'EHR within an EHR' accelerates workflows
By Julie Larson and Amanda Hill, September 2012
Julie Larson Amanda Hill
As it transitioned to an electronic environment, St. Vincent Healthcare’s outpatient gastroenterology center had to identify solutions that addressed its unique workflow needs.
The momentum surrounding adoption of electronic health record (EHR) systems in the ambulatory surgery center (ASC) setting is accelerating as more examples emerge of their far-reaching benefits, in particular improved patient care and revenue cycle management. The challenge St. Vincent Healthcare’s outpatient gastroenterology (GI) center and other ASCs face as they seek to transition to an electronic environment is identifying solutions that address their unique workflow needs.
St. Vincent Healthcare (SVH) is a not-for-profit organization in Billings, Mont., consisting of a 286-bed hospital and 30 clinics. When SVH set out to open a gastroenterology (GI) center, we looked to advanced EHR technology and automation to form the foundation of a paperless environment. This strategy proved to be a positive step forward as the center is now benefitting substantially from streamlined workflows, increased patient volumes, improved diagnosis and enhanced care delivery.
Successful deployment of our IT strategy hinged on a discovery that was made early in our analysis of the center’s system needs – that the inpatient EHR would not adequately address the specific needs of outpatient GI workflow. Instead of trying to force-fit technology designed for hospital workflows into the ASC setting, our team developed a strategy that would essentially construct “an EHR within an EHR.”
Facing the challenge
Modernization of health IT has been a core value of SVH in meeting the needs of our patients. We offer a cutting-edge telemedicine program and continuously seek out new ways to improve patient care through efficiencies and automation.
One of the first steps as the business plan for our new GI center began to unfold was to assign a project team to review potential vendor products and identify critical system elements needed. The team was tasked with looking for an application that would efficiently and effectively address workflow needs from registration through the clinical process and discharge.
Digital imaging was identified as a core component for any system to be a viable consideration. However, we also wanted an application that would eliminate the inefficiencies inherent with paper-based processes. A focal point was eliminating the need for our physicians to write out and then dictate their notes, a process that created a costly budget line item for transcription services. We also wanted to automate the time-consuming manual processes required for report building.
It became clear that the inpatient Centricity EHR deployed in the hospital would not be adequate, first and foremost because it did not offer digital imaging. It was also not designed to address the documentation and process needs of physicians in the ASC setting – a workflow that is much different than that of physicians in the hospital setting.
After careful consideration, we decided to move forward with the deployment of two applications designed specifically for the outpatient GI environment – ProVation MultiCaregiver and ProVation MD for Gastroenterology. Our project team did its homework before making the decision, completing a site visit with another ProVation client in Salt Lake City and also comparing it to products from other vendors.
We discovered that, in addition to addressing the center’s identified needs, the technology provided interfaces into the Centricity EHR. This essentially created an “EHR within an EHR” platform across which the center’s staff can more efficiently and fluidly manage its workflow without impacting interoperability with the main health system.
Why it works
The benefits of using software designed specifically for ASCs, and GI in particular, lie in the simplicity and efficiency with which information flows across the patient encounter. From the initial phone call with a patient to the onsite history and forward, ProVation software eliminates duplication and provides our physicians, nurses and other staff members with intuitive navigation that addresses all unique parameters of patient care provided at the GI center.
ProVation MD enables physicians to more efficiently and comprehensively document procedures at the point of care, then automatically generates complete, coding-ready and image-enhanced documentation. In a complementary fashion, MultiCaregiver addresses our nursing documentation needs by eliminating the inefficiencies of paper charting and automatically collecting information on vitals.
Physicians are able to document directly on images, pointing out important evidence such as the location of polyps and specific information related directly to the needs of a particular patient. Important to elevating patient care, charts are customized specific to each patient instead of relying on generic templates. The technology also allows for electronic signatures, and charts are time-stamped, creating additional efficiencies to workflow.
Reporting tools provide an enhanced method of analyzing data, enabling quick and easy views of per-physician case numbers, medications utilized and physician-to-physician comparisons of key data to identify outliers that may require addressing, such as scope withdrawal time, adenoma detection rate and rate of cecal intubation.
Another expressed benefit is the rapid reporting available for referring physicians, which allows such items as radiology and lab reports to be sent automatically. Post-op reports are also faxed directly to referring physicians with delivery automatically confirmed.
Realizing the benefits
SVH’s GI Center now operates in a purely electronic environment. By automating key processes, we have been able to eliminate paper costs equating to more than $7,400 annually and transcription costs of $39,000. Drawn from 2009 statistics, these numbers appear to be conservative and would likely be much higher today based upon ongoing analysis.
In late 2011, SVH transitioned to eSummit as its system-wide EHR, and as of June 2012, both the ProVation MultiCaregiver and ProVation MD products interface directly into the house-wide EHR. This integration allows patient information to be updated in a timely manner and made available to all hospital clinicians involved in a patient’s care.
Staff members are utilizing the data-reporting tools and realizing the benefits in full measure. These tools include a monthly review of inpatient and outpatient stats, as well as procedure types. Because of efficiencies with the technology’s report-building capabilities, we are able to use the data for high-level analysis and planning.
Specifically, the difference in the amount of time it takes to build a report has been noteworthy – decreasing from one hour to three minutes. Report data is now being used for initiatives such as conducting physician audits, reviewing documentation practices and pinpointing weak areas that need follow up.
Satisfaction and ease of use for staff and physicians proved to be a huge asset for making the transition, and strong confidence in the availability of technical support boosted acceptance of the new products into workflow. Patient satisfaction has also increased because intuitive navigation eliminates the need to ask repeatedly for the same information.
While ASCs are not faced with the same regulatory pressure to deploy EHR technology as hospitals and physicians, the benefits of making this investment are clearly evident, including substantial cost savings and the ability to provide an enhanced level of patient care. SVH’s GI Center is not a free-standing ASC, but the operational practices and workflows run parallel and are comparable.
When considering which technology to deploy, it is important to analyze whether a particular solution can address the specific workflow needs unique to these environments. Technology created for hospitals will have limitations in this regard, potentially leading to difficult deployments and clinician pushback.
As demonstrated by SVH’s experiences, leveraging advanced technology is a winning proposition for GI Centers; these specialized units can position themselves well for the future of healthcare by choosing the right technology.
About the authors
Julie Larson is nurse manager for peri-anesthesia services, St. Vincent Healthcare. Amanda Hill is the Epic ambulatory technical support director for St. Vincent Physician Network. For more on Wolters Kluwer, click here.
Others who contributed to the development of this article include: Steve Neary, ancillary system administrator; Brett Close, systems and technology center specialist; Susan Pogue, BSN, RN, GI center clinical supervisor; and Dallas Kucera, BSN, RN, GI center staff nurse.