Texas Scottish Rite Hospital for Children

Neurology DepartmentOffice Patient Management Record

Contact Information:Mauricio R. Delgado, MD

mdelgado@tsrh.org(214)559-7831

Texas Scottish Rite Hospital for Children• TSRHC treats Texas children with orthopedic

conditions, as well as certain related neurological disorders.

• Established in 1921 when a group of Texas Masons approached Dallas’ first orthopedic surgeon Dr. W. B. Carrell about caring for children with polio regardless of the family’s ability to pay.

• With the introduction of the Polio vaccines in the mid-1950s, which virtually eradicated polio in the Western Hemisphere, TSRHC broadened its focus to other orthopedic/neurological conditions.

The hospital has treated >200,000 children since its inception, with >40,000 clinic visits each year. The hospital takes a multidisciplinary approach to care, tailoring

treatment to the individual needs of each child and family.

TSRHC Neurology Department• The Neurology department provides care for orthopedic patients with related

neurological and neuromuscular disorders. These include developmental delay, cerebral palsy, brain malformations, epilepsy and other conditions due to brain abnormalities. Childhood motor disorders, tuberous sclerosis complex (TSC), holoprosencephaly (HPE) and peripheral nerve disorders.

• The Neurology department is very active in research aimed at improving the diagnosis, prevention and treatment of a variety of neurological disorders. The department has an international reputation of being one of the leaders in neurological research in the areas of cerebral palsy, HPE and TSC.

• The department includes two full-time and two part-time neurologists, 6 RN coordinators, 4 research RNs, 2 research assistants, 2 FTE Physician Assistants (PAs), 2 PTE PAs, 3 PRN PAs, 3 neurophysiology technologists, 3 support staff, and one administrative director.

Neurology Department Clinical Load

• Neurology follows >1400 active patients.• Between 3000- 4000 outpatient visits are

managed by our team every year. • Thousands of laboratory tests, hundreds of

electrophysiological and radiological studies, and hundreds of consultations are requested every year.

• The office receives 40-80 patient related phone calls every day.

Outpatient Clinic

Clinic visit is documented…

Hospital Medical Record and Office Patient Management Record (OPMR)

• Patient demographics• Dictated medical notes• Dictated operative/

procedure notes• Laboratory results• Radiology results• Consultation records• Auxiliary services notes• Nursing notes• Inpatient notes• Pharmacy records

• Patient contact information• Handwritten clinic notes• Pending

radiology/consultations• Lab requests and results• Radiology requests and results• Consultation requests and

results• Documentation of patient

related PHONE CALLS• Other requests and letters

Hospital Medical Record OPMR

The Hospital Medical Record is stored in the hospital’s Medical

Records Department (4 floors below our office).

It is used by all services.

OPMR is filed in the Neurology office.

It is only available to Neurology staff.

OPMR

OPMR are pulled for:• Every patient related phone

call• Every test• Every clinic visit• Every request (RXs, school

orders, PT, OT, etc.)

300-500 a week

OPMR (front cover messages)• Who wrote what?• Who crossed that item?• What does it say?• What happened with

the card?

OPMR MovementCurrent Process

• Files are pulled for clinic visits, phone calls, prescription fills, forms requiring completion, & pending needs (i.e. following up on referrals, labs, and initiating phone calls to check status)

• Assistants pull files from current program & “check out” to last person who had file

• Files are “checked in” when returned to file room• Files may have a “pending date” in which the file will

then be pulled on the designated date and given to last person who had file

Filing OPMR

• 300-500 files a week• There is a risk of miss

filing• System is compromised

when office assistant is on vacation or sick

OPMR filing system

OPMR filing system

OPMR filing system

OPMR filing system

OPMR filing system

OPMR filing system: pending results

Limitations of present OPMR filing system

• Files require process of physically looking for it when needed and can sometimes be misfiled or “lost”; excess time is utilized on process of obtaining the file itself

• Files are often pulled multiple times for one single report and its duplicates, leading to unnecessary excess time for matching such reports

• Files require constant “checking in” and “checking out”

Limitations of present OPMR filing system

• System does not capture WHAT file is pending for• System does not capture WHO needs the file• System allows only one pending date at a time• System does not allow remote access (for physicians on

call)• System is not always capturing pending dates as needed• System is not always populating an accurate list of files

that are pending, in turn putting responsibilities of the medical staff in jeopardy

Enterprise Document Management System (EDM)

• Electronic medical record produced by Siemens• It will go live in our hospital on Sept. 15, 2011• It will provide Medical Record Access via

Intranet Portal• It will not provide test/consultation tracking

system

What EDM will change?• We will be able to electronically retrieve patient

medical record• It will allow remote access• No need to keep physical medical record for entries

after 9/15/11 • Access to notes entered before 9/15/11 will require

physical chart• May need to keep OPMR for some time????• No testing/consultation result tracking system will be

offered by EDM

What do we need? Wish list!• Create an electronic OPMR filing system that will allow:

– Creation of new file using info from EWS (demographics)– File search by multiple patient identifiers (i.e., ID#, name, DOB)– Access by multiple users – Remote access– Tracking of file location and user– Tracking of test(s)/consultation(s):

• Allows multiple entries of test(s) requested, requester(s’) identity, date(s) when tests were ordered and for expected results, actual results, and allows documentation of who and when was informed about the results.

– Information and alert messages to all interested parties about the pending results (i.e., MD, nurse, PA, etc.)

– Documentation of patient phone calls (i.e., date, time, who spoke with whom, message)– Special notes (“Spanish speaking only”, “drug allergies”, etc.)– Generation of daily, weekly, monthly reports– A link to EDM (?)

Technical Questions• What product will be used for the application?

(Front end & back end)• Are there any IT responsibilities envisioned

from the TSRHC standpoint? (During and after development, other than storage)

• Will the working/development team be working remotely?

• Who will ultimately be responsible for turning the finished product over to IT at TSRHC?

Thank you!