A healthcare leader in Southern California, Sharp HealthCare has long championed quality and the use of innovative healthcare information technology to enhance the quality, safety and efficiency of care delivery and improve the patient experience. A not-for-profit integrated regional healthcare delivery system, Sharp includes four acute-case hospitals, three specialty hospitals and two medical groups, complemented by a wide spectrum of other facilities and services.
Sharp’s commitment to clinical excellence and e-health has earned national recognition. The health system received the 2007 Malcolm Baldrige National Quality Award, the nation’s highest presidential honor for quality and organizational performance excellence. It has also been named one of the country’s “most wired” healthcare systems for 11 consecutive years in Hospitals & Health Networks’ Most Wired Survey and Benchmarking Study.
Since 2004, the organization has spent more than $11 million to automate ambulatory records and consolidate inpatient clinical systems as part of The Sharp Experience, its enterprisewide performance improvement initiative that has resulted in advances in clinical outcomes and patient safety.
To manage and ensure the successful implementation of inpatient and ambulatory electronic health records, Sharp adopted a phased, modular implementation approach. For example, the ambulatory EHR and computerized physician order-entry systems went live in 2006 and 2009, respectively, at Sharp Rees-Stealy Medical Group, a 400-doctor multispecialty group with 18 locations throughout San Diego County.
To date, Sharp has deployed an EHR at Sharp Memorial Hospital and Sharp Mary Birch Hospital for Women & Newborns. It will install the system at three additional hospitals this year and connect its remaining two facilities in 2011.
Approximately 42 full-time IT employees—double the number assigned to the outpatient project—and a half-dozen clinical educators and nurse infomaticians are supporting inpatient deployments. Additionally, Sharp will place several trainers at the hospitals for two to three months prior to their go-live dates to complete user training, and continue intensive support at the hospitals for several weeks post-live.
The systems have been well-accepted by physicians, as evidenced by 70%, 85% and 90% CPOE adoption rates at Sharp Rees-Stealy Medical Group, and Sharp Memorial and Sharp Mary Birch hospitals, respectively.
Every medication at Sharp Rees-Stealy is prescribed electronically except controlled substances, which by law must be written on paper. Once the Federal Drug Enforcement Administration rule allowing the electronic prescribing of controlled substances becomes effective June 1, Sharp Rees-Stealy will have the opportunity to unify all prescribing activity within its EHR. This will further boost the efficiency and safety of prescribing processes by reducing the number of errors caused by illegible handwriting and misunderstood oral prescription orders. Electronic prescribing is also a tremendous hit with the patients, who no longer have to carry paper prescriptions to a pharmacy before the filling process can begin.
Strong physician leadership is the key to ensuring the successful implementation and adoption of these IT initiatives. Both the ambulatory and inpatient projects were led by separate groups of physician champions. Each group worked with physician advisory teams composed of leaders across every medical specialty that helped Sharp select and implement the system to doctors’ needs. The ability to have teams of trainers on-site and accessible to end-users was another critical success factor.
With every new technology adopted, Sharp enhances its ability to provide better, safer and more cost-effective care—at the point of care.
Cost savings realized by the medical group include decreased labor for storing and distributing the former paper charts as well as redeploying the space formerly used for chart rooms. The organization also has dramatically reduced transcription costs since deploying and integrating speech recognition technology with its outpatient EHR last summer.
To further enhance quality and service, Sharp recently launched a patient portal, mySharp, providing patients the online conveniences of accessing laboratory results, e-mailing physicians, requesting prescription refills and appointments, and paying bills. So far more than 21,000 patients have signed up for the portal.
Sharp also plans to roll out modules for urgent care and ophthalmology, and upgrade its physician documentation component by early 2011.
Additionally, the health system is preparing to demonstrate meaningful use of EHRs to qualify for incentives under the American Recovery and Reinvestment Act of 2009. To accomplish this, Sharp’s strategy calls for it to take whatever steps are necessary to comply with the definition of a certified EHR, which still must be defined by HHS.
As part of it preparation, Sharp has performed a gap analysis to identify differences between the way it uses EHRs and the proposed meaningful-use requirements HHS released earlier this year. Once HHS finalizes the criteria, Sharp will fill the gaps, which at the moment include configuring its systems to ensure clinicians ask and properly document patients’ smoking status.
Meanwhile, the organization is communicating on an ongoing basis with its vendors about their efforts to update their systems for meaningful use. Sharp is also evaluating its interoperability strategy so that its facilities and medical groups can easily participate in a regional health information exchange in the future.
Sharp anticipates that its medical group and the hospitals live or going live this year will be ready to meet meaningful criteria beginning in 2011.
Bill Spooner is senior vice president and chief information officer at Sharp HealthCare, San Diego.
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