Niche Move

Turning to a boutique software vendor, a small hospital in Illinois automates its emergency services documentation.

Health Data Management Magazine, 02/01/2010

Graham Hospital faced a dilemma common to small, rural community hospitals-if not many larger systems. Based in Canton, Ill., the 70-bed hospital had eked out a productive relationship with its core hospital information system vendor, Westwood, Mass.-based Meditech. Yet, when it came to the Emergency Department, the Meditech system fell short. Graham licensed-and used-the Meditech ED module for only a short spell before the system's limitations-primarily around workflow and ease of use-became apparent, says Sherry Alton, R.N. "The ED is a unique situation," she adds. "It has so many things going on simultaneously. Meditech works well with the inpatient setting and the outpatient labs." (see box for inpatient service listings)

In October 2008, the hospital turned to a system from Dallas-based T-System Inc. designed specifically for ED use. The system enables clinical documentation, order entry, and patient tracking. The 12-bed ED still uses Meditech for patient registration, but all other functions fall to the T-System, adds Jim Schreiner, director of information technology. "Physicians put orders in T-System, they are fed back to Meditech to be processed, and then the results return to T-System," he explains.

It's made possible through a series of HL7 interfaces. And with some 17,000 annual visits in the ED, the system has become the day-to-day workhorse for the department's four full-time physicians.

Meeting Expectations

"The new ED system has met our expectations," Alton says, noting that the department relied on paper charts prior to the deployment. "It has streamlined documentation and enhanced safety," she says. "It is a comprehensive system and the final output includes lab, radiology and discharge instructions."

That final chart is fed back into the Meditech system as a document image file that runs three to five pages, says Schreiner. "It's a report, not discrete data," he adds.

Alton declines to provide the cost of the T-System. But she says that the technology has helped the hospital increase patient flow in the ED. That's because the software has a built-in tracking mechanism that enables the staff to see exactly where the patient is in the ED workflow. Physicians, for example, can see when a patient's lab or radiology test is back, and tend to them right away. "The physicians can see what the nurses are doing," Alton says.

On Display

The department displays the patient tracking information on a large display monitor in the department. Graham Hospital has two of the boards, which Schreiner says replaced the old-fashioned grease boards where patient information would be hand-written. Displayed on two 42-inch Plasma monitors, the boards highlight both the waiting room patients and those already admitted. "It shows which patient is in which room, whether they're waiting for a lab or not," Schreiner says. Private information, such as the diagnosis, is not shown.

Access Devices

Graham Hospital offers a variety of devices to access the ED software, including tablet PCs, stationary workstations and mobile carts. The lightweight tablets (which sport 12-inch screens and weigh less than five pounds), from Fujitsu America Inc., Sunnyvale, Calif., have been well received by the physicians because of their flexibility. "The physicians can use them like a regular laptop," Schreiner says. "The tablets can also function as a desk workstation after the physicians dock the units."

But it took more than easy-to-tote tablets to win over the physicians. Unlike the inpatient setting, the ED physicians place their orders electronically, Alton says. Yet, gaining physician acceptance of CPOE in the ED did not happen magically.

Working with physicians, the department created order sets that streamlined their workflow and incorporated some best practices. For example, with two clicks, the ED physicians can pull up a chest pain protocol that includes labs, medications and other tests. For follow-up medications, the department uses the system to generate a printed prescription that patients can take to the pharmacy.

It's another story with the Graham Medical Group, the 27-physician, wholly owned group practice that serves the hospital. Using an ambulatory EHR from Westborough, Mass.-based eClinicalWorks Inc., the multi-specialty group practice has full e-prescribing capabilities, with medication orders sent directly to local pharmacies, notes Kevin Scott, clinical analyst in the group's I.T. department.

Connecting the Dots

The medical group receives updates from the T-System ED application when any of its patients visits the ED. If a patient is seen in the ED, the T-System will auto-fax an image file summary that goes to the appropriate physician's inbox in the eClinicalWorks EHR, Schreiner says.

Ironically, it was the group practice's EHR implementation that led the ED to test the tablet computers. The group practice EHR was deployed a few months before the ED went live on T-System. The narrow hallways of the group practice setting precluded using mobile carts, so the group opted for tablets. They were such a hit, Alton decided to incorporate them into the mix into the ED.

Inpatient Services

Here's a list of Graham Hospital's major inpatient departments. Located about 200 miles southwest of Chicago, the hospital also operates a school of nursing.

* ICU. The Intensive Care Unit consists of 5 beds around a central monitoring station. Critical Care monitoring includes hemodynamic, cardiac, pulse oximetry, and ventilatory support.

* Post-critical care. The 14- bed Post Critical Care Unit of Graham Hospital has the capacity to monitor patients with telemetry. The focus is individuals with multiple diagnoses including cardiac, congestive heart failure, angina, stroke, and respiratory disease.

* Med-Surg. The 36-bed unit provides a range of services covering every age group from newborns to seniors with a variety of medical conditions.

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