Rockcastle Regional Hospital - A successful switch

HMS creates solutions for Kentucky hospital to successfully integrate an electronic health record and bring physicians on board.

When administrators at Rockcastle Regional Hospital and Respiratory Care Center in Mt. Vernon, Ky., embarked on the transition to a paperless information system, they were determined to bring everyone on board, even physicians.

Cindy Burton, chief nursing offi cer, knew that getting physicians acclimated to an electronic system and trained to enter patients’ orders themselves would be challenging. With a supportive staff, strategic training and support from HMS, the team at Rockcastle was able to achieve that goal.

“HMS was responsive to our needs as an organization and stayed positive for us,” Burton says. “Whatever it was that we were trying to accomplish, HMS was looking for ways to help us be successful.”

Since choosing HMS for an electronic health record (EHR), along with Computerized Provider Order Entry (CPOE) and a host of other clinical and fi nancial applications, the not-for-profi t community health system has received statewide recognition for its commitment to improving patient care and safety (see sidebar). Rockcastle, which operates an eight-bed emergency facility, a 26-bed acute care facility and a 93-bed long-term respiratory care center, was among 1.5 percent of hospitals in the country, as of late 2009, with a comprehensive electronic record system, as defi ned by the March 2009 issue of the New England Journal of Medicine.

“Everyone in the organization is using the technology,” Burton says. “From registration and scheduling to the doctors’ offices, we took the attitude that we were going to do this.”

Since Rockcastle went live with the HMS system, Burton says she has noticed signifi cant changes. For example, transcription errors are down. “It’s hard to measure the ability to communicate, but we know communication is much better now as far as being able to access information on a patient,” Burton says.

From the beginning, the project had strong support from the hospital board, administrators and clinicians, who saw the need to wean the organization off of its reliance on paper for patient care.

Locating charts used to be a hassle for nurses, who were constantly trying to dig up records on patients who made frequent visits to the hospital at all hours of the night.

“Patients might come into the emergency department who had been there a week before, and we couldn’t lay our hands on that piece of paper with the record of their past visit,” she says. “It might be 2 a.m., and we would have to send someone to medical records, which was closed, to dig through fi les looking for the patients file.”

Because Rockcastle was already using an electronic platform in its lab and business office, the hospital looked for a vendor that could offer an integrated system throughout all its facilities. Representatives from the fi nancial and clinical departments, as well as physicians, saw demos from several vendors and liked the way the HMS system looked and how user-friendly it was.

When administrators at Rockcastle Regional Hospital and Respiratory Care Center in Mt. Vernon, Ky., embarked on the transition to a paperless information system, they were determined to bring everyone on board, even physicians.

“It is a flexible, flowing system—and that is what has helped us be successful with it,” Burton says.

“As the hospital prepared to make the transition, HMS was there to help build fi les, train staff, fix technical issues that arose and offer encouragement,” Burton adds.

“If anyone had concerns about the speed of the system or anything else, we could talk about those problems with the HMS staff, and they would help us create a solution for it,” she says. “That’s what HMS does—create solutions.”

Nurses worked closely with HMS to build and customize assessment forms and appreciated the expertise and resources that members of the HMS implementation team brought to the process.

“They had another way of looking at some of the things we were used to doing, and they made suggestions to help us think about those another way,” Burton says.

Because of the physicians’ hectic schedules, administrators knew they would have to simplify training on CPOE to get them to participate. The hospital arranged training sessions to familiarize physicians with the system and then set up individual training sessions tailored to each one. After the system went live, CPOE reference guides were placed at each order station, and nurses assisted physicians directly with entering orders for the fi rst two weeks until they adjusted.

Physicians also collaborated with hospital staff to create their own order sets, so they could click through quickly and select what they needed.

“After six months, they were asking if we could make the system do this or that,” Burton says. “When they started asking those questions, we knew they were ingrained in it and understood it.”

Now that all physicians are entering their own orders through CPOE, patients are able to receive the right medications faster. Nurses don’t have to worry about misreading orders, and clerks who used to process them are free to work on other tasks. Applications like Clinical View and Patient Care Documentation allow clinicians to update and access patient records in real-time, and Lab, Pharmacy and PACS (Picture Archiving Communication System) give them immediate access to vital information they need to treat patients.

Best of all, the hospital is able to quickly and easily gather data to make the right decisions about processes and protocols regarding patient care. “We’re able to abstract more information about how we are providing care to patients than in the past,” Burton says. “There is nothing we put in their records that we don’t have the ability to pull a report on… It’s truly about having the information at your fingertips.”

Rockcastle Regional ahead of the curve

Rockcastle Regional Hospital and Respiratory Care Center serves a small patient population in a rural area, yet the leaders there take a large view when looking for cutting-edge ways to improve patient care and safety. “We try to be ahead of the curve, even though we’re a small facility,” says Cindy Burton, chief nursing officer.

Evidence of their success is highlighted in this list of the hospital’s recent awards:

• CPOE/Bar Code Scanning of Medications at the Bedside, Kentucky Hospital Association Quality Awards, 2009
• Big Bang Implementation of the Electronic Medical Record, Kentucky Hospital Association Quality Awards, 2008
• Kentucky Association of Healthcare Facilities Innovative Program Award Eastern District and Statewide Winner, 2008
• Kentucky Initiative for Quality Best Practices Award