Many IT directors dream of a paperless hospital where patients' electronic records are entirely online, where any paper documents are scanned, and where there is 100 percent computer-based provider order entry (CPOE). For Tanya Townsend of Saint Clare's Hospital in Weston, Wis., that dream has become a reality.
Townsend joined the planning team exactly two years ago, tasked with helping to create Wisconsin's first all-digital hospital. The plans for the near-paperless hospital began in 2002. And after a slew of weekdays, nights and weekends, Saint Clare's opened its doors in October 2005.
Part of Ministry Health Care, Saint Clare's is a 107-bed hospital, which sits on the Weston Regional Medical Center campus along with a diagnostic and treatment center as well as two provider clinics.
Saint Clare's planned from the start to create a hospital that was all digital or was as close to it as possible. Like the hospital's leadership, the staff shared the same vision. Throughout every interview for job seekers, the managers asked the same question." They said, "We're going to be completely digital, so are you comfortable with the computer? Because if you're not this might not be the best place for you."
Going digital meant Saint Clare's would need an electronic medical record (EMR) system with common tools shared across the campus. That also eliminated the need for long-term paper-based medical records storage. "We actually don't even have a filing room for medical records," Townsend says.
The thinking behind getting rid of paper was simple, but the process was anything but. The idea was to allow the hospital staff to share information with colleagues in order to provide the best possible care for patients.
The hospital went with a best-of-breed approach. "Our core tool that we are using here is IDX Last Word which is now combined with GE (GE Healthcare Integrated IT Solutions, Barrington, Ill.), and we have our homegrown tool which is developed by the Marshfield Clinic proprietary system," Townsend says. "Those are our two core systems that make up probably 90 percent of our medical record, and then we have several other systems which also come into play."
Without a Map
One of the major hurdles the digital hospital faced was that there was no roadmap to follow. "We had to pretty much make it up as we went along,"Townsend says. "We had to really start from scratch. We had nothing to go off of so we had to design all processes, all policies. Everything had to be planned from as basic a process as registration, all the way through to the advanced functionality of CPOE. We really had to sit down and start with a blank slate in terms of starting at all."
And while not having a map was a challenge, it seems the curse may have also been a blessing. "We went with the big bang approach. We didn't try to implement in different phases,"Townsend says. "We had the opportunity to start that day from day one being completely digital, rather than the hybrid approach of having some information on paper and some information on the computer. We had that luxury of being able to start from scratch. Ordinarily, in an existing model, you kind of do have to phase it in so that you're not causing chaos,"she says.
Creating the digital hospital was not without glitches -- one vendor even dropped out. In terms of lessons learned, Townsend says there are three fundamental keys to going digital: make sure to get the leadership buy in from the beginning as it is a team effort; start the mapping process early as workflows will be changed; and don't assume the project is complete, even on the day of "go live" since as long as "users (are) being innovative and dreaming up ways of using new technology, our work is never done."