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Seemingly every health care organization is head-down and working toward meaningful use of electronic health records, reshaping themselves as accountable care organizations and preparing for the conversion to 5010 transaction standards and ICD-10 coding.

With deadlines fast approaching, some organizations are homing in on the specific capabilities necessary to get incentive checks. Others, however, are trying to think through the process and interject and upgrade technologies that, while not tied into incentives, can significantly improve patient safety.

SSM Health Care of Wisconsin, for example, has put together a closed-loop medication administration for all inpatient areas at its St. Mary's Hospital in Madison, St. Clair Hospital in Baraboo and one affiliate hospital. Two more affiliates will get the technology in October, as will a new SSM Wisconsin facility in Janesville when it opens in January 2012.

A physician places an order in the Epic Systems EHR, and the system then checks the dosage before sending the order to the pharmacy queue, where the pharmacist can apply another check. Then the bedside nurse applies bar-coded medication administration technology, going through the "five rights" before giving the medication. "That piece has huge patient-safety implications," says Annette Fox, R.N., director of clinical systems for the Wisconsin Integrated Information Technology and Telemedicine System, a joint venture of SSM Wisconsin and Madison-based Dean Clinic.

"There's a learning curve, but once [clinicians] get used to it, they love it," Fox says of bar-coded medication administration, so resistance has been minimal. She says St. Mary's has recorded more than 97 percent usage each month the system has been in operation, and some months are close to 100 percent.

This is but one example of high-impact technologies health care providers are employing to boost patient safety. Interjecting the technology takes forethought and planning, which is not necessarily an easy proposition with all the other I.T. projects going on.

But even with budgets stretched by EHR and mandate-related investments, providers are putting dollars into integration of medical devices with EHRs; wireless and mobile technologies, including real-time location systems for tracking staff, patients and valuable assets, as well as improving patient flow; and alerts for reporting of critical test results, among other technologies.

Linking devices

A little more than a year ago, Cooper Health System in Camden, N.J., was planning the nursing documentation part of its EHR implementation, the last piece its Cooper University Hospital was going to need to achieve meaningful use in 2011. "We knew that this would add time, and they would not like this," CTO Paul Shenenberger said of the nursing staff.

At the time, Cooper had about two connected medical devices per inpatient bed. "We expect that to grow to three or four," Shenenberger says, so it would only make nurses' jobs more difficult if they manually had to enter device readings into the Epic Systems EHR.

To ease the transition, the hospital contracted with iSirona, a Panama City, Fla.-based, vendor of medical device connectivity technology to create an electronic bridge between devices and the EHR. "We were able to get this live within 30 days," Shenenberger reports.

iSirona extracts information from patient monitors and other devices every 15 minutes, sending the data to the EHR via HL7 message. The nurse simply clicks to "commit" the reading to the patient's record.

"I've done a lot of projects in I.T. This is the first I.T. project I've ever worked on that has been universally loved and embraced by everyone involved," says. He calls the integration the primary reason why nursing documentation was successful. More importantly, it has made care safer.

"We believe we have significantly reduced transcription errors," Schoenenberg says. Soon, the hospital will be extracting data from devices for research purposes and to help develop best practices.

Safety at the fingertip

In June, NYU Langone Medical Center in New York City turned on a system called PatientSecure, from Tampa-based vendor HT Systems, that scans the veins in the palm with near-infrared light to identify and authenticate patients. Palm vein patterns are said to be 100 times more unique than fingerprints. "It had the highest accuracy and highest usability of any biometric technology we looked at," said NYU Langone Chief of Hospital Operations Bernard A. Birnbaum, M.D.

The ID technology is interfaced with NYU's new Epic EHR that also came online June 5, when the organization activated patient registration, billing and some ambulatory clinical documentation functions.

"All sites have scanners as they come live on Epic," Birnbaum reported. That includes NYU Langone's Tisch Hospital, the Rusk Institute of Rehabilitation Medicine, the Hospital for Joint Diseases and several affiliated medical practices.

"The most important reason why we did this was for patient safety," Birnbaum says. NYU Langone also now takes photos of patients as they register so staff can visually identify patients as another level of security. "If someone forgets to close out my patient account, someone else could come in and look at it," Birnbaum notes. The photos help prevent confusion, potentially stopping a clinician from entering information into the wrong patient's record.

The scanning and photography lengthen the initial registration process, but it saves time on subsequent visits because patients only have to re-scan their palms to bring up all their information, then verify their date of birth. "Repeat registration takes less than a minute," Birnbaum says. There is no more need to keep Social Security numbers to identify patients, Birnbaum added, a safeguard against identity theft and other fraud.

"It's in the sweet spot between patient safety and convenience," Birnbaum says. "It's pretty foolproof."

NYU Langone is taking advantage of the biometric scanning to create more complete records by matching up duplicate files. The organization reports having 125,000 instances where at least two patients have the same first and last names, and much of the overlap is due to patients registering under their full name one time and a nickname on another visit, or perhaps shortcuts by staff. Either way, information gets fragmented.