In November 2005, Wheaton Franciscan Healthcare committed to a new business model and strategies to optimize clinical outcomes, physician relations, and financial performance. The key enabler was our electronic health record, designed to deliver timely and actionable information to clinicians at the point of decisionmaking. We committed to a systemwide approach using evidence-based best practices to design a common clinical workflow, change policies and procedures, and underpin practice changes with a single application suite across multiple organizations in two states. Our mission calls us to provide exceptional and compassionate healthcare service, and the EHR is a prime tool assuring we are equipped to fulfill that call. Creating a single-access point with our EHR allows the computer to be the complete source of clinical information.
Wheaton Franciscan Healthcare
We successfully transformed the patient-care delivery process by deploying 22 applications in nine hospitals and more than 30 clinics within three years. This was accomplished with a philosophy of design it once; implement it many times, always incorporating best practices, developing systemwide nursing standards and ensuring regulatory compliance. To remain focused, we identified clinical and financial benefits for each application and monitored results. The total budget outlay for our EHR implementation is in excess of $50 million.
Two critical groups were formed to oversee the initiative: the governance team and EHR operations team, both including executives from our information services (IS) vendor. Other teams were created to support implementation of various applications.
In addition, a technical team worked with external vendors to create and refine the infrastructure, addressing technical issues associated with infrastructure for EHR applications and leveraging vendor expertise. This team was also responsible for what is known as real application cluster (RAC) technology, which allowed us to implement a single database to be spread across multiple lower-end servers instead of one large server. As a beta site, Wheaton Franciscan Healthcare was the first to use this technology. With RAC, we implemented applications on a single database, significantly reducing hardware costs.
The education team was led by our organizational development department, which created educational tools to minimize the number of hours needed in a traditional classroom setting. These computer-based tutorials incorporated competencies. The communication team developed a detailed plan to keep associates throughout the organization informed on the progress as well as educate staff on key features of the applications.
Each application team was led by a clinical leader supported by an IS leader, an IS vendor expert and physician champion. Team members were selected from bedside clinical staff representing all sites so as to be multidisciplinary and cross-regional. Each team created a detailed scope document to assure focus and boundaries as the work progressed.
Here are some major achievements and improvements we have achieved as a result of implementing our EHR:
- Standardization of clinical workflow based in evidence and best practice: Reduced the number of orders in computer physician order entry (CPOE) by 71% (more than 34,000 system orders reduced to fewer than 10,000).
Improved patient safety with a common allergy documentation process designed and implemented for all patient access points.
Nursing standards and scales incorporated into the nursing documentation are based on research and evidence.
Assured compliance with JCAHO regulatory measures, which were incorporated into the electronic database to generate automatic referrals to other clinical departments.
- Developed innovative physician engagement model to provide both horizontal and vertical integration of physicians across two states and all facilities in order to assure physician buy-in and successful use: Innovation – worked collaboratively with our vendors CPOE outline design tool, an approach that will now be available to the vendors other clients.
- Improved clinical quality and patient safety: Reduced adverse drug events (ADEs): moved from the 50th percentile to exceeding the 90th percentile for ADEs.
Achieved top decile performance in publicly reported measures that comprise the Hospital Quality Alliance (CMS), Wisconsin Collaborative on Healthcare Quality and Wisconsin Hospital Association Checkpoint. For example, our surgical documentation application hardwires surgical care improvement project documentation.
- Improved productivity: Decreased home health clerical full-time employees (FTEs) with a 13% savings.
Improved utilization of clerical staff in the operating room by 30%.
Improved productivity of physicians utilizing our portal to view test results. Use of logins has increased by 100% between July 2006 and April 2009.
- Decreased expenses: Decreased radiology film costs, storage, and FTEs with savings of $2,030,254 to date.
Eliminated record storage in medical records department. One site decreased by 94%.
Our strategy for seeking the American Recovery and Reinvestment Act of 2009 funds is already under way with a systemwide team charged with examining all required criteria and performing a gap analysis between our current status and stimulus law requirements. Once we have identified the gaps, work teams will be established with specific goals and timelines. Our ultimate goal is to be in a position to receive stimulus law funds in fiscal 2011year one of stimulus law eligibility.
Vice president of operations, EHR
Wheaton Franciscan Healthcare
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