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Our Journey to Integration

Our Journey to Integration. Amy Hyopponen, RN, BA Clinical Informatics Systems Analyst April 28, 2009. Objective. Discuss our journey to a fully integrated electronic medical record along with the successes and challenges. About St. Luke’s. A Private, Non-Profit, Tertiary Care Facility

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Our Journey to Integration

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  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. Luke’s • 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@slhduluth.com 218.249.3056

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