The time and cost clinicians and staff spent on maintaining a high level of patient care, while facing the administrative challenges of a paper-records system, was significant in the decision to go digital.
In 2008, Memorial Hospital of Sweetwater
County (MHSC) decided to implement an electronic health-records
(EHR) system, due to the time and cost clinicians and staff
spent on maintaining a high level of patient care, while facing
the administrative challenges of a paper-records system. The
amount of excess time and money spent on caring for patients
using an inefficient paper system was time consuming and costing
the hospital too much, according to
Linda Simmons, RN, and vice president of operations and chief
nursing officer at MHSC.
“There were many redundancies within the
paper system,” she explains, “as nurses found themselves
charting the same patient information several times on different
forms and patient records, taking time to write information
already elsewhere in the patient records. Medical histories were
taken every time a patient visited a hospital, regardless of
whether a history was taken during a previous visit.
“Furthermore, administrative staff also spent
a lot of time accessing patient records from previous visits.”
she adds. “They had to trot down to the medical-records
department several floors below the medical floor if additional
patient information was needed.”
MHSC is a 99-bed hospital owned by the county
in rural Rock Springs, Wy. The facility is Sweetwater’s regional
trauma-referral hospital, with approximately 24,000 emergency
department (ED) visits a year. The hospital has a busy
outpatient-services program, including services in medical
imaging, MRI, CT, lab and surgery.
Memorial is the first hospital in Wyoming to
have a fully implemented, integrated, electronic medical-records
(EMR) system, including computerized physician order entry
(CPOE) and bar code medication administration (BCMA). It became
paperless in 18 months at the cost of $2 million.
“At a time when hospitals are still reviewing
EHR options and racing to implement EHRs to qualify for ARRA
funding, MHSC is looking ahead to further advance its healthcare
IT after its successful open-source EHR implementation,” Simmons
says.
With the previous paper-based system,
transcription of physician notes and handwritten orders onto
paper charts took up too much time, she says. More worrisome was
that many patient records transcribed from physicians’ verbal or
written orders had mistakes, causing confusion and unclear
orders. Transcribers often found reading the physician’s
handwriting difficult, causing further errors in the paper
records.
“Upcoming local regulatory policies were also
conducive to implementing an EHR system,” Simmons explains.
“With Medicare’s plans to withhold reimbursement for ‘never
events’ occurring at hospitals, and with a mission to improve
patient care at the hospital, we fully understood that it was
difficult for clinicians to remember every single clinical
treatment detail for a variety of diagnoses in patients, and a
checklist on an electronic health record would be a reminder for
clinicians to help avoid medical errors.”
Memorial Hospital selected Medsphere’s
OpenVista EHR system after carefully considering numerous EHR
systems that prioritized ease of use among physicians and
providers. Hospital executives reviewed the clinical benefits of
open-source technology, which allows clinicians to build EHR
templates for patient care, a series of safety checks to ensure
that clinicians give their patients the best of care, depending
on their medical state and treatment diagnoses. Depending on the
patient’s diagnosis, the clinician may be provided a template
(created by other clinicians) that includes a helpful checklist,
to ensure the patient receives the care he needs and help
minimize medical errors.
“Another factor in MHSC’s decision was cost,”
Simmons says. “We compared open-source EHR technology to
traditional, proprietary solutions. The open-source technology
of OpenVista made the system affordable.”
Five-year, $2-million Contract
OpenVista cost the facility $2 million for a
support contract with Medsphere for five years, which includes
implementation, support and upgrades to the EHR system, as
needed. Memorial Hospital also received both CPOE and BCMA,
along with integrated support for radiology and lab systems – at
significant cost savings compared with other vendors’
proprietary solutions.
Memorial Hospital made the decision to go
live in one day instead of rolling out the technology in partial
components. The OpenVista EHR was implemented across the
facility, with BCMA adopted the following day. “Given the size
of the facility, having one department digital with another
still relying on paper was thought to create more problems and
confusion,” Simmons explains.
MHSC did initially face some opposition to
EHR implementation. Many staff members at MHSC were unfamiliar with the technology. Physicians also were accustomed to relying on nurses to write their orders.
Memorial Hospital decided to add extra staff
for the first week of implementation, knowing that adopting the
new technology might be stressful for some. MHSC also had extra
“super users” on hand to help clinicians ease into digital
records.
At MHSC, all super users were nurses, and
tended to be younger staff who went through training programs at
facilities with EHRs. Additionally, each staff member at MHSC
received approximately four hours of training, with additional
one-on-one training with every physician at the facility.
One-day Move Proves Easier
“Having all departments on digital records
was stressful to clinicians and staff,” says Simmons, “but the
feedback from medical staff following a month after going live
was positive. It was much easier to integrate EHR technology and
patient care in one day, preferable than several weeks or months
of gradual adoption.”
MHSC initially faced some opposition to EHR
implementation. Many staff members at MHSC were unfamiliar with
the technology. Physicians also were accustomed to relying on
nurses to write their orders instead of giving the orders
directly themselves. Now, physicians are trained to insert data
and type in orders to the EHR themselves.
“In time, even the ones who were most
resistant to EHR became the biggest fans,” asserts Simmons. “For
example, older physicians, who initially resisted EHR
technology, are now some of the most popular users of OpenVista
at MHSC.”
Since the full rollout of the EMR system,
there have been numerous benefits, Simmons says, including
clinical, operational, administrative and compliance
improvements. Medical records now follow patients as they move
throughout the hospital departments, and staff can instantly
access the records when needed. There is no need to archive
paper records, and the electronic medical records are
continually updated instead of new records created for every
visit.
“More importantly, MHSC improved clinical
care dramatically following the implementation of OpenVista,”
Simmons says. “The omission of medications, for example, the
number-one reason for medication errors at Memorial Hospital,
decreased to a minimal one to two per quarter following the
implementation of the EHR system. Furthermore, late
administration of medication, which occurred in the hundreds per
quarter prior to EHR adoption, decreased to 33, as clinicians
were prompted by alerts from digital patient records.”
Clinical documentation has also improved, she
adds. Antibiotics administered an hour prior to surgery were
only documented 27 percent of the time with paper records. After
EHR implementation, they are now documented 92 percent of the
time.
Records Easily Accessible
“Operational efficiency has also improved
through EHR technology,” Simmons says. “Charting patient records
is easier with digital records; as patients enter, their medical
histories and records are easily accessible by the clinician.
With paper records, a patient had a new paper chart for every
visit, requiring a comprehensive medical history to be taken
every time a physician saw a patient. If prior records needed to
be accessed, a staff member or security guard (during weekends
and evenings) had to go to the medical-records department. The
efficiency in time saved accessing patient charts has
dramatically improved.”
Simmons says that having an EMR has improved
MHSC’s compliance with patient safety and regulatory standards,
since most information can be incorporated into charting
templates and queried for data collection. Joint Commission
standards, for example, are built into the templates MHSC uses
for patients so clinicians are reminded of compliance directives
when treating patients.
“Patient privacy has also improved, since the computer times
out in three minutes, and digital records, unlike paper ones,
are not left unattended for long periods of time,” explains
Simmons. In addition, MHSC staff accesses patient records using
fingerprint technology, so passwords are not easily accessible
to others or forgotten by clinicians.
From the Catalog
According to www.medsphere.com: Medsphere OpenVista represents a single solution that can be leveraged across the continuum of acute, ambulatory and long-term care environments, as well as in multifacility, multispecialty healthcare organizations. The high degree of integration across the enterprise has significant advantages in increasing clinical performance, reducing costs and improving healthcare outcomes. It also facilitates the collection of data for the extended-care team and for non-clinical uses such as billing, quality management, outcomes reporting and resource planning.
For more information on
Medsphere solutions:
www.rsleads.com/911ht-204
