Virginia Commonwealth University Health System (VCUHS) is an academic medical center that has served the Richmond, Va. area for more than 160 years. The VCU Health System’s academic mission supports and is directly linked to Virginia Commonwealth University. As the clinical delivery component of the VCU Medical Center, VCUHS is a regional referral center for the state. MCV Hospitals is the teaching hospital component of the VCU Health System, which also includes several outpatient clinics and MCV Physicians, a 600-physician, faculty group practice. Also included in the system is the 779-bed Medical College of Virginia Hospitals (MCVH) and VCU’s Massey Cancer Center, a National Cancer Institute designated facility. The VCUHS treats more than 80,000 patients annually in its emergency department, which is the region’s only Level I Trauma Center. Recently, HCI Associate Editor Kate Huvane Gamble spoke with Alistair Erskine, M.D., who serves as CMIO and Internal Medicine Hospitalist at VCUHS, about his role with the organization, his thoughts on pushing forward during tough economic times, and how his organization is leveraging technology to improve the safety and quality of care.
KG: So in your case, the HIMSS Analytics rating isn’t a true reflection of where the organization is in terms of IT adoption.
AE: Yeah, and the official letter of the law in terms of HIMSS Analytics is you only need it in one unit to be able to meet the requirement for that stage. So we actually considered putting barcode medication in the palliative care unit; you know, some sort of low-risk unit, just to be able to call ourselves stage 6. But then what’s the value of that? Okay, so we’re stage 6 — so what?
KG: That’s a very good point. Are there plans to deploy barcoded med administration?
AE: We would have it up and running now, if it weren’t for the fact that our capital dollars evaporated with the economy. We have it on the road map and we actually already bought the software. We’re just in a place where we don’t have the capital dollars to implement in right now. It’s kind of sitting on the shelf waiting for us to either get some additional support or wait until we have renewed capital.
KG: Unfortunately, that’s a recurring theme in these times. It’s very frustrating, I’m sure.
AE: Especially because when these things lose momentum, it does take a certain amount of effort to get them back up to speed. So if you stop a project like that, all the people who’ve been involved and preparing and thinking about it and trying to come up with design decisions, come to a screeching halt. And then a year later, it takes a fair amount of effort to get it back up again and going. That can be frustrating.
KG: One of the technologies not stuck on the shelf is a patient hand-off system from PatientKeeper. What’s the status on that?
AE: It’s in the process of being rolled out. We have had some initial very quick successes with a lot of adoption from the people we were rolling out to, almost on their own, which is a good sign, as they’re the ones that are actively involved in trying to make it better. There are a couple of objective measures we are examining that we don’t have results on yet.
One of them involves residency training. There are a lot of rules surrounding work hours, and the ACGME (Accreditation Council for Graduate Medical Education) is the group that basically oversees training programs and will fight organizations if they have residents that spend more than 80 hours a week at the hospital. So what we found, before we move forward with the sign-out tool from PatientKeeper, is that part of the reason that residents would remain in the hospital for longer than 80 hours is because they were spending an inordinate amount of time creating these word for Windows documents to sign out to their colleagues that can e-mail. And those documents had a series of problems with them. Number one, they weren’t always accurate. Number two, they were fixed in time from the last moment they were updated. Number three, they took a lot of time to create. Number four, they were in a location on a shared drive that did not permit users to really know who was accessing the document, which is something that, for HIPAA reasons, you really need to have. You wouldn’t want me to do be able to go and look at somebody else’s sign-out report about a patient without there being some sort of audit trail that I was doing so. And in order to facilitate general accessibility to these sign-outs for clinical reasons, they would put it on the shared drive. A resident will come up with any kind of work-around possible to be able to deliver clinical care. So you can just imagine the variation in ideas — jump drives and shared drives — of how they would share this information.
Trying to solve this problem of making it more efficient and making the document itself more accessible in a HIPAA-compliant way, and making it more accurate so that it was automatically being fed by EMR content, was definitely the goal we were trying to accomplish.
KG: And the plan is for it to tie in to the EMR?