Endoscopy Center Trailblazing With Electronic Documentation

After years of discussion, debate and development, it looks like the electronic medical record (EMR) is finally becoming a reality in healthcare facilities across the nation. Slowly but surely, isolated islands of patient information are being integrated into central data repositories that make password-protected information instantly accessible. Medical institutions like ours, the Endoscopy Center at Winchester Medical, are at the forefront of this pervasive evolution towards the EMR.

One of the reasons that the EMR has been so elusive has been the lack of adequate software to meet widely varying clinical needs. Departments invested hundreds of thousands of dollars in packages that were so complicated to learn, and so cumbersome to use, that clinicians simply bypassed them in favor of conventional dictation and manual record-keeping.

Winchester Medical Center’s Endoscopy Center has managed to avoid this problem, thanks to a sophisticated IT group and a forward-thinking, supportive management team. For years, Winchester Medical Center has been ahead of the pack when it comes to finding IT solutions that address automating processes, streamlining workflows, ensuring patient safety, cutting unnecessary costs and administrative burdens, and improving patient and physician satisfaction.

Greater efficiency, even in a highvolume, high-stress environment

With a total staff of 27, including 15 RNs per day, our department performs more than 12,000 inpatient and outpatient procedures a year — 80 percent of them endoscopic. We average more than 45 patients a day, though we experience occasional spikes that recently reached 68 patients in a single shift. Since we have just 19 private bedrooms, we place a high priority on efficient, streamlined patient throughput that still allows for top-notch patient service without compromising patient care.

It’s an environment that could become chaotic were we not equipped with the right tools. We installed ProVation™ MD for Gastroenterology for our physicians’ use in 1998, and added ProVation RN for our nurses in December of 2002. The two systems work together to automate procedure and nursing documentation as well as coding compliance.

Both systems quickly became a part of our clinical routine, putting us at the forefront of our institution’s EMR drive and helping us accommodate a rapidly growing caseload. We are able to track all our patients and procedures electronically on 12 wireless laptops — one in each of our six procedure rooms, one in the IV room, and five more to cover our 19 pre- and post-procedure bedrooms.

Much of our information gathering is now automated through the software.

For example, when a patient arrives, the system automatically pulls in the patient’s registration information from our scheduling program. And in the procedure room, it automatically captures monitoring data from our EKGs, pulse oximeters, and blood-pressure equipment.

Information that can’t be captured automatically — sedation details, for example — is entered with a click of the mouse or a few keystrokes. By streamlining our information-gathering, we have been able to increase patient throughput without sacrificing patient care.

A flexible solution that evolves as we do

No two endoscopy units are exactly alike, and some tailoring is required of any system that addresses workflow and documentation. Using simple administrative tools, we have been able to tailor the program to mimic our existing workflow — in essence, taking the information we once documented manually on paper forms and making it all electronic. We’re also able to easily add new procedures as we incorporate them into our practice.

This adaptability is a major reason we decided to go with the software in the first place. Some nursing-documentation products tend to be inflexible.

Winchester’s IT group, along with our department administration, was savvy enough to avoid becoming tied to a system that would not evolve as we do. We have configured the software to meet not only our center’s needs, but also the requirements of other hospital departments that track what we do.

Future paperwork reduction expected

The “paperless” movement has finally hit healthcare, and as hospitals struggle in a tough economy, reducing costs spent on unnecessary paperwork is becoming more and more important. An example is our outcomes monitoring, which is tracked by our Performance Improvement department. We used to prepare these reports manually each day, submitting about 1,000 pieces of paper to this department each month. That’s no longer the case. Using our current software package, we’re able to provide the same information in Excel format each month, which immediately identifies issues we need to address. Additionally, software can make a big difference in terms of reducing the volume of paper we deal with. Instead of printing out and distributing multiple copies of paper reports, we will be auto-faxing reports to the referring physicians’ and the endoscopists’ office. Because we now offer a web-based physicians’ portal, finalized reports are automatically available for viewing.

Using technology to streamline audits

One of the benefits of using software like ours is the fact that I can easily pull out the information needed for audits by groups like JCAHO. They’ve always liked the way we collect our data; I believe they’ll now appreciate how quickly and easily we can retrieve the information. Once we capture procedure information electronically, we’re just a few mouse clicks away from retrieving that information for review. That’s a lot more efficient than calling and waiting for paper charts to be tracked down and delivered from the medical records department.

It will also be very easy to accommodate any changes or additions that our auditors might recommend, or that our own facility might institute. Instead of revising multiple forms, we’ll be able to use the software to make any necessary adjustments or additions; the finished reports will be updated automatically.

Doing more with less

We’re anticipating a prompt payback and a solid return on our IT investment. And as we continue to take better advantage of its capabilities, we expect to see further improvements. We’ve already seen significant benefits — our streamlined workflow has positioned us to accommodate ever-increasing volumes of patients without proportionate increases in staff.

In the end, automating means we have more time to do what we got into nursing to do — help the patients who have entrusted their care to Winchester Medical Center. The directive for healthcare is to provide a medical repository that allows quick access to patient information from all service areas — and the Endoscopy Center is already one step ahead in that process. As healthcare continues to embrace technology, the goal needs to be focused on providing intensive, personalized patient service. Our current software system does just that — and I can’t think of any better reason to automate.