EMR and Palliative Care

Outline

• Case
• Evidence/literature
• Local examples of EMR
• Questions

No disclosures
I do use Cerner at two health authorities

91 M

• EHS-witness choking episode w caregiver
• Syncope, poor recovery, likely aspiration event
• Remains obtunded, hypoxic, hypotensive
• No Home DNR, level of intervention unclear

In the ED

• Triaged to Trauma Room
• MD #1-primary assessment
• MD # 2-computer assessment
• EMR-Cerner

Triage
"to sort"

Canadian Triage and Acuity Scale(CTAS)

• attempts to accurately define patients' needs for timely care
• helps evaluate patients' acuity levels and resource needs
• may also be used in real time for pandemic surveillance and identification

Barriers to Good Palliative Care in ED

• Triage bias (constipation vs MBO)
• Lack of time
• Lack of familiarity with patient and or condition
• Privacy
• After hours communication with eg. Oncology, FP, Palliative Med
• COVID-19 hurdles*

Can we improve this with EMR?

Good EMR Could...

• Care Connect (or equivalent)-provision of medical details
• Level(s) of Intervention
• Advanced Directives
• GOC documents

'Palliative' identifiers-both good and bad

Future...

Improving Palliative Care with Deep Learning

• Avati et al. 2017 BMC Medical Informatics
• overestimation of prognosis + treatment intertia=mismatch at EOL
• Deep Learning+EHR algorithm
• Triggers Palliative Care Consultation
• 13,654 dimensions analysed to predict mortality

Reactive vs. Proactive PC consultation

JAIMA Open 2018

• Bush et. all
• Systematic review of EHR and PC
• 5 areas identified

EHR for PC cont'd

• ID individuals who could benefit from pall approach
• ACP documentation
• Patient-reported outcome measures eg. pain scale
• Augmentation of EHR PC data
• Enhance multidisciplinary documentation

Cox et. al 2015

• EMR in Critical Care setting
• Utilization of technology to integrate Palliative Care into the ICU

Mitigation Slide

• This presentation will use Cerner to illustrate an example of how EMR may work for Palliative Care purposes
• I am not/never have been paid by Cerner or the EHR company

Case Conclusion

• patient with aspiration symptomatically supported (HFNP, low dose opiate, antibiotics, fluids)
• prior dc summary outlines GOC
• GOC/Code Status updated on EMR
• Admitted to Palliative Care service for ongoing care

Take Aways

• EMR will assist with triage of patients based on past encounters
• Leads to enhancement of interdisciplinary communication
• Supports Goal Concordant Care
• Future may involve Artificial Intelligence

Discussion