Our Latest Stage 6 Customer: Erie County Medical Center
In pursuing an integrated I.T. system throughout their organization, leaders at Erie County make patient safety and care quality a priority.
(4/21/2011)

When you work at a cutting-edge teaching hospital, achieving Stage 6 Recognition is just one stop along the winding path to excellence. Just ask the folks at Erie County Medical Center (ECMC) in Buffalo, New York. Although they are happy to acknowledge their success in reaching Stage 6, Erie County's leaders are already looking ahead to their next goal.

"We are very proud of the work everyone in our organization has done to reach Stage 6," says Erie County CIO Leslie Feidt. "It's been a long time coming for our physicians and for our clinical environment, but we have a lot more to do yet."

A Platform for Excellence
ECMC delivers a wide spectrum of care from pediatrics to geriatrics, including a fully automated Behavioral Health unit. The medical center is LIVE "house-wide" with MEDITECH's Bedside Verification (BV) and Nursing documentation, and has implemented CPOE throughout many of its emergency and outpatient units.

Since recently becoming one of only fifteen nationwide winners of ARRA's Beacon Community Program grant, ECMC plans to use that funding to complete their MEDITECH Advanced Clinicals implementation. Its 5.6 go-LIVE later this year will bring physician ordering and documentation functionality to inpatient floors, including med/surg and the ICU, and also complete the roll-out within the main Emergency Department. This will allow the hospital to share information from the ED, such as discharge documentation, with home health agencies.

"Having an integrated system is key to providing care across the continuum. We look to get everything we can out of the technology," says Feidt.

Patient-Centric and Technology-Driven
Prior to learning about the HIMSS Analytics EMR Adoption Model, ECMC already had a Clinical Informatics Steering Committee in place to rate project priorities. The committee included staff members from Pharmacy and Nursing at each meeting, which is one of the reasons for their successful BV deployment.

"Never underestimate the importance of including all the right people, who can actually do what you know needs to get done," emphasizes ECMC's Healthcare Information System Specialist Larry Moessinger. "When all parties come to the table, and you take the time to hear your staff out and embrace their ideas, it really does speak to the success of your implementation."

Feidt adds that ECMC's main focus has always been on electronic medical records and patient safety. "By implementing Nursing documentation and BV first, we were poised to introduce more functionality throughout all areas of our organization," she says.

Moessinger agrees: "Once our physicians saw the benefits of the Nursing documentation and having key information at their fingertips, they came to us looking for more tools."

In addition, ECMC's residents are able to enter orders into the system. Physicians can then see the on-line orders and any associated Nursing notes, fostering an environment of more informed decision-making. "Open communication still occurs, but information is always available when our physicians need it," says Feidt. "After our residents use the electronic tools, they don't ever want to go back to using paper."

Increasing Clinician Usage
To help bolster system interaction with their generational-mix of physicians, the I.T. department offers a variety of hardware devices, including dual monitors. Moessinger says placing the dual monitors in some locations was an idea piloted to encourage use of the EMR. "Because our clinicians each had different degrees of comfort with I.T., the goal was to encourage system use by making it available to everyone at every level of technology," he says.

"We outfitted one of our physician meeting rooms with the monitors and it has worked out well. Our physicians are using the EMR a lot more. They look at Nursing notes, which automatically populate the physician documentation, as well as perform look-ups of best practices on one monitor, while viewing the patient chart on the other."

Although physician buy-in has been particularly strong at ECMC, Feidt hopes other hospitals don't overlook the role of the physician champion in overcoming resistance. "It is critical to have a physician champion for every project involving the Advanced Clinicals," she says. "You need to have someone leading the charge and taking ownership from a clinical point of view. No system out there is perfect, which is why one of the biggest challenges is setting and managing reasonable expectations."

Both Feidt and Moessinger believe that a successful implementation is also about being honest. "It's important to be clear that I.T. isn't so much about doing things faster, but about improving patient safety and the quality of care so that you can decrease the patient's length of stay," Feidt says. "And we've definitely found that physicians who are ordering and documenting on-line have better turnaround times for things such as lab results."

Well-Positioned for ARRA
With Stage 6 now under their belts, the folks at ECMC are already preparing for the next stop along their journey to Destination Excellence. Hospital leaders recently created an ARRA interdisciplinary team to look at gaps and variances with the hospital's reporting measures.

"We already do a lot of reporting to the State of New York, and after reaching Stage 6, we now have even more quantitative data we can use," says Feidt. "We can share information electronically and develop more core measures, which will help us with ARRA compliance."

The folks at ECMC feel strongly that they will soon have enough solutions in place to be one of first hospitals in the nation to implement and demonstrate Meaningful Use certified EHR technology. "We are very focused on moving forward with I.T.," says Feidt. "I guess you might say we're perfectionists, but we feel it's expected of us. Our patients deserve nothing less."