In this Episode:
The Real Time all-the-time Tile helps to manage the cohort of patients who have advanced illness and may be planning for hospice or palliative care.
It helps ensure the right conversations happen in a timely manner for patients with multiple chronic end-stage conditions, signs of advanced dementia or a history of palliative care based on the hospital’s protocols and procedures.
Jeff Terry: Let’s take a look at the Advanced Illness Tile.
Like any Tile, we access it from Tile Viewer. You see in this implementation there are 10 Tiles, but we’re going to drill into the Advanced Illness Tile. The data you see is fake. Of course, everything here is happening in real time. So when there’s a change in the EMR or the source system, or the machine, it updates live as the user is using this within about 30 seconds. So always real time.
Now, for a patient to be on this Tile, you see on the lower right, there are 345 patients out of our 1,100 bed health system. Those are patients that are either at a high deterioration score, have either a palliative consult or a hospice consult, or have one of several alerts like an end stage condition or multiple chronic diseases.
Now, up in the upper right, you see we’ve started with a profile of palliative care managers selected and that brings us down to 19 patients that the palliative care manager may want to virtually round on. And those are patients with a high deterioration score and a palliative consult either ordered or completed.
I’m going to walk left to right to show you what each row contains. It tells us the length of stay of that patient. It tells us the patient’s alias and their medical record number.
We see the patient’s deterioration score. If I hover, it tells me the last time that was updated.
Now, we can pull that out of the EMR using any deterioration score you like or calculate one according to your medical staff. To the right of that, we have the palliative care consult status, which is either ‘complete’ or ‘ordered’. The ‘ordered’ goes red if it’s been gone too long without being closed. When I hover, I get the information you see there about the ordering provider, about the priority; when it was ordered, the order number, etcetera.
Over to the right, I get the same information about a hospice consult if one has been ordered. And then on that next column, we get several alerts. For example, that first one there, if I hover it will show me that this is a dementia patient with at least one other chronic condition… so you see they have dementia and they have pneumonia.
To the right of that, that icon’s telling me that this patient is either currently on the hospice or palliative care program or has been on the palliative care or hospice program. That’s very useful for those managers to know. And down below you see a septic patient. If I hover over that, it tells me that patient’s in septic shock. The ICD code, when that was added, etcetera. And then there’s one other up above. In the second patient, you’ll see it tells me that that’s a patient with multiple chronic conditions. It tells me what those are. Clearly that’s a situation that is important and needs to be watched carefully.
Now that’s one example of a user. Every user can set up their own profiles. Let’s look at a couple others that we’ve seen in practice. You see the hospice manager may want to look at the prior hospice patients to see who’s an inpatient now that’s been on the hospice program, and you can see that there’s 14 patients that come up there. I can also click and see patients that are on… the physician on duty might want to look on the overnight “Who are the patients with the high deterioration scores?”
So I want to make sure if I’m the overnight physician on duty, there are 42 patients out of our 1,100 that have a high deterioration score. And I can see what’s their status in terms of palliative care and hospice program. Another example, you might be campus specific. So you see the second to the bottom there, that’s a leader at St. Janice Medical Center who just wants to see patients on this Tile that are at her medical center, and you can see that there are 2 of them. And she’s also added a filter for deterioration to get it down to 2 patients.
Now, you may be thinking about those alerts. A reminder that if I want to know what an alert is or what alerts are available, I can always see that up in the ‘info’ button. So, that’s sort of my Legend. I can see, ‘What do these different things mean?” “What are the thresholds down below?” “What are the alerts that this Tile will show?” Up at the top, by the way, where it says ‘Quick Ref’ and ‘Actions’, that’s where each health system stores a PDF that describes their protocol for putting this Tile into action. And if I click on it there - let’s do one last thing. Let’s create a profile.
So, let’s just clear these filters that we had set up and let’s just create a new profile. And I do that by clicking on ‘Profile’ and then going down to ‘create new’. And let’s say I want to name it ‘Demo’ and then I can determine, you know, ‘What do I want to do?’ ‘How do I want to have it sorted?’ And you’ve seen during this demo, it’s been auto scrolling. Maybe I want to have my auto scroll turned off in my profile so it doesn’t advance unless I advance it. And then down below, you can see where I can build these filters.
Ok, I want these units and these alerts. Or this this patient class. And if I click on one of those, you can see the list that comes up where I can just click to add the filters. I would save that and - I’ve created that demo profile. And I’ll just do that quick. And you can see now up in the dropdown, that demo view that I’ve created is now available to the next user. Or sorry, now available to me as a user, along with the others that I have saved.
So, each user sets up their own profiles however they want, and then uses them to very quickly round on different cohorts of patients. So that is the Advanced Illness Tile. Again, one of many Tiles that’s available on the Command Center software platform. All about making sure that we’re giving the best, appropriate care to patients with advanced illnesses. Obviously a high-risk population.
Congratulations to the leadership at CHI Franciscan Health which is the the organization with whom we first designed this, and it’s now being implemented at other hospitals worldwide. Thanks very much.