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I turn off the alarm clock and start preparing to go to “work”. “Work”—that’s what I call it and that’s what it feels like. But its really a training program.

The Medical City, under its CIO Dr. Mike Muin, initiated a training program called NITP which stands for Nurse Informatics Training Program. And this is what’s been keeping me busy for the past two months now.

I and my two other trainee-mates are helping the Clinical Applications team create the Nursing Module that will be incorporated into the Health Information System. We’re currently working on digitizing the Medication Treatment Record, I and O sheet and the Vital signs monitoring sheet.

Going back to my story, on my way to work I think of the things that I need to accomplish for the day.
Yesterday it was about the MTR or the Medication Treatment Record for TMC PRIME. TMC PRIME (Patient Records and Integrated Medical Exchange) is TMC’s Health Information System.

• Project Overview Statement—Done
• Process workflow—Done
• User Stories—Done
• Presentation—Done

Everything has been emailed to our supervisor who uploaded it to Asana, a project tracking tool. We also had a meeting with our outsourced development team. It’s one of the weekly meetings we have regarding project updates. Later in the day I had to log onto Google Docs and answer some clarification questions from the developers about MTR. I’m happy be exposed to the wonderful world of Google’s tools: Google Calendar, Google docs, Gmail.

Today, we will be meeting with NSO personnel and gather requirements that needs to be incorporated into the Nursing Module of TMC PRIME. It’s important that we consult with them so that they actually get a system that they would want to use!

Coordination is key. It’s our role to get user requirements and to relay them accurately to the development team. Hence the documents, presentations and meetings. Not that I’m complaining. It’s really just the way things are.

For next week, I hope that we’ll get to work on the Laboratory Information System (LIS). We get exposed to the different systems hospitals use, and the main goal is to integrate all of these into one Healthcare Information System—TMC PRIME!

It’s so cool and exciting. With LIS, we get exposed to the process of choosing vendors/suppliers and dealing with maintenance agreements—and of course HL7 compatibility. For LIS, there’s the migration and version upgrade. We’re sort of late on this project.

Doc Mike also gave us lectures about Electronic Medical Records and Project Management. But the most interesting lecture was about HL7.  The concept is just so simple and yet it can accomplish so much data sharing among different systems. Let’s just not get into the technical part. My poor brain just won’t be able to take how it’s all coded!

Of course, it’s not just us nurse trainees doing all the work with regards to Nursing Module, LIS, e-Kardex data migration and other projects. We work under project managers who guide us and who can address our questions. Its a really nice experience all in all.

If someone would ask me if I’d recommend NITP to others, I’d say YES. The exposure that you’ll get here can’t be found anywhere else. The exposure to the Health IT world is fascinating. Its just so valuable because as I see it, health IT is just beginning to grow in the Philippines and the NITP is a good push to get that head start in this growing industry.

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Comments welcome! – Dr. Mike Muin

Target start date is June 18, 2012. Applicant interviews will start as soon as possible. Training program will take 14-16 weeks to complete depending on the projects assigned.

New projects added to the ones in the original post include:

• Nursing module
• Medication Treatment Record
• Vital Signs Monitoring Sheet
• Input/Output Monitoring

Interested nurses should review original post and submit their Letters of Interest (short essay on why they want to join) and CVs to mbmuin(at)medicalcity.com.ph. Letters of interest can be placed in the body of the email.

Thanks!

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It’s already been a month since I became part of the Nursing Informatics Training Program (NITP) under the IT Department of The Medical City. The work environment is very dynamic and there are a multitude of projects going on at the same time. It’s just as busy as a nursing unit, and I have to say that I’m enjoying myself. Working in IT is very different from what I’m used to since my background is purely bedside nursing. The information coming in can be technical and a little overwhelming, but I see that as a challenge.

Right now, I am working with the Clinical IT team on the Cathlab results and Tumor Registry automation. For the Cathlab, TMC PRIME will become a platform in which physicians can enter the results of different procedures with a uniform format and more speed and accessibility. We have met with the Cathlab staff and they seemed enthusiastic about the project and have been very accommodating. We made a Project Overview Statement (POS) and process flow diagrams. One of the senior nurses familiar with the workflow at the Cathlab has already seen and approved both documents. I have also written a separate POS for the migration of existing Cathlab results. Our concern right now is that we do not have any input from the doctors who will be the end-users for this project. We plan to meet with them to present what we have accomplished, gather feedback, and find a possible physician champion for the project.

We are also working on the Tumor Registry for Cancer Research. There is a lot of statistical data to be dealt with and an improved automation of its registry seems necessary. I was present at a meeting with one of the doctors of the center wherein the forms to be used were discussed. I have also talked to the staff several times regarding their workflow process. We made a POS and a process flow diagram and sent a copy of the POS to the doctor who said that it looks aligned with their goals. (However, we need more specific input with regards to the success criteria.)

After the workflow was laid out into a diagram, it became obvious that data collection was taking up a large amount of time which could be allotted for other tasks (such as the actual input of data into their existing registry). This made me realize how much more effective work would be with the use of technology.  It would help to automate many parts of their workflow but it might not be cost-effective. Another obstacle that we identified is the lack of manpower, as only two people make up the staff for cancer research.

What I am very excited about right now is the possibility of electronic nursing documentation. It gave me a lot of ideas. Nurses need to fill out more and more forms as hospitals continue to seek improvement in care by better documentation, legal protection, and compliance with JCI requirements. I used to dream of having one big Trodat stamp with a template of what is commonly written down in nurses’ notes. This is probably the closest thing to it.

Charting can be very time-consuming and anything that will make it quicker and easier will help, especially since it must be done for each patient. Small things (such as calculating your patients’ BMI, manually filling up patient’s name and PIN number on headings of each page, or computing their 24-hour input and output) can accumulate and take a big bite out of our time—and time is very important for a nurse. Imagine how much weight would be lifted off our shoulders if we had a nursing documentation system when we go on duty for 2 straight shifts with 8 patients assigned to you.

If done correctly, computerization of nurses’ notes can lighten our workload and allow us to allot more time for accomplishing other tasks. TMC can serve as the pioneer in electronic nursing documentation and as a model for other hospitals. I think it would make a good impact on the nursing community here in the Philippines not only because it will be the first of its kind in the country, but because there are so many advantages to be had with its implementation.

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More notes to come (I hope!) from the other 2 trainees. Comments welcome. Thanks! – Dr. Mike Muin

We have 3 trainees. All nurses with clinical experiences. 2 of them have both IT degrees and RN degrees.

Last week was all orientation. We gave them an overview of all Health IT projects.

This week, I gave a lecture on the following topics:

• Fundamental Concepts in Health Informatics
• Overview of Healthcare Information Systems
• Telemedicine and other areas of biomedical informatics
• Lessons learned in Health IT practice
• Introduction to Project Management Concepts

The discussions during the lecture was very lively. I appreciated all the questions. I gave them an assignment to do the Project Overview for each of their assigned projects.

We will start assigning them soon to these projects:

• ICARUS/Medication Management/Barcoding
• PRIME – Cath Lab, Cancer Center
• PRIME – Eye Center
• Ophtha Telemedicine
• PRIME Phase 2 Planning
• LIS and MUSE HL7 Integration Planning
• MID OMRI and PRIME Integration Planning
• Telemedicine

2 weeks almost done. 12 weeks more to go. I’m excited. I think this is going to be fun!

Please click here to join: http://pinoymd.net/main/authorization/signUp?
(If link doesn’t work, please copy and paste to your browser.)

Some of the features of the new platform include:

• discussion forum
• member blogs
• events calendar
• groups
• social network integration with Facebook and Twitter

The Pinoy.MD Community forum (http://pinoy.md/ipb) will continue to be online but we’ll close off new registrations by end of February 2012 and close off new topics and posts by end of March 2012. The site will remain online as a discussion archive site.

This is part of our continuous improvement effort to serve the Filipino Doctor through online resources and collaboration. We hope that this shift will us manage the site more efficiently and effectively so we can focus on delivering better user engagement and content.

As always, we welcome your feedback, questions and suggestions.

See you there!

1. Do’s and Dont’s of Telemedicine

We are currently exploring Telemedicine for The Medical City and this article provides good insights for our implementation. I especially liked his practical tips in using common Web meeting technologies to improve telemedicine programs.

1. Why adoption of EHRs is a transformational event for physicians

This article explores why role-reversal in the hierarchy of medicine might help boost EHR adoption.

1. Why EMR is a dirty word to most physicians

I especially liked this article. It is a personal discourse on the kinds of challenges that HIT professionals like me will face as we advocate and promote EMR adoption.

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The IT Department of The Medical City, in coordination with the HR Training Department, will be starting a Nursing Informatics Training Program (NITP).

Overview:

This is a 14-week introductory course to the Basic Nursing Informatics Concepts and Applications for Nursing graduates.

Objectives:

• To provide all participants of the course with the necessary knowledge, skills and experience in the fundamentals of Nursing Informatics;
• To provide all participants opportunity to apply knowledge and skills in clinical systems analysis and software development and design;
• To prepare the trainees on how to work professionally in a corporate environment; and,
• To align the trainees to the corporate mission and vision of the hospital.

Target Participants or Trainees:

• Graduate of Nursing;
• Preferably a Registered Nurse (RN);
• At least with two (2) years of clinical experience;
• With basic computer knowledge and skills (Windows and MS Office); and,
• Must own laptop/notebook for use during training and practicum.

Methodology:

• Lectures;
• One-on-one coaching and mentoring sessions;
• On-the-Job-Training; and,
• Practicum Work (Special Projects).

Major Topics:

• Introduction (TMC and IT);
• Concepts in Healthcare Informatics and Nursing Informatics;
• Computer Applications in Healthcare and Nursing;
• Principles of Healthcare Interoperability and Integration;
• Effective Software Development and IT Project Management; and,
• Systems Analysis, Design and Implementation for Clinical Applications.

Practicum Work:

Participants will be working with the TMC-IT Special Projects team. Special projects may include:

• Electronic Medical Record (Clinical Documentation);
• Clinical Data Repository;
• HL7 Integration;
• Telemedicine;
• Electronic Medication Administration Record with Barcode;
• e-KARDEX Planning and Design;
• Hospital Information System Planning and Design; and,
• Outpatient Clinic Management System.

Other Details:

• Training is free. There is NO fee.
• Only a maximum of 3 participants will be accepted.
• Target start date is on March 1, 2012. All three slots should be filled up.
• Participants will be interviewed for fit into program and interest in Health IT.
• Program Duration is a minimum of 336 hours (8 hours per day, 3 days a week, 14 weeks)
• Certificate of Attendance shall be given to the trainees who have satisfied all the requirements in the Practicum.

Procedures:

• Interested and qualified participants should submit the necessary documents to the TMC Training and OD (TOD) Department and pass the initial interview:
  • Letter of Interest specifying the participant’s intention to be exposed and be immersed in the Nursing Informatics Practicum and Training Program that is being provided by the Information and Technology (IT) Department,
  • Updated copy of their resume with 1×1 or 2×2 size picture,
  • Nursing Diploma or Nursing License.
• Shortlisted applicants will be forwarded to the IT Department for their final interview. If the participant passed the final interview, the IT Department shall forward its recommendation to the TOD Department for creation of a Memorandum of Agreement (MOA) between TMC and the participant to cover the training program.

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Interested applicants may also send their application requirements to mbmuin(at)medicalcity.com.ph. I can forward the application to HR for initial screening before final interview with me and IT Department.

Questions, comments and suggestions are welcome.

Last January 27, 2012, the IT Department underwent extensive training in deploying, setting up and implementing all the acquired equipment. The next day, January 28, 2012, a small group of doctors and nurses were trained in the use of the equipment and software.

Why is The Medical City exploring telemedicine?

• To improve delivery of healthcare services within the whole TMC network of clinics and hospitals
• To expand service offerings beyond what is available in each local site
• To be the leader in delivering quality patient care services that goes beyond geographical boundaries

Pilot implementations of the telemedicine project will most likely include TMC Iloilo and TMC Angeles.

Telemedicine

We are looking at improving and expanding the healthcare services of The Medical City including the satellite clinics and provincial hospitals (TMC Iloilo and TMC Angeles).

MID OMRI

OMRI is the document management system for our medical records. This is were scanned images of previous patient charts are stored and managed by the Medical Information Department (MID). We plan to improve the interface, features and security of the program to allow access into the system from the various nursing units and clinical areas.

ICARUS Medication Management

The ICARUS system is our medication management system that uses barcode technology. It is deployed in all nursing units. Full compliance is a bit challenging. Poor Wi-fi coverage for the handheld units also need to be addressed. This year, ICARUS will have to be "re-implemented" to get more units to adopt the system and increase compliance.

Once ICARUS is "re-implemented", we can work with NSO for more IT projects that improve nursing workflows.

Laboratory Information System

Plans for this year include fully implementing the Microbio, Blood Bank and Histo-Cyto modules. We may need to look into building another system for Blood Bank to handle donor management.

HL7 integration of the system with SHAMAN (ADT and OMG) and PRIME (ORU) is also planned for this year.

PRIME Phase 1 Roll out

PRIME stands for Patient Records and Integrated Medical Exchange. It is our clinical data repository and electronic medical records platform. We just finished development December 2011 and we plan to roll this out in the ambulatory units within the year. First pilot implementation is at Wellness. Wellness should be working with the system by February 2012.

Roll out of the clinical documentation feature to the other ambulatory units should commence by mid-Feb or March 2012.

PRIME Phase 2 Development

There is still more to be done with PRIME. We have just touched the surface for what we need in clinical documentation and electronic medical records. Phase 2 will incorporate the clinical research agenda of the hospital.

PRIME Results Integration

We need to integrate the following systems with each other: SHAMAN, MUSE (ECG System), Laboratory Information System (LIS), OMRI, ICARUS Medication Management and PRIME.

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This blog post is to help disseminate information among doctors and clinicians of TMC.

As always, I welcome comments, suggestions and questions. I also encourage active participation of clinical units in our efforts.

Thanks!

Text4baby receives high grades

Surveyed participants in text4baby, a health information text messaging service for pregnant women and mothers of newborn infants, reported high levels of user satisfaction, according to researchers from the University of California San Diego (UCSD) and the National Latino Research Center (NLRC).

…

Additionally, 63 percent of respondents reported that text4baby reminded them of an appointment or the need for an immunization; 75 percent reported that text4baby informed them of medical warning signs that they’d been unaware of; and 71 percent reported speaking to a physician about a topic they learned of through text4baby.

This is great use of texting for consumer health IT purposes. The text4baby site is here.

However…

Joint Commission- Doc ordering via text is unacceptable

Here’s the original post at the Joint Commission site.

Is it acceptable for physicians and licensed independent practitioners (and other practitioners allowed to write orders) to text orders for patients to the hospital or other healthcare setting?

No it is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting. This method provides no ability to verify the identity of the person sending the text and there is no way to keep the original message as validation of what is entered into the medical record.

I know this practice is somewhat common here in the Philippines.

What do you think?