"It's all integrated"---EHR helps Thayer improve safety

HMS helps hospital implement technology to improve patient care and safety.

For clinicians at Thayer County Health Services in Hebron, Neb., providing area residents with quality healthcare close to home has always been a top priority. Now that the 19-bed critical access hospital and clinic has fully implemented an electronic health record (EHR) with help from HMS, Thayer clinicians are able to accomplish that mission more effectively than ever.

“If a patient comes to the ER, we can pull up past medical and surgical history on the computer and fi nd out if the person has any allergies and what medications they take,” says Susan Moore, director of nursing. “You don’t have to find a chart somewhere. The ease of information retrieval is awesome.”

Patient care wasn’t always so seamless for the hospital when the staff used computerized charting but still relied on paper for most of its clinical tasks. Each department had its own set of forms and requisitions. Papers containing patient information were often needed by more than one person at a time.

Using funds from a health information technology grant that awarded $1.6 million each to Thayer and 15 other critical access hospitals around the country, the hospital launched a much-needed upgrade in September 2007. HMS systems for billing, coding and registration were already in place, and Thayer added most of HMS’ clinical modules and moved toward a complete EHR.

“We had 18 months within the grant parameters to transition to a complete electronic health record so we had to move much more rapidly than most hospitals do when it came to implementation,” Moore says.

HMS helped staff members at the hospital think through the transition—not only teaching staff how to use the system, but also working with them to customize different modules to better suit their needs. When the system went live in April 2008, the conversion was so smooth that the hospital administrator was amazed.

“She was out that morning, and when she came back at 2 p.m., she noticed that everything was running smoothly,” Moore recalls. “She said, ‘I thought we were going to go live today.’ And we said, ‘Oh, we did that hours ago.’”

Though there was some resistance to the new system among some clinicians, it didn’t take long for everyone to see how much more efficient it was.

“It takes less time to chart and note orders,” Moore says. “You don’t have to thumb through paper requisitions to see if something was done. You can just pull the result up on the computer instead of waiting for a piece of paper to make it to you.”

HMS’ bar coding technology and computerized provider order entry (CPOE) have helped clinicians have a comprehensive record of each patient at their fi ngertips at all times. The bar coding technology helps ensure that the right medication in the right form is given to the right patient at the right time and in the right dose. Any clinician can see all medications administered immediately after they have been given. Electronic order entry ensures that all orders are immediately available in the receiving department for prompt action. Unlike in the past, when nurses had to transcribe orders from the written physician’s order sheet, the orders are known by the receiving department immediately, there is no misinterpretation of an order or chance of ordering an incorrect test, drug, or dose according to Moore.

Another useful HMS module has been Patient Care Documentation, a multidisciplinary, on-line charting application with extensive organization and navigation capabilities.

“We use it throughout the facility in a variety of departments, including nursing, physical therapy, and home health,” Moore says. “The ability to tailor the documentation to different departments is really nice.”

For example, it allowed the hospital to create an online repository for different sets of forms across departments, so nurses can access them faster. Also, “if there is something nurses need to make notes on outside the normal documentation, they have the ability to do that,” Moore adds. “It’s all integrated.”

The system also enables clinicians at TCHS’s five satellite clinics to access lab and X-ray results sooner and share that information during the patient’s visit. “When patients come in, they can show them the results on the screen,” Moore says. Since adopting a complete EHR, the hospital has seen a dramatic reduction in medication errors, Moore says. When unresponsive or minimally responsive patient presents to the ER, “you don’t have to wonder what allergies they have or what meds they are on,” she says. That information is available at any computer in the hospital or clinic. Thayer recently received the Nebraska Association Quest for Excellence Award, in recognition of the patient-care improvements.

“The ultimate goal in patient safety is to reduce medical errors and the complications that can result—and that has happened across the board, all the way from when an order is taken to the point of delivery,” Moore says.

February 2010