In Ankhos, we display a lot of information in different places, the most comprehensive of which is the patient’s calendar. I’ll talk about what we put on the calendar, what it looks like, and one of the tricks we have used to make it very fast.
Posts Tagged ‘EMR’
Partial patient calendar caching with Memcached
October 5, 2011Guest Post: Joy Hester
February 2, 2011Joy Hester, our lead nurse was kind enough to write a guest blog post about her experiences with EMR. She has been with the practice for many years (I won’t say HOW many) and has been invaluable in the development of Ankhos.
Hello. This is my first attempt at blogging. So I am a little nervous but here I go!
I am a nurse. My knowledge base is in people, not in macros, pigeon holes or textboxes. Over the years I have learned a lot, self taught, what I like to call a “computer geek wanta be.” I know enough to get by. Let’s just say I know just enough to be dangerous.
Having said that, when the very busy Oncology Practice I work for purchased an EMR I was asked to help as a super user and was eager to get involved. Why not? I love this stuff!
I worked on developing the chemo regimens and single agent favorite list of drugs. I also developed documentation tools call Questionnaires for nursing documentation. I thought Questionnaires was an odd name for a documentation tool but, after a while it made sense. The Question was “Why does this have to be so hard?”
I could go on and on about how difficult the EMR was to use but I do not want to relive that. We finally scrapped the drug ordering and administration portion of the software. We now only use the scheduling and note portions of the EMR. We looked at other systems and did not see anything we wanted to pursue.
Then along came Ankhos.
Ankhos is so easy to use. I even have some privileges to add and modify drugs and procedures. These are called Orderables.
In the old system this was the hardest part. We are nurses. We are surrounded by patients who need our attention. We need an easy to use adaptable system where doctors can order and nurses can document treatments accurately.
We now have it.
We are in the enviable position of having an on staff software developer, Nick Orlowski, available to build the software to meet our needs. All we have to do is ask.
Working with Nick, I began to understand that the software should work for me, not me working on the software. I started to ask what Ankhos can do for me. These things are coming and I am excited to see how they develop.
We are accurately documenting on our patients. All the documentation requirements are being met. One of the best parts for the nurses is to be able to pull the treatment to an order sheet when the patient goes to an outside facility for their chemo. Ankhos tracks the location of the patient’s treatment and I am then able to verify the treatment is given after notification from the hospital the treatment is complete.
I review all the previous days encounter forms and having the drugs documented in Ankhos has saved me so much time when there is a question about a charge on a form. All I have to do is pull it up. I would have to physically find the chart to verify the treatment before Ankhos. It is wonderful to have it right there.
We have just begun. I am excited to see what is coming.
-Joy
Milestones
January 31, 2011Hello, stranger! Been a while!
A few weeks ago I wrote a post about a distinct feature of Ankhos called sandboxing. The feedback from our users has been overwhelmingly positive. Many of our users came from outside clinics or hospitals where drug entry was a daily(or weekly) task and each agent had to be ordered at once. The ability to easily modify a published regimen (or order labs, blood, etc.) is a boon to provider productivity.
The past few weeks have been very busy. We have reached some serious milestones in our project:
1. Nurses are completely paperless. All infusion time charting and Nursing notes are done in Ankhos.
2. All labs are available in the EMR, imported directly from the clinic lab machines (as well as a Labcorp interface).
3. All Providers are creating their orders in Ankhos.
a. The new Doc is well-trained as Ankhos has actually helped orient him to the practice’s idiosyncrasies.
4. 10 new Toshiba Sattelite (17″/4 g/300 g) were purchased and placed in exam rooms. I will write another post regarding the decisions and setup of our client hardware. The biggest draw is the great quality of the wide screen. Ankhos is a web app so we don’t need a lot of processing power.
5. My sister was happily married to her long-time boyfriend in a fabulous wedding in downtown Charlotte.
Hopefully I will get back to blogging our development more in the future as things move more towards maintenance mode (HA!)
The oncologist’s workflow
December 21, 2010I’ve been pretty busy lately, but I’d like to share a link I found about the general clinical oncology workflow. Hopefully this may shed some light on why clinical oncology EMR systems are so much different from the EMR systems of other types of practices.
It takes dedication and focus to come up with a competitive product in this market, and just providing ‘templates’ is not enough to increase productivity, safety and ROI.
Quick edit:
One divergence from the article that Ankhos takes is our lack of automatic drug calculations. There are handy calculators integrated into the system to calculate AUC and BMI, but every dose must be entered by a human in absolute milligrams (or cc, etc.). The computer is not allowed to determine or alter any doses.
Screenshot: Advanced regimen sandboxing
October 19, 2010Ankhos provides lots of flexibility when it comes to creating chemotherapy regimens. Not only is it easy to create a custom regimen, but it’s also easy to modify them on the fly. We do this with a technique we call ‘Sandboxing’.
Whether we’re using a regimen straight from the textbook or creating our own, we have the option to place it in the ‘sandbox’. Anything can be placed in the sandbox, from entire regimens to x-rays to comp panel orders…. Anything that occurs with some periodicity in conjunction with patient treatment.
Ankhos provides a 'sandboxing' technique for easy regimen creation/modification.
Once in the sandbox, these agents and orders can be modified on a day/cycle basis in order to match the needs of the patient. Clicking on the right and left arrows will increase/decrease the cycle length, and the days of a treatment can either be typed in or inserted on days 1,8,15,… by clicking the weekly checkboxes.
The sandbox outlines a patient’s entire treatment schedule in one fell swoop. We won’t need to do any physician data entry for weeks… or until a change is needed.
The sandbox pictured above outlines 4 weeks of (made-up) treatment. Once the treatment is in the sandbox, You can cycle these four weeks as many times as you want. Three cycles of CHOP-R? Easy. Weekly CBCs for 6 months? Easy.
The sandbox has received many accolades and nearly every user who has experienced it describes it as ‘very powerful’ or ‘incredibly easy’.
One limitation of the sandbox is that it is not practical to schedule a follow-up one year from now or mammogram in 6 months, but we solve that problem by ordering the simpler tasks like a normal EMR might… one at a time.
A final note: As far as patient safety is concerned, each treatment must be electronically signed by an MD before it can be administered so any dose reduction that is required does not fall through the cracks.
Re-Re-Thinking the iPad
October 18, 2010A few of the users at Carolina Oncology Specialists have been persistent about using the iPad. It’s exceedingly long battery life and relatively light weight have proven to be big advantages compared to other form factors. We did find that a non-slip case that also provides a stand is essential.
So the iPad is back on. We now have a two-factor setup in the office now for the physicians. The first is a kiosk-type style with a widescreen monitor in the main hub. The other is the iPad; users are encouraged to use what comes naturally to them and so far, this is the setup that has evolved.
And, of course, Ankhos is a web (browser)-based app, so any computer with an internet browser on the internal network can access the application. This allows great flexibility for our our users to evolve how and where they interact with the program.
This sort of thing is another reason I love my users. They are persistent in discovering what will work best for them and provide feedback that allows me to accommodate it. It only took a few tweaks to get the iPad working like they wanted, then they were off and running.
Next up? Android and Windows tablets…. Let’s get ready to rumble.
Re-thinking the iPad for EMR
September 15, 2010After a few weeks of evaluation, it is the general consensus that the iPad is not right for most functions of Ankhos. There are a few users who prefer them (mostly nurses who are always mobile) but the iPad just leaves too much to be desired in the way of displaying and entering large amounts of information quickly.
The iPad also does some frustrating this with data entry, such as capitalizing every text field automatically. These ‘best guesses’ probably work well in the living room and on normal media web pages, but not in a medical office using a rich application where every second is money spent.
Ankhos is a web app and, as such, is very portable. This portability will be able to accommodate both users of the iPad and of the desktop. Those who wish to use the iPads may happily continue to do so. For others we will use our existing windows workstation ‘hubs’ for the forseeable future.
The past few weeks have been so busy and so fun. All of the people here at COS are extremely smart and very invested in improving their practice… and we get to improve our software along the way.
What’s Next?: No Oncology Trial Patient Left Behind
August 16, 2010Now that we’re well on our way to full implementation, we’ve begun to think about the next steps we’re going to take.
Nearly every day I have the opportunity to listen to drug reps pitch their wares to our MDs, PAs and nurses. I have also had a chance to demo a bit of Ankhos to them. Most are completely wowed. They say “None of our other oncology clients has anything close to what you guys are doing. Your software will be a success.”
And then I ask what I ask nearly everyone at the office: “Great! Now what would you like this software to do for YOU?”
The drug reps will take a step back, collect their thoughts and say “We want to never miss a potential trial patient again.”
So that’s our next goal. We will compile study criteria and patient data and make sure that we have cancer staging, treatment plans, diagnoses and everything else we need and constantly monitor our patients for potential trial fits.
I think Ankhos is poised to do this with excellent precision because it is “Regimen Aware”. It can answer questions like “Is the first time this patient with stage II breast cancer has been on the regimen FLOX with a Creatinine level of x?”
Just like the past few months… I’m very excited and have so much to learn.
Down to the wire
July 8, 2010
It’s been really busy lately (thus, the lack of posts), but we’re finally starting 1.0 on Monday! We’re going to be going side-by-side with the paper charts until we determine that all the bolts are screwed in tightly.
I’ve been working very closely with the staff at Carolina Oncology Specialists. I’ve spent weeks, nay, months watching, listening, asking questions. And it has paid off. Ankhos is almost unrecognizable (even the name) from what we started with nearly 10 months ago. This is a good thing. I owe much to the staff who have helped with this effort, especially Dr. Orlowski and lead R.N. Joy Hester. Their enthusiasm and willingness to take my after-dinner calls has been indespensible to the progress of Ankhos.
The staff is armed with their cache of iPads and we’re ready to rock. This weekend will certainly be a busy one. There are many usability findings that need fixing in these next few days. They are little things like ‘this button should be bigger’, or ‘This link should be on this page’, but hopefully these are the types of bolts that need tightening.
Here’s looking forward to 1.1 and the innovative solutions we have for patient scheduling!
