Smart Sign Out’s Idea Conception to EMR Integration

Optimized-Smart SignOutA video by the startup Smart Sign Out cites a Joint Commission study, which said that defective handoffs in hospitals are responsible for up to 80% of serious preventable adverse events. The video continues that, given this high percentage, it’s likely that you or someone you love has been affected by a bungled handoff.

In fact, this is true for Smart Sign Out Chief Technology Officer Matt Mombrea. His mother — who has since recovered from her injuries — saw a grave hospital visit turn even worse when staff forgot about her case and left her alone on a bed in the hallway.

The injury that landed her in the hospital occurred while she was out riding. A deer had startled her horse, which reared up and fell backward on top of her. “She was taken to the hospital with a broken spine and her voice box was crushed,” Mombrea said. “They sent her down to a basement floor of a hospital in Buffalo to get a CAT scan and an MRI. And after they did those procedures, they wheeled her out into the hall, and at that moment a shift change took place.”

As a result of her information getting lost in the shuffle, Mombrea’s mother was abandoned for more than an hour. Panicked and unable to speak, she finally managed to alert a custodian who called for help.

Handoffs occur hundreds of times throughout the day in one hospital. Almost every time a patient switches locations within the facility, a handoff takes place. In many hospitals, the receiving team at best gets handwritten notes on a new patient and at worst gets nothing.

The purpose of the Smart Sign Out software is to ensure that anyone who might be responsible for a patient during his or her hospital stay, can access that patient’s real time information. However, it’s not a complete medical record. The software brings to the surface the pertinent information a new care team needs, such as the patient’s diagnosis, his or her medications, as well as detailed notes and instructions.

So it would be nice if this tool that was meant to compliment a more detailed electronic medical record could integrate with an electronic medical record. Currently, that’s in the works.

“Our goal going forward with the software is to hopefully integrate with as many EMRs as we can. But that process has been very difficult, except for Allscripts so far,” Mombrea said. Smart Sign Out is in the middle of a process to integrate with the Allscripts EMR. This is taking place through the Allscripts Open App Challenge, an initiative to encourage some of the best ideas in medical software to interact with Allscripts’ system.

In March, Smart Sign Out was named a winner of phase one of the challenge, the part that called for entrants to submit app models or prototypes. Now in phase two, the winners must work with a client — that either will or won’t be able to vouch for the app’s value — to integrate it into its Allscripts EMR.

Mombrea’s mother’s experience wasn’t the only story that Smart Sign Out company members had originally heard about faulty patient handoffs. One employee’s husband is in the residency program at the University of Buffalo, and he told the company of his first-hand accounts with the problem.

“We started developing software almost immediately after we had that conversation, and a couple of months later we were starting our first pilot program in Buffalo,” Mombrea said.

The pilot took place last year and spanned four different hospitals in the Buffalo area. Based on critiques from that period, the company made more than 250 feature improvements to the software. Mombrea hopes that similar feedback comes out of the Allscripts project.

“Really this is going to be our first full-fledged integration with an EMR system,” he said. “We’re really expecting to get a lot out of it in terms of experience and refining our product to work well with these larger medical records systems.”

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