Electronics Connect Records, Schedules, Physician Cellphones

Marcia Frellick

May 04, 2017

LAS VEGAS — A new software program can draw information from an electronic health record, connect it with a hospital's scheduling software, and text a hospitalist's cellphone when a patient is readmitted to the hospital within 5 days of discharge.

The Murmur program is meant to bridge a gap caused by the rotation of hospitalists, especially in large hospitals, and by the lack of interconnecting systems, said Nader Najafi, MD, an assistant clinical professor at the UCSF Medical Center in San Francisco, where the program was developed.

"If you go off service and the patient you discharged on your last day is readmitted, you may not have any way to know that," he explained.

Although readmission notification can be set for any period of time, 5 days was chosen as the default because of the likelihood that a readmission during that period would be linked to the care the patient got in the hospital, and will provide instructive information, Dr Najafi told Medscape Medical News. And there weren't enough instances of 5-day readmissions to overwhelm busy physicians, he pointed out.

In a 2-week trial of the program, 18 attending hospitalists were notified about 14 readmitted patients, according to findings presented here at the Society of Hospital Medicine 2017 Annual Meeting.

Real-Time Surveys

Murmur can also be used to administer real-time surveys to physicians on duty. This could help gauge daily workflow, Dr Najafi pointed out.

Without a connected system, researchers have to rely on hospitalists to remember how busy they were over the past few days or weeks. But with Murmur, hospitalists on duty can be asked to respond in real-time to texted questions, such as "Is your census manageable today?" or "How busy do you feel?"

Such surveys could help reduce avoidable hospital days, he added.

"If we knew that not having enough lung doctors to do bronchoscopies, for example, was causing avoidable days for our patients, maybe we could make the case for another pulmonologist," he explained.

The survey questions are short, most are multiple choice, and they are only sent to hospitalists for whom the questions are relevant, Dr Najafi emphasized.

The low-cost program runs every day on a timer, so physicians don't have to download or learn new software. But hospitals do need a subscription to the REDcap web-based survey program.

The program was designed to work with Epic inpatient electronic health records. "That's what I like about Murmur; we used things that a lot of institutions have," he said.

For other systems, the software will have to be customized. However, the source code and information on the components that need to be rewritten are online.

After the presentation, a member of the audience asked how long it would take to develop a new query. Something simple, such as 5-day readmissions, would take an experienced programmer about a day to put together, Dr Najafi reported. Other queries might take more time.

This program could reduce readmissions, said Emanuel Kokotakis, MD, from the MedStar Montgomery Medical Center in Baltimore.

If skilled nursing facilities, rehab centers, and primary care offices, which take most of the patients from my medical center, are linked in, communication would improve, he told Medscape Medical News.

"Before they rush somebody back by ambulance, it would be good to communicate in real time about what the problem is — whether it's a chronic condition or something that really requires readmission," he explained. Using the program, "decisions could be made in real time before a patient is rushed back inappropriately."

This would be a great use of the platform, said Dr Najafi. And any healthcare provider's contact information can be added to the directory, not just hospitalists, he noted.

He and his team are exploring other uses for Murmur, such as automatically identifying patients who have been admitted for sickle cell anemia and sending the information to the hospitalists on the sickle cell anemia consult service.

They have also discussed capturing the number of unexpected intensive care unit transfers as a potential quality measure, something Murmur could easily calculate with its link to electronic health records, said Dr Najafi.

Dr Najafi and Dr Kokotakis have disclosed no relevant financial relationships.

Society of Hospital Medicine (HM) 2017 Annual Meeting. Presented May 3, 2017.

Follow Medscape Internal Medicine on Twitter @MedscapeIM and Marcia Frellick @mfrellick


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