The OneCare Program is one of the most important priorities we ’ve ever undertaken—it is one of the ways in which we’ll transform health care. We will do this by creating a universal health record for each CHI patient—regardless of where they receive care. This new way of providing care will continue to break down barriers between care sites and providers. It will allow us to provide comprehensive, coordinated care along the continuum. As a result, the OneCare Program will fundamentally change how we deliver care at CHI.
More specifically, the OneCare Program will help us to improve patient safety and clinical outcomes. How? First, eliminating handwriting from the system will make the environment much safer for our patients. We’ve all heard the stories about illegible orders or prescriptions. By removing this variable from how we deliver care, we will create a safer environment. Second, the clinical standardization work will result in better overall outcomes. Right now, we are using the collective wisdom of our MBO clinicians to design clinical standards that we will all use. We will also continue to update these standards as time goes on—resulting in continuous clinical improvement. We have seen other health systems embark on similar journeys and they have watched their outcomes improve with this new consistency. What ’s more, these systems have also been able to use the power of the information they’ve gathered to make improvements over time.
Once we ’re live with all of the OneCare projects, we will also improve the experience for our staff and clinicians. We know it will take some time, but once we have a complete system that is populated with data, we will greatly improve the speed and effectiveness for our teams. How? It ’s simple really— By having all of the information they need at their fingertips, and By increasing the speed with which we send orders. I know that there will be a time in the future when we will wonder what we did without OneCare.
That national build will include evidence-based content. We will ensure that the clinical standards and order sets are the best ones for our patients—that they will produce the best outcomes possible.
Building a consensus for the electronic health record
Building a Consensus For the Electronic Health Record Norma Muscella Sese Williams Thomas Colley Theresa Schenfeld Jacksonville University April 14, 2013
DefinitionsEHR-An electronic health record is defined as a systematic collection of electronic health information about a patient.It is a record in digital format that is theoretically capable of being shared across different health care settings. In some cases this sharing can occur by way of network- connected enterprise-wide information systems and other information networks or exchanges.EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age, weight, and billing information.
Not to be confused with EMREMR-a digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in one practice. EMRs have advantages over paper records. For example, EMRs allow clinicians to: Track data over time. Easily identify which patients are due for preventive screenings or checkups. Check how their patients are doing on certain parameters such as blood pressure readings or vaccinations. Monitor and improve overall quality of care within the practice. But the information in EMRs doesn’t travel easily out of the practice. In fact, the patient’s record might even have to be printed out and delivered by mail to specialists and other members of the care team. In that regard, EMRs are not much better than a paper record.
Why Electronic?“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”With a subsequent adoption of ten-year plan through the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 (HHS Press Release, 2010; Center for Health Statistics, 2005).--President George W. Bush, State of the Union Address, January 20, 2004.
EHR’S reduce errorsAutomatically checks for conflicts when new medications are orderedEnables clients and providers to have reliable access to patient education opportunitiesAssist providers with cross check of symptoms and provides probable list of diagnosisSupports evidence based decisions at point of careExposes potential safety problems when they occur and can help providers quickly and systematically identify and correct operational problemsEnhances research, monitoring and benchmarking for improvement in clinical quality
With electronic health records, providers have the information they need to provide the best possible care. Providers will know more about their patients and their health history before they walk into the examination room.
EHR will change healthcareEHR will change healthcare
The information gathered by the primary care provider tells the emergency department clinician about the patient’s life threatening allergy, so that care can be adjusted appropriately, even if the patient is unconscious.
Improve patient safety and clinical outcomes10
Patient EmpowermentA patient can log on to his own record and see the trend of the lab results over the last year, which can help motivate him to take his medications and keep up with the lifestyle changes that have improved the numbers..
Patients can receive electronic copies of their medical records and share their health information securely over the Internet with their families.
Provide clinicians, staff andpatients with necessary tools and information 13
The lab results run last week are already in the record to tell the specialist what she needs to know without running duplicate tests.
Build the electronic Build the electronic health record with health record withevidence-based contentevidence-based content
The clinician’s notes from the patient’s hospital stay can help inform the discharge instructions and follow-up care and enable the patient to move from one care setting to another more smoothly.
BenefitsEnhance the patient experienceProvide clinicians and staff with necessarytools and information across thehealthcare spectrumStandardize information collected andsaved for the patients’ EHRStrategically position patients andclinicians for the future
Why Electronic?Increase patient safetyConform to government mandates inregards to Affordable care act andmeaningful use
What is Meaningful Use?The set of standards defined by the Centers for Medicare & Medicaid Services (CMS) Incentive Programs that governs the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria.
What is involved?Electronic physician documentation in all patientcare areasElectronic prescribingIntegration of laboratory resultsNursing documentationInpatient computerized physician order entry(CPOE)Medication management including bar-codedmedication administration (BCMA)Clinical reportingScanning archive and data repository
More definitions!CPOE-a process of electronic entry of medical practitioner instructions for the treatment of patients (particularly hospitalized patients) under his or her care.These orders are communicated over a computer network to the medical staff or to the departments (pharmacy, laboratory, or radiology) responsible for fulfilling the order.CPOE decreases delay in order completion, reduces errors related to handwriting or transcription, allows order entry at the point of care or off-site, provides error-checking for duplicate or incorrect doses or tests, and simplifies inventory and posting of charges.
CPOE Key BenefitsSaves time by eliminating duplicative processesand allows the clinician to articulate care fromanywhere, anytimeReduces medication errors and adverse drugeventsProvides error-checking for duplicate or incorrectdoses or testsSimplifies posting of chargesPotential to decrease errors related tohandwriting or transcription, decreaseturnaround time, decrease length of stay anddecrease cost of care
Built in alerts!Not only are prescription errors reduced in the translation between the doctors office and pharmacy, but CPOE lessen the likelihood of harmful drug interactions due to built in alerts.
How do we arrive?Every journey has a beginning
The journey begins…..Investigate: What do I want my Electronic Record to do for me? How much am I willing to spend? How long will it take? Do I have the infrastructure in place or will that be an additional expense?
Assemble GroupFinancial officerComputer literate staff (InformaticsNurse)Information TechnicianFrontline staff familiar with work flowRisk managementPatient registrationFinancial services
Define GoalsAssemble lists of “wants” and “musts”.Invite vendors to demonstrate functionalityIncorporate questions regarding “personalizing” applications.Assess securityDetermine down time applications, how long, how often and how much of the system is affected.
Choose Vendor! Begin to build …. Flow from admission To DischargeStop in all departments along the way Evaluate Modify
Establish a timelineDefine usersManage hardware and softwarepurchasesInstall servers, cables wireless and wirednetworksVerify that HIPAA privacy, security andbreach notification policies are in placeDevelop internal training planDevelop policies and procedures tosupport new technology and vocabulary.
TESTIn the test domain, a patient will be created along with a problem list. That patient will mimic a typical admission and followed through a hospital visit. .
TRAINEnd users will follow a typical patient inthe train domainUse blended learning strategySimulated chartsSmall classes with classroom assistants tohelp those not comfortable with computersQuestions are validated and answered
Go LiveMinimize vacation timeVendor and super users available realtime.Anticipate challenges develop an “issueslog”Celebrate facility achievement
In ConclusionSuccessful conversion to EHR will take significant energy and resources.Preparedness assessments must be thorough.Detailed mapping of workflow with standard operating procedures and emergent situations studied with the inclusion of clinicians.All end users must be trained.Access provided must be tailored to job classComprehensive security planning is essential.
Referenceshttp://www.physicianspractice.com/ehr-stimulus-complehttp://www.omnimd.com/meaningful-use/emr-vs-ehrhttp://georgewbush-whitehouse.archives.gov/infocus/teHebda, T. & Czar,P (2005). Handbook of Informatics for nurses and healthcare professionals. Upper Saddle River, New Jersey: Pearson.