Nurses Play Key Role in Scanning and Archiving at New Bluewater Health Facility
(11/18/2009)

Bluewater Health had a mountain of paper in front of them as they prepared for moving into their new facility in Sarnia, Ontario. But rather than view this as an obstacle, hospital leaders believed the move presented the perfect opportunity to work toward the organization's electronic medical records goals, which included automating nearly everything in this 326-bed community hospital by 2010.

Already a MEDITECH customer, Bluewater Health chose to implement MEDITECH's Scanning and Archiving solution to automate its more than 10,000 paper forms. "MEDITECH's Scanning and Archiving solution fit so well into our other applications, it only made sense to implement it so we could continue moving forward," explains Karelyn van Wynen, CHIM, manager, health records at Bluewater Health. "We felt we'd be able to maximize our use of space in the new facility by eliminating as much paper as possible, and we also wanted to improve clinician and administrative workflows throughout the hospital."

Since the transition would touch so many areas of the hospital, Bluewater Health chose to take an interdisciplinary implementation approach, which ultimately led to the project's success. "Our Nursing Informatics team was particularly invaluable during this project," according to van Wynen. "They brought in a whole other skill level, and because we had a clinical group involved, buy-in from other groups became easier."

Interdisciplinary Committees Set the Stage for Successful Rollout
Senior management recognized the need to create formal committees which would support the Scanning and Archiving implementation. Bluewater Health's strategy included forming a Scanning and Archiving committee as well as a separate Forms committee.

The clinical areas of the hospital would be represented on these committees to help communicate the ways in which Scanning and Archiving would affect their workflows. "Our Scanning and Archiving committee consisted of a three-member Nursing Informatics team, the Health Records Department, and members of our I.S. department," according to van Wynen.

"Having committee members working alongside I.S. is absolutely key," adds Anna Bej, RN, Nursing Informatics team member. "It proved educational for all of us, in that Nursing Informatics came to realize the needs of the Health Records Department, who, in turn, learned about the needs of our physicians and interdisciplinary teams."

First Things First—Tackling the Paper Trail
Before starting implementation, the Scanning and Archiving and Forms committees had to get a handle on what seemed like the endless trail of forms, and it wasn't long before the advantages of a well-assembled committee became clear.

"With so many forms to sort through, nurses were able to provide input when it came to defining terminology and creating new naming conventions," explains Bej. "This approach led to hospital-wide consistency and a better understanding of what each form was used for by the care teams."

The Forms Committee was responsible for creating a labeling scheme with alpha prefixes so staff could quickly and easily determine which form belonged to which department. "For example, forms with the prefix 'ED' are for the Emergency department; likewise, forms with the prefix 'CC' refer to the Continuing Care department," Bej explains.

Next, the newly formed Forms committee undertook the role of overseeing the creation and use of any new forms. The Forms committee is chaired by Health Information Services, and it includes the hospital's Health Records, Laboratory, Stores, and Professional Practice departments. "The Professional Practice department is made up of policy makers for nursing. They helped write the documentation standards for all forms moving forward, addressing the types of things you need to look at when moving data from paper to electronic form," explains van Wynen.

The new hospital standards include using only black ink, eliminating the use of highlighters, coming up with ways to record red ink, and keeping forms single-sided. In addition, any forms not bar coded are brought to the attention of the Forms committee, as bar coding is a hospital requirement. Furthermore, all requests for new forms go through the Forms committee to meet new template standards.

Van Wynen points out that while the Forms committee is charged with managing the complicated process of standardizing the electronic forms, the effort ultimately serves the needs of clinicians and staff members. "Our goal is not to stifle our clinical areas but rather to support them," says van Wynen. "The electronic version mimics the paper chart form; all the information on the form appears in the same order. That is how we build one cohesive, consistent electronic medical record."

Nurses Set the Tone for Process Change
The nurses at Bluewater Health assisted greatly with ensuring the success of this important transformation project. "Our charge nurses took on the role of training the rest of the staff how to use the electronic system," says van Wynen. "Previously, nurses had grown used to pulling paper for each item, such as follow up information, or calling the Health Records Department. But the nurses were able to show how relying on the on-line system could improve workflows."

According to Nursing Informatics team member, Margie Hull, RN, "Implementation team members often deferred to the nurses' expertise to quickly identify where certain pieces of patient data sit in the chart. Their assistance allowed the implementation project to move along quickly."

Advancing the Electronic Medical Record
The Scanning and Archiving implementation at Bluewater Health has been a success, as the majority of staff members are now using the system and relying less on paper. "We're moving closer to our electronic goals," says van Wynen. "We are increasing on-line documentation and decreasing paper forms. Our processes are clearly streamlined and we work more efficiently, moving toward more archiving and less scanning."

"The most immediate impact has been on our Emergency departments," explains van Wynen. "Clinicians benefit from being able to view records on-line rather than having to call the Health Records Department each time someone needs a patient chart. You can imagine the significance of this when patients are being seen in various locations."

Many of Bluewater Health's physicians have also seen a major reduction in paper and are very happy they can access charts from their offices. Continues van Wynen, "In addition, our costs related to printing are way down. We are currently shutting off the ability to print copies of the Discharge Patient Chart and anything MEDITECH-generated is no longer printed."

Bluewater Health's future goals include getting more of their physician groups and nursing units used to on-line workflows, eventually allowing the organization to stop printing the majority of their forms as clinicians view patient information through MEDITECH's Patient Care Inquiry software. "The implementation of the Clinical Review component of Physician Care Manager will help that effort," states van Wynen. "Over time, we also plan to implement e-signature, providing our physicians with even more tools and data at their fingertips."

 

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