Our Journey to Integration

1
Our Journey to Integration

• Amy Hyopponen, RN, BA
• Clinical Informatics Systems Analyst
• April 28, 2009

2
Objective

• Discuss our journey to a fully integrated
  electronic medical record along with the
  successes and challenges

3
About St. Lukes

• A Private, Non-Profit, Tertiary Care Facility
• Level II ACS Approved Regional Trauma Center
• Licensed Beds 269
• Average Daily Census 150
• Clinics 35
• Off Campus Sites 11
• Employed Physicians 482

4
Culture

• Administrative Support Early Adopters
• Integration Commitment Meditech/LSS
  CoreVendors (with interfaces to outside vendors)
• Lean Healthcare Initiated in 2007
• Systematic Approach to Examine Processes
• Goals Process Improvement Waste Elimination
• Education
• Support for Continuing Education
• Conferences

5
System Life Cycle

• System Planning (Multidisciplinary Approach)
• System Analysis (Process Analysis)
• System Design (Identify Success Factors,
  Configuration)
• System and Functional Training (Testing)
• Education of Multidisciplinary Stakeholders
• System Implementation (Conversion and Go-Live)
• System Evaluation, Maintenance, and Support
  (Operational, Technical, Enhancements, Upgrades,
  Ongoing analysis)

6
Human Factors

• Ergonomics
• Software and User Interface
• Creating Streamlined Menus
• Minimizing Access to Meet Needs

7
Patient Room Configuration
8

• Computers with Scanners
• All Patient Rooms, All Med Carts, All Med Rooms
• Wall Arm or Cart depending on space
• Laptops on Carts (Small percentage PreOp and
  Mental Health)

9
Meditech Milestones

• Milestones
• 2003 Admitting (ADM), Billing (BAR), Scheduling
  (SCH), Other Financials
• 2004 Order Entry (OE/POM), Pharmacy (PHA),
  Laboratory (LAB), Imaging and Therapeutic
  Services (ITS), EMR
• 2005 Emergency Department Module (EDM), Medical
  Practice Management (MPM)
• 2006 OR Module (ORM)
• 2007
• eMAR/BMV (Big Bang, February 2007)
• PCS (Gradual Rollout by Nursing Unit, 2007-2008)
• RXM (Electronic Medication Lists and Printed Med
  Reconciliation Forms)
• LSS/EAR/PWM/AOM (Gradual Rollout by Clinic)
• 2008
• Physician Documentation (OB)
• Scanning Medical Records Upon Discharge (paper
  orders, progress notes, etc.)
• E-Sign for Orders
• Integrated Picture Archiving and Communication
  System (PACS)
• Critical Care Monitor Interface
• Replaced stand alone system for titrated drips
  and vitals documentation in Critical Care
• Bedside Shift Report on Cardiac Care (Pilot)
• 2009 5.55 Upgrade (February)

10
Integration Successes

• One Med List Across the Continuum of Care-Med
  Reconciliation Process
• One Allergy List Across the Continuum of Care
• Shared Interventions Between EDM and PCS
• Shared Queries (Questions) Between LSS/EAR and
  PCS
• New Open All Visits Option in EAR (Allows Users
  to View All Information on Following Panels
  Special Panels, Imaging, Laboratory,
  Microbiology, Pathology, Other Reports)
• Improved Compliance with Preventative Care
  Measures with LSS/EAR

11
Integration Successes

• Information Available Real-Time in the EMR
• Improved Trending
• Decreased Redundancy
• Ability to Extract Data
• Data (Identifying Sources and Requirements)
• Information (Data Mining, Reports)
• Knowledge (Patterns, Benchmarking, Compliance
  Reporting)
• Wisdom (Application of Knowledge)
• More Data on Patient Summary Screen in the EMR
• Clinical Decision Support (i.e. VS and Lab Values
  Presented in BMV)

12
Integration Challenges

• Standardizing Entries for Med Lists and Allergies
• Hospital and Clinic Screens Different for RXM
• CPOE Not Yet Implemented
• Creating Concise Documentation Templates
• Balancing Documentation Templates and Narrative
  Notes to Tell a Story
• Continuing Rollout
• Data Display in the EMR
• Display of Titrated Drips and Vital Signs

13
Integration Challenges

• Response Time
• Physician Acceptance
• 5.55 Upgrade Data Conversion Issues, System
  Stability Issues (Downtime), Workflow Issues
• Maintaining Custom reports
• Full integration has still not been realized (two
  separate records EAR vs. EMR different panel
  options)
• Paper Record (Scanning Upon Discharge)

14
Communication/Education

• Intranet
• Sharepoint Sites
• Newsletters
• Computer Based Training
• Healthstream Completion/Tracking
• SnagIt Screen Captures
• Go To Meeting or VM Encoder - Videos

15
Lessons Learned

• Integration Committee for High Level Oversight
• Clinical Documentation Committee
• Physician Advisory Committee
• Careful with EMR IDs
• Drug Types (Diuretic vs. Water Pill) Use NPR
  reports to facilitate

16
Valuable Resources

• Administrative/Executive Support
• Meditech Specialists and Issues Lists
• Meditech Enhancement Suggestions (MIX Requests)
• Project Managers/Implementation Team
• Networking
• Meditech Events
• List Servs SISU, Nursing Informatics
• MUSE
• NPR Report Writers

17
The Journey Continues

• Bed Board and Bed Placement
• Lean Projects
• PCS Implementation for Rehab, Case Management,
  Outpatient Areas
• Continue Rollout of Physician Documentation
• eMARs (ED, Day Surgery, PACU)
• LSS Scanning
• E-Prescribing
• PACs Rollout for Clinics
• Interagency Referrals
• Barcode Scanning for Blood Products (TAR)
• CPOE

18
Contact Information

• Amy Hyopponen, RN, BA
• ahyopponen_at_slhduluth.com
• 218.249.3056