SMART EMR Diabetes Demo

FOR DYNAMIC DEMO   Userid: sEMRguest  Pwd: guest  CAVEAT: This is not a functional EMR, but an interface prototype that is intended to demonstrate concepts only.

Single Management Console Reconfigured with Context This interface is a prototype suggesting how dynamic reconfiguration based on clinical context could provide cognitive gains, better status and management tools, all readily at hand. This may make best practices easier to achieve, and provide more patient relationship time, gained from data hunting time.

STATIC present-generation EMRs Tables of categorized data All health conditions together Cognitive work of building a mental model when seeing a patient for a specific concern is intensive For example, dealing with diabetes in a 72yr old with other co-morbidities

A SMARTER way On the left, static table of conditions On the right, an interactive and graphical icon that: - shows the condition on roll-over - engages knowledge engines to configure the EMR for the condition chosen – presentations, anticipated actions, resources, all at hand Diabetes is in this mannequin located on the pedestal

Context-dependent Reminder Menus The Smart EMR can utilize reminders which are gateways to schedules, actions, resources – these can be varied by the EMR for the clinical context In this example, the Patient is at the Medical Home, and these are general reminders which can vary based on known conditions (if not smoker, don’t put SMOKING in) and demographics – In moving to Diabetes Management, these would be tailored for important reminders for diabetes, such as ACE/ARB prescription

Diabetes - Tailored and Organized Information Health conditions shown are now restricted to those relevant to diabetes Tests shown are now restricted to those relevant to diabetes and its co-morbidities eg high BP Trends important in assessing current status are prepared and displayed ready for physician analysis REMINDERS are customizable active links to elements of Care Pathways that apply to this patient with specific status indicators The mannequin is persistent, so that navigation to Patient Home, or other conditions, are always present

Diabetes-specific Management The Reminders have now been generated by the EMR to be specific to this patient’s diabetic status… To engage in management decisions, the ENCOUNTERs circled in red will bring up an example of what might be a Management Console

Diabetes Management Console The area in yellow shows the most recent diabetes quality indicators, including medications. The Show Alerts toggle can remind the physician (or not) of actions that are due, according to guidelines…as shown for Foot exam in red By selecting the brown area across from the measures, labs can be ordered, medications changed or renewed, right from here…without having to duplicate these actions in “Prescriptions” or “Referrals” The SOAP notes permit physician annotations.

Diabetes – Resources Reminders can be configured to provide actions, or documents, or analyses In the SMART knowledge-based system, these Reminders can be configured dynamically In this example, the Diabetes Rx in red will bring up the Guideline table of diabetic medications. If it’s there, it might be used.

Management Console Potential As it is important to know whether the diabetic status has been stable, or changing, preparing a graph showing the HgA1c over time should be done by the Smart EMR Clicking on the HgA1c button will then display the graph, without having to go into the Lab module to graph this test.

Management Console Potential As it is important to know whether the diabetic status has been stable, or changing, preparing the trend of BPs can be prepared and ready to show. Clicking on the BP button will then display the data without having to do multiple clicks to achieve an important function.

Conclusion Smart EMRs could: Reduce cognitive burden Show what is relevant Prepare analyses and trends ready to display Organize and structure information and actions specific to a patient’s clinical status Enable and converge care to best practices Shift time used to chase information to relationship time