Children’s Treks Towards EMR
from Practice Update, Winter 2006
The Children’s Hospital will soon be one of the first children’s hospitals in the country to have a fully integrated electronic medical record (emr). when it’s complete, this multi-year project will impact patients, referring providers, specialists and nurses in nearly every interaction they have with the children’s hospital. the conversion from paper records to electronic records at the children’s hospital began in 2003, with the goal of providing readable information that is available real time to staff and clinicians involved in patient care. the epic products being implemented include an integrated set of applications that manage all aspects of patient care, both administrative and clinical. enhanced access to information will improve the quality and continuity of care that we provide patients.
The following update takes a look at the pieces that comprise the children’s hospital integrated electronic medical record and the impacts anticipated for patients, referring providers and the children’s hospital staff.
EMR and Referring Physicians
Improved communication between The Children’s Hospital and community physicians who refer their patients to the hospital is a top-priority initiative and the EMR is helping us reach that goal. Community pediatricians and family physicians interact with the EMR in two ways.
First, they are the recipients of the consult letters and reports that are being generated directly from Epic by physicians in ‘live’ clinics. The ability to directly enter information into the EMR rather than dictate can provide more efficient, timely communications with referring physicians. Many times, our referring physicians are receiving the report via fax within a few hours of the patient being seen in the clinic.
Recently when referring physicians from several local practices were asked to review a consult letter regarding one of their patients faxed directly from EMR the feedback was overwhelmingly positive. Specifically, primary care physicians appreciated how quickly the letter was received. Since the initial roll-out, we continue to enhance the faxed letters to enable primary care providers to find information as quickly as possible.
The second way primary care physicians interact with the EMR is through TCH Connect. TCH Connect is the community provider’s read-only piece of our EMR. This tool allows primary care providers to access their patient’s records from the office or home, through the Internet. TCH Connect provides read-only access to the patient’s chart as soon as new entries are completed. Primary care providers have access to clinic notes, lab results, radiology films and reports, and will soon have access to all inpatient documentation.
Community practices currently using TCH Connect are pleased with the functionality of the system and the ability to access a patient’s records from anywhere they have an Internet connection. The number of hits to TCH Connect has steadily increased each month over the past several months with a high of over 1,300 hits for the month of October (see Chart 1). TCH Connect users currently include primary care providers from Fort Collins to Parker to Grand Junction .
The Children’s Hospital Physician Relations department would be happy to introduce your practice to TCH Connect or answer any questions about the system. Please contact us at 720-777-1234
Ambulatory Clinic Documentation
In September 2003, the first pieces of the EMR were rolled-out, with the introduction of new registration, scheduling and billing applications for all of The Children’s Hospital. The following February, clinic documentation went live, with the neurology clinic beginning documentation in the electronic format. Mary Ann Maddox, nurse practitioner in Neurology commented, “With Epic, you can find the entire patient’s record in one location – no more searching for paper charts. This provides better continuity of care.”
Cheryl Poissant, clinical manager of the Neurology department added, “one of the most significant advantages of being electronic is being able to pull charts from the desktop when a parent calls with a question, rather than putting them on hold while the chart is pulled or having to call them back later when the chart is available. We are providing better service to our patient families.”
Since February 2004, more than 35 clinics or specialties have converted to the EMR. All Children’s Hospital ambulatory clinics are expected to be using the EMR by mid-2006.
ED and Urgent Care
Clinic successes were quickly followed by roll-outs in the Emergency Department (ED) and Urgent Care Centers in November 2004. White boards, loose papers, dictation and clipboards have all been replaced by workstations on carts that are available wherever they are needed. Clinical information recorded in the ED is immediately available on the nursing units when patients are admitted. PCP’s now have information available in their offices when they arrive for work in the morning about care provided overnight. An EMR user noted in an ED Satisfaction Survey that the system offers, “Improved quality and consistency of documentation. It saves time for patients and providers because information is available more quickly. It also improves communication between team members and across disciplines.”
Electronic Signature Coming
As a part of the overall process, the method for signing off on dictations and completing charts will change from a paper process to an electronic process. This spring, providers who treat patients at Children’s will be able to electronically ‘sign’ their dictations and will no longer have to visit the Health Information Management department to sign paper copies of their dictations. In addition, providers will be able to access and read patient charts via the Internet. Several providers have been asking for this functionality and Children’s has decided to bring up the electronic signature part of the project ahead of the inpatient go live. Stay tuned for upcoming alerts and information regarding how to begin using this time saving feature!
Coming Soon: Pharmacy, Inpatient Documentation and Physician Order Entry
In 2006, several pieces of The Children’s Hospital electronic medical record will be implemented, including the Pharmacy module, the Inpatient module and full Computerized Physician Order Entry. The pharmacy piece of the EMR will provide enhanced order entry for pharmacists, featuring weight-based dosing and clickable buttons for suggested doses. The pharmacy module will also provide nurses with real-time feedback on allergies and interactions and one-click access to The Children’s Hospital formulary monographs.
The inpatient, clinical documentation phase of the EMR project will involve the conversion of all inpatient documentation currently in the paper chart to an electronic chart. This includes histories, medication, flowsheets, notes, care plans and patient education. The inpatient EMR will provide real-time information to all clinicians involved in a patient’s care, including hospital-based providers and the patient’s primary care provider via TCH Connect. All physicians who attend at The Children’s Hospital will be trained on the inpatient module in the spring of 2006.
Order entry will round out the roll-out of the EMR in October 2006. Order entry allows for all orders to be placed electronically. Electronic order entry will provide improved order clarity and enhance access to the patient’s chart to place and sign orders.
All of the various modules interact seamlessly to provide a fully integrated electronic medical record. In addition to these modules, some additional programs and benefits will be added. A full document management system will help capture paper documents that may still be generated during patient visits, and scan them into the EMR, with the intent of providing a fully integrated electronic record.
Feedback
As our EMR implementation continues, we welcome your feedback on what you receive from The Children’s Hospital and how we communicate about your patients. Please contact the Physician Relations department at 720-777-1234 with any comments as well as suggestions for improvement. We look forward to hearing from you.
