Enhanced clinical trial recruitment, chronic care management and patient safety
Reduced nurse triage time due to e-prescribing and legible notes
Fewer chart pulls
In the late 1990s, physicians at Memorial Hospital and their outpatient clinic, the Family Care Center, knew that utilizing an EHR was going to be essential to providing quality care in the 21st century. However, once the decision to purchase an EHR was made, choosing and implementing the right EHR was an important challenge for Medical Director Dr. Arnold Goldberg and Dr. Charles Eaton, who were deeply involved with the process. "We started the selection process with the long list of EHRs and used networking and recommendations from the American Academy of Family Physicians (AAFP) to narrow it down. Now organizations have the benefit of CCHIT certification to provide standards," says Dr. Goldberg. "At the time we made the purchase, that was not available."
As providers at a larger hospital’s outpatient clinic, Dr. Eaton and Dr. Goldberg had specific system needs. "We evaluated what was most important for our Center, and that was having robust templates that would focus on disease and care management and that could convert into reporting functions. As part of the hospital system, it was critical to be able to easily import labs, X- rays and results from the hospital." Both physicians agree that they would also benefit from the EHR’s built-in capability for tools to support best practices like clinical reminders, allergies and medication lists, as well as an integrated and organized chart system. The hospital ultimately decided to purchase the GE Centricity EHR and the implementation process began.
“If I am on-call and receive a phone call from the Emergency Department, I can pull up the patient’s record and give them critical information when they need to know it, including medication history and lab results.”
Dr. Eaton explains, "We had a motto. At every decision point during selection and implementation our job was to determine what would give us 'more gain and less pain'. To do that, you have to work to understand what is important for your group by examining how you make decisions and what you value. You can’t go from being disorganized on paper to an EHR. The computer creates an organized system that requires you to do things in a specific way, so you should be reasonably organized first."
The clinic chose to implement in a staged approach, a tactic that allowed for more gradual changes. Their tipping point of implementation for all staff came when they had a computer in every exam room in the Family Care Center.
As part of their staged approach, the Center elected a group of super-users to test everything prior to widespread implementation. "The group was composed of staff that included the front office, nursing and clinicians. We looked at who needed to do what—who could take vitals, who could schedule appointments—and we worked to make the system faster." The super-users were always more advanced than the main group and were able to help find solutions for others when necessary.
"Though we had some initial resistance, the realization that we now had the ability to work remotely began to take that away. This gain was far greater than the pain. Other substantial gains for our physicians and staff were the e-prescribing function and the importing of patient labs, tests and reports from the hospital." A more significant challenge for the group was the need to convert, in some cases, 20 years of paper records. While some physician groups choose to scan or enter the entire contents of old charts, others entered none. Memorial found their choice to enter problem lists, allergies, and medications for go-live to be a smart decision.
Dr. Eaton and Dr. Goldberg attribute much of their success to keeping a heavy focus on training and IT support. "Whether you are large or small, always put more in the IT budget than you anticipate." Their workflow decisions include allowing for free text in their templates and utilizing a standard progress note that gives flexibility to clinicians.
"Utilizing an EHR has improved both the safety and the patient care that our providers are able to give in many ways. If I'm on-call and receive a phone call, I can pull up the patient's record and talk to the Emergency Department about critical information when they need to know it, including medication history and lab results. We can also monitor when a patient misses an appointment and print letters to send them immediately." Because of the EHR’s extraordinary reporting functionality, providers can check at any time whether patients are up to date with vaccinations or mammograms by pushing a few buttons. They can manage diseases by monitoring asthma, cholesterol and diabetes patients, and easily see who is at goal and who needs follow-up. These types of quality improvements would not be possible without clinical reports from the EHR.
The EHR also allows for more patient-centered care. "We utilize self-management goals and shared decision making tools. We can show patients the decision support and heart age tools and they can see trends in their own data. This ultimately gets our patients more involved in a way they couldn’t be involved before."
E-prescribing through their EHR has also provided substantial benefits. "It has saved both the staff and the physicians’ significant time and greatly benefits us when we are on-call and can see a comprehensive medical record. And it helps ensure patient safety: we can monitor drug interactions and verify medication lists."
Don't expect Memorial Hospital to slow down any time soon. They plan to integrate with Rhode Island's Health Information Exchange, currentcare and are planning to integrate Lifesensor® personal health records with Centricity. "The EHR allows us to take part in patient-centered programs—without it, you really could not participate."