Jul 11, 2009 - 4 Comments - healthcare, industry, technology -

EHR/HIT done right and save too!

Recycle that paper

Ever suffer from too much paperwork? Now multiply that by a a few thousand employees and a monumental cost ensues. To bring costs down and increase productivity you would have to reduce the use of hard copy documents. Is it possible for several thousand people to just stop using paper? Here is how one hospital system solved that issue.

Banner Health, a hospital system in Phoenix, Arizona was so convinced that the uncoordinated systems that they originally had in place, was not working for them that when they built their new hospital they purposely attempted to standardize all policies. Hospitals generate lots of paperwork, they need to for your records. Banner Health knew that the old methods of workflow were not consistent among departments and so during the building of the new facility they began the revamping of their system, while closely working with input from their clinicians. There is no one universally implemented computer system for hospital automation, their are some at the forefront but often its very difficult to work them into an expanded hospital. Many hospitals started small, but over time they grew as the needs of the community grew. So too the technology and the ability to help people recover did as well. So goes the build up of differing systems in a hospital and lots of paperwork. How a new system starts is by workflow modeling,

The modeling of prescription workflows or other complex systems requires tools, like any other thing we build, analysis and a requirement to develop testable and repeatable error free logical arrays, or decision points that are not redundant or return errors when can come back coded later on into software applications a hospital could use. Some of these tools are linguistic analysis and UML. One specific UML modeling tool is Rational Rose. IBM makes Rational Rose.

First, the existing business model that the stakeholders wish to modify is analyzed. Stakeholders could be doctors and nurses Once the previous system is analyzed, the new system is built from building blocks of predefined type. What is to be kept or left from the old system is a decision for the modeler and the stakeholder’s decision to make. The modeler is the professional software designer that was hired to build the new electronic health record system, or any other healthcare system. That which is kept from the old system is included in the new through building blocks as well. These predefined building blocks could be human activities, system or computer processes and decision points. Because the modeling of health care systems involves many systems and many constituents it is often called enterprise modeling. Enterprise modeling most often involves a facilitator who in a chauffeured manner drives the modeling process forward. The chauffeur typically uses modeling tools, such as computers, modeling software and other tools such as simple drawing mechanism.

When Banner Healthcare was building their new hospital they drew up new software for the building to be equipped with and the clinicians to use. One of the things they focused on was the modeling and modification of prescription workflows in their hospitals. Banner Health Care with input from doctors, nurses, administration, IT and other staff was able to alter 92 of its internal processes in a dozen core areas. Banner Health care was able to change processes across departmental lines and interactions that occur between multiple departments.

Between January and June 2007 Banner Estrella Medical Center had 29.9% fewer medical error claims as well as 71.8% lower costs due to those lower claim rates. Banner Estrella had 15.8% fewer nurses leaving the hospital system once the new EHR system was in place as well as 15.8% less cost associated with replacing the nurses who left the hospital system. Banner Estrella had 5.3% less costs incurred for overtime expenditures, 17.8% lower pharmacy and drug costs and a 95.6% lower cost in document storage per 1,000 persons. These safety and overall efficiency increases amounted to a 2.6 million dollar savings due to overall efficiency increases from January 2006 to June 2006 of that year. Ninety-five percent less cost on paper, neat!

St. Jude Children’s Hospital is another example. St. Jude has implemented the Open Clinical Foundation program which stores electronic medical records, a data storage facility, Powerchart which allows users to access data by a graphical interface, and Discern Expert which lists searchable details on best clinical practices, all use built-in clinical based rule systems. Moreover, EHR’s, when fully implemented lower medication error rates. With Banner Estrella Medical Center in Phoenix, quality, safety and efficiency metrics were used to define how their new EHR/HIT systems affected their hospital systems as well as patient care. Avoidance of adverse drug events, reduction in medical claims, increases in nurse retention, overtime reduction, pharmacy costs and document storage costs reduction were found during the study period between January and June of 2006. St Jude and Banner Estrella are examples where EHR’s was adopted whereby, IT not only created safer hospitals, but helped patients get better faster, with less cost for everyone. That’s not bad at all. Hats to St. Jude Children’s Research Hospital, Banner Healthcare and IBM for Rational Rose.

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