Why VisualMED?
VisualMed (VMCS.OB)
VisualMED is the only existing, comprehensive clinical informatics system that saves time and money while encouraging practitioners to practice the highest quality medicine. Rather than re-duplicating paper systems, it replaces them without generating wasteful make-work.
VisualMED - clinically-based, reality-checked
In addition to ease of use for healthcare providers, VisualMED's compelling advantages are that it saves time and money and is fully scaleable to suit any clinical environment.
VisualMED can be fully functional on either a single ward or across the wards of a large hospital, and can be introduced module by module as time and budget permit
VisualMED incorporates all clinical medical and nursing functions with results reporting and image retrieval and interfaces with existing legacy systems.
VisualMED modules can pay for themselves over 24 to 36 months depending on the size of the installation and local practice habits, without imposing "prescribing rules" for practitioners.
Frequently asked questions:
How can VisualMED clinical system screens function in clinical environments unique to each hospital site?
VisualMED screens are constructed using parametric components. Though within the system order entry screens there are a number of different ways different users may arrive at the same set of completed prescriptions, those same screens can often be configured to function along broadly different, though “parallel” lines of function. The most striking example of this parallelism is in the existence of two broad methods of drug order entry. In one method of screen flow, the user chooses the drug and drug “format” from a single list. In the alternative method, the user selects from a shorter list of drugs and chooses the drug format in a second step. The latter method, though seemingly adding an “unnecessary” second step to the order entry process, was built as a parametric addition to the system as it is most appropriate to the practice of pediatric medicine. It was developed specifically at the request of our first pediatric installation.
At a more granular level (ie., for any given configuration), VisualMED screens are already “adapted” to the requirements of most sites that already have developed tried-and-true approaches to order entry and clinical charting. This is because most VisualMED screens allow the user to prescribe and chart according to more than a single “allowed-method.” There is usually more than one route to accomplish a given order entry or charting task, and therefore it is highly likely that at least one existing VisualMED method “already” corresponds to the order of work chosen by any individual user. Without making any modifications to the system screens as they currently exist, a diversity of approach is already present: In order entry, orders can be generated en-bloc or one at a time; administration times can be specified broadly or exactly; navigation can be alphabetical or “logical,” orders can be prescribed individually or may belong to ordersets. In the nursing activities screen, nurses can review scheduled activities using an icon display or a tabular display; they can review the schedule for the entire care unit, for selected rooms belonging to the units, or for selected nurses working on the unit. The nurse can chart his or her data entries through the activities screen or directly in the MAR, depending on which screen they feel more naturally reflects their existing approach to the clinical process. In results reporting, graphs can be navigated in “analog” mode or in “value” mode.
VisualMED manages clinical processes as “modular,” ie., as related to the individual specialties of medicine and surgery. Orders and procedures relevant to only certain specialties or sites may be displayed only at those sites, wards or services so that workflow documentation and order entry follows established local requirements.
VisualMED is actually capable of maintaining individual, but linked, clinical information systems at each of the principal hospital sites belonging to a Hospital System. Therefore, the navigation flow, the order types available, the drug listing and test listing content, as well as all of the decision support related to each of these, may be tailored to the individual sites. Additional screen development may be necessary to deal with clinical investigation or other projects that would be unique to each site belonging to a university system.
How is the VisualMED “clinician’s desktop” designed?
The VisualMED desktop itself, like all other VisualMED screens, may be navigated using the keyboard or touch. Mouse may also be used. « Hotkey » navigation allows the user to rapidly access clinical functions documented by doctors and nurses, all of which are displayed in plain sight at all times. The screens are open and uncluttered and color navigational cues are used consistently across all screens. Drop-down menus requiring users to « guess » at what lies beneath are avoided. Doctors and nurses navigate an electronic interface which, rather than borrowing from traditional paper charting methods, actually reflects clinical workflow as performed by the clinical staff. Our unique U.I. is based on our successful « legacy » U.I., originally developed on the clinical teaching units of the Department of Medicine at the Royal Victoria Hospital, specifically for the practice of tertiary care medicine and surgery. In our second generation system, we have taken those features proven successful over the past seven years and incorporated them into a state-of-the-art Windows interface.
The desktop may be configured by the client so that patient names are entirely hidden until logon, while nevertheless showing the presence of screen icons indicating the existence of certain critical clinical situations. It may also be configured to contain button controls giving access to non-system screens and/or internet data sources. Automatic signoffs prevent unauthorized access and no patient data may be viewed without biometric logon. Logon is, in fact, entirely biometric and no PIN or password is required. This streamlined process results in a false (+) rate of less than one in 2,500,000.
The principal physicians’ screen, in fact a « desktop », displays the list of hospitalized patients on the specific unit. The list can be explored by using the up and down arrow keys or the TAB key, or touch to move from column to column. At the top of the screen are located buttons that give access to other system clinical functions, including the VisualMED electronic patient record. To the left of each patient’s name may be displayed one or more icons containing critical information relating to the appropriate patient.
icons indicate that the specified patient has a positive microbiological culture for a body fluid AND is not receiving appropriate antibiotic therapy; has at least one numerical laboratory test result outside of a defined normal (or “alerts”) range; has at least one vital sign reading outside of a defined normal (or “alerts”) range; that there is a message concerning the patient to the attention of the patient’s doctor; that the patient is in a state of dehydration or hypervolemia. The biohazard icon may also be displayed in such a way as to indicate that though a culture is positive, the patient is already receiving appropriate antibiotic coverage. As well, the laboratory alerts icon may be display so as to indicate that laboratory results have arrived on the ward within the past hour for designated patients. The message icon stores not only text messaging from other system users concerning the designated patient, but may store voice messages as well. To access any additional icon “content,” the user highlights the icon of interest, and simply presses ENTER and VisualMED will open a small window containing additional related information.
VisualMED displays a number of icon images in the principal nursing screen that specify information unique to specific patients. Notification of the existence of pre-op or post-op orders written by a physician is given by displaying icon content to that effect. Pre-op and post-op orders may be accessed directly through the appropriate icon.
VisualMED displays an icon to the left of the names of patients scheduled for blood tests. Upon opening the icon, the nurse or technician may then sign-off the blood drawing activity, with the date and time sent immediately via HL7 to the appropriate laboratory. A hemodialysis icon is displayed to the left of the names of the patients who are dialyzed and have drug orders associated with the dialysis schedule. The message and discharge icons available in the physicians’ desktop are also available in the nursing desktop.
Desktops unique to the functions of the pharmacy and of the unit coordinator also exist within two additional principal VisualMED screens. Paramedical users access the system using one of the four currently existing principal screens.
Which VisualMED modules and functions take advantage of portable wireless devices?
All VisualMED modules and functions currently run in a wireless environment using a computing tablet. The tablet displays the full VisualMED desktop at 1024x768 resolution, and allows for the performance of all system functions. All entries are communicated in real-time to the system tables, bidirectionally.
By-the-bedside clinical signs data entry and voice messaging is currently available using a hand-held device which allows for touch data entry. Voice messaging regarding the currently specified patient is communicated to system tables as a WAV file where it is “stored” inside the same message icon displayed on the principal system screens used to display text messages. Message icons displayed on workstations designated as “non-public,” ie., that are not located in a designated public space, such as a corridor, will play-back stored voice messages when opened by users who have access rights to this function.
Can VisualMED results reporting capture data for both clinical and research purposes?
Whether or not a particular laboratory examination was initially prescribed through VisualMED, all numerical, text, and image data stored originating on the appropriate laboratory system is available for review through the VisualMED clinical information system. Clinical data which was prescribed as part of a researcher’s protocol, because it nevertheless originates in one of the hospital laboratory systems is automatically forwarded to VisualMED tables. Data required purely for research or protocol purposes may be defined for efficient capture through the use of the VisualMED Protocol Data Administration screens. Initially developed for the VisualMED VisualONCOLOGY module, the flexible design of that screenset allows its use to be generalized to apply to any defined research protocol, including those outside of the domain of oncology. Because the VisualMED CIS (clinical information system) allows for the ad hoc definition of clinical modules, a module may be defined to which only specified user groups have access, and such groups may be defined to contain just a single individual. With no special modification to the VisualMED clinical information system, clinical protocols may be maintained for which only a few individuals have access, including the access to the sets of data defined as associated for that module through the Protocol Data Administration screens referred to above. Though VisualMED currently supports the concept of “sensitive” data, limiting the disclosure of such data to the prescriber and the patient’s attending physician, with respect to the maintenance of “private” data, field changes to the current table structure would be required, but are customizable at the request of the client.
How can the VisualMED clinical information system support disease management programs?
A disease management program can be defined as a grouping of multidisciplinary services targeted at patients with a specific family of diseases. The VisualMED CIS currently supports disease management programs through its incorporation of specialty-related ordersets and protocols that may be easily modified, without coding, so that they apply to the reality of the patient population treated at individual sites of a healthcare organization. Though ordersets and protocols may be designed to reflect practice at individual sites, because the system makes use of its own internal data dictionary, data collected at each site may be meaningfully compared with respect to outcomes analysis. Each protocol can also be identified with predetermined outcome targets. All CIS clinical data, including data captured in the patient chart and physician’s note, is coded and therefore also available for outcomes analysis. The VisualMED CIS promotes the implementation of disease management programs through the seamless integration of the documentation of all clinical activities by all members of the health care team, including physicians, nurses, consultants, residents, and paramedical personnel. The CIS already contains a basic set of clinical reports that may be used as case-finding tools, identifying patients at risk for clinical deterioration or poor outcome. The longitudinal CIS patient record promotes continuity of care, and, in conjunction with VisualMED Consent Management included with the CIS Ambulatory Care functionality, gives staff in off-site locations access to a unified electronic patient record.
CIS features that facilitate the implementation of a disease management program include the following:
· Specialty-driven ordersets and protocols that reflect best practice at individual hospital sites with varied patient populations, integrated with MAR and Care Plan.
· Target outcomes that may be attached to defined protocols.
· Built-in case finding tools
· Integration of the clinical process and of the documentation of the clinical process, for all members of the healthcare team.
· Entirely coded clinical data entry by health care personnel.
· Longitudinal electronic medical record
· Consent Management allowing on and off-site access to all or part of a patient’s electronic record.
· Audit capability for evaluation of clinical outcomes.
For more information on the VisualMED System, click here.
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