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If the patient had recently visited the hospital, any number of physicians could have checked out the chart, or it could be among the many charts in the physician completion room awaiting completion. If this was the case, it could take significantly longer to retrieve the chart. It could take even longer if it was misfiled amid the 1/4 million records in the file room.
Rivera's job is quieter now. Although physicians and nurses still call her with questions, they no longer call requesting charts. They can immediately access patient charts themselves from a PC in the emergency department using ChartMaxx Electronic Patient Record (EPR) System from MedPlus, Inc. For Rivera, this means that she has more time to analyze charts and perform other important job functions. For the caregiver, this immediate access to data can save lives.
"If you're searching for a living will or other document, you can go right to it rather than flipping through paper," Rivera says. "It's virtually impossible to lose charts. The system automatically arranges documents in the right folder and in a standard order that best suits the department. So there is no chance of putting the record in the wrong place."
In addition to chart retrieval, physicians are electronically authenticating charts with the MedPlus system. Each physician is assigned an encrypted digital signature, a secured signature password that cannot be altered or forged by another user. When physicians log on to the system, their log-on menu shows the number, type and location of deficiencies to be completed. With the click of a button, the physician can access each chart to be reviewed and completed. Physicians can also edit transcribed documents online in real time rather than sending them back to the transcriptionists.
The hospital estimates that emergency department physicians are completing charts in 1/15 of the time it previously took with paper. To make it as convenient as possible for physicians, Wuesthoff is strategically placing ChartMaxx workstations throughout the hospital, including the physician lounge and 18 nursing stations. In the future, the hospital plans to establish modem lines, so physicians can access and complete charts from their offices.
"It is very convenient to be able to retrieve and complete charts on the system," says Paul W. King, MD, director of Wuesthoff's emergency department. "Since the medical records department is in another building, it was logistically difficult to retrieve charts when we were confined to paper. It was especially difficult to give up a staff member in the middle of the night to retrieve these records from the department. And then there was the possibility that the chart was checked out by someone else. Now we can pull up the chart right away without leaving the department.
"ChartMaxx has definitely helped me feel more comfortable treating patients," he continues. "If someone comes in with chest pains, for instance, I can access all information from previous visits right on the system. This helps me make better diagnoses and treatment plans."
According to Sue McKay, information systems analyst, EPR personnel have assisted in physician buy-in and elimination of initial resistance to the new technology by making training as simple and painless as possible. They also make every effort to work around physicians' busy schedules. "The system sells itself once they use it and see the benefits it produces. We can analyze records more thoroughly, detect errors, and forward them to physicians much faster than we could working with paper charts. Ultimately this helps speed and increase reimbursement. And physicians receive a higher quality document than before."
Debbie Madison, assistant vice president, medical information services, concurs, "Physicians like the system, and tell us they will like it even more when they are able to access records from their offices. All the issues typically associated with medical record completionÑdictation missing from charts, signing stacks of charts in the physician completion room, waiting for a chart that has been signed out by another physicianÑare going away."
ChartMaxx has made work more efficient for medical records clerks, as well. "Using the system has decreased the time spent processing ER records in half," Madison says. Clerks no longer have to run from department to department to locate charts or flip through bulging folders to perform deficiency analysis. They retrieve only the encounter that requires analysis to be performed. The system also has an auto signature function which assigns a signature deficiency for transcribed reports to the author of the report."
"If a file is missing an EKG, for instance, the deficiency analyst can locate the orders on the Meditech hospital information system to determine if the test was cancelled," McKay adds. "They can determine that the test wasn't ordered because of an allergic reaction the patient was experiencing."
Security is always an issue when a hospital moves to computerized patient records. One of ChartMaxx's strong points is its ability to limit chart access down to the document level. The system can even restrict certain pieces of information on a given chart. The system administrator can limit viewing of HIV test results, for example, so only the attending physician or other authorized individuals can view this information. It also gives the administrator the ability to limit system and application usage, and printer, fax and e-mail access.
Along with encrypted digital signatures, users are provided with encrypted passwords to foil attempts at password intercepts. This circumvents unauthorized individuals from accessing the system. Users create their own passwords so they remain private.
The emergency department, the most frequent user of medical records services, was the first department at Wuesthoff to gain access to ChartMaxx. Staff members and physicians now use the system, interfaced with Wuesthoff's Meditech hospital information system, to manage all emergency care, outpatient and ambulatory care surgery records. In a few months, Wuesthoff will begin adding all inpatient records. When this occurs, Wuesthoff will be one step away from its goal of a paperless environment. After storing documents for a determined amount of time following the scanning function, medical records personnel will shred the paper charts.
Once inpatient records are added, the hospital plans to move ahead with the installation of modem lines so physicians can access records from their offices. Wuesthoff has recently won approval to open a new 50-bed hospital in nearby Melbourne, Florida. When it opens, they will implement ChartMaxx throughout the facility to automate the medical records process.
While there are still many developments waiting to take place, Wuesthoff's commitment to electronic medical records has already helped establish the hospital as a pioneer in information technology. This reputation has not gone unnoticed by the medical community. In today's competitive healthcare environment, attracting good physicians has become a high priority. By offering productivity-enhancing tools, such as an EPR system, Wuesthoff has a considerable advantage over other hospitals.
"The system has been a great selling point when recruiting other ER
physicians," King said. They are very impressed when they see the capabilities
it provides. There simply aren't many hospitals that have this type of
technology."
TEN ESSENTIAL ATTRIBUTES OF AN ELECTRONIC PATIENT RECORD
To gain the full benefits of an EPR system, it is important to first ensure efficient and cost-effective work processes are in place. Make sure the vendor has the expertise to examine your work practices, offer recommendations for improvement, and implement or help implement them before you make a purchase decision. They should be able to provide proof of the return on investment, savings and efficiency gains you'll achieve by implementing the recommended process improvements and technology. Above all, they must involve all people affected by these changes and users of the system. This will help ensure buy-in and future success with the system.
Successful implementation of an enterprise-wide EPR requires careful planning, as well as technical expertise. Look for a vendor that will support and guide you through this most vital process. On-site project management, interface customization, system installation, user training and ongoing 24 x 7 toll-free phone support should be included with your system. It is important that you are assigned an experienced project manager that will develop detailed project plan for your organization and oversee and monitor the implementation.
Instituting an EPR system is usually a gradual process, often beginning with a departmental imaging system and building toward an enterprise-wide solution. The system you choose should be built modular and scalable to grow as your needs grow, without requiring changes to your system. To leverage your current IT investment, the system should also include features, such as image enabling, which allows you to access charts through your hospital information system.
The EPR system should be based on industry-standard, open technologies for easy integration with various information systems. The ideal open system should use reliable, proven technology, such as UNIX and/or Microsoft Windows NT servers, an Oracle database, Hewlett Packard hardware and open standards such HL7, TCP/IP, ANSI and SQL.
Workflow is an essential component of any EPR system. With it, you can effectively manage and track all activities the system supports, greatly increasing staff productivity and efficiency. To gain the greatest benefit, make sure the system has a workflow component that can be easily tailored by you to match your work processes.
Find an EPR system that enables you to administer security permissions to limit system access, application usage, printer, fax and E-mail access and chart or document viewing, or any other criteria you establish. The system should give you the ability to assign permissions on a group or individual basis. The system should also offer encrypted digital signatures for chart completion, which ensure signatures cannot be altered or forged by unauthorized users, and encrypted passwords to foil attempts at password intercepts. Also, make sure system security includes full audit trail to enable the administrator to track all users' activities on the system, including chart viewing.
To build a complete patient record consisting of all clinical and financial information, you will need an EPR system that incorporates both electronic and paper-originated information. The best systems offer HL7 and ANSI 835 (for structured data) and Computer Output to Laser Disk (COLD) interfaces with full scanning (imaging) capabilities, such as redaction, annotation and other features.
Make sure the vendor can provide access to remote users either via a Web browser or modem connection. The vendor should also be able to provide the necessary software and services to enable sharing between the hospital and physician offices.
Find a vendor with a proven track record of successfully implementing and supporting EPR systems in health care organizations. Talk to their customers to find out their experiences with the vendor and its products and, if possible, visit their facilities to see the system in action. This is the best way to determine if the company's product lives up to its marketing claims.
The ideal system will include applications designed to automate specific work processes in your department and improve the overall efficiency of your operations. Some vendors offer workflow-based modules especially designed for medical records, patient accounts and other hospital departments.
Debbie Madison is Assistant Vice President, Medical Information Services at Wuesthoff Health System, Rockledge, Florida. For more information, contact MedPlus, Inc. at 800-444-6235, or visit the company's web site at www.medplus.com. Email can be sent to info@medplus.com.