That is why Altschuler pushed the information systems organization to select a single vendor for inpatient and outpatient applications. “We looked at all the vendors that were out there and eventually, after a lengthy selection process, chose Epic,” Wolf says.
In 2007, the hospital replaced its existing business applications for processes such as registration, scheduling, discharge and billing. It then switched to Epic's inpatient clinical modules in January 2011 after a period of planning, testing and end-user training. “We are a very deliberate organization,” Wolf says. “Whenever we introduce technology, it has to be as close to perfect as possible.” Why? “We are always very mindful when we do these things that the safety of our patients comes first,” he says.
Children's Hospital's IT department also worked with Epic to customize the computerized physician order entry application for the field of pediatrics. One example: the ability to order the appropriate dose of a medication based on a child's weight.
Wolf says he plans to roll out clinical documentation for nurses and physicians this fall—at which point he predicts that Children's Hospital will be 95% paperless.
The hospital still has some very specialized non-Epic software applications—such as in the cardiac center, surgery and anesthesia—which require employees to duplicate data entry, Wolf says.
The IT department also developed analytic tools, allowing managers to “take all of this data that we are sitting on and analyze it for research, for outcome studies, for better patient care,” Wolf says. “We think that is key—to make the data accessible to people so they can manage based on data.”
The next step is the rollout of cost-accounting software by year-end.
“What we have struggled with is understanding the cost of a service line. For example: a transplant. How much does that actually cost the institution?” Wolf says. “You take into account not only the professional fees of the surgeons and physicians, but also the cost of the ICU, the OR time. All of those different pieces.”
Managers will combine information on costs and quality to demonstrate the value of the organization's services to payers, Altschuler says.
Electronic health data is not only useful in clinical operations but also in research. Information gleaned from electronic patient records helps fuel new discoveries in research and build evidence for best practices in patient care.
“We really integrate the research and the clinical,” Altschuler says.
For example, in 2006 the hospital launched the Center for Applied Genomics with a $40 million investment. Researchers analyze information from de-identified medical histories in combination with genetic information, which is derived from biological samples stored in a biobank, to identify links between genes and disease. They already have identified genes associated with type 1 diabetes, autism, and attention deficit hyperactivity disorder, or ADHD, among others.
“There are at least 50 different disease areas where we have begun to discover genes,” Johnson says.
The goal, Altschuler says, is personalized medicine. “You can imagine that if you find a specific gene that is responsible for ADHD, that allows you to find or build more specific drugs with higher efficacy and fewer side effects,” he says.
Children's Hospital's biobank now has 150,000 samples.
In addition to genomics, Children's Hospital also has developed expertise in clinical informatics—using information technology to improve patient care—and biomedical informatics—using information technology to manage very large amounts of data for medical research, such as in genomics.
One example of clinical informatics is Care Assistant—a Web-based tool that displays alerts about evidence-based protocols through the EHR system. Care Assistant also alerts pediatricians when one of their patients meets the criteria for a clinical trial.
Hospital researchers are in the midst of creating an application that will track the proper care of premature infants and issue electronic reminders about blood-pressure screenings, immunizations, and eye and hearing examinations.
Care Assistant already has been linked to improved outcomes. For example, in a one-year analysis, the up-to-date immunization rates at four urban clinics among 24-month-old children increased from 81.7% in 2004 to 90.1% in 2005, according to a 2007 article in the journal Pediatrics.
“Everything we are doing is to take care of the health of children and to have better outcomes,” Wolf says. “You have the sense that you are making a change—a difference—in someone's life early on.”
Linda Wilson, a former Modern Healthcare reporter, is a freelance writer based in McHenry, Ill. Reach her at [email protected]