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Springfield Clinic Healthcare Final


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Springfield Clinic Healthcare Final

  1. 1. Microsoft Customer Solution Healthcare Industry Case Study Multispecialty Clinic Improves Continuity of Care with Electronic Health Record Solution Overview “With Allscripts Enterprise EHR, we now have one Country or Region: United States Industry: Healthcare—Healthcare record for each patient regardless of how many providers providers that patient sees. That record is updated Customer Profile instantly when the patient sees any of our providers.” Springfield Clinic, based in Springfield, James Hewitt, Chief Information Officer, Springfield Clinic Illinois, employs more than 1,400 people, including 195 physicians and surgeons Springfield Clinic, the second largest medical clinic in Illinois, has who represent nearly every specialty. It has 24 locations across the state. more than 195 physicians and 24 locations. Many of its patients see more than one physician at various locations, so multiple Business Situation The clinic needed to consolidate multiple charts were often created for the same patient. The clinic wanted to paper patient charts into a unified patient maintain one record for each patient that could be easily and record that was easy to use and that physicians could access from anywhere, at securely accessed by providers, at any time, from any location. It any time. also wanted to analyze clinical data to improve processes. To Solution achieve those goals, Springfield Clinic implemented the Allscripts Springfield Clinic deployed Allscripts Enterprise® Electronic Health Record (EHR) system on Motion Enterprise Electronic Health Record system and Tablet PCs running on Windows XP, Tablet PCs running Windows® XP, Tablet PC Edition. Allscripts Tablet PC Edition to all of its locations in a Enterprise EHR, based on the Microsoft® .NET Framework, is easy to phased deployment. use and flexible enough to meet each medical specialty’s Benefits requirements and individual practice styles to enhance continuity of  Enhanced patient care, expedited results  Easy accommodation of practice styles care, increase efficiency, and reduce medical record costs.  Reduced medical records expense  Expanded clinical information  Increased recruiting power
  2. 2. “We needed to find a Situation As the number of Springfield Clinic patients It is no secret that administrative costs play a and physicians grew, so did the organiza- very lightweight, major role in the high cost of healthcare tion’s Medical Records staff. By 2005, the browser-based solution today. And much of that cost can be clinic had 160 full-time Medical Records staff attributed to the sheer volume of paperwork— and 22 file storage locations holding an that would allow filling out, processing, filing, retrieving, and estimated 45 million pieces of paper. Some providers to gain access storing millions of pieces of paper. Driven of that paper represented duplicate charts for partly by the provisions of the Health patients who see a primary care provider at to our system over a Insurance Portability and Accountability Act one location and specialists at other standard Internet (HIPAA) governing the standardization of locations. Having the right chart at the right electronic administrative, financial, and place became a challenge. If a patient’s chart connection no matter patient data, and partly by the growing need wasn’t available at a new doctor’s site, that where they were.” to contain costs, healthcare organizations provider would create a new “shadow chart.” have begun to look at how to convert all of This made it difficult for a physician to have James Hewitt, Chief Information Officer, those pieces of paper to more easily the full patient record. It also meant that Springfield Clinic accessible electronic data. Springfield Clinic specialists who visited outreach locations had to load all the X-rays Springfield Clinic, headquartered in and charts for the patients they were going to Springfield, Illinois, is nearly finished with see into the trunk of their car and unload achieving that goal and has already moved them at the outreach location. Then they had three-quarters of its locations to paperless to load them all back into the car for the environments. return trip. Founded in 1939, Springfield Clinic today has Keeping most of its clinical data on paper more than 260 medical providers, including also made it difficult for the clinic to analyze more than 195 physicians and surgeons its clinical data to support quality reviews. covering virtually every specialty. To respond And it was difficult to create accurate reports to the organization’s growing patient base, it for emerging initiatives such as the Health expands by an average of 10 physicians each Plan Employer Data and Information Set year. The majority of the clinic’s providers are (HEDIS), which measures performance based located at Springfield sites, including the on important dimensions of care and service, main campus in Springfield, Illinois, where a and Pay for Performance, which rewards 118,000-square-foot building expansion is healthcare providers for meeting certain scheduled to open in August 2008. The clinic measures for quality and efficiency. “We had also operates more than 25 satellite offices done a great job of building systems on the and outreach locations throughout 12 operational side, but we weren’t able to truly counties in central Illinois. These offices are mine the data from a clinical perspective to staffed by local primary care providers and get an objective view of how effective any offer the services of more than 20 Springfield particular treatment or process was,” says Clinic specialists who travel to the outreach James Hewitt, Chief Information Officer for locations several times a month to see Springfield Clinic. patients.
  3. 3. By 2005, the clinic had automated some  Company viability—including their ability parts of its operations. It used the IDX to support large organizations and the level Flowcast (now GE Centricity Business) of the vendors’ research and development practice management system for patient expenditures to ensure that the product registration, scheduling, and billing. It had a would evolve with the needs of the repository system from Allscripts that stored industry. all transcribed patient reports and test  Practical usability—including ease of results. And it used PeopleSoft for deployment, ease of use, and ease of accounting, purchasing, and human management. resources. The clinic ran its infrastructure on the Windows Server® 2003 operating system The project was made more challenging by and used Microsoft® Exchange Server 2000 the fact that a majority of Springfield Clinic for messaging. Both the administrative staff outreach locations are not owned by the and providers used Microsoft Office 2003 clinic and so were not part of its network Professional running on the Windows® XP infrastructure. “That presented a major operating system with Service Pack 2. challenge in our search for an EHR system,” “Allscripts understands says Hewitt. “We needed to find a very the complexities of The Springfield Clinic wanted to take the next lightweight, browser-based solution that step to enhance patient care by implement- would allow providers to gain access to our various specialties such ing a system that integrated all patient infor- system over a standard Internet connection as oncology, infusion mation—reports, test results, digital images, no matter where they were.” and related correspondence—into a single units, and electronic patient record that was available Based on those criteria, the IT committee ophthalmology and immediately to physicians in the Springfield narrowed the original list to four vendors. Clinic network regardless of location. In After closer evaluation, including visits to the offers the flexibility to addition, the clinic wanted to expedite test vendors and talking to other customers, the meet those needs.” results and reduce paper handling and Springfield Clinic selected the Allscripts storage costs. So the clinic went in search of Enterprise Electronic Health Record. James Hewitt, Chief Information Officer, an electronic health records (EHR) system. Springfield Clinic “We picked Allscripts Enterprise because it Solution supports the needs of a large, multispecialty The Springfield Clinic IT committee, which clinic,” says Hewitt. “It’s a full-blown EHR included providers, IT staff, and administra- system that allows us to do all of our charting tive staff initially looked at virtually all the without dictation. Allscripts understands the EHR solutions available at the time, complexities of various specialties such as evaluating them based on several criteria, oncology, infusion units, and ophthalmology including: and offers the flexibility to meet those needs.  Features and functions—including how Also, it is a browser-based system, which the solutions integrated with third-party allows us to address the requirements of our applications, which hardware they outreach clinics.” supported, and their flexibility to be adapted to specific requirements of Gaining Browser-Based Access individual medical specialties. from Anywhere
  4. 4. “We wanted to create an Allscripts Enterprise takes advantage of the pilot site because it was the farthest away Windows Forms, ADO.NET, and ASP.NET Web from the main campus, because one of its implementation process services components of the Microsoft .NET physicians was a strong champion of the EHR that could be replicated Framework 2.0 so that users can access all implementation, and because it was very the Allscripts Enterprise modules through a efficient with paper charting. The location consistently across our browser. “If providers have a Windows also had a small staff of four physicians and entire clinic." Mobile® device, they can access our one nurse practitioner. application through that as well,” says Lee James Hewitt, Chief Information Officer, Shapiro, President of Allscripts. “The great To prepare the pilot site, the clinic had to Springfield Clinic thing about being on the Windows operating stabilize connectivity between the main system is that it allows our clients to access campus and the Hillsboro location and set up Allscripts Enterprise anywhere they have the wireless network infrastructure. “None of secure access to the Internet.” our sites had a wireless network so we had to develop a wireless strategy and deploy that In addition to the software, Springfield Clinic network in a short amount of time”, says needed a hardware device that was portable Hewitt. “I can’t emphasize enough the impor- enough to be easily carried to the point of tance of making sure that your technology care, yet had a large enough screen so infrastructure is sound, because you’re providers could clearly read text and view moving all of the processes that were done digital images. The device also had to be on paper to a very mobile solution where fairly lightweight and provide at least an everything is now in electronic format.” After eight-hour battery life. The selected device setting up the wireless network, the IT staff also needed to support fast performance, installed docking stations for the Tablet PCs, built-in wireless connectivity, the ability to printers, and scanners. record dictation, and biometrics so that providers could log on and write prescriptions Meanwhile, the IT staff installed 12 Allscripts and orders and sign off on documents with Enterprise EHR modules on two clustered HP just a scan of their finger. “Biometrics is very ProLiant DL580 G3s and four ProLiant DL360 important because physicians sign hundreds G4s all running Windows Server 2003 R2 of pieces of paper every day, and we didn’t Standard Edition in the clinic’s data center on want them to have to pen in a password that the main campus in Springfield. All the many times a day to approve forms,” says information collected through the various Hewitt. After looking at several vendors, the EHR modules is stored in a Microsoft SQL clinic chose to deploy Motion Computing LE Server® 2005 database using an HP 5000 1600 and LE 1700 Tablet PCs running the Storage Area Network. Windows XP, Tablet PC Edition operating system. The Springfield Clinic IT committee decided to implement the entire Allscripts Enterprise Working Out the Details at the Pilot Site EHR suite of products—including Base, At the end of 2005, Springfield Clinic Document, Dictation, Results, Rx+, Note, partnered with Allscripts to develop an Charge, Scan, Orders, Analytics, Dragon enterprisewide EHR implementation strategy. Dictation, and Physician Home Base—at the It chose its Hillsboro, Illinois location for the same time in the pilot site. “By implementing
  5. 5. the full EHR system one site at a time, we charts were available if absolutely necessary could do a complete reautomation of the but were rarely needed. After two days, the paper workflows and provide a high degree of Hillsboro physicians and nurses asked that training and support at that site. After the site paper charts no longer be pulled, and the site was stable, we moved on to the next site,” was officially declared paperless. From that says Hewitt. point on, all information and tasks were handled through the Tablet PCs. Some The implementation team, consisting of four physicians resumed a full patient schedule nurses and one technical person, arrived at within two days, and all resumed a full the pilot site in March 2006. “Because schedule within two weeks. At that point, the Hillsboro was our first site, we spent a lot of clinic started scanning all the paper charts time getting the whole process right,” says into the Allscripts Enterprise system. Hewitt. “We wanted to create an implementa- tion process that could be replicated consis- Following the successful Hillsboro site tently across our entire clinic. We also deployment, the implementation team moved needed to refine the new digital office to each additional site and repeated the workflows as well as test the entire technical process. By the third site, implementation infrastructure.” was completed within two weeks. “On average, each site has been declared About six weeks before the go-live date, clinic paperless after two days. It is truly amazing,” physicians started reducing their schedules says Hewitt. for the week of deployment. Two weeks before the go-live date, the Education Accessing Many Tasks through department began training the providers. One Interface Physicians were required to take eight hours Approximately 1,300 Springfield Clinic staff, of one-on-one training, and nurses were representing patient accounting, research, required to take four hours. Then both groups nurses and providers, quality management, had to pass a test to make sure that they and administrative staff, use the EHR system. were proficient on the system. On two The patient scheduler can see physician evenings during the week before going live, availability online through the link between all the providers and administrative the Practice Management system and employees at the pilot site ran simulations of Allscripts Enterprise. The nursing staff patients going through the clinic to work out creates patient charts on the Tablet PC, process and technical issues. writing notes directly into Allscripts Enterprise. Then the physician enters further Bright and early on June 12, 2006, the notes into the chart, orders labs, writes implementation team flipped the switch, and prescriptions, and creates correspondence. the system was immediately available to the Physicians dictate into the Tablet PC, Springfield Clinic Hillsboro staff. They started sometimes while meeting with the patient, immediately using Allscripts Enterprise EHR and forward those files to the appropriate on their Tablet PCs for charting, dictating, voice server for transcription. In January ordering tests, writing prescriptions, and all 2008, Springfield Clinic started pilot testing the other tasks related to patient care. Paper
  6. 6. Dragon NaturallySpeaking speech recognition “Continuity of care is very important,” says software to expedite transcription. Hewitt. “Now, even if a patient sees multiple physicians at the clinic, all of those “With Allscripts Enterprise EHR, we now have physicians have instant access to the most one record for each patient regardless of how current information from their Tablet PCs. many providers that patient sees,” says And if a physician on vacation gets a call Hewitt. “That record is updated instantly about a patient, the physician has immediate when the patient sees any of our providers.” access to those same records.” Within the Allscripts Enterprise Physician Springfield Clinic physicians also use Portal, physicians view schedules, practice- Allscripts Enterprise to instantly communicate performance data, and medical content. They with hospitals, insurance providers‚ and also order medications and tests and review pharmacies, which means faster test results, work tasks that need action such as lab more accurate coding and faster answers results waiting for review and open charges regarding insurance coverage. It also results “We caught up with the that need to be finalized. In many cases, in less wait time for prescriptions, and greater new system within about launching one of those tasks will launch a patient safety. Microsoft Office program. two weeks of The increased speed of results initially implementing Allscripts As of March 2008, the implementation team presented an unexpected challenge for clinic had completed 28 of its 35 sites. The nurses. Before Allscripts Enterprise was Enterprise, and in some organization had also scanned 30 million of installed, the nurses always completed all cases, our turnaround an estimated 45 million pieces of paper into tasks on their desks before they left for the its Allscripts Enterprise EHR system. day. The introduction of Allscripts Enterprise times for results went reduced the turnaround time for results from weeks, to a few Benefits verification and so increased the amount of By deploying Allscripts Enterprise EHR, work on nurses’ desks. “All of a sudden, the days.” Springfield Clinic enhanced patient care by nurses had 15 days worth of work in front of James Hewitt, Chief Information Officer, making it easier for physicians to access a them in the Allscripts Enterprise workflow Springfield Clinic comprehensive patient record, order tests, portal, and they felt they had to stay to finish and get results faster. The clinic also was it all,” says Hewitt. able to configure the system to match individual practice styles, reduce medical In the transition period, the nurses had to get records expense, improve clinical processes, used to the idea that the tasks waiting for and improve recruiting prospects. them came in several days earlier than they would have with the paper-based system. It Enhanced Patient Care and took some time to catch up with the new Expedited Results system, but in the meantime, they were urged By implementing the Allscripts Enterprise to go home at the end of their shifts. “We EHR system, Springfield Clinic now has a caught up with the new system within about single electronic record for each patient that two weeks of implementing Allscripts is accessible, not only from any clinic Enterprise, and in some cases, our location, but from anywhere in the world.
  7. 7. turnaround times for results went from positions were eliminated in the Medical weeks, to a few days,” says Hewitt. Records department, were offered other positions in the clinic, including many new Easy Accommodation of Practice Styles positions such as scanners and electronic The rich user interface in Allscripts Enterprise indexers. made it relatively easy for providers to adapt to using the Tablet PC–based system. “The By moving to a paperless patient record rich user interface that we found in the .NET system, Springfield Clinic was also able to Framework allows us to provide a very rich eliminate 22 file storage rooms throughout its level of application functionality in Allscripts sites. In some cases, the space was Enterprise that really wasn’t available with converted to clinical or expanded waiting classic Web-based applications,” says room space. In other cases, the space was Shapiro. In addition, because .NET supports repurposed for offices, a centralized storing large amounts of information in local transcription area, and a call center. In other memory, providers enjoy nearly instantane- cases, because the clinic was leasing the “The rich user interface ous response time within Allscripts Enterprise storage space, they were able to end the that we found in the modules. leases, resulting in an immediate savings. .NET Framework allows Thanks to the rich user interface, Allscripts Expanded Clinical Information us to provide a very rich Enterprise is easy to configure to meet the With all aspects of patient care recorded in needs of individual specialties and match the system, Springfield Clinic is able to level of application individual providers’ practice styles. “A analyze its processes more accurately to functionality in Allscripts neurologist doesn’t practice the same way as continue to improve its quality of care. “To do a pediatrician; even two physicians in the a quality audit with the paper-based system, Enterprise that really same specialty may not practice the same we had to send out a small army to pull wasn’t available with way,” says Hewitt. “We’re able to easily charts and do some sampling to see how we modify the workflow in Allscripts Enterprise to were doing on a particular treatment,” says classic Web-based quickly respond to the needs of a variety of Hewitt. “Now, we have the entire census at applications.” practice styles and specialties.” the click of a button and have 100 percent accuracy across the board on all kinds of Lee Shapiro, President, Allscripts Reduced Medical Records Expense diagnoses.” Hewitt estimates that when all of the sites within the Springfield Clinic are on Allscripts The new availability of clinical data will help Enterprise, the Medical Records staff will Springfield Clinic supply data for industry have no more than 60 full-time-employee measurement initiatives such as HEDIS and equivalents, compared to 160 with the paper- Pay for Performance. The clinic is also using based system. So far, much of that reduction that data to analyze nonmedical aspects has been handled through a normally high such as average wait time. “We’ve never attrition rate in the Medical Records been able to figure out what our average wait department. “During the months preceding time is because we’re spread out,” says the deployment of the new EHR system, as Hewitt. “Now, with the click of a button, I can people left, they were replaced with run a report by specialty, by physician, by temporary staff,” says Hewitt. Others, whose
  8. 8. For More Information clinic, and look at average wait times so we Microsoft Solutions for the Healthcare For more information about Microsoft can better manage that side of the business.” Industry products and services, call the Microsoft Healthcare and life sciences organizations Sales Information Center at (800) Increased Recruiting Power are under tremendous pressure to meet 426-9400. In Canada, call the Microsoft Springfield Clinic also finds the Allscripts regulatory requirements, improve patient Canada Information Centre at (877) Enterprise EHR solution useful in recruiting care, and reduce the time it takes to develop 568-2495. Customers who are deaf or new physicians. Allscripts Enterprise EHR is drugs and take them to market. To meet this hard-of-hearing can reach Microsoft text used by more than 3,500 clinics and 700 challenge, Microsoft and its partners have telephone (TTY/TDD) services at (800) hospitals nationwide and was ranked first in developed cost-effective solutions that 892-5234 in the United States or (905) the KLAS physician satisfaction rankings for enable healthcare organizations to 568-9641 in Canada. Outside the 50 2007. The KLAS Top 20 is an industry streamline and automate daily processes that United States and Canada, please contact ranking based on service performance and improve productivity and deliver information your local Microsoft subsidiary. To access results from in-depth interviews with whenever and wherever it is needed. The information using the World Wide Web, go thousands of providers who actually use result is enhanced productivity, safety, and to: Allscripts Enterprise EHR in clinical practice. quality. For more information about ALLSCRIPTS “Because EHRs are becoming more and more For more information about Microsoft products and services, call common in large clinics, new physicians see solutions for the healthcare industry, go to: (800) 654 - 0889 or visit the Web site at: it as almost a requirement to consider joining a clinic,” says Hewitt. “Allscripts Enterprise EHR has such a strong satisfaction rating For more information about Springfield among providers that it further enhances our Clinic, visit the Web site at: recruiting position.” Software and Services  Microsoft Office  Microsoft Server Product Portfolio − Microsoft Office Professional Edition − Windows Server 2003 R2 Standard 2003 Edition − Microsoft Exchange 2000 Server Hardware − Microsoft SQL Server 2005  Motion LE 1600 and LE 1700 Tablet PCs  Windows XP, Tablet PC Edition Partners  Allscripts This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY. Document published May 2008