With
the Physician Desktop, Harrison Memorial Finds Good Things
Come for Small Hospitals
(9/16/2009)
Some of MEDITECH's most progressive
customers are small organizations in less populated areas of
the country. Take Harrison Memorial Hospital (Cynthiana, KY),
a regional medical center located 28 miles northeast of
Lexington. At first glance, the hospital seems an unlikely
candidate for I.T. success: a 61-bed general, acute care
hospital with a non-24-hour pharmacy, one hospital-managed
physician practice, and only 10 private practices in the area
with approximately 17 physicians. Although Harrison is 65%
Medicare-driven and located in rural Kentucky, the Board of
Directors is committed to technological advancements, and the
results of that commitment are getting a lot of attention.
"We are now successfully LIVE with MEDITECH's CPOE
solution and Physician Desktop. At last count, 17 providers
are entering 90% of Harrison Memorial's orders electronically,"
says Martha Sullivan, the hospital's I.S. director. "Going
LIVE with the Physician Desktop—in addition to
CPOE—was crucial to Harrison Memorial's accomplishment.
The physicians really like the Desktop and are very positive
about it."
A
Single Screen for Streamlined Workflow
What exactly is the Physician Desktop? A component of
MEDITECH's Physician Care Manager (PCM), the Desktop
consolidates access to PCM's most commonly-used
functions—including Clinical Review—onto a single
screen, enabling providers to manage their patient
populations more efficiently and to prioritize tasks.
"The Physician Desktop provides patient data in a much
improved, streamlined manner, allowing me to access and view
information in a clear and concise format," says Stephen
Besson, MD, internist and physician liaison at Harrison
Memorial.
In addition to simplifying data access and views, the Desktop
also makes rounds easier on physicians. Sullivan notes that
their favorite feature is the Rounding List.
"They really like the Rounding List, because it's always
been accurate," she says. "They all understand how
to add another physician to their Rounding List or to remove
one if necessary. They like this level of control. And,
because the Rounding List is patient-driven, it makes it
easier for covering physicians to pick up coverage. They've
also commented on how much they like their newly available
Outpatient Rounding List, as well."
Clinical
Review Enhances Readability
Also popular with Harrison Memorial's physicians is the
Clinical Review component of PCM, which organizes patient
data in easy-to-read formats for quick navigation and
analysis. From the Desktop, physicians have immediate access
to Clinical Review spreadsheets, graphs, and panels. Panels
include multiple values in one location, which shortens the
time spent searching for information and reduces the number
of key strokes. Another benefit for providers — they're
able to sort data by department, date, time, or data item by
simply clicking on the panel header.
It's this efficiency between the Desktop and Clinical Review
that's had the greatest impact on patient safety and quality
at Harrison Memorial. "Physicians are able to see
critical values through Clinical Review, which is always
easily accessible from the Desktop," says Sullivan.
"The color coding and spreadsheet-like charts enhance
readability. Quality is always enhanced when viewing becomes
friendly to the eye and information is arranged in a way that
makes data easy to locate."
In addition to providing fast access to Clinical Review, the
Desktop—when used in conjunction with Clinical
Review—features notifications, immediately available to
physicians upon signing in. Sullivan says, "Dr. Schultad,
a surgeon who's also a physician champion, uses the
notifications functionality. Consultations flow right to his
Desktop, alerting him immediately upon login. He's a big fan
of this capability."
Physician
Champions Set the Course for Implementation Success
Sullivan credits Harrison Memorial's successful PCM
implementation to its two physician champions, Karl Schultad,
MD, the aforementioned surgeon, and Dr. Besson. These two
physician leaders combined efforts to ensure the Desktop
meets the needs of both surgeons and medical doctors.
"Surgeons are heavy users of transfers, so it was very
helpful to have Dr. Schultad's assistance in tailoring the
Desktop to make it most useful for them," says Sullivan.
"Dr. Besson helped map the clinical panels and previewed
the software at medical staff meetings in order to give
physicians as much notice as possible of the implementation.
He worked one-on-one with physicians well before their go-LIVE
to get them ready and ease their fears about the transition.
"Dr. Besson also assisted us with a lot of the building.
He built clinical panels that deliver information quickly to
the physicians, helping to get them on board. He also spent a
couple hours a week building order sets with a pharmacist."
Staggered
Implementation Speeds Acceptance
Harrison Memorial staggered its PCM implementation, going
LIVE with the Physician Desktop and Clinical Review in July
2008, then CPOE in November 2008. Their reasoning? By
training physicians on the Physician Desktop and Clinical
Review first, they would get the providers accustomed to
point-and-click technology with user-friendly features such
as e-Signature, after years of using keyboard navigation in
Patient Care Inquiry (PCI).
Another advantage to the staggered implementation involved
managing physician training. Besson, who trained physicians
one-on-one on both the Desktop and Clinical Review, broke up
the training sessions, so his colleagues would be less apt to
get frustrated with all the changes.
"Physicians less accustomed to technology were a little
apprehensive at the start, so they practiced in test to get
the feel of the software. This turned out to be a great
learning experience," says Sullivan. "For instance,
they turned on all the Desktop's notifications and alerts,
and quickly realized it was too much information at once."
PCM
Implementation Advice
For a smooth PCM implementation, Sullivan recommends
involving a physician, a pharmacist, and a registered nurse
on the core team. She believes hospitals need to consider
input from all three perspectives in order for the core team
to concur on Desktop elements. "Because it will be a
"working rollout," you really need the physicians
to see it favorably," says Sullivan. "You'll also
want to involve clinical people who can communicate well with
physicians. Physicians would rather talk to a nurse on the I.T.
staff than an I.T. person. Providing lunch usually helps, too."
Along with representatives from all three disciplines on the
core team, Sullivan recommends hospitals of comparable size
to Harrison Memorial should dedicate clinical resources to
the project. "We have two dedicated RNs on our I.T.
staff," she says. "Administrators pushed these
resources from the top, because they didn't want the nurses
to be pulled into patient care."
On the physician side, Sullivan suggests recruiting provider
assistance in building order sets. "Even though Dr.
Besson built the order sets, if we could do it over again we
would add one more physician to the team to help offset that
workload," she says.
100% Adoption
Rate, No Mandate
Thanks to a great core team, Harrison had a smooth go-LIVE
which impressed everyone on staff. "Clinical Analysts
Jodie Sharpe and Linda Ring worked with the more nervous
physicians during the rollout," says Sullivan. "In
fact, some of the physicians complained there were too many
resources available to help them. They wanted to try to make
their way through the software without feeling as if they
were being watched, judged, or timed."
After conferring with executives at several other hospitals
regarding whether or not to mandate the Physician Desktop,
Harrison Memorial's administrators strongly encouraged, but
did not require, providers to use the tool. Despite no
official mandate, all in-house, active physicians are at 100%
usage.
In order to accommodate such high user rates, Harrison
Memorial has a physicians' workroom with six PCs on the med/surg
floor. They also have mobile carts with thin clients, which
some physicians use during rounding, as well as a few tablet
devices in the wireless environment.
Paper-Free
Future
Now that their physicians are using the Desktop at 100%,
Harrison Memorial is moving on to other PCM-related goals.
Right now, the organization is rolling out POM to consulting
physicians who typically submit heavy orders. Over the next
year or two, the organization's long-term goal is to
implement Ambulatory Order Management (AOM) in the outpatient
arena.
"Our ultimate goal is to be 100% paperless a few years
from now," says Sullivan. "We're definitely headed
in the right direction with MEDITECH."
MEDITECH
Medical
Information Technology, Inc.
MEDITECH Circle
Westwood, MA 02090
781-821-3000
www.meditech.com