HIMSS: Welcome to the starting line--EMR optimization
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In the process of a deployment, an organization can and will find ways to extend its EMR advantage even further, Reese and Levin said during a Feb. 22 HIMSS11 educational session.
Sentara began its EMR selection process in 2003, signing Epic in 2004. The first Sentara hospitals went live in April 2007. The strategy was to deploy one version of software across the eight-hospital organization, and go slow to go fast: “Do it right the first time and then accelerate through your implementations,” Reese said. Sentara christened its system eCare.
Taking a long view was critical for Sentara, which budgeted for a 10-year horizon: The total cost of EMR ownership was pegged at $237 million over 10 years, with an estimated savings of $35 million annually. Expenses were loaded at the front end, with very little in the way of expected short-term benefits: It took $4 million per month to carry the project, said Reese.
“Most organizations don’t recognize that if they slow down their implementation rate, they’ll have a burn rate that could be 2 percent to 3 percent of the bottom line. You’re paying for new software, teams, etc., and you’re paying for your old environment," he said.
New expenses included adding 189 FTEs for the implementation project. “We thought it would be better if IT taught doctors and nurses; we didn’t think we could teach IT pros. That slowed us down initially, but in the end, it gave us a better project,” Reese said. Optimization teams remain with each hospital for two years, he said.
The results: 117,400 potential medical errors have been avoided to due to barcoding. Medication administration time—the average time from order to availability—went from 59 minutes to 4.5 minutes, and Sentara currently has a computerized physician order entry (CPOE) use rate of 87 percent.
“This is not an IT project, this is something that has to be led by clinical and IT people,” said Levin. “If you don’t have a physician group, I strongly encourage you to create one.”
Cycle times for physician ordering and patient receiving dropped from 90 minutes to 30 minutes. Order entry dropped to four minutes, and “now you’ve got pharmacists who are much more focused on cognitive activity,” Levin said.
The turning point for acceptance of Sentara’s EMR was the response to H1N1 that it enabled. When the potential for an epidemic in the area became apparent, the organization analyzed EMR data to show where patients were being seen. It designed order sets and documentation templates that prompted physicians to ask the right questions and document the results. The platform itself could be used to get word out. Finally, Sentara used volumetric reports to intelligently allocate resources such as vaccine or respiratory masks.
“We were able to instantly put best practices information and tools in the hands of the community all at once. The response was amazing: After the pain and suffering of implementing and stabilizing the EMR system, people really got it.” The templates worked and the organization was able to handle the spike in volume without adding staff, Levin added.
Sentara is now aiming to be in the top 10 percent clinically, in patient satisfaction, employee satisfaction and financial stewardship.
But simple improvement is not enough, said Levin. We’re going to see an exit from hospitals to care outside the acute care setting. We’re going to improve outcomes, increase same-day access, and focus more on coordination of care. If you engage the outpatient world and create greater access, and engage patients shortly after discharge, in an acute care setting, you can have a pretty dramatic impact.
“In effect, we climbed out of the horse and buggy into a Model T,” he said. “It’s not a Ferrari yet, but it’s better than where we were.”