The US Department of Health and Human Services (HHS) is moving full steam ahead with the adoption of electronic prescribing (e-prescribing) and electronic health records (EHRs). The Centers for Medicare and Medicaid Services and HHS recently proposed rules that represent a unified effort to move forward with the goal of enhancing the health care of Medicare beneficiaries and all Americans. The proposals will accelerate the adoption of health information technologies by hospitals, physicians, and other health care providers to improve quality and safety for patients.
Rolling out total EHRs can take years for many organizations.Many health care sectors are moving toward EHRs in stages. Aside from a cost factor, the stepwise approach allows organizations to gradually implement new technologies at their own pace based on their needs. Allscripts, a provider of clinical software, connectivity, and information solutions for physicians, is familiar with this scenario. The company used a modular approach with its TouchWorks Electronic Health Record. The company had a number of applications previous to TouchWorks. The company launched the TouchWorks solution in 2000. When health care providers select TouchWorks, they are purchasing a single application.
"In many cases, the trend a couple of years ago was to purchase one product at a time to get their feet wet," said Dan Michelson, chief marketing officer at the company. While TouchWorks can be implemented with full EHRs, the solution also provides health care sectors with the option of using the modular approach to allow physicians to initially adopt one or a few modules of the total solution. Once comfortable, more functionalities can be added over time, eventually progressing to full EHRs.
Allscripts has taken its experience with EHRs and authored The Electronic Physician: Guidelines for Implementing a Paperless Practice. The book discusses the full gamut of implementing a successful EHR program.
Studies have shown that e-prescribing, a component of EHRs, is being implemented more rapidly across the health care industry. In many cases, e-prescribing is the first step taken toward full EHRs. As one of the first providers to bring e-prescribing to the market, Larry Trusky, vice president of product development for Allscripts, said, "There has been a lot of momentum in the industry around e-prescribing. E-prescribing has been the most popular, but it does not mean everyone starts with it."
When working with health care providers, Allscripts likes to know their "point of pain." "All the groups are different in what they want. It is not a one-size-fits-all approach. They [physician practices] can add on seamlessly with our solution," said Michelson.
George Washington University Medical Faculty Associates (MFA) knew its source of paintoo much paper. MFA relied heavily on paper methods for storing patients' charts, prescribing medications, tracking laboratory tests, and a variety of everyday activities. The paper-based methods were labor-intensive and time-consuming.
The physicians practice decided to purchase EHRs. They evaluated 6 leading solutions on the market and decided on TouchWorks. Instead of implementing in stages, MFA set a new standard for rapid EHR implementation by bringing 99 physicians, 130 residents and interns, and >200 support staff live on TouchWorks in less than a month.
NorthEast Medical Centera 457-bed medical center in Concord, NChas taken a slower approach in implementing full EHRs. The medical center has been using Allscripts' e-prescribing solution for 3 years, according to Keith McNeice, vice president and chief information officer of the hospital. Currently half of the center's clinics are using e-prescribing.
McNeice said the main reason for deciding on the TouchWorks solution was its modular capabilities. "The modular approach gave us the ability to build the patient database. We can literally go physician by physician to see what they are comfortable with."
The medical center recently connected its physicians across 33 locations using the TouchWorks Electronic Health Record. With the added functionality, physicians have the ability to communicate the full patient record with everyone in the health care delivery process.
It will probably be another 2 years before NorthEast Medical Center fully implements EHRs, according to McNeice. In the meantime, the medical center is planning to revisit its clinics already using e-prescribing and add the remaining TouchWorks functionalities to make the clinics have total EHRs. McNeice said they also plan to implement e-prescribing into the clinics that are not using this technology.
Children's Healthcare of Atlanta decided 21/2 years ago to move forward with a single EHR platform. The hospital needed to find a vendor that could provide a pediatric-specific EHR. "We needed a system that could configure to meet the needs of pediatrics," said Ellen Hansen, director of clinical informatics at the hospital.
The hospital evaluated 4 vendors before selecting the clinical information system Epic. In June 2004, stage 1 of the Epic implementation took effect. The system provided staff with access to clinical results, transcriptions, and patient lists. The pharmacy management portion and medical records components were deployed in early 2005.
The health care system's 2 anchor hospitals began using EpicRx in 2005. Children's at Egleston began on January 25, and Children's at Scottish Rite began on March 16. The application allows the pharmacy to send medication administration records directly to laser printers in each nursing station; schedule medication times; add a medication report to the inpatient summary activity; as well as other functions to improve the process of dispensing medications. "We now have a single pharmacy system across our campuses," explained Hansen.
Children's also changed the way it managed patients' charts with Epic's ChartMaxx document scanning. The application creates a digital copy of all paper records for patients at the point of discharge. The component allows the staff to countersign orders and notes from any computer in the hospital.
Children's continues to use the paper record, however, for the patient until discharge. The application was launched on March 22 at Children's at Egleston and April 12 at Children's at Scottish Rite. Children's continued its transition to EHRs with implementation of Epic's medication administration record in November 2005. This phase allows staff to enter laboratory, radiology, and physician orders into the system. Additionally, nurses began using an electronic admission database, and pharmacy staff started putting orders into the system. While the implementation will not impact physicians as heavily, Hansen noted that it marks the first time clinicians will have to get into Epic.
Overall, the staff has found the move to the Epic system positive. "They [the staff] find the system more user-friendly than our previous system. There are more verification features, and it has reduced the number of phone calls" between hospital departments, said Hansen.
Epic's effectiveness will go under a microscope with a grant to study and document the system. The Agency for Healthcare Research and Quality has awarded a $1.5-million, 3-year grant to Children's, Georgia Tech, and Emory University. The study will evaluate patient quality and safety, human-computer interaction, education, and job satisfaction.
To help with the transition to EHRs and a paperless environment, Children's recently implemented 300 mobile workstations for patient data capture and access at the point of care within its 2 anchor hospitals, each with 250 beds. The mobile carts from Flo Healthcare are wireless and battery-operated.
"We chose carts instead of computers because PDAs were too small for the amount of data, and tablets and laptops were too expensive and can be dropped and broken. The carts have a small footprint and give mobility," explained Hansen.
Prior to selecting Flo Healthcare, Children's brought 3 vendors into both hospitals and had 800 employees and physicians evaluate the workstations. Children's ultimately chose Flo Healthcare because it offered more in terms of service. A real bonus was how the company handled evaluation of its carts. "We gave them feedback, and they made changes to their cart based on the feedback. It was very impressive," commented Hansen.
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