Case Study #2: Transplant Labs Discrete Data Capture with Optical Character Recognition. Darla Phillips Joy Larney Collins Clarkson Michael Watson

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1 Case Study #2: Transplant Labs Discrete Data Capture with Optical Character Recognition Darla Phillips Joy Larney Collins Clarkson Michael Watson

2 HOSPITAL ADMINISTRATOR PROFILE Darla Phillips, RN, MSN, CCTC Clinical Operations Director, Duke Transplant Center (DTC) - Clinical leader for implementation of electronic support for DTC - Implemented Maestro Care in Clinical Care & Clinical Education in Transplantation from Clinical Transplant Coordinator

3 IT ANALYSTS PROFILE Collins Clarkson & Michael Watson DHTS Application Support Analysts - Testing and evaluation of application - Application Monitoring - Security/Interface Monitoring - End user support - Our key role is following the document from the time it is faxed until it reaches the EHR (Maestro Care).

4 IT ANALYST PROFILE Joy Larney, RN, MSN Nursing Informatics System Specialist II - Phoenix Analyst that Supported LabDE Go Live - Collaborated with Operational and Support teams to design workflow and build - Maestro Care Education Specialist,

5 PROBLEM: Large number of organ transplants every year. Each patient needs close follow up for years after. National Trends Organ Procurement Transplant Network (OPTN)

6 PROBLEM PROBLEM: Duke Transplant Center needed to streamline and expedite the process of entering external lab results into Maestro Care, the Duke Health electronic health record. OPPORTUNITY: Use of Optical Character Recognition technology to decrease the burden of capturing electronically.

7 Duke Transplant Center Multi-organ specialty transplant center Heart, Lung, Heart-Lung, Liver, Kidney, Pancreas, Kidney- Pancreas, Intestine and Vascular Composite Allograph (extremity transplant) Largest thoracic transplant program in country in volume Multi-organ transplants common Patients are seen pre transplant and post transplant and require variable testing including laboratory studies to monitor end organ function. Monitor large volume of patient laboratory results 3222 post transplant patients 775 pre transplant patients

8 PROBLEM: Duke Transplant Center Trends increasing with increasing numbers of patients needing follow up. Monitoring a large volume of patient laboratory results 3222 post transplant patients 781 pre transplant patients

9 PROBLEM VOLUME: Clinical staff busy with more patients in clinic and increased transplant volume DATA ACCESSIBILITY: Needed a way to do work anywhere not just in the office MONOTONY: Administrative staff stated frustration of entering lab values "all day long" with little variation in their current role DATA ERRORS: Data entry errors could not be easily identified as source document was a paper document discarded after nurse review

10 PROBLEM We identified an application to handle the inefficiencies due to inoperabilities encumbered in the health care IT systems. These inefficiencies led us to find an innovative solution.

11 DESIGN What is Optical Character Recognition Technology? Software application that accurately captures over 80% of faxed, nondiscrete clinical laboratory data as discrete data elements. The Medical Secretary utilizes the program and is able to edit and add data. This intelligent data extraction empowers faster analysis and increased accessibility of lab results across the enterprise. OCR data capture process is all done electronically which reduces errors and the redundancy inherent in paper-based workflows.

12 DESIGN Maestro Care Ambulatory Implementation Stakeholders Transplant Staff Interface Citrix OCR Database Application Analysts OnBase RightFax

13 Pre OCR Workflow (average enter/edit 6 min 10 sec) 25% Savings in Time to capture lab data discretely Lab Results faxed to Transplant Office Secretary would sort document Create documentation encounter in EHR Manually enter external lab results via enter/edit results Hard copy forwarded to Transplant Coordinator for review. Current OCR Workflow starting July 2016 (average 4 min 38 sec) Lab results faxed to Transplant Document is placed on shared drive LabDE picks up Document LabDE extracts results through OCR Transplant Medical Secretary ve rifies data OnBase receives image and creates link to EMR. Results & Images are available for viewing in EMR

14 DESIGN Workflow in Maestro Care Transcribe Order Encounter Created Existing External Order Released External Order Entered if No Existing Order & Released External Order Available During Verification Process Released Order Sent to LabDE

15 HIT View Defaults to Order Review

16 HIT External Lab Preference List

17 HIT OCR Verification

18 HIT OCR Results to EHR

19 HIT Judy Smith, RN, BSN Transplant Coordinator Duke Transplant Center

20 VALUE Optical Character Recognition Implementation Benefits Source lab document available within the medical record via a link External results are rapidly reviewed to determine clinical intervention Clinical users state they are more efficient in their role Increased number of labs available as discrete results for trending & reporting Delay of labs sent to Transplant Coordinator for review is reduced Volume of lab documents and fax volume now available for workload assessment QA process identifies common errors for re-education or user specific coaching

21 VALUE 9000 Lab Volume Saved 203 hr 8000 Lab entry has grown tremendously with an increase of 32% quarterly through March Saved 138 hr Lab Volume LabDE: 4:38 min Enter/Edit: 6:10 min Saving: 1:32 min Q Q Q Q Q Q Q1

22 VALUE End of Business work volume remaining is a metric followed closely Go Live with OCR End Of Business Labs EOB report at 4:30 PM EOB Labs Current performance is <10 faxes per day remain to be reviewed Q Q Q Q Q Q Q1

23 VALUE Future of OCR at DukeHealth Adding new features to LabDE system to enhance user experience. Expanding to other Duke clinical programs including the Reference Labs performed at Duke Hospital (Living Donor Panel and Newborn Screening)

24 References Duke Transplant Center Organ Procurement and Transplant Network