Review a patient's data in the ICU can be incredibly cumbersome, especially for pre-rounding. The current EMR at NYP has greatly improved patient care, avoided errors and made things more efficient for physicians as well as nursing staff. However, the time required to understand a patient's chart still is very time consuming. In some cases such as cardiac arrests or rapid responses learning the information rapidly is of utmost importance to saving the patient's life. The goal of this tool is reduce the amount of clicking and searching an Intensivist has to do make clinical decisions on a daily, often hourly basis.
How it works
Understanding how an Intensivist Rounds for each patient is essential. Keeping each component of patient data review in mind, the ICU Rapid Review Data System is intended to be a separate tab in the existing NYP's EMR system. All lab values, parameters and data points that were placed in the organized fashion were pulled from the existing data structure of NYP EMR, allscripts. The tab is intended to be a symbiotic addon to the existing EMR used at NYP. It is not intended to replace it.
The old flowsheet is appreciated, but blood pressure ranges, heart rate ranges, temperature ranges, pulse oximetry, bowel movements, glucose ranges are not only text organized in tabular format, but graphically as well.
The medications section is broken into Active Medications, Home Medications, Medications given in the last 6,12,24 hours. This is to allow the physician to access a complete history of the medications in multiple different fashions without having to search, adjust settings to view meds, or become confused with a verbose system. Additionally, active drips as well as blood products given are listed/counted. A special supplemental tables section is provided to help correlate important lab values with corresponding medications. The anticoagulation trending table correlates anticoagulation medications with coagulopathic markers noted on the table. It reduces the physicians need to go back and forth between medications tab and the labs tab. The glucose trend monitoring table allows physicians to correlate medications that may be increasing or decreasing fingerstick levels. Its the easiest way to get a better picture of how well a current insulin regiment may or may not be working. The glucose table provides a trend over the last 24 hours. The blood pressure and medications trend table is intended to correlate blood pressure, pressor drip rates as well as oral medications given to the patient. It provides a trend over the last 24 hours. It's a great way to see how pressor usage is affecting blood pressure ( MAP) without having to rely on purely verbal data or subjective data. The drip rates are stored by nursing staff in the existing flowsheet. The Antibiotics table is intended to make understanding the antibiotic history of the patient during the course of patient's admission. Less calculations, less looking up data and guesswork is possible when a clear time of the patient's antibiotics are presented neatly in this table.
I do not intend to reinvent the wheel with labs. I love the existing NYP EMR labs system. This was just another additional proposed system of organizing labs so that 95% of the labs pertinent to each system that are viewed everyday relevant to the system are viewable using the existing EMR data infrastructure. This tab was left a pure dream for possible expansion of the existing labs organzation.
The microbiology tab is intended to collect all cultures, antibodies, serologies, pcr, and immunology markers since admission and display them the order by last updated format for easy use, viewing. It allows the physician to see the latest updates in the microbiology/virology/immunology section without having to search, click and scroll again and again to collect all the pertinent results.
An additional Sensitivities analysis table was provided to help the physician easily correlate any overlapping antibiotic possibilities. Again the goal is to make the physician's job easier as he/she ask the same questions again and again. Why cannot a computer help in these scenarios?
The radiology tab is intended to make viewing of radiology reports quick easy and rapid. No extra clicking. The drop-down menu focuses on the type of the radiology scan to allow easy reading.
The Quality Measures tab
The quality measures tab is intended to tie up loose ends. It helps physicians identify old central lines that need to be removed, foley catheters that need to be removed, a check on whether the patient had GI prophylaxis or not, anticoagultion or not.
Challenges I ran into
Designing something to incorporate so much information with ease is difficult at best. I'm not a designer at heart. I am a clinician. So please focus on the content of my presentation more than the design style of it. An intesivity unknowingly organizes all this information in his/her head everyday and tries to make correlations before making clinical decisions. Why cannot a computer help provide the medical correlations between vitals signs/medications/microbiology/radiology so that the physician can spend more time thinking about the assessment and plan, and spending more time at the bedside instead of in front of the computer?
Accomplishments that I'm proud of
I'm an MD and a developer
What I learned
Developing is not easy
What's next for Rapid ICU Patient Data Review System
The real intention of this extra ICU tab to be integrated into the allscripts EMR system is actually to help physicians cover the H &Ts: (Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper-/hypokalemia, Hypoglycemia, Hypothermia & Toxins, Tamponade(cardiac),Tension pneumothorax, Thrombosis (coronary and pulmonary), and Trauma) . that need to be covered during a CAT or RRT. A more efficient ICU tab can help a physicians apprehend the necessary information to help a patient in a faster more meaning way than possible before.
Please Call me regardless of whether this is accepted or not at 4088363164- Rahul Malireddy M.D. NYP:Queens Internal Medicine Resident PGY3, Software Developer. I'd like to know if i'm thinking in the right direction of medicine and technology.