With the potential for millions in meaningful-use incentive reimbursements, Cooper Green put themselves on the fast track for implementing electronic health records (EHR) last year. Within 18 months, hospital executives researched, purchased, installed, and gelled their new EHR with two other specialty packages to go live as an electronic hospital in May.
“It was really complex, because we were fighting with the county commission for funding at the same time,” says James Floyd, MD, chief of orthopedic surgery and the physician leader on the hospital’s EHR team.
The main criterion for the package was that it mesh with the VA’s medical records. “We wanted one that was federal-government approved, so we picked one that already met their standards. And now we’re on the winning side if the government ends up financing things,” Floyd says.
While they sought their EHR, Cooper Green also wanted to convert their imaging department to digital. “It would make images available instantly throughout the facility,” Floyd says. “And it saves us on filing, film, developing chemicals, and storage.”
In addition, Cooper Green needed to improve their scheduling and billing module, which presented a third software program to integrate. “I’m not saying it was a smooth process,” Floyd says. “But we got the companies talking, purchased the hardware needed to run them, and got them interfaced within 15 months.”
Just to handle the digital imaging upgrade required purchasing new servers and monitors while expanding networks to move the images throughout the hospital. “We didn’t have switches on each floor to handle that,” Floyd says. “We could handle 15 stations per floor, and we went to 60 to 100 per floor by putting in new switches and wiring. We didn’t have wireless access points either, and we put those in within six weeks.”
By March, Cooper Green had the infrastructure in place, including mobile computer stations and wireless communication. They went live on May 1. “It was the most amazing thing,” Floyd says. “If you’ve ever played football, it’s like we assembled the defensive, the offense, and the special teams in one year and then made it to the playoffs.”
One flaw in the new EHR shows up in the emergency room. “It doesn’t support a tracking system like we had with the old system. That’s a real failure with this software,” Floyd says. “We didn’t know it wouldn’t support the tracking, because we were told that that function was in their upgrade plans and would be ready by the time we rolled out. But at this point, it’s not operational.”
Floyd says that’s the one function they should have spent the money on to ensure its inclusion. “If it’s more bucks, then it’s more bucks, because if you want to save money, I wouldn’t choose to do that in the ER.”
An annoying shortfall of the new system is that it doesn’t allow scheduling to overbook by even one patient. “We didn’t even think to ask about that. And it doesn’t let you schedule for less than 15-minute slots either,” Floyd says. “Right now we’re creating paper calendars for the overbooks.” The next upgrade will purportedly solve the problem. “And at least their documents are all readily available because they’re digital, so we don’t have to worry about pulling charts to be ready.”
Floyd says these errors point to a fault in their planning process. “We needed to change our mix of people involved in planning to include more rank and less file. We had a lot of managers and not enough of those working the system.”
But the new digital platform has brought notable changes in efficiency and ease for the staff. “Before, to discuss x-rays with a patient, I’d have to find the folder with the film and then find a lightbox somewhere,” Floyd says. “Now I click on a program, and it puts the x-rays right in front of me and the patient.”
The biggest advantage, says Floyd, is the ability to digitally complete medical reconciliation of medications and current orders for labs. Before their EHR system, when an ER patient was admitted, the physician would write a list of meds and labs. Those papers got handed to the ward nurse, who had to rewrite those orders again on her floor forms.
“But the EHR makes it an automatic process,” Floyd says. The orders now show on her computer as a checklist that she ticks to confirm as reviewed. “And the EHR tracks when each item is done, so there’s less error. And if something doesn’t get done, you immediately get an alert.
“This is something we should have done years ago. It’s going to be a big improvement in patient care,” Floyd says. “Digital healthcare is in that technological stage that cell phones were in back in the 80’s when they were big and chunky. But come 2020 or 2025, medicine will hit the iPhone stage. It’s going to be amazing when it does.”