HOLLI W. HAYNIE

A patient enters the Methodist North emergency room via ambulance with acute symptoms. By the time he reaches the nurses station, and often before, his information is already entered and being tracked. Whether seen in triage or admitted, the patient will notice computer carts being used by nurses throughout the floor, as well as computer stations in patient rooms. The physician and nurse will enter and update vital information into the hardwired or portable computer in real time, which is then checked against the patient’s medical records. Connectivity, efficiency and safety oversight are managed system wide with this advanced health information technology (HIT).

“No longer will we have to wait on numerous orders being written that need to be transcribed by a secretary or nurse,” explained Rhonda Murchison, chief nursing officer at Methodist North. “Orders are in there and when the patient arrives upstairs in the nursing unit, all of those orders have already been processed. All the caregivers can access all the patient information at the same time if they want to. There’s no longer the (issue) where we have to look for a chart or waste time trying to find information.”

On April 1, Methodist North Hospital went live with fully integrated electronic medical records (EMR) and HIT, the culmination of a six-year journey developed for the entire Methodist Le Bonheur Healthcare system. The plan has been executed in phases since 2002, utilizing the OneChart system of EMR, a secure patient information access system. It began with digitizing the pharmacy, fully integrating the ER and training nurses to utilize computers in critical care and step down units, including computer carts, tablet PCs and electronically controlled medicine drawers in patient rooms. The final stages included the implementation of OneChart’s electronic medical administration record (eMAR) and the computerized order entry (CPOE) which brings physicians and administrators into the technology fold.

“All of the elements have been brought together into one completely integrated comprehensive system electronically,” said Donna Abney, executive vice president of Methodist Le Bonheur Healthcare. “Why that’s so important is the introduction then of the decision support tools that are available to assist clinicians in decision making about patient care.”

The eMAR and CPOE allow physicians and caregivers to access patients’ complete medical records, including their medical history, medications, allergies, test results, vital signs and other medical information, via secure, password-protected computers at the bedside and throughout the hospital

“The big driver behind this was to increase our opportunity to provide safe care and high quality care to our patients,” explained CEO of Methodist North, William Kenley. “Overall the foundation allows a level of safety and quality that is just not possible in paper environment.”

Caregivers will be able to instantly update patient records and multiple caregivers can access the same records simultaneously from multiple computers, not to mention that it eliminates the legibility issue. Plus the system keeps track of who’s using the records and when, providing seamless organization of patient care.

As the pilot hospital for the Methodist system, North can work out the technological kinks while other hospitals can focus on training their staff.

“The adoption rate by our associates and clinical staff has gone pretty consistently,” Kenley said. At press time, 73 percent of all physician orders had been entered directly by the doctor or the doctor’s extender. “We’re still literally working with people shoulder to shoulder to help them learn the technology and get comfortable and most importantly, help them get proficient with the system.”

A concern for primary care physicians was whether it was going to add more time to their rounds. While the transition has been cumbersome for doctors, “some have gotten much quicker with it and in (just) a few days of using the system have found it will really be time neutral to them,” explained Dr. Karen Hopper, chief medical officer of Methodist North. In fact, Hopper recalled, during rounds a busy internist received a call from a patient who expressed symptoms of pneumonia. Unaware of the patient’s previous visit to a different Methodist ER, the doctor selected an antibiotic that was immediately red flagged on the computer screen for the penicillin allergy. The OneChart system correctly checked the patient’s past history against the physician drug orders, avoiding a potential medical error.

Currently all hospitals in the Methodist system have linked ERs and EMR, while various staff members are attending classes to learn processes on documenting care in this new work environment.

Plans to expand the two-step finalization process of eMAR and CPOE to each of the five Memphis-area hospitals in the Methodist system are underway, with Methodist Germantown staff preparing for the implementation of eMAR in mid-June and CPOE by October. Next year begins with Le Bonheur and by mid 2009 the University and South locations will go fully live. The goal is to have everyone up by late 2009, early 2010.

“You simply wouldn’t make this size of an investment and be this transformative for your company unless you saw something that superceded all the money, all the time, all the angst and agony of doing this – and that’s patient safety,” concluded Abney. “To me, it’s like going over the Alps and all of a sudden finding this wonderful new world that you can render care in now.”

Using this advanced EMR technology is already saving lives. A dedicated team at Methodist North worked within the EMR to create an electronic warning that alerts hospital medical staff to patients in danger of sepsis and has already decreased mortality due to sepsis by 30 percent. Look to Memphis Medical News for updates on the sepsis prevention program and how the EMR transition is progressing through the Methodist system.



May 2008