November 20, 2009

Communication wizard keeps referring physicians updated

Communication wizard keeps referring physicians updated

Vanderbilt University Medical Center is testing a clinical IT solution to ease communication of patient information from Vanderbilt to community referring clinicians.

Referring clinicians need prompt information about specialist findings and patient status following surgery and at hospital discharge, whether from a consultant's letter, an operative note, a hospital discharge summary, an updated medication list, a radiology summary, a lab summary, etc. When referring clinicians don't receive this word, they could start referring patients elsewhere.

Vanderbilt's new provider communication wizard was developed to facilitate, verify and report the provider communication process.

The wizard is a feature of StarPanel, the innovative medical records system developed at Vanderbilt. (In the IT world, a wizard is any computer interface involving a sequence of dialogue boxes.)

It's powered by a database of verified contact information for some 17,000 community referring clinicians — it says a lot that Vanderbilt Medical Group created three new full-time staff positions expressly to assemble and maintain this database.

The user selects the patient's referring providers, attaches the relevant clinical documentation from the electronic record and hits send. The system handles the faxing; 97 percent of clinicians in the database having said they would just as soon get these documents by fax than by mail. Any unsuccessful transmissions bounce back to a central staff for resolution.

If a name does not appear in the database, the user enters it along with the town where the practice is located, which allows the central staff to chase down the contact information and complete the processing.

Jim Jirjis, M.D., MBA

Jim Jirjis, M.D., MBA

The wizard remembers the patient's referring providers for next time. For the few referring clinicians who've said they would prefer receiving these documents by mail, the user is prompted to select the secretary's electronic in-box for processing in the clinic.

The system is being piloted in the Thoracic Surgery clinic and will spread to all VUMC clinics and hospitals by the end of next year. The project is led by Jim Jirjis, M.D., MBA, chief medical information officer and medical director of Adult Primary Care; Sue Muse is the project administrator.

On the hospital side, Medical Information Services is charged with relaying clinicians' notes and reports to referring providers, while for clinic visits this communication is the responsibility of physicians and their staff. Part of the problem has been that patients often wind up seeing multiple Vanderbilt specialists, a pattern which apparently makes it easy for community referring clinicians to drop off provider communication lists.

And on the hospital side, the residents who write the progress notes and discharge summary may understandably be at a loss to identify a patient's community referring clinicians, leaving staff in Medical Information Services to search the medical record in vain for this key bit of information.

The wizard is “huge for the staff and doctors here,” Jirjis said, “because it's very efficient and it reminds people of who needs to be communicated with. It's huge for the docs in the referring provider community because they get much more reliable, responsive communication. And it also creates the ability for us to measure and manage how we're doing. With each clinic visit and discharge from the hospital, we can learn whether we're communicating with people or not.”

“I'm tickled with it,” said neurosurgeon Peter Konrad, M.D., Ph.D., one of a small group of VMG specialist physicians who've provided early feedback for development of the wizard.

“This is going to do wonders for improving Vanderbilt's relations with community referring providers. I've been using it for a few months, and our referring physicians are all just ecstatic about how rapidly they're hearing back from us.”

LeaAnne Smith, N.P., handles patient discharge on the medicine service at Vanderbilt University Hospital. “It's a great time-saver. It relieves my mind to know someone is ensuring this information is forwarded to the next person who's going to be providing care. I think there's a safety issue in getting the information handed off,” she said.

“This system does it all,” said thoracic surgeon Jonathan Nesbitt, M.D. “It couldn't be more complete in terms of assisting this communication. This will help greatly to maintain Vanderbilt's referral base, while allowing our clinicians to practice as they always have.”

Nesbitt also notes that better communication with referring providers could help cut down on redundant lab testing following patient discharge.