In 2004, Mercy Health Partners embarked on a project to expand its portal-based clinical information system to an electronic health record including physician order entry, clinical decision support, clinical documentation, lifetime clinical repository and a data warehouse.
Mercy Health Partners has three facilities in the Toledo, Ohio, area including two community hospitals and a tertiary-care hospital with a childrens hospital. Our technical goal was implementation of a standardized system and content for all sites with customization to support local service lines. The EHR project was physician-led with focus on quality and service improvement through the use of evidence-based medicine and best practices with a proactive outlook on the future practice of medicine.
Total cost of the project including staff (12 technical analysts, four clinical educators and 18 EHR support technicians), new hardware (mainframe, servers, workstations, computers on carts), license fees, and consultants was $13.58 million. This investment moved us from a HIMSS Analytics EMR Adoption Model Stage 2 to Stage 4 putting us in the top 6% of hospitals in the country.
The Mercy Health Partners EHR has over 900 order sets with over 200 evidence-based clinical guidelines. Over 1,000 community physicians and 500 residents used the system in 2008. The computerized physician order-entry component has approximately 30 clinical rules that collectively trigger over 1 million times per month directly to users as alerts or indirectly through logic that checks clinical criteria for qualification.
The greatest challenge in this project has been CPOE. Physicians and nurses entered almost 900,000 orders in 2008. Our health system is in a competitive environment for physician loyalty so senior leadership has refrained from mandating CPOE use by community physicians.
Nevertheless, almost 60% of orders are self-entered by physicians. (Pre-CPOE, 70 to 75% of orders were handwritten by physicians.) Ultimately, all orders are entered into the system by a physician or nurse activating clinical-decision tools such as alerts.
Quality and service improvements were immediate benefits of CPOE when the tertiary care center with a childrens hospital, went live. Average laboratory order results turnaround time and average medication administration time were reduced by 50%. Combined with a parallel project for bar-coded administration of medications, our adverse drug event rate was reduced by 67%. Across all three facilities, almost 400 medication orders per month are aborted or changed prior to final entry based upon allergy alerts. Clinical-decision support functionality imbedded in nursing clinical documentation has led to improved compliance with Joint Commission requirements. Vaccination screening alerts resulted in improvements in immunization for pneumonia and influenza from 67% to 70% of indicated cases to 98% to 100%.