Operating room management in OpenEMR

raoul wrote on Saturday, November 21, 2009:

The summary is, we need an operating room, patients and staff
management tool and an ambulance formsheet database.

The operating room management should enable the physicians to
simply assign tasks to the staff and enter patient’s information
and have them listed in an operation room management plan.
It’s a key application in any hospital I know.

We have 4 operation rooms and one room we do injections in.
Operations and injections are planned on sheets of paper. The
needed result is a DinA4 sheet of paper which lists staff tasks
and operation room plans. The operating rooms are room I to IV
and we even have a room V we rarely use. In addition to that
there is the injection therapy room which’s plan is listed on a
seperate DinA4 sheet. OpenEMR should be able to print these two
DinA4 sheets from the stored staff and patient data.

The first sheet printed should list a table with columns:
operating room number (I, II, III, IV, V, injections room),
patient’s ward, patient’s last name, patients first name,
patient’s birth date, patient’s insurance status (pirvate or
regular), diagnosis, planned operation (therapy), used implants,
patient’s position on operation table (back down, abdomen
down,…), planned operation time, surgeon and assistants,
kind of anaesthesia. The rows should list the patients each. The
sheet of paper should list staff tasks, too. These are ambulance
duty, night shift, admission duty, incapacitation for work (if
any), off duty after night shift, holiday, advanced education,
consultation-hour for backbone problems, consultation-hour for
general problems, consultation-hour for foot problems, ultrasound
examination of nurslings, other tasks and remarks (text field).

The second sheet of paper should list all patients who are
planned for injections therapy. Note that these could simply be
treated as operations and the injection room could be an
operation room. The idea is that we would list the injections as
operations in the operation room “injection room” and are able to
plan them.

This is quite a load of information. Not too easy task, but I
think it’s really widely needed. I can say that there are only
few hospitals in germany which use computer assistance for this
operating room management. I personally only know of one
hospital.

Then there should be the possibility to have a custom admission
form. The goal would be for me to be able to gather exactly the
information needed for patient admission without clicking through
lots of forms. It should be easy to set up such forms as requirements
differ between hospitals and change from time to time.

However, after gathering the needed information I would like to
be able to produce some kind of PDF-file or well formatted
html-site to print out on paper and put it inside our paper
files. This would be great for transition to the new system.

It would really be necessary to pursue my chief and staff to switch
to a new system. The best way would be to simply introduce it for
myself. With the admission form and paper printing I could simply
demonstrate the system works. All admissions I will be doing will
be done in the new system and printed. The technique would be to
have the new system installed on my home computer and using this
one over an SSL encrypted line from the hospital’s web browser.

Next step would be to let the staff use the already described
operating room management on my home computer. Then I would like
to install all this on a computer inside the clinic building.
From there I could go on with the outpatient management which
still is totally on paper, too. The fact that everything is still
on paper is why it would be easy to pursue people to simply use
the new system, which would be already there. Last step in my plan
would be to put the paperwork on the wards inside the new system.

I am located in germany and I can tell you making hospitals
switch systems or even introduce system is a really tough call.
People are really lazy in this and once something is working in
any way they are afraid of changing anything because they fear
the changes might put everything to the worst.

I personally don’t see so much danger. In the introduction phase
described above there is no more risk than needing to redo the
current admission on a sheet of paper or to write the operating
plan by hand as was always done in case the system at home fails.

I’d really appreciate any hint how this can be done in Free Software.

Sincerely,

Raoul

bradymiller wrote on Sunday, November 22, 2009:

My quick thoughts:

1) Customized forms : There is a perl commadline tool openemr/contrib/forms/formmaker/ that can be used to build customized forms (it will at least be a starting point in your forms, which you can then further customize). Another option to consider, since your using the cvs development version, is a new feature Rod introduced called Layout Based Forms (LBF) which is described here :

2) Scheduling : My initial instincts would be to simply create a openemr user for each OR/infusions room( ie. OR 1, OR 2, etc.), then you’d get schedules for these on the calendar if set calendar on in administration->user settings. You could even secure these “dummy” users be removing them from all acl groups in acl->admin to not allow any logins with the dummy users. Of course, more customizations will be needed but could be a theoretical starting point. Anybody else have any input here? I agree the OR/infusion schedule would be a nice feature.

3) Reports : Check out the appointment reports etc. These can always customized or new ones added to get desired reports (the great thing about open source).

-brady

  : http://sourceforge.net/projects/openemr/forums/forum/202506/topic/3344495

raoul wrote on Tuesday, November 24, 2009:

Thanks for the fast answer with that dummy user suggestion. This may work.

On the other hand this seems a bit like a hack to me. I think real operating room management is definitively needed.  The dummy user solution would even lack patient and staff overview. Who has to be operated how soon and which staff memeber is available on any day should be easily viewable.

I wonder wether using some groupware like eGroupware, Opengroupware.org or OpenERP. I remember sb suggesting using OpenERP for accounting tasks in some open source HIS, nice idea.

Perhaps other existing software can serve as operating room management, too. There are very versatile pieces of software for calendar management out there. Question is how easy it would be to integrate them with OpenEMR.

Sincerely,

Raoul

bradymiller wrote on Wednesday, November 25, 2009:

hey,

It would simply be a start as you begin to work through and learn about the code. (As an aside, staff members could have their own calendars to see who’s available). I think all the pieces are there to do this, but there will definitely be a fair amount of customization/coding required. If the scheduling can be worked out via the hack, then could always turn the hack into something real (ie. create a room/OR instance rather than just all physicians/staff with calendars).

Probably the next little step after the OR calendars are worked out would be to make a way to attach multiple physicians/staff to an OR appt or patient appt.

-brady