Critical Path Network
High-tech hospital gives staff more patient time
Notebook computers provide real-time info
At Dublin (OH) Methodist Hospital, the clinical staff carry notebook computers into patient rooms, communicate through wireless communications badges, and rarely touch a piece of paper or a pencil in their every day work.
The 94-bed hospital, which opened in January 2008, is one of the few hospitals in the country with a 100% electronic medical record.
The hospital's technology package is a combination of 176 different systems, many of which have been successfully implemented in other hospitals in the OhioHealth system, and all of which interface with each other to create a medical record in real-time, says Corey Perry, JD, MDiv, director of organizational excellence for the Dublin, OH, hospital.
The whole premise behind the paperless hospital is to create a high-tech, high-touch environment of patient care, Perry says.
"We use a lot of technology in order to free up the clinician to spend more time at the bedside instead of doing paper work," he says.
Planning and development of technology for the paperless hospital was in the works for nearly two years, Perry says. During that time, the hospital system's information technology staff worked closely with vendors to customize off-the-shelf software to meet the hospital's particular needs.
Where possible, the clinical applications were developed with input from clinical staff who had used the same systems at other hospitals in the system.
The case management software system that already was being used by hospitals in OhioHealth required little modification to interface with the new technology system at Dublin Methodist, Perry says.
The technology interfaces in the new system, allowing case managers and other clinicians to enter the patient record and move through the various information systems to access the information they need to manage the care of their patients, saving a lot of time previously spent on paperwork, he adds.
The system eliminates duplicate documentation that occurs when nurses and case managers use different software folders.
The hospital uses a blended model of case management, with social workers and case management sharing responsibilities and working collaboratively. They follow the same patients through the hospital and work closely with the hospitalists and attending physicians.
"Even though we are very focused on using technology in the delivery of care, it never replaces face-to-face communication," he says.
For instance, case managers may be able to accomplish much of their work at their work stations because the technology system gives them instant access to the information they need to create a plan of care or communicate with a third-party payer, Perry points out.
"However, we still want them out there being active and available to patients and family as well as medical and nursing staff."
Here's how the paperless system works:
When a patient presents to the emergency department, he or she is immediately taken into a room for bedside registration by a registrar using a laptop computer.
"All the clinical staff use laptops in patient rooms. Registration uses one system. The physicians use another product for their documentation and ordering. Radiology and cardiology use other systems but every clinician's documentation automatically feeds into a single patient record," Perry says.
When patients are transported from one unit to another, their electronic medical record is instantly accessible by the receiving unit. For instance, if a patient is moved from the emergency department to the surgical suite, all of the data entered into the record in the emergency department are available to the surgical team. The surgical team uses a surgery management software product and the anesthesia department uses another but both feed into the electronic medical record.
"There are multiple things that cause avoidable delays and create log jams within the throughput process. This system eliminates all that in real-time," he says.
Real-time records
When the patient is moved to the ICU or the inpatient unit, the staff document in another set of software but it all feeds into the same system.
"The patient's medical record is available in real-time to any clinician who needs it. When someone documents, all they have to do is click that they're done and the information is in the patient folder. When a patient gets to the floor, the case managers no longer need to find out who has the record. It's right there," he says.
When the case manager, the bedside nurse, or the physician enter anything in the record, he or she just clicks that he or she is done and it's automatically in the record and available to all staff.
"It saves a tremendous amount of time. It eliminates delays in service when the orders sit on the desk because the unit clerk is backed up or the order sheet gets lost before it's entered into the record," he says. For instance, tests are no longer delayed because an order for fasting hadn't yet been entered into the record of a patient scheduled for a test.
The patient care process is much more efficient because every clinician has access to the same information at the same time, Perry adds.
Every clinical person in the hospital wears a wireless communication badge that hangs around their neck and can be used for instant communication with other staff.
"The device allows staff to press a button and ask for a physician or a nurse by name or if they need a particular role or function, they can ask for an X-ray tech," he says.
The device ties in with the nurse call system and paging system for physicians, allowing the staff to receive calls from the outside.
When patients press the call button, their call goes directly to the wireless communication device, which routes it to a nurse.
"We have no centralized nursing stations. All medical records are accessible to all staff at all times through the laptop computer so we don't have to worry about a place for storing charts. All communication is by the wireless device so we don't need a unit clerk to field calls or direct calls," he says.
The hospital designed its documentation program to prompt physicians for documentation when they enter orders into the system.
For instance, if a physician selects an ICD-9 code for pneumonia, the system produces a menu asking for details — such as aspiration pneumonia or community-acquired pneumonia — resulting in better documentation for the MS-DRGs, Perry says.
"We designed tools for the physician that help us early on to ensure that the diagnosis and appropriate documentation is in the medical record. The system guides them in entering the patient diagnosis, how they arrived at it, and the plan of care," he says.
All of the clinical staff have access to wireless notebook computers, located at kiosks throughout the hospital. They can move the notebooks on a stand or carry them on their rounds and use the table in the patient's room for documentation.
Some laptops have radio frequency identification that sounds an alert if someone takes them from a certain area. The system also limits access to a patient's medical information on a need-to-know basis.
"When we designed the system, we were very careful about information security. It's impossible for everybody to access everything," Perry explains.
Making it convenient
There are pods and perches located throughout the hospital where staff can sit and do documentation.
"The reality is that all staff are no further than 30 feet from a patient room. We want our staff to be close and accessible to patients," he says.
The hospital encourages patients and family members to intermingle with the staff but also has set aside areas where staff can meet in private or take a break.
One of the biggest challenges that case managers have encountered is resistance to electronically submitted information from third-party payers.
"It's a paradigm shift for payers who are accustomed to working in a paper environment. We can get them the information they need in a matter of minutes through an electronic fax. Initially, we had payers saying they didn't want to communicate electronically. Now they realize it saves a huge amount of time," he says.
At Dublin Methodist Hospital, all the resources for most diagnostic procedures come to the patients. The exception is major procedures such as CT scans.
For instance, if a patient needs an X-ray, a technician from the imaging department comes to the patient's room and shoots the film, which is transmitted wirelessly to the radiologists.
"We try to keep the number of hand-offs and movement of patients between areas to a minimum. It's a patient safety issue," he says.
The hospital operates under the acuity adaptable model of nursing care, which makes every room capable of being a critical care room. The critical staff come to the patient rather than moving the patients to a critical care unit.
"We rotate staffing to accommodate the need," Perry says.
The hospital staff came on board in November for two months of training and preparation for the hospital to open.
"Most of that time was devoted to teaching them the information system, helping them feel more comfortable with the technology, and testing the system to determine stability," Perry says.
The tests included several mock live events during which the hospital would admit 30-40 test "patients" at a time, putting them though the system to make sure that all pieces of the system fit together and that the clinicians could navigate the system.
"Nothing has come close to the amount of learning that has occurred since we have been on line. It's one thing to learn the system. It's another thing to learn how the system works with patient flow. In the live environment, it's easier to understand the flow and integrate the flow to achieve good clinical throughput," he says.
(Editor's note: For more information, contact Corey Perry, director of organizational excellence, Dublin Methodist Hospital, e-mail: [email protected].)
At Dublin (OH) Methodist Hospital, the clinical staff carry notebook computers into patient rooms, communicate through wireless communications badges, and rarely touch a piece of paper or a pencil in their every day work.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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