately, no such medical record was available for children with complex heart disease and lengthy intensive care unit stays. The program decided to design its own web-based EMR, then consulted with Teges, a small software company to ensure the success of the project.
Benefits of this web-based system were apparent right from the beginning. Data from numerous databases in the hospital was now available to all participants in the patient's care, when and were it was needed. A photo collage of the patient?s hospital course was developed, with pictures of the patient being taken daily. Parents of patients calling for information weeks or longer after discharge could now be assured that the person responding to their question had access to the complete medical record, no matter what time they called. The data was also now capable of being evaluated in database form. Outcomes for cardiac surgical patients were updated in real-time, and we made these outcomes available to the public via our website www.pediatricheartsurgery.com. When choosing Miami Children's Hospital for their child's surgery, parents could be confident they were making an informed decision. Miami Children's Hospital's pioneering outcomes reporting model is continuing to lead the industry in its attempts to achieve health care transparency. A current project will allow us to publish health care costs in real-time from the hospital record.
Our EMR continued to evolve and improve when we teamed with i-Stat, manufacturers of a point of care device for use in the ICU. Data from these devices was now immediately uploaded into the EMR, and can be displayed in graphic form, an invaluable tool for the clinician.
Our development of this product continues today. We are currently using i-Rounds to track our patients over the course of their life-times. A patient portal has been developed to allow our patients access to their actual medical record from anywhere in the world via the world-wide-web. With the completion of this project, no patient will ever suffer the consequence of an adverse outcome because caregivers had insignificant data to make informed decisions, anywhere in the world.
We are also helping to develop software programs which will allow mining of outcomes data in a fashion similar to searching for data via the world-wide-web. This pioneering work has come through our association with Teges and Florida International University.
Better Health & Lower Costs
Since the beginning of this project, mortality for children undergoing congenital heart surgery has significantly diminished by over 50%. Our highest risk patients have had the most improvement. On countless occasions, as the most senior cardiac intensivist in the program, I have been consulted late at night and often a great distance from the hospital and had all the clinical data available (including ECG and hemodynamic tracings) to make a well informed decision. Countless patient have undoubtedly benefited from this.
Our sister program in Orlando (250 miles away) has a group of very experienced cardiac specialists and twice weekly our patients benefit from the ability of specialists from both programs to "i-Round" on our most complex patients. Clinical data, photos and images are available to all participants.
We are also beginning to see a decrease in adverse events after discharge, no doubt attributed to this program's ability to act as a follow-up tool for these children with complex problems.
