Challenges of the OPD
The OPD presents many logistic and clinical challenges to an organisation.
- High demand from the hospital and the community
- Increasingly complex patients
- Junior staff on rotation looking after complex patients
- Low discharge rates to the community
- Managing bookings, re-bookings, cancellations, notifications
- Managing patients when they arrive in the OPD
- Managing clinical results
Alcidion have developed Miya Clinic, a solution that adds clinical context into OPD management to ensure that high risk patients don’t fall through the cracks, and that referrals into the OPD can triaged and booked using a distributed workflow.
The Miya Clinic helps organisations achieve:
- Efficient triage of referrals via electronic workflows
- Integration of clinical risk and priority so patients can be triaged to minimize harm in the case of a missed appointment or clinic cancellation
- Ability to set quotas for each clinic, including by source
- Dramatic reduction in staff time for information access and in time spent monitoring junior staff
Miya Clinic 2
Miya Clinic can integrate with your existing booking system, or it can run the whole outpatient clinic. Miya Clinic comprises clinical views and administrative tools that integrate to support the complex OPD workflow.
Before the patient even arrives Miya Clinic 2 supports workflow automation of referrals and wait lists, clinical triage of referrals, bookings with quotas. On the day Miya Clinic 2 will warn if a patient has been admitted, manage interpreters and transport, track patients within the OPD, and provide clinical views with decision support.
Bookings & Quotas
You can configure each clinic with individual doctors, or with doctor types. Appointment lengths can vary by doctor, doctor type or appointment type. Quotas can be assigned to each clinic, including quotas for source of referral, such as inpatient, out of hospital referrals, or emergency department. The bookings and quota view quickly shows availability of appointments.
Cancellations and other unpredictable events are handled using lists to show who needs rebooking and their clinical priority.
Referral Management
Electronic or paper? Miya Clinic supports both. Electronic referrals are web based forms that include the ability to gather clinical data to assess eligibility, prioritise appointments, and provide pre-requisite tests and information for the clinic. Referrers can see average waiting times for each clinical priority level to set expectations. Paper referrals from the community can be scanned into Miya Clinic and then assigned to different units for prioritisation, supporting a full electronic workflow. Letter or email generation is automated to reduce the workload for admin staff.
Patient Tracking
On the day Miya Clinic presents a view of which patients are due, who is late, and if they have arrived. Miya Clinic also tracks the booking and arrival of interpreters. Arrived patients can be tracked in detail in the department so you know if the patient is with the doctor, the clinic nurse, getting tests, or has just stepped out. All workflow metrics are captured and can be analysed to better understand how to improve patient flow.
Results Tracking
The clinical views in Miya Clinic show doctors who is waiting, and presents the electronic data in an easy to understand way. Labs are risk rated, radiology can viewed (via integration with PACS), future and past appointments are displayed.
Optionally, Miya Clinic can support rebooking guidelines so junior doctors are guided when discharge to the community is appropriate.
Coming Soon to Miya Clinic 3
In early 2011 Alcidion will release Miya Clinic 3 which will bring the full functionality of the Miya Platform to the outpatient department.
Clinical Notes
Miya supports both structured notes entry with templates and free text. Custom templates can be activated for specific presenting complaints, pathways, or diagnoses (e.g. trauma). The Miya platform stores notes using standardised terms and generated free text notes automatically. Decision support can be integrated to recommend treatments and automate orders.
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Letters
Miya’s Letters system outputs customised letters, patient information sheets and follow up instructions. Condition-specific checklists can be incorporated to ensure clinical staff comply with best practice and don’t forget important steps, such as follow up tests or referrals.
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Patient Outcomes
When is a patient ready for discharge into the community? Miya Patient Outcomes monitors outcome indicators, observations, lab results and assessment scores and displays them so clinic doctors can quickly see how a patient is progressing, and whether they are ready for discharge to the community or require further treatment. Outcome tracking is configured on a per clinic basis, and can be customised to track measures against established criteria. Advanced use of the Patient Outcomes system can use metrics to recommend the frequency of recall to mitigate clinical risk.
Smart Forms
Alcidion’s Smart Forms technology drives Miya Checklists and Guidelines. These interactive forms support numerous question types and sophisticated branching logic. Use Smart Forms to implement national or local best practice guidance at the point of care, health assessments, and reminder checklists. The system is designed to be fast to use, has a full audit trail, generates clinical documentation and can automate tasks such as ordering. Checklists and guidelines can be implemented at triage, registration, diagnosis, discharge, or in response to clinical conditions.
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Pathways
Miya’s pathway system tracks patients at each stage of a designated pathway, and can automate tasks at each step, such as generating reminder checklists and order sets. Lab results and clinical data entry can automatically trigger the next step in pathways. Miya will also track if patients are no longer on a pathway so you can track the number of pathway appointments and ad-hoc appointments.
Order Entry & Sets
Miya’s QuickPicks allow you to configure the most common orders for fast access. To control ordering behaviour and costs restricted orders are clearly visible can be configured to require senior clinician approval — quickly using Clinical ID. Orders can be printed or sent electronically with full tracking of the order lifecycle. Order sets can be configured and recommended by condition or other patient factors.
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Medication Management
Miya Medications integrates with MIMS interaction checking and customised business rules to manage safe prescribing. Common formulary items are accessed via QuickPick shortcuts, and administration tasks are generated automatically for nursing staff. You can view medication orders on a standard medication chart, or a task-oriented display with full administration recording capabilities.
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Observations
Miya can incorporate multiple types of observations and present them in an intuitive way so clinical staff can detect trends quickly. Like all data in Miya, observations can be risk-rated and notifications sent if thresholds are breached. Key observations can be displayed on the main Clinical Dashboard if required.
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Clinical ID
The goal of Clinical ID is to present clinical staff with the information they want in under 1 second of walking up to the computer. Clinical ID allows clinical staff to log in to Miya with a simple swipe of a card, or using any other biometric or token technology. Clinical ID integrates with organisational directory services to authenticate users, and then allows them to access Miya using RFID cards, for example. Higher level security can be placed over specific activities, such as medication ordering.
Task Management
In the busy ED environment it’s easy for jobs to slip. To reduce the strain on memory Miya Task Management is a distributed to-do list with reminders, escalation and automatic completion. For example, checking a result on Miya automatically completes the associated reminder task — you don’t have to manually check tasks off. You can also create tasks for other members of the care team.
Alerts & Decision Support
The Miya Decision Support Engine (DSE) monitors all data flowing through the system and can trigger alerts and notifications. We call this active monitoring. Miya plays an active role in supporting clinical staff. The Miya DSE can be configured to monitor and alert for clinical and organisational risks.
Performance Monitoring
Miya captures KPI performance and risk data in real-time. Measures include occupancy, length of stay, clinical activity and costs. You can add additional metrics as. Managers and clinical heads can get a real-time view of the organisation and respond to changes as they occur, rather than months after the event. As with all parts of the Miya Platform, alerts can be attached to any data or thresholds.
