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.

Linda Simmons, RN, at right, vice president of operations and chief nursing officer at Memorial Hospital of Sweetwater County, Rock Springs, Wy., works with a mobile computer.

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

October 2009

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