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could make an immediate impact on clinical quality, but also one capable of producing consistent fi nancial improvements over the long term with substantial analytics and reporting features. They also wanted a highly user-friendly technology to ensure quick uptake and ongo- ing support of clinicians. Specifically, the ED ex- pected an EMR to facilitate documented improvements in

Linda Deville is CEO of Bunkie General Hospital in Bunkie, La. For more on CMR solutions:

patient volume, left without being seen (LWBS) rates, admis- sions percentage, coding levels, and Centers for Medicare and Medicaid Services (CMS) core measures (particularly those related to infection control and disease management). After a thorough review of systems that met these criteria, Bunkie General selected and implemented CMR, an emergency de- partment information system (EDIS), based on the product’s solid industry reputation and the fact that the user-friendly software easily integrates with other hospital-wide enterprise information systems. A best-of-breed technology designed for EDs of all sizes, the EMR presents a traditional chart layout to ensure that busy staff can easily and quickly access and input critical patient data.

Knowing it had one shot to gain clinician buy-in, Bunkie General placed a high priority on end-user training and clini- cian workfl ow. By investing signifi cant time and resources into these activities, leadership could make certain the EMR would improve effi ciencies and not interfere with patient care. Bunkie General involved ancillary departments that interact with the ED in the training process to harmonize the patient experience throughout their continuum of care. Soon after implementing its new EMR system, Bunkie General’s ED began to recognize signifi cant operational and clinical benefi ts, including a decrease in patient turnaround time from approximately 160 minutes to near 100 minutes, a more than 35 percent reduction. The ED also was able to improve its hospital admission percentage from 6.2 percent to 14 percent, an average increase of 52 patients per month. These results, combined with higher across-the-board coding levels, led to a nearly $2 million annual windfall for Bunkie General.

The EMR software has placed Bunkie General squarely on the path to achieving meaningful use with a number of compli- ant functionalities, including an up-to-date problem list, active medication lists, quality measure reporting and medication reconciliation. The solution also enables the ED to provide its patients with electronic copies of records, including discharge instructions and a care record summary. The forms eliminate the problem of illegible physician orders and instructions, thereby increasing patient safety.

The EMR has allowed Bunkie General to better accommo-

date ED-specifi c patients and expedite care for time-sensitive illnesses. ED staff is afforded a charting tool designed for their unique workfl ow, leading to improved care coordina- tion and communications effi ciency among physicians and

nurses. The ED software facilitates more data collection as well, which has improved chart audit results and enabled fully electronic patient transfers. And with more thorough and accurate physician orders, medical records department staff have reported signifi cant increases in effi ciency since they rarely need to chase down a physician or nurse with questions about a chart.

The automated patient record enables the ED to capture data more easily, which is then distributed in a report format that provides a glimpse into the department’s performance, including patient volume and satisfaction levels. With this information, hospital leaders can identify exactly where im- provements are being achieved and what areas are still lagging. Bunkie General has learned from its new decision-support data that patient-care costs have declined and personnel have become more effi cient, which has translated into higher levels of patient, clinician and employee satisfaction levels. Prior to implementing its EMR, Bunkie General could not pay for full-time physicians, leaving many of its 17 part-time ED doctors to practice in other hospital departments. With greater fi nancial stability, the ED now includes a core group of four well-compensated physicians. And with a revised hospital- ist program, two local physicians who share one week on call and provide care to unassigned patients are able to help ease the burden during spikes in ED patient volume.

An eye on the future Bunkie General provides telemedicine as part of the Loui-

siana Rural Health Information Exchange, which links patients to specialty physicians with the Louisiana State University (LSU) Health Sciences Center in Shreveport. For its efforts, the hospital was recognized by U.S. News & World Report magazine with the Silver and Gold Award for its exceptional care to patients suffering with heart failure. More recently, the hospital was listed as one of HealthGrades’ top Louisiana institutions in the management of chronic obstructive pulmo- nary disease (COPD) and pneumonia. Realizing near-term operational improvements with its

EMR, Bunkie General is now determining how it will use the EMR to assess and reassess its core measures, provide ongoing education for its staff and utilize additional data to ensure ongoing clinical and fi nancial improvements. The ED is also looking to integrate the software with its telemedicine capabilities to facilitate bedside registration and drive quicker clinician response to time-sensitive illnesses. None of these activities would have been possible without an ongoing belief that rural hospitals continue to play a vital role in the nation’s healthcare system. The operational barriers that these institutions face are indeed daunting. But with the right fi nancial incentives; a core group of administrators, clinicians and staff dedicated to improving the health of rural popula- tions; and technologies that help increase caregiver effi ciency and heighten patient satisfaction, small communities will see their rural facilities thrive for years to come.


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