Electronic records system assistsWritten by Jacob Ruhe | | firstname.lastname@example.org
The Bush administration announced in 2004 that every American citizen should have an electronic health record by 2014, yet only about 10 percent of hospitals currently utilize such technology.
Mercy Health Partners, a seven-hospital health care system that serves Northwest Ohio and Southeast Michigan, is among the small percentage of health care providers that have implemented EHR systems.
The term electronic health record refers to the computerization of a patient’s medical record, which includes patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. In the past and even at most hospitals today, medical records largely consist of handwritten documents.
Mercy launched its $17 million EHR program in 2004 after beginning work on it in 2000. All of its metro-Toledo facilities currently use the technology. They include Mercy Children’s Hospital, St. Vincent Mercy Medical Center, St. Anne Mercy Hospital and St. Charles Mercy Hospital.
Mercy officials say they are the first health system in Northwest Ohio to implement computerized physician order entry at all of their Toledo hospitals. Dr. Ken Bertka, medical director of information and process services for Mercy Health Partners, said not all EHR systems have this feature.
“The computerized physician order entry is really what makes Mercy’s system special,” Bertka said.
Mercy’s facilities in Defiance, Tiffin and Willard will introduce EHR systems with computerized physician order entry next year.
Medical error reduction
One major benefit of the computerized physician order entry component of Mercy’s EHR system is it reduces medical errors that can put patients in danger. Everything a patient needs requires a doctor’s order. In health care systems without EHR, doctors usually dictate their orders to someone who writes them by hand. Mistakes can be made in the dictation, and poor penmanship can lead to misapplied orders.
Within Mercy’s EHR system, physicians avoid these potential mishaps by choosing orders directly from a computerized checklist.
A 1999 study by the Institute of Medicine concluded between 44,000 and 98,000 people die in U.S. hospitals each year as a result of preventable medical errors.
Bertka said many of the avoidable deaths cited by the study result from systematic errors computerized order entry helps correct.
Dr. Kelley Shultz, assistant director of inpatient pediatrics for Mercy Children’s Hospital, said the orders checklist provided by Mercy’s EHR system helps remind physicians of standard procedures for different conditions.
The electronic order entry system has a number of other safety mechanisms to reduce medical errors, too. It warns the physician when a prescribed dosage varies significantly from the norm. This can happen when a doctor accidentally misplaces a decimal point. If such an error goes unnoticed, it can have severe consequences.
The computerized order entry system also alerts physicians about potential allergy problems medications might cause. It also informs physicians of drug-interaction problems when they compose their orders. This prevents doctors from accidentally prescribing a harmful mix of drugs.
“These alerts and warnings wouldn’t happen in a paper world, without the interaction of another person, such as a pharmacist,” Shultz said.
Bertka said another major advantage of Mercy’s EHR is increased efficiency in obtaining patients’ medical histories, making clinical decisions, prescribing drugs and providing treatment.
He said prior to EHR, doctors had to track down lone copies of disparate medical tests and information, often from different facilities. Physicians regularly had to make multiple phone calls and faxes to obtain just a fraction of a patient’s medical record.
“One of the big problems in medicine in the last 10 years is how much time physicians have had to spend on paperwork instead of practice,” Bertka said.
Shultz said EHR improves the efficiency of clinical decision-making and treatment by making it easier to access a patient’s complete medication history and current medication list. In many paper-based medical record systems, physicians must wade through numerous documents by hand to obtain this information.
By reducing the time doctors spend retrieving medical records, Mercy’s EHR allows them to spend more time on practice and help patients receive care faster.
One component of Mercy’s EHR system has garnered national recognition. The Joint Commission on Accreditation of Healthcare Organizations recognized St. Vincent Mercy Medical Center as a best practice for its electronic medication reconciliation program. JCAHO is the nation’s predominant standards-setting and accrediting body in health care.
Shultz said Mercy’s medication reconciliation program is innovative because it’s electronic, whereas most hospitals’ programs are not.
JCAHO established a new goal requiring all hospitals to accurately reconcile medications across the continuum of care.
“Hospitals and care providers all across the country are struggling with medication reconciliation,” Shultz said.
Medication reconciliation is a process that compares the patient’s most current list of home medications against the physician’s orders upon admission, transfer and discharge, addressing discrepancies to avoid under-medication, over-medication and harmful drug interactions.
“The main thing medication reconciliation does is make sure patients go home on the best medication,” Bertka said.
To do this, medication reconciliation programs strive to clearly inform patients when and how their medication routine changes.
For example, following a stay in the hospital, physicians often alter the dosages and kinds of medications a patient takes. Following a procedure, one medication may replace another, some medications may no longer need to be taken and the prescribed dosages for medications may change.
When patients’ medication routines are modified, medication reconciliation programs aim to help them transition without error.
Shultz said Mercy’s electronic medication reconciliation program has the advantage of guiding the hospital staff that uses it, making it less likely it will forget necessary steps. The program’s electronic framework will also allow Mercy to more easily gauge its effectiveness and search for ways to reduce even more errors.
As part of the recognition it received from the JCAHO, St. Vincent and Mercy Children’s Hospital were profiled in an educational program broadcast to more than 700 hospitals. They served as models of how to implement a medication reconciliation program successfully.
Jim Albin, chief information officer for Mercy Health Partners, said many community-oriented hospitals have tried to adopt an EHR system, but failed because their physicians were unwilling to tackle the time-consuming demands of adapting to a new system.
“For most physicians in their 40s or 50s, this [EHR] is probably the largest change in the practice of medicine they’ll face in their careers,” Bertka said.
He said the commitment of Mercy’s physicians to learn the new EHR system demonstrates the concern they have for their patients.
Albin said Mercy decided to adopt EHR early, despite its demands, because patients deserve the technology’s benefits.
Mercy also wanted to avoid installing a system quickly under the pressure of a mandate.
ProMedica Health System
A spokeswoman for ProMedica Health System, the nine-hospital health care system that includes Toledo Hospital, said it also has an electronic medical record system. ProMedica’s EMR system went live at the Toledo Hospital in 1996 and was implemented in all of its care facilities by 2001.
It features “smart pump technology,” computer-based software and bedside hardware that regulates the delivery of intravenous medication. Smart pump technology reduces medical errors by preventing the administration of dangerous dosages.
ProMedica’s EMR system also includes eICU ProMedica, a telemedicine system for patients in critical care units that was launched in January.
The computerized system allows nurses and physicians in a clinical operations room at Toledo Hospital campus to monitor ICU patients around the clock at all of ProMedica’s facilities.