Bloorview Kids Rehab Lays Foundation for Provincial EMR, One Innovation at a Time
(7/22/2009)

Given the challenges characterizing congenital and acquired childhood disabilities, it's only natural that innovation in health care delivery comes with the territory. Bloorview Kids Rehab (Toronto, Ontario), Canada's largest children's rehabilitation hospital, is a perfect example of one such facility—having met the complex needs of its patient population with innovative I.T. tools which are up to the task. 

One such innovation is Bloorview's interface to a ventilator monitoring system. Although many hospitals have interfaces which monitor bedside devices such as ECGs, not every hospital can say it monitors its patient ventilators electronically, sending valuable information and readings in real-time to its core information system.

"We are able to capture and send information to the MEDITECH Patient Care System, making data immediately available to nurses, doctors, and respiratory staff," says Sheila Hops, information systems clinical manager at Bloorview. "Integrating data from the ventilator monitoring system has heightened patient safety, pleasing not only patients' parents but also our hospital staff. We've also found that each new on-line piece becomes a building block to documenting, ultimately laying the groundwork for the EMR."

Elevating Patient Safety
The ventilator interface at Bloorview represents part of the hospital's carefully-scripted plan for its new state-of-the-art-facility, which was built in 2006. When planning the building's physical design, the health care organization carefully considered ways in which bedside devices could better integrate with the hospital's information system, to improve the delivery of patient care.

Along with audible alarms and pager alerts, the ventilator solution sends visual alerts to the desktop screen at the nurses' station. In the old facility, an alarm went off outside the patient's room, but it wasn't always audible by a nurse. Now, the monitoring system not only sounds an alarm, but also pages the nurse. If the nurse doesn't respond to the page, the respiratory therapist is paged next, so there's always a prompt response to the patient.

The interface to the patient's ventilator not only captures readings but also information about the device itself. For example, if there's a blockage in the ventilator, the alarm sounds immediately, saving valuable time in making sure everything is working properly.

"In the past, a nurse would have to physically go to the patient's room and manually examine every machine to see which one was triggering off the alarm," explains Hops. "Now, a nurse sees everything on the desktop at the nurses' station, so it's clear what's happening to the patient at all times."

Bloorview's staff also saw several extra steps being shaved off their workflow. "Nurses used to manually document patient ventilator information every hour," explains Hops. "Now, because the system captures the information encompassing both the patient and the ventilator device, nurses can immediately chart against the information presented using the Get Monitor Data feature within the MEDITECH Patient Care System. The information then automatically flows to the EMR."

Automating the documentation process also allows Bloorview's clinicians to be more readily available to their patients. "We have about 12 children ventilated all the time, so you can imagine how much we need our nurses and respiratory therapists on the floor," notes Hops.

Building a Foundation for the EMR
Learning the new system helped Bloorview to establish the foundation for building the EMR—one of the biggest benefits the hospital realized as staff started capturing more and more information electronically. "Our nurses are enthusiastic about building more data in the system. They've started asking us to add more pieces to the patient chart," says Hops. "We started with vital signs and the eMAR, and are in the process of going LIVE with all inpatient documentation."

As the hospital brings more pieces of the patient chart on-line, documenting within the system is now becoming second nature to the clinicians at Bloorview. Physicians on the inpatient units have been entering all orders via MEDITECH's Physician Order Entry, creating a history of order sets as well. As a result, staff can now easily change the statuses of orders, so nurses and other clinicians no longer have to question whether an order has been completed.

"We are excited about adding all of these key elements," say Hops. "We're a small hospital in terms of staff, and we chose a creative path by incorporating the ventilator monitoring system interface. I'm happy to say that we are already reaping the benefits of electronic documentation and leading the way in terms of building the Provincial EMR."

MEDITECH
Medical Information Technology, Inc.
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Westwood, MA 02090
781-821-3000
www.meditech.com