Paradise Valley Hospital Adopts Best-of-Suite Path to Better and Safer Care

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1 CliniComp, Intl. CUSTOMER SUCCESS STORY PARADISE VALLEY HOSPITAL Number of beds Number of physicians: (including 13 Obstetricians) Number of nurses (including 45 perinatal RNs) Annual inpatient discharges... 14,167 Annual deliveries... 1,189 CRITICAL ISSUES: Patient Safety Quality of Care Workflow efficiency and care coordination Real-time access to accurate and complete patient information Liability risk The beauty of Essentris is that it merges everything together. We chose CliniComp because its clinical documentation was integrated with fetal monitoring. Also, competing EMR vendors could not match or deliver the plethora of application capabilities CliniComp offered, Paradise Valley Hospital Adopts Best-of-Suite Path to Better and Safer Care For years, obstetric (OB) physicians and nurses at Paradise Valley Hospital (PVH) routinely charted on paper and closely watched fetal monitors so they could spring into action at the first sign of trouble with expectant mothers. The fragmented paperand-fetal monitoring system created workflow inefficiencies that led clinicians at the 301-bed facility in National City, California, to spend more time on administrative tasks than on direct patient care. To better support clinicians, streamline care and provide the best possible experience for patients, PVH decided in 2005 to automate its maternity department. The hospital considered but soon rejected extending their existing enterprise electronic medical record (EMR) to the OB unit because it lacked the functionality and features necessary to address their rigorous obstetric care requirements. This decision led the hospital to adopt a best-of-suite automation strategy to cover the critical perinatal gap in its enterprise solution. After evaluating several vendors, PVH determined that the Essentris Perinatal EMR from San Diego-based CliniComp, Intl. would best enable their facility to provide better, safer and more efficient care to expectant mothers and newborns. The beauty of Essentris is that it merges everything together, said Robin Gomez, RN, MSN,. We chose CliniComp because its clinical documentation was integrated with fetal monitoring. Also, competing EMR vendors could not match or deliver the plethora of application capabilities that CliniComp offered.

2 SOLUTION Improves quality of care, safety and workflow by offering realtime access to data spanning the entire perinatal range, from antepartum through postpartum Integrates with a wide range of devices and systems to serve as the core clinician documentation and EMR system Offers a flexible and configurable platform enabling hospitals to quickly address needs as they emerge Performs clinical calculations automatically, imports maternal data to the newborn s record, provides decision support, and manages monitoring and clinical alerts Simplifies data capture with a variety of flowsheet templates Facilitates adherence to standards of care from the American College of Obstetricians and Gynecologists; American Academy of Pediatrics; Association of Women s Health, Obstetric and Neonatal Nurses; and Joint Commission Unlike the system from their existing EMR vendor, for example, Essentris enabled nurses to annotate and document on fetal strips in the electronic medical record at the point of care. When RNs write notes on the electronic strip, that information automatically appears in a digital flowsheet. The process saves nurses considerable time and helps enhance patient safety by giving RNs access to accurate and complete patient information in real time. Prior to Essentris, nurses annotated on paper strips and entered that information into the chart later. This created the possibility that inaccurate information could be incorporated into the chart. The need for accurate and up-to-date information in the OB environment cannot be overstated. Although injuries to mothers, fetuses and newborns are infrequent, OB or labor and delivery (L&D) is the second most litigated medical specialty in a hospital after the emergency department. Healthcare organizations and physicians that perform deliveries pay significantly higher malpractice insurance premiums and judgments for personal injury and death than most hospital areas and specialists. Implementation Challenges PVH, which went live with Essentris in 2005, initially encountered some clinician resistance over concerns about changes to workflow as well as the need to learn a new technology. However, the director of obstetrics, quickly won physician support by approaching and enlisting the chief of obstetrics and obstetricians to champion the EMR. It further secured buy-in by educating and seeking input early and often from doctors and nurses to configure Essentris to support optimal clinical workflows. After they became aware that the EMR s functionality mirrored their workflow and helped them make better informed and safer decisions, clinicians quickly accepted the system. Clinical leadership, stakeholder involvement and team approach are critical to ensuring successful implementation of an EMR, Gomez said. IT personnel can certainly build a system, but they do not understand how nurses and physicians work. You cannot design a user-friendly EMR without the input of the people at ground zero who know clinical workflow best and can tell what will work or what will not. Lack of funding was another challenge. Because PVH s previous owner, Adventist Health, only had enough money to interface Essentris to the admission, discharge and data system, the hospital deployed Essentris without a CPOE interface. This action required doctors to enter orders for a patient separately in their inpatient EMR, creating duplication of data entry. To avoid the possibility of losing physician support, PVH shifted the duplicate data entry task to nurses. At the same time, administrators made it clear to nurses that the situation was temporary and would be addressed at the earliest opportunity. In March 2007, however, Adventist Health sold PVH to Prime Healthcare Services (Prime), which operates13 facilities in California.

3 The sale delayed the planned interface with CPOE because Prime wanted to evaluate PVH s technologies, Gomez said. After examining the situation, Prime deinstalled and replaced our existing EMR system with another commercial facilitywide system. Since the new EMR lacked the OB flowsheet and integrated fetal monitoring capability we had with Essentris, our new owner retained the Essentris system for our obstetrical unit as a best-of-breed exception. IT personnel can certainly build a system, but they do not understand how nurses and physicians work. You cannot design a user-friendly EMR without the input of the people at ground zero who know clinical workflow best and can tell what will work or what will not, Training 45 nurses also proved challenging. Although many hospitals shift mothers to a separate recovery room following birth, PVH houses patients from antepartum, L&D and through postpartum in the same room until discharge to reduce the stress to mothers. Thus, depending on their duties, perinatal nurses at PVH must specialize in two or all three of those specialties. This, in turn, required these nurses to utilize the capabilities of the EMR throughout the entire perinatal continuum. Even though nurses were performing redundant data entry, they were quick to embrace Essentris after experiencing first-hand how the technology was easy to use and relieved them of much of the stress caused by manual documentation processes. Streamlined access to electronic consolidated patient data meant that nurses no longer wasted precious time chasing down paper charts and information for physicians. Nurses found the EMR particularly advantageous when patients were in the late stages of labor, which requires them to do real time documentation quite frequently. In OB, workflow is very fluid and documentation time frames accelerate as labor progresses, Gomez explained. L&D nursing documentation is very demanding from the early stages of labor, when the charting is less frequent, to the later phase of labor when the charting is very frequent. However, they were challenged to keep up with charting demands when we were using paper. It is imperative they place patient safety first, which at times requires them to complete their documentation at a later part of their shift. Essentris allows them to go in and out of screens and enter data quickly and efficiently. The nurses have access to more accurate and up-todate patient information, which enhances decision-making and reduced rework and duplicate orders. The best benefit of Essentris is that it gives nurses more one on one time with their patients. The birth of a child is a very special time for a woman, and L&D nurses have the privilege of using their expertise to enhance that experience for the mother. It is vital to maintain optimal efficiency and Essentris allows us to achieve that.

4 Second Pair of Eyes FETAL MONITORING REMOTE DISPLAY Displays multiple patient fetal information simultaneously in real time from a central station Stores and archives fetal and maternal traces, and generates visual and audible alarms when fetal heart rates are too fast or too slow Alerts nurses when patients are disconnected from fetal monitors Enables users to visualize all monitored patients in one central location Implementing and integrating a perinatal EMR with fetal strip surveillance has substantially enhanced workflow efficiency and helped clinicians provide better, safer and coordinated care. Enhanced quality of care management and patient safety are two significant benefits of the technology. Essentris includes a fetal monitoring remote display (FMRD) that enables nurses to monitor up to 20 patients from a central monitoring station. When a fetal heart rate goes outside normal range (as defined by the hospital for tachycardia and bradycardia) during a contraction, the FMRD sets off visual and audible alarms at the central nursing station. These alarms provide an invaluable second pair of eyes for charge nurses to monitor all antepartum and laboring patients. The charge nurses are responsible to assist the primary nurses in keeping our patients safe and having the central monitoring system allows for that, states Gomez. The charge nurse can get a snap shot of all the antepartum and laboring patients with in one central location. Before the EMR, charge nurses had no efficient way of knowing whether the floor nurses under their supervision had heard and responded to alarms triggered by the fetal monitor. The FMRD resolves this problem by configuring the alarms to sound at the central monitoring location. It also allows for the charge nurses to visualize a problem from its conception. The nurses can go to the room to assist the patient or the primary nurse. Having a central monitoring system, allows the charge nurse to be in more than one room at a time. Prior to the central monitoring system, the charge nurses had to walk from room to room searching for the alarm sounding or look in on every patient under their care, which was extremely inefficient. Another major advantage of Essentris is that its split-screen feature enables nurses to monitor a second patient while being present at an individual s bedside. L&D nurses have a busy workload, as they typically cover two patients until a baby is delivered, Gomez said. Using the split-screen functionality, they can monitor one patient on one screen while charting the care for another patient on a separate screen. This capability is invaluable in maintaining quality of care and safety standards. Essentris also helps PVH deliver safer care by enabling the incorporation of the latest clinical protocols and regulatory requirements from the American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Association of Women s Health, Obstetric and Neonatal Nurses and other entities. Prior to 2005, nurses and physicians were unable to immediately document their adherence to the latest standard of care when new protocols were issued because they had to wait for new charts to arrive.

5 We can easily customize Essentris to our unique needs, which helps a great deal in simplifying the process of preparing for and complying with regulatory requirements from the Joint Commission, Centers for Medicare and Medicaid Services and other agencies, Gomez said. Most of the time we make the programming changes ourselves, and CliniComp is always responsive in helping us complete those more challenging change requests. By adopting a best-of-suite approach to automation, we were able to address the biggest concerns in the OB department, which were to optimize quality, boost safety and reduce potential liability risk. Today, we re on the cusp of deploying a true enterprise-wide EMR that will support continuity of care between the L&D and other hospital areas while advancing the quality and cost effectiveness of care delivery, When we found that nurses were not documenting parent education for their newborn s hearing screen, which is a regulatory requirement, CliniComp assisted in adding that field in the postpartum worksheet, Gomez noted. Within a month, we were 100 percent compliant with the documentation requirement. PVH also made similar changes to address patient safety requirements calling for documentation of anesthesiologists providing informed consent and of the facility taking a time out prior to any procedure in order to decrease risk of error. Results In addition to enhancing regulatory compliance, PVH has used Essentris to realize the following benefits: Increased nursing efficiency The EMR has streamlined a nurse s time to chart a new admission from a range of 90 to 120 minutes down to between 15 and 20 minutes. Because the EMR allows nurses to update records at the bedside, they no longer need extra hours of charting at the end of each day, saving PVH overtime costs. They just bring up the templates, click on drop-down menus and efficiently complete their documentation, Gomez said. Decreased transcription costs. PVH has nearly eliminated dictation and transcription costs for the physicians working in the L&D. Today, obstetricians dictate only complex cases where additional information is needed to complete the description of the patient care provided. Enhanced clinician satisfaction. The solution has boosted clinician satisfaction, consequently strengthening PVH s nursing retention rate, which is at 97 percent, as well as physician retention and recruitment efforts. Essentris also has reduced PVH s legal exposure by helping clinicians practice evidencebased care to minimize medical errors. OB is one of the costliest and most litigated medical specialties partly because successful plaintiffs tend to receive high awards when babies or mothers are injured or die at birth.

6 For more information on Essentris Perinatal and the Essentris suite of electronic medical record solutions, please contact us at or visit us at clinicomp.com PVH, which averages 100 to 120 deliveries monthly, credits Essentris design to support best-practice documentation, the highest quality patient care and efficiency in creating a record of care. In a paper-based environment, for example, L&D nurses commonly write on paper strips, a practice fraught with documentation and medical liability. First, the strip can be misplaced, lost, or fade over time. Second, it would be difficult for PVH to prove when documentation was handwritten. This is especially problematic in cases involving retrospective charting where questions are raised whether the organization deliberately edited or altered a record to hide potential negligence. With Essentris, nurses document on an electronic strip as developments unfold. Integrated time stamps and audit trails provide an unadulterated record of the care delivered. Next Steps PVH anticipates their return on investment from the Essentris system will accelerate this year when the EMR, radiology and laboratory applications from MEDITECH and a medical records archiving system from McKesson Corp. are interconnected for data exchange. The hospital plans to connect Essentris with CPOE from MEDITECH in fourth quarter 2011, followed by a pharmacy information solution interface. Implementing and integrating a perinatal EMR with fetal strip surveillance has substantially enhanced workflow efficiency and helped clinicians provide better, safer and coordinated care, Gomez commented. But we want to drive OB quality, safety and evidence-based practices to a higher level by providing the care team access to a more comprehensive view of the patient s condition. In a perfect world, PVH would have preferred to implement and connect Essentris with ancillary systems from the get-go. However, the reality is that, like every hospital across the nation PVH must prioritize needs due to finite financial resources. CliniComp, Intl Towne Centre Drive San Diego, CA [800] [858] Fax Ultimately, what is important is not how fast an organization can become paperless but that it moves in that direction successfully, Gomez concluded. By adopting a best-of-suite approach to automation, we were able to address the biggest concerns in the OB department, which were to optimize quality, boost safety and reduce potential liability risk. Today, we re on the cusp of deploying a true enterprise-wide EMR that will support continuity of care between the L&D and other hospital areas while advancing the quality and cost effectiveness of care delivery. clinicomp.com Copyright 2010 CliniComp, Intl. All Rights Reserved. Essentris and Essentris Perinatal are registered trademarks of CliniComp Intl.