30 Mar Portal to e-records boosts care at Children's Hospital
Wauwatosa, Wis. – In the medical field, the Joint Commission on Accreditation of Healthcare Organizations is the sheriff that sets and maintains the standards of healthcare delivery, and it does so through evaluation and accreditation of healthcare organizations.
It recently shortened its name to the Joint Commission, but its recommendations carry just as much weight.
One of these recommendations pertains to medication reconciliation. Whenever a patient is admitted to a hospital, providers are directed to compile a list of home medications and compare it to the list of medications that will be used to execute the hospital’s treatment plan. The same practice is to be followed anytime a patient is moved within a hospital – from the operating room to the intensive care unit, for example.
The purpose is to enable as much continuity as possible, to make sure that nothing is missed, and to avoid mixing incompatible medications that, once inside the body, could result in a traumatic health event.
For Children’s Hospital and Health System in Milwaukee, medication reconciliation wasn’t always easy prior to the introduction of a Web portal that aggregates – in one spot – data from various technology applications, including Sunrise Clinical Manager, the hospital’s main clinical system.
It’s also an example of how health information technology does not have to be dazzling or expensive to be effective.
Since doctors and nurses at Children’s Hospital have a number of applications to access, comparing the home list to the in-patient list of medications once involved a lot of clicking around, user name and password memorization, and worrying about an open record timing out (as mandated by HIPAA) while searching another data set. It was always time consuming and universally frustrating.
Portal of call
Since the introduction of the portal, caregivers are able to use a tab that places both medication lists side-by-side for easier comparison, but medication isn’t the only justification for the portal.
In the old world of paper charts, Dr. Dick Berens, an anesthesiologist, would have to wade through a stack of documentation that outweighed most babies, but searching through various electronic records was a different problem. With the portal, Berens no longer has to open five different windows to access a patient’s medical history when he’s preparing for a case.
The aggregation of data not only enables more efficient use of time, it probably benefits sicker patients more than run-of-the-mill patients because Berens can more quickly gain an understanding of their special problems.
In preparing for a procedure to repair damaged air passages, for example, Berens would need to know if the patient had experienced difficulties with such procedures in the past, what was done to successfully intubate (place a breathing tube in the patient), and whether the approach to care has changed over the course of multiple hospitalizations.
“In my world, the aggregation cuts down patient data acquisition from many minutes to a few key strokes,” Berens said.
The medical staff did not start out to address the aggregation issue. Their initial concern was finding a single sign-on solution due to the hassle of learning multiple user names and passwords, but their focus shifted as they understood that data aggregation could solve another problem and would not look “too busy” on their screens.
“It began to take on the character of a real solution to all kinds of functional gaps in our system,” explained Dr. Carl Weigle.
According to Mary Lou Weden, manager of clinical informatics, the two-year process that ended with the Nov. 14, 2006 “go live” date involved the investigation of multiple vendors, testing, and end-user feedback.
Children’s Hospital went with a portal technology developed by Medical Data Automation, a company run by Oleg Semin, who has served as a consultant for Children’s Hospital on past projects.
With a price tag of about $500,000, including $300,000 for the programming piece, it represented a relatively inexpensive upgrade, and since the project involved a portal to aggregate existing data, rather than installing new applications, it did not require the hospital to revise long-standing clinical processes.
The implementation, said Anthony DiCristo, a senior systems analyst, was a constantly evolving process “until we went live.” For several months, the portal was tested and tweaked in a pilot project by a clinical systems support group of 100 physicians, clinicians, and information service personnel.
For those who openly wonder how to get reluctant health providers to “buy in” and actually use electronic medical records, Weden believes the clinical systems support group provides a model. The end-users are involved in the development process, and therefore feel they have more of a stake in the technology.
“As we test a system, people are able to access that support group,” Weden said. “They know the systems and they are clinicians, and so we have found them to be instrumental in the testing.”
There still is functionality to develop for hospital units such as ambulatory care, but portal functionality should eventually expand across all hospital units.
“It’s about collecting the information in one place versus collecting it in different applications,” Weigle said.
No doubt the Joint Commission would approve.
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