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Crozer-Keystone’s Clinical Transformation Journey Picks up Speed

Crozer-Keystone is on a journey to safer, more effective and efficient care using the latest information technologies. The health system has made many strides on this journey, but there are many changes to come in 2012 that will require the continued outstanding teamwork and collaboration of our entire clinical and administrative workforce. 

An integrated system helps overcome the kind of challenges that fragmented care creates in an increasingly complex health delivery system. Duplication of diagnostic services and medication conflicts are just two examples of why securely shared, readily-accessible patient information is so important. 

“Having a fully electronic health record system for a patient assists physicians in making informed decisions about care,” says Karen S. Scoles, M.D., Crozer-Keystone Health Network primary care physician and medical director of Information Systems. “In this way, appropriate treatment can be administered while expensive, duplication of services are avoided.” 

The health system’s pioneering progress in using information technologies to date has allowed it to be the recipient of more than $6 million in federal and state grants in the area of “meaningful use” of certified electronic health records (EHR) systems.   

An Automated, Centralized Pharmacy

As the first part of the meaningful use EHR is phased in, CKHS has moved forward with a key component of the plan: centralized distribution of medication. A centralized drug distribution system was installed at Crozer and by Spring of 2012, all hospitals will be serviced through this process. It’s estimated that approximately 90 percent of medications will be dispensed using a centralized carousel system. 

The goal of “safety in dispensing” will be supported by state-of-the-art “Talyst” carousels. These automated dispensing carousels vastly improve the safety and accuracy of drug dispensing, as all medications require barcode confirmation as part of the process. 

“The barcodes on every medication are scanned in and out of the carousel as a safety measure,” says David Showalter, PharmD, MBA, assistant director of Pharmacy Services. “Its ‘Pick to Light’ technology — in which each bin lights up when the prescription order is being processed — is another level of safety in dispensing. It makes it easier, quicker and safer to select the right medication to fill the order.”

 Once the prescriptions are dispensed at the central pharmacy, they are distributed to individual Pyxis MedStations to be administered to patients. Several of these new units have been installed in patient floor locations throughout the health system so that nurses can easily access barcode-ready units of medication. 

Medication Administration Checking

As a final and critical layer of safety in dispensing, nurses perform Medication Administration Checking (MAK). MAK is an electronic system that helps ensure that the right patient receives the right medicine, at the right dose, at the right time and through the right route (oral, topical, nasal, etc.) 

Before administering a medication, nurses scan their own barcode, then the medication, and finally, the patient’s wristband. The system matches the scanned information with the information entered into the system to ensure that they are all in sync. 

“We have been successfully using this system at Taylor for several months and look forward to implementing it at Springfield and Crozer in early 2012, and DCMH next fall,” says Don Reed, vice president of Information Services for CKHS. “Of course, a system can only be successful if every layer of movement works together—and that starts with the order placement.” 

Electronic Order Entry

A key component of CKHS’ clinical transformation is the electronic order entry system, where Laboratory, Radiology and Pharmacy orders will be entered. Seamless integration of all ordering is a step-by-step process, with multiple “phase-ins” along the way. Currently, phase 1 is live at Taylor and Springfield with unit secretaries electronically entering orders. Crozer is set to come on board in early 2012 and DCHM, the following year. 

“Ultimately, we are looking to phase in a completely Computerized Provider Order Entry (CPOE), where the physician or healthcare provider can enter his or her orders in directly,” Reed says. “The benefits of CPOE are many, most significant being the speed and accuracy of automation. There is no time lost deciphering handwriting and the risk of errors due to misunderstanding the orders is greatly reduced.” 

But simply entering orders isn’t the only capability of the streamlined system. Scoles says that in the future, CPOE can provide clinicians with “order sets.” These evidence-based best practices will be viewable and “clickable” so that physicians can review and select appropriate interventions. “They will have immediate access to published patient care guidelines for specific conditions and diagnoses,” Scoles says. 

Electronic Document Management

Starting in the spring of 2012, the Medical Records Department at all hospitals will begin scanning, post-discharge, all hand-written forms produced on units throughout the health system during inpatient stays, observational stays and short procedures — such as progress notes, orders and nursing documentation. This practice will be achieved using high-speed scanners located at each Crozer-Keystone hospital. Paper records will no longer be maintained after this process begins.  

In addition, current electronic-based testing results – such as Radiology and Laboratory results – will be automatically combined with the scanned images to form an online medical record.  

Caregivers will be able to view patient records from any computer via a secure server using a system called the Soarian HIM. Physicians will continue to be notified about incomplete charts, but they will be asked to view and, if needed, sign off on them electronically using the system. 

“The new electronic document management system is very user-friendly and it offers many benefits to all caregivers as well as patients. Most importantly, electronic medical records will dramatically decrease the number of deficient charts from the hospital,” says Walt Bisbee, administrative director of Medical Records for Crozer-Keystone. “Physical charts will be available simultaneously to anyone who has access to the online medical records. This will save a tremendous amount of time, and allow physicians to access online records wherever they are – at a hospital, in their office or at home. In addition, electronic records have a better level of protection than the paper record.” 

The new electronic document management (EDM) system also will cut down on storage costs since paper records will no longer need to be stored. Medical Records and Information Services representatives will provide comprehensive education and support for all practitioners before, during and after the launch date. 

“We are well underway in our preparation to launch EDM,” Reed says. “We are working to interface the records and are readying the system with pre-populated information.” 

e-Care Navigator

To access all of these initiatives (except MAK), caregivers can use the new eCare Navigator which goes lie in January 2012. Users can find the e-Care Navigator icon on all CKHS computers. 

Additional features include the display of a patient’s estimated Calc Cr Cl to assist with appropriate drug dosing for patients with impaired renal function, metric weight, allergies and admitting diagnosis. It will also provide access to UpToDate, which will allow physicians to obtain and track Category I CME credits for reviewing clinical topics. 

Scoles points out that the clinical transformation provides not only a huge opportunity to improve patient safety, workflow efficiency and cost effectiveness, but also to recruit and retain the best clinicians. She says, “All of these initiatives position us as the kind of forward-thinking health system that attracts medical professionals who are interested in practicing in an EHR environment, where exceptional patient care is paramount. We have been recognized as one of the leaders in the field.”

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