Volume 1 - Issue 4 - August/September 2006

Haywood Regional Medical Center (HRMC), a not-for-profit, comprehensive acute care Medical Center, is located in the beautiful Smoky Mountains of Western North Carolina. With 195 beds, HRMC is the largest healthcare facility in Western North Carolina west of Asheville. HRMC is a member of a 16-hospital RHIO, one of the first operating RHIO’s in the United States.

HRMC went live with MEDITECH's Emergency Department Management (EDM) module just about a year ago, in August 2005. John Olivier, Director of IT, talked with us about the implementationand the benefits they continue to reap from a paperless Emergency Department.

What was the scope of the project?

For us, the implementation of MEDITECH’s Emergency Department Management (EDM) module was a step towards Electronic Medical Records (EMR). One of the objectives of our organization is to establish an EMR/EHR and we thought that the ED would be a good place to start, essentially to get our feet wet first before rolling out EMR to the entire organization. The other thing was to improve patient safety through improved documentation. I came here to Haywood Regional Medical Center in May 2005 and we actually went live in August 2005, so I wasn’t part of the actual product research and decision to purchase MEDITECH, but it has proven to be a good product.

Who comprised your implementation team?

Our implementation team consisted of the VP of Nursing, Director of IT (myself), a Clinical IS Coordinator, the ED Director, one of the ED Physicians, and an ED Nurse.

What were the biggest challenges your organization faced with your implementation project?

One of the biggest challenges in this project was the fact that we had to completely change the way we do business in the ED. That meant going from a completely paper-based system to an electronic system. So, changing all the processes was a great challenge. Nurses and other staff in the ED were used to following the same processes for years. Now they’re not documenting on paper any more, and are actually entering everything in the computer and having to go through the various screens for assessments. The nurses, just like everybody else, have all different skill levels as far as the computer is concerned. We had some nurses that picked it up and ran with it, and we had other nurses that weren’t as computer savvy and required a little closer attention to bring them up to speed.

Another challenge we had to overcome was the tendency to take everything we were doing on paper and make it electronic. We knew, realistically, that’s not what we should do and the challenge was to evaluate the patient flow and various processes we had in place with our paper method and determining what we actually had to convert to an electronic form. So there is a lot of planning and thought that goes into deciding where and how certain processes or forms may be streamlined. You don’t necessarily want to convert every piece of paper word-for-word, field-for-field into an electronic environment. It was a very big task to evaluate all of those processes and forms in order to make the right decisions which result in greater efficiency.

Another challenge for us is that we had a brand new ED. It was an addition to the hospital. So we had to look not only at the processes, but take into account the architectural aspect and how installing a new system would impact the patient flow. So, we had to re-evaluate how we receive patients and try to streamline that process as much as possible to reduce the length of stay in the ED.

What specific actions were taken to overcome these challenges?

Well, as far as converting from a paper-based system to an electronic system with the nurses, we identified those nurses who might require a little more ‘hand-holding’ and spent a significant amount of time with them to bring them up to speed on basic computer skills in some cases, and working with others to further their skills within an electronic environment. So, we had to identify the various skill levels of the staff and train each of them accordingly. We really couldn’t have a standard training for everybody because it just wouldn’t work. We had to really customize and tailor the training to the specific individuals’ skill levels. If one of the nurses or staff were experiencing a certain level of anxiety, we’d take the time to work one-on-one with them to get them used to the system until they were more comfortable with it. We had an IS Clinical Coordinator who did a lot of the training. But, we also identified a few Super-Users in the ED that we worked very closely with because we had to have a lot of support, around the clock, when we first went live with the system. We wanted to make sure that we had somebody there on all shifts to support all of the nurses with any of their needs. So, the Super-Users took responsibility for some of the training as well. Thisfurthered their exposure to the system andhelped them to become better trainers.

The other action was to put the time in up-front in the planning stage in order to break down the processes and define what we needed to make electronic. Some things we could leave out, some things we just needed to streamline. So, there were a lot of process improvement initiatives.

What results did your organization achieve from these actions?

We’ve had a ton of great results. For starters, we’re wireless down in the Emergency Department now. We have point-of-care devices, computers on wheels (COW’s), sothat the nurses can do their documentation while they’re with the patient. The nurses have become very comfortable with the system. They went from being afraid of the technology to the point now where they’re almost territorial about their COW’s.

Because we’re electronic now, we have better reporting capabilities electronically through the system. We’ve standardized documentation. We have more completerecords and don’t have a problem with lost documentation. We use Patient Discharge Instructions (PDI) and have electronic prescription writing now too, and that feeds into the electronic medical record. If a physician wants to go in and look at vital signs or anything else, he doesn’t have to wade through a two-inch thick paper record to find it. He can just bring up that specific visit on the screen and access all of the details. All the information is normalized and presented very well for the physician to go back to look at specifics.

Patient information is more secure now since you don’t have medical records laying around. All of the information issafe behind a user ID and password.

There are, of course, financial benefits too because now all of the charges are tied directly to the documentation. It’s all transparent to the nurses because they’re just doing their documentation, but in the background, all coding is being done correctly and charges are being billed appropriately.

Were there any things you might do differently if you were to implement this again?

If I were to look back and re-do this project now, I would probably have done more attribute development up-front. We did build some attributes and it really streamlines the process for the nurses and physicians as they go through the screens,and makes it easier to navigate the system. But, I would probably have done even more attribute development prior to going live with the system. We are continually enhancing the screens to improve them. But, it would probably have streamlined the process for the nurses and physicians if we had done more custom designing up-front.

What are some important pieces of advice you have to offer other sites who are embarking onthe same project?

I would recommend doing a lot of process analysis up-front, breaking down the current workflow processes into finite elements to see what you’re doing in your current environment. Then, address those processes one by one to determine what you should be doing in an electronic environment. You need to recognize that a one-to-one conversion from paper to electronic is not always possible, or even ideal. Sometimes that’s tough for some people to do. They have paper forms that they want to replicate exactly, and that’s not always the best thing to do.

Of course, communication is, like with any other project, key to success. Keep the communication with the nurses and physicians constant. Try to have not only a physician champion, but a nurse champion for the system, because they’re going to have a lot of exposure to the system and you want to make sure they’re going to happy with it.

John Olivier is the Director of IT for Haywood Regional Medical Center in Clyde, NC. He holds a B.S. in Management Science and has 9 years of experience implementing MEDITECH systems in various hospitals across the United States.

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Tricks of the Trade: NPR Client/Server -- Pulling Fields from Other Modules Without Using a Fragment

Contributed by: Pat Korolog, Applications Specialist II,Kalispell Regional Medical Center.

When you are creating a report there is often a need to pull a field from a DPM other than the one in which you are writing your report. The most common way to do this is by creating a fragment report and linking that report to your main report. There is another way to pull fields from another DPM without writing a fragment report.

Let’s say the user needs a report for which most of the fields reside in ADM.PAT, but wants the balance out of BAR.PAT.

We need to do four things to get this field from BAR.

Write a macro to set up your custom list:

AL START open macro will open up the BAR database (BAR.XXX will be your BAR database).

AL D get.data macro will link to the BAR account and use the BAR.PAT.number.x to look through the BAR accounts.

AL CLOSE.UP close macro will close the BAR database.

Finally, we need to place the field BAR.PAT.balance on the picture of the report.

We can also create a computed field and subscript the value we need. We still need to open and close the database. Here is an example of a report that is written out of ABS.PAT but we need a field from MRI.DRC.

Our footnote would look like this:

AL START %Z.link.db(Q("MRI.XXX"),Q("O","B",1))

AL CLOSE.UP %Z.link.db(Q("MRI.XXX"),Q("C","B",1))

Our computed field, xx.pat.city would look like this:

DAT=FREE

JFY=L

LEN=20

VAL=@MRI.DRC.pat.city[@mri.urn]

The above information should help you with a couple of ways to obtain fields from a DPM other than the one from which you are writing your NPR report.

Pat Korolog, RN, is an Applications Specialist II for Kalispell Regional Medical Center. Pat has over 12 years of experience working with MEDITECH HCIS, performing implementations, applications support, and NPR report writing and training.

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Recent News: LSS Awarded CCHIT^SM Certification

The Certification Commission for Healthcare Information Technology (CCHIT^SM) has confirmed that MEDITECH's partner vendor, LSS Data Systems, has achieved full CCHIT Certification^SM of the Client/Server (C/S) Medical and Practice Management (MPM) Suite, Version 5.5 (Service Release 2.1) for CCHIT Ambulatory EHR 2006. CCHIT certified^SM product certification designates that this product has been tested against a comprehensive set of functionality, interoperability, and security criteria and has passed inspection of 100 percent of the criteria. LSS has also announced its intent to seek CCHIT Ambulatory EHR 2006 Certification of another Ambulatory EHR product, its MAGIC Medical and Practice Management (MPM) Suite, Version 5.5, toward the end of 2006.

Citizens Memorial Healthcare (Bolivar, MO) is the first MEDITECH/LSS customer to go LIVE with the latest version of the C/S MPM Suite. "We're very excited to receive LSS's latest update and want to congratulate them on achieving certification," said Denni McColm, chief information officer at Citizens.

CCHIT is currently developing its criteria for inpatient EHR certification. MEDITECH is participating in this process, and will apply for certification when the application period opens.
http://www.meditech.com/aboutmeditech/pages/newsLSSCCHIT.htm

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Worth a Read: Articles of Interest to the Healthcare IT Field

Automating the ED
By Mark Hagland
Healthcare Informatics, July, 2006

More and more Emergency Departments are looking at technology to help them gain efficiency. ED Information Systems show great promise in tracking patients and improving patient flow through the system.
Read article

Microsoft's Health IT Venture Stirs Up Interest
By M.L. Baker
Ziff Davis Internet, July 27, 2006

Microsoft's purchase of a little-known health solutions software company that makes an application based on its own technology framework is a bit like a giant following an ant. It probably won't make much of a difference unless the giant goes to the colony.

Read article

Lending Rural Hospitals a Hand
By Bill O'Leary
HealthCare Informatics, May, 2006

A Meditech Hospital shares its model for improving rural patient care statewide while helping to finance the purchase of a PACS system. Rural patients can receive treatment the day of the exam rather than going home to anxiously wait for results.
Read article