When El Camino Hospital in Mountain View, Calif., launched its medical information system (MIS) in 1971, it was the first computer-based healthcare organization in the world to so. Designed for use by medical professionals and developed in partnership with Lockheed Missiles & Space Co, Sunnyvale, Calif., the computers were constructed from Sony TV sets on 4K base units. Light pen pointers selected pre-coded orders and observations.
Now, the original MIS has been retired and, although it's not terribly obvious, there is a new system known as El Camino Hospital Online (ECHO). And although clinicians continue to enter and receive information from computer screens much as they have done for 35 years, there are changes. Chief among them is the ability to view all medical results on the computer and eliminate some paper. The system's design enables a review of the patient's record on a computer screen anytime and anywhere by authorized staff.
One of the greatest implementation successes was in the emergency department. The staff had been early responders in developing a plan and building order sets for the cases they most often encounter. And they were rewarded with ECHO's performance on the first day. An electronic patient status board was a bonus.
Some observers see an advantage to ECHO for those who think in a Windows mindset, enabling them to logically create the flow of orders and information in a seamless system. The ability for clinicians to tie all chart notes and reports into a single portable document is another major advantage.
Users expect bumps along the road of transition. Many have already been found and addressed in the testing and go-live process.
Marilyn Davis, R.N., perhaps the first medical professional to use the old system which began on her unit in 1969, likes ECHO's functionality. Highlights include physician and nurse order entry, online triage notes, an emergency department manager, vital signs transmissions via the Sensitron system, recording of patient intake and output and access to all laboratory and radiology results and nursing notes.
It is a significant point that physicians at El Camino are enthusiastic about digital records and communication because all of them are independent and have the option to take their patients to any hospital in the area. Many hospitals that have implemented such systems have not received physician support unless they owned the medical groups or the physicians were on staff at the hospitals. Although some physicians admit that medical ordering is taking longer at the beginning, they know that the new system will soon save time and assist in the process of ordering, results review and medical care. They commonly cite the easy access to patient information and decision-support tools for everyday tasks such as calculating medication dosages as positives of the new system.
Managing the changeover
Several outside consultants and experts assisted El Camino with the project. These included IBM (Armonk, N.Y.), which provided design and implementation of the emergency department; MaxIT Healthcare (Westfield, Ind.), which conducted a readiness assessment and provided implementation support; and Vitalize Inc. (Kennett Square, Penn.), which provided technical and reporting services. Information systems management at El Camino Hospital is outsourced to Eclipsys, Boca Raton, Fla., which also manages several other integral parts of the process, including the management of medical records.
During the conversion planning, the hospital elected not to bring years of patient medical information into the new system. Instead, it provides an electronic tab on the new charts that allows for a reach into the old database for review of patient information from older tests and visits.
Unlike the old system, where users needed only to learn the system, ECHO users familiar with the Windows-based user interface have a distinct advantage, as do those who understand the nuances of complex medical practice and how the system is constructed, which is very different than the old system. Training on the new system has proven, if not essential, very highly beneficial, and El Camino has supported independent physicians by paying them to be trained.
Helping smooth the transition to the new system is a 24/7 call center where all physician orders, results and patient care activities are monitored. In the first few days of conversion, more than 1,000 questions entered the center, some of which dealt with requests to change the system to improve the patient-care process. In addition, "super users" wearing red shirts were on the nursing units 24/7 assisting the conversion and first days' processes.
In the old system, users had to pull the right information from files that contained hundreds, perhaps even thousands of lines of information. With ECHO, medical professionals expect the system to push critical information to them based on sets of rules.
Through ECHO's clinical decision support, clinicians have access to the 300 best-practice order sets that are in use today. (An additional 300 are in the creation, review and approval process.) And there are 24 different I.V. drip order sets, which have widespread approval among the staff.
The physicians and staff at El Camino Hospital pioneered the use of medical information system technology in the early '70s with what was then state-of-the-art technology. Now, 35 years later, the first magnet hospital in the San Francisco Bay area and one of the most wired hospitals in the world enters a new and exciting realm of information technology to enable 21st century medicine and patient care.
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