Transcript: Kathryn Wohnoutka, RN, Citizens Memorial Healthcare

100% Paperless Environment?
Yes, we are 100 percent electronic and actually have gone a step further and we don't maintain paper charts either. Our system consists of hospital, Long Term Care facilities, residential care, home care services, home health hospice, and also physician clinics. And so throughout our system, we've been able, we share one Electronic Medical Record and we've done away with our paper charts. So that's been a big improvement for patient safety, trying to be very patient focused. It is their record and that's what we're gearing towards.

Strategic Planning for Stage 6
Keeping the patient as the focus with patient safety, this has been very important for us and has really helped us achieve this. It even starts at the point where when the physician is putting in a legible order because it's electronic, we don't have to reinterpret what they're trying to say. If it's a complex order, they can use an order set, so it starts at the point that they're entering the order. That order has interaction checking that takes place against their allergies, existing meds, and even possibly regarding diet issues that might be going on or diet orders. Once that happens, that's one phase, so I mean we actually do three checks. So the ordering part of the system that we use through MEDITECH is the first part. The second part is when it goes through pharmacy verification. So when they go through it and take a look at it, again, another safety check. And then with the nurse at the bedside, we're getting the check of when they scan the patient's armband, are we getting the right patient? Then it's comparing against, that we've confirmed that we're on the right patient, we're confirming the rest of the five rights for patient medication safety, med administration. This is tremendous.

Using EHR: "We're All Contributors"
MEDITECH offers an opportunity not to look at the current visit, just it, but also various visits. You can sort by type, view all of them together. If that data in other parts of the system is not consistent in how it's going to appear on the Electronic Health Record, we did not service our community very well without our patients because when you pull the data together, that's pulling the whole story together so that you do have a beginning, a middle, and an end. Definitely you've got to have all staff involved because it their record as well when they become patients at our organization. And they do.

Exchanging Information in the Community
We are working toward Stage 7 and in our community. We're in Southwest Missouri, and we are in a fairly rural community. There are a level 1 and a level 2 trauma center roughly 30 to 40 miles away from us but they're working on implementing an Electronic Health Record but they're not quite there yet. So the ability to exchange information with them is not at that point yet. We do have another practice in the town where we reside at, and they do not use MEDITECH. However, we do give them access into our systems, so they do send patients to us and they're able to work within MEDITECH and be able to access that information, and they even schedule procedures from their clinic into our system as well. So that is something that we do want to do because it's very, very important to us. Again, very patient focused. What does the patient need? And we should be able to meet those needs.

Now we do have that if if Radiology, we have all of our Radiology images digitalized and we send those on CD, we do exchange data on CDs. If they need an Electronic Record printed out, we don't print because that would be our paper. So we actually put it on a CD and then provide that so that they can look at spending the money on their paper. 

Something else that we're doing which is very near and dear to my heart, because I have children, is that we are working on patient portal. So one of your partners, LSS, we're working with our clinics, that we have a clinic LIVE with the patient portal and I then have immediate access into my children's immunization records. If the school needs them or for a particular reason, I can go online and be able to access that information, print it off, and then send it right there. I did not have to make an appointment with my clinic. I did not have to rely on someone else. I could do it myself and get it done, and know that it was taken care of. So the patient portal access, we do plan on expanding that all to the rest of our clinics and we're very excited regarding that. And we'll be able to communicate with the physicians and do online bill pay. 

Preparing for ARRA
We feel that already being at the Stage 6 that's been assigned by the HIMSS Analytics puts us in a very strategic position to be ready to receive those funds. We do know there's going to be other requirements beyond Stage 6. We've been participating in webexes, finding our more data on that. Our CIO, Denni McColm, has been serving on several different boards and certifying boards for Electronic Health Records and she has also been making sure that we're right on top of what's coming so that we're going to be in a position to really take advantage of that opportunity.