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Proud to be Paperless

January 17, 2013
by Rajiv Leventhal
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Florida hospital joins Stage 7 elite—here is how it happened
Florida Hospital North Pinellas

Ten months ago, Karen Owensby, chief clinical officer at Florida Hospital North Pinellas—an Adventist Health System (AHS) facility in Tarpon Springs, Fla. that supports 44 campuses and employs 55,000 individuals—never would have thought that she would soon be working in a paperless system. Now, as the hospital just recently received the Stage 7 Award from the Healthcare Information and Management Systems Society’s (HIMSS) analytics division, she can take pride in all of the hard work it did to get there.

“It went much quicker than we thought. I would have expected this journey to take at least two or three years, and I’m incredibly proud that it took less than one,” says Owensby.

Understanding the level of electronic medical record (EMR) capabilities in hospitals is a challenge in the U.S. healthcare IT market. HIMSS Analytics, the authoritative source on EMR adoption trends, devised the EMR Adoption Model (EMRAM) to track EMR progress at hospitals and health systems. The EMRAM scores hospitals in the HIMSS Analytics database on their progress in completing the eight stages to creating a paperless, advanced patient record environment. 

In Stage 7 of the EMR Adoption Model, a hospital is truly paperless. Clinical information can be readily shared via electronic transactions that adhere to standards with all entities within health information exchange (HIE) networks (i.e. other hospitals, ambulatory clinics, sub-acute environments, employers, payers and patients). In this stage, a healthcare organization demonstrates that it can support the true sharing and use of health and wellness information by consumers and providers alike. Also at this stage, healthcare organizations use data warehousing and mining techniques to capture and analyze care data for performance improvement and advancing clinical decision support protocols.

As of the third quarter of 2012, the 168-bed Florida Hospital North Pinellas is among the 103 U.S. facilities—or 1.9 percent—of the more than 5,000 U.S. hospitals in the HIMSS Analytics database to be awarded the HIMSS Analytics Stage 7 Award. Florida Hospital North Pinellas will be recognized for that achievement at the 2013 Annual HIMSS Conference & Exhibition in New Orleans, on March 3-7.

Stage 7 signifies an elite classification in the healthcare IT spectrum, and that’s not lost on Owensby. “It represents rapid change, because we went from a 0 to a 7 in pretty much nine or 10 months. Our organization was able to adapt to such significant change, and it made patient care safer,” she says.

Patient safety is the driver, and when you put that as your fundamental goal, it’s hard to ignore all the effort it takes, adds Janet Jones, clinical informatics director at Florida Hospital North Pinellas. “The pace of healthcare is so quick now, and there is just no way we can take care of patients today without EMRs to manage planning and implementation.  We’re all able to look at the same set of information in almost real time, and that makes it a great communication tool. That in itself—the communication of health information in a rapid environment—is so critical.”

The EMR implementation at Florida Hospital North Pinellas was directed by AHS, which had implemented many sites before this one. Owensby credits AHS’s implementation strategy for getting Florida Hospital North Pinellas to Stage 6 by February, 2012. “Stage 7 is a different story,” says Owensby, who realized that AHS could not change the culture and practice for them. “As a team, we reviewed all the requirements to achieve Stage 7, completed a gap analysis, developed and then implemented the changes required to meet the standards.”

Perhaps the most challenging EMRAM standard for the hospital to meet was documenting medications given during clinical emergencies.  Solving this challenge took a group of people (clinical informatics education, pharmacy, nursing and nursing supervisors) working together for the best solution, says Owensby. “It was a cultural transformation for nearly everyone involved. We were dependent on paper for everything. But our physicians have embraced technology and now do their own order entries. It’s been a huge cultural change that has involved a ton of planning.”

Another key step in the process involved the hospital’s CNAs (certified nursing assistants), who were recording vitals on paper and entering them into the EMR at a later time. “We identified that their device configuration was impeding appropriate real time charting. The original configuration of a small tablet mounted with Velcro on a [patient monitor] proved unstable and difficult to see,” says Jones.

At that point, the hospital’s IS (information systems) department came up with a new device configuration. They mounted a patient monitor on a workstation on wheels (WOW) and installed full size laptop computers with 17-inch screens. These devices were much easier to use and the CNAs began appropriate real time charting of vital signs, Jones says.

As for the future, the next level is full sharing of information across different organizations, and that’s the ultimate goal, says Jones. “Ideally, a patient can walk into our hospital, check out, fly home to Illinois, see his/her primary care doctor, check into a hospital there for a follow up, and have all of the information readily at hand. That’s the future of healthcare. That’s where cost savings are and where patient safety and patient quality are going in order to make us efficient and effective.”