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From the October 2001 Issue HIPAA and MCOs: Administrative Simplification or IT Modernization? |
For Your Files The simple quest for automated archival and retrieval leads St. Luke’s hospital to adopt an electronic patient record solution. It’s not often that a hospital can solve a rash of problems by searching for just one automated solution. We did exactly that. We started simple—and ended up with far more benefits than we expected. PROBLEM St. Luke’s Hospital is a 298-bed hospital in Maumee, OH, processing more than 250,000 patient encounters a year. We faced an overwhelming problem in our paper-based medical records department. Storage cabinets and entire rooms were filled to capacity with old files. Stacks of records piled up waiting to be assembled, analyzed, coded and returned to physicians for completion, and our Health Information Services (HIS) team struggled with how to get ahead of the ever-complicated medical records process. Our HIS team conducted performance improvement studies indicating that it took an average of 16 minutes for medical records staff to locate, pull and send a chart to the emergency department. When the medical/surgical nursing units requested charts, it could take up to two hours to complete the request. As the hospital grew, conservation of space became a more pressing issue. Our department was forced to begin microfilming medical records within a year and a half of the date of service. We were spending $96,000 a year on microfilming alone, not including the cost of human resources to handle the process. But the use of microfilm compounded our problems. When clinicians requested older files, we either had to locate, copy and deliver the files to the point of care, or the clinician had to view the microfilm records in the HIS department. This process could take a day or even two to complete. SOLUTION Our HIS team decided to pursue an electronic solution to our archival and retrieval problems. We established a task force to steer the decision-making process. The task force included physicians, nursing staff, representatives from each of the ancillary departments, and staff members from medical records, patient accounts and patient registration. The original scope of the project was to look for a system that would efficiently store records and make them easily retrievable. But the task force soon concluded that additional efficiencies could be realized if we explored broader automation solutions—efficiencies such as online chart completion, release of information and remote access to patient records using an electronic medical records (EMR) solution. We then shifted the focus of our search and invited six vendors to demonstrate their EMR products. We visited three facilities where the specific products were already in place, and we subsequently invited representatives from two of the vendors back to the hospital for further demonstrations and meetings with senior management. Following a careful evaluation of their proposals, we made a decision to go with MedPlus® ChartMaxx™ solution. Shortly after the contract with MedPlus was signed, implementation of the system was put on hold while the hospital prepared for a JCAHO survey and worked on Y2K compliance. But in January 1999, implementation of ChartMaxx began in the emergency department. We chose emergency for several reasons: The size of the records is much smaller; there were fewer physicians and staff to train in this department; and implementation was possible prior to the completion of all interfaces. Outpatient surgery records were the next patient type to be brought into production. This process took about four months for complete implementation. By June 2000, most of the interfaces had been completed, so we next decided to begin bringing inpatient records into the system. Because of the number and size of inpatient records, the number of doctors requiring training, and the fact that all of the forms were not bar coded, this decision created a six-month period where HIS was extremely busy and somewhat chaotic. Medical records staff were learning to prep, scan, quality review and upload medical records. Other staff members were learning to manage online analysis and abstracting of medical records. When a physician accumulated 10 incomplete medical records in ChartMaxx, he or she was invited to HIS for a training session. This training allowed physicians to receive actual hands-on experience using the system with their own records rather than generic patient records set up as a test. To date, we have conducted training sessions for 409 physicians and 379 clinical staff members. RESULTS With more than 100 points of access throughout the hospital, physicians and other caregivers can now complete their medical records without leaving their work areas. The emergency department and medical/surgical nursing units can retrieve medical records in seconds; no one has to locate files and deliver them to requesting locations. Staff from pharmacy, nursing and infection control can access the system directly to complete their quality review activities. Prior to the implementation, they were required to send a list of records, which often included 100 charts per project, to HIS and wait for those records to be pulled and made available to them. We have completely eliminated our use of microfilm, and we have entered all medical records dating back to 1996 into the ChartMaxx system. Interfaces between the hospital’s financial system and electronic medical records system allow staff in the patient accounting department to access UB92s, detailed bills, HCFA 1500s, zero balance statements, and explanation of benefits without leaving their workstations. Because physicians complete their medical records online, medical records staff no longer have to pull, check and re-file hundreds of paper medical records a day. Before ChartMaxx, visitors to the HIS often would see carts loaded with medical files waiting for physicians to complete them and more carts of medical records waiting for transport to a remote storage area. Recent visitors have been amazed to find HIS looking clean. Aisles are clear and only one or two people remain in the reception area to answer phones and assist visitors. With electronic patient records, we have eliminated the need for vast file storage space. We turned part of our space-saving efficiency back to HIS for office space and a new scanning area; we turned another entire room back to the hospital for other departments’ utilization. Through the hospital’s Physician Information Network, a pilot group of 40 physicians also have been offered the option of completing their medical records from their homes or their offices. By early fall of 2001, we will expand the pilot group to include 140 physicians. The process of implementing an electronic patient record system is long and arduous at times. However, the benefits to patients, physicians and hospital staff members make it worth the effort. SOURCE Sharon Laurell PRODUCT/COMPANY
© 2001 Nelson Publishing, Inc |
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