Jon Langford, Pulmonary Diagnostic Lab Manager, Texas Children's Hospital
Paper, faxing, and scanning were the ways data got pushed into a patient’s Electronic Medical Record (EMR) from point-of-care testing. Paper could be lost. Data could get lost or misplaced in a fax. The scanning process usually takes at least one full day if not longer to get all the information finalized. With technology moving faster and the world getting smaller, the pulmonary lab at Texas Children’s Hospital had to join the information age.
A little over two years ago, Texas Children’s embarked on a journey to improve the flow of data with its point-of-care testing within the pulmonary lab. It took a large group that involved information technologists, pulmonary lab staff, software vendor personnel and project managers. It took months to build the platform where the information would flow and subsequently, months to test that flow of information. Finally, all the pieces were in place and all tests had been completed successfully. Basically, the movement of data started when the provider entered an order for a test. The tech performing the test would then send the results back to the ordering provider once the test was complete. A process that historically could take days to finalize and have in the patient’s EMR, could now take seconds.
This has opened a new door for providers and patients. For patients in the hospital needing point-of-care testing to determine their discharge date, the process is more efficient. With portable testing machines, a tech can go into the hospital and perform a test on a patient. The data get sent immediately to the provider. While the provider is doing morning rounds they can have the data needed sent to them without having to stop and request it or going to find it somewhere. This allows them to move more efficiently and decide earlier if the patient can be discharged home or not. If a patient needs a specific test for their cancer medications, this can be done immediately as opposed to having to wait to schedule in advance. There was one patient that found out late in the day that they could qualify for a special new cancer treatment, but they needed a lung diffusion test to determine the final qualifications. The cut-off for the treatment acceptance was 3 p.m. and it was getting close to 2:30 p.m. With the new software integration, the test was ordered and performed within minutes. The results were able to be sent to the provider within seconds of completion so that the provider could determine eligibility and notify the required personnel immediately. The patient did qualify and because everything was done in a timely manner, they were able to get into the treatment program. Without the new software integration in place, this would not have been a possibility and yet now, this patient has a new chance at survival.
"With technology moving faster and the world getting smaller, the pulmonary lab at Texas Children’s Hospital had to join the information age"
The benefits don’t stop within the hospital. Texas Children’s is the largest pediatric hospital in the country. It serves a very large community that is spread far and wide. Patient’s families sometimes travel for hours and struggle to find parking in downtown Houston to be able to be seen by a provider or even to have one ten-minute test performed. With this new software integration, they can utilize satellite locations more efficiently. Now, if a patient needs just a basic point-of-care test performed for routine follow-up, they can go to the nearest location to have the test performed. The results can be sent to the primary provider immediately. The primary provider can view and finalize the results, making any needed medication treatment changes before the patient leaves the testing center. This option has given patient families hours of their time back and saved them hundreds of dollars (if not more) annually in traveling and parking fees. This option also allows a provider to see more patients. Not having to fill open time slots with routine point-of care-test visits allows the provider to keep those times open for new patients or more complex routine clinic visits.
One of the main challenges is training staff to use the software functions appropriately. Technology is only as good as the person using it. Part of the overall software integration was putting together a very detailed training plan. This plan was sent out across various communication networks and staff received intensive hands-on training to ensure competencies were met. Staff now feel comfortable performing point-of-care tests and delivering results back to providers. The providers are now more comfortable receiving all data electronically. There is a detailed step-by-step plan for any new staff member or provider that joins the team.
Software integration has also improved wait times. The average wait time for a patient to get a point-of-care test complete was 30 minutes. Since the project completion, the average wait for a test is now 8minutes. Data output has also improved. From the time the test is complete, to the time it enters the patient’s EMR takes about ten seconds. It is because of all of these functions that the software integration project has greatly improved point-of-care testing within the hospital and across the community.