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Customer
Spotlight: Haywood Regional Medical Center Reaps Benefits
from Paperless Emergency Department
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 implementation and 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.
This furthered their exposure to the
system and helped 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),
so that 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
complete records 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 is safe 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
on the 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.
