1 Glacial Ridge Health System now at the forefront of Electronic Medical Record SUCCESS STORY
2 Glacial Ridge Health System (GRHS) is a non-profit, 501(c)(3), 19-bed, critical access hospital in Glenwood, Minnesota. Three area medical centers are under its umbrella: Glenwood Medical Center and two satellite clinics, Brooten Medical Center and Kensington Medical Center. All physicians work in the hospital and the clinics. GRHS provides medical, surgical and acute care, 24-hour emergency services, outpatient services, specialty services, health education, and support group, home and hospice care to a population of approximately 12,000 residents in Pope County. It employs 200 people, including nine physicians and two NPs, and is governed by a district board of directors. The mission of GRHS is to provide high quality services to enhance quality of life and promote healthy lifestyles for patients, clients, employees, organization and communities. It seeks to lead by example through compassionate, caring and comprehensive health care services. Background GRHS was one of Healthland s first customers and began using its core financial applications in 1981, including financials/revenue cycle management, physician practice management, and appointment scheduler. However, because the then-ceo was technology averse, GRHS did only enough to get by and little else. All that changed in June of 2005 when Kirk Stensrud, an ardent proponent of technology and an early adopter, was named CEO. Stensrud formed a strategic planning committee to assess the use of technology and what GRHS should implement, and to determine and monitor a migration path. That committee included physicians who were strong advocates of technology, among them the hospital s chief of staff. Around the same time, a federal mandate was issued that hospitals nationwide need to be using EMR by 2015, giving Stensrud and the strategic planning committee even more incentive to act quickly. The committee recommended beginning the transition to EMR immediately and implementing both financial and clinical solutions. Long-term goals included: Having a fully integrated EMR system that is totally redundant. The ability to share information with facilities outside of GRHS. Better and more accurate clinical information to improve patient outcomes. Electronic billing, improved revenue cycle management and more accurate financial information and reporting. Process A health information technology (HIT) squad was created and held its first meeting In December This squad was and continues to be made up of staff members from each of GRHS s departments and clinics to ensure accurate representation. The squad reviewed the technology that GRHS currently had in place as well as the equipment and solutions that were needed and wanted to implement EMR. A number of vendor systems were considered but it was ultimately determined that Healthland provided the best value. Because GRHS already had Healthland financial systems in place, the transition to EMR has involved learning to use those applications as well as purchasing and implementing various clinical applications. Since May of 2006, when Healthland s transcription application was implemented, the vast majority of processes at GRHS have become electronic. This includes patient intake, clinical documentation, patient care guidelines, medication management, lab result review, medical messaging, patient care instructions, and data retrieval. The final step on the initial EMR migration path began in May 2008, when GRHS went live with the first phase of implementing physician practice documentation (PPD), software that enables physicians to take notes electronically during a patient exam instead of after it. In 2010, computerized physician order entry (CPOE) will be implemented. This will allow physicians to place orders electronically instead of writing them by hand and having a nurse then transcribe them into the system. This will save time and enhance security and accuracy.
3 Scanning One of the things that distinguishes GRHS from other facilities is its implementation of EMR is scanning. The majority of facilities hire third-party vendors to take at least a significant portion of charts offsite and scan them, a sizable task in and of itself. After careful consideration, GRHS decided against outsourcing and undertook the entire process internally. They thought doing scanning themselves would give them better control of the final product and be less expensive than sending documents off-site. Scanning has been done in phases. In the fall of 2006, reference lab, pathology and signed x-ray reports were scanned. In January of 2007, EKGs and advance directives were scanned; in July 2007, ER charts and consults and procedure notes were scanned. Batch scanning of patient charts began in the summer of 2007, starting with historical patient charts. Current clinic charts are now being scanned; this remains an ongoing project. The process entails scanning documents, verifying back-up, then shredding the original documents. At the outset of the batch-scanning process, a total of 450 linear feet of medical records required scanning; approximately 220 feet have been scanned thus far. Various issues have arisen throughout the scanning project. Some were solved internally, others required assistance from Healthland. These include: We decided to go paperless because we needed clinical automation as well as centralized electronic access to clinical information. We chose Healthland because it provided the best value. The solutions are integrated and designed specifically for small rural hospitals like ours. - Kirk Stensrud, CEO Documents the staff hadn t created a type for. Determining which documents needed to be scanned in color. Documents that wouldn t scan clearly unless they were scanned in color. Glitches in software and hardware. GRHS has had three employees working full-time on scanning since November of Initially, GRHS anticipated needing two full-time employees on this project: one for prepping and another for scanning. However, GRHS was advised by Healthland and another facility that the ratio of prepping to scanning staff should be 2:1, and added the second prepping person. Once the scanning project is complete, these employees will be reallocated to other departments. GRHS has learned that neither the prepping nor the scanning staff needs a medical education or medical experience. Rather, the prepping person, who takes the lead role in the project, needs to be highly detail oriented even while working at a repetitive task for long periods of time. The scanning staff needs to be detail oriented and computer savvy. This information could be useful to other facilities seeking to undertake scanning internally.
4 Training From the outset of the EMR implementation, training has been an ongoing priority. In May of 2006, when the implementation of various clinical solutions began in earnest, GRHS hired an IT manager. Not only did GRHS not have anyone to oversee the EMR project, they didn t have an IT department and realized it was time to create one. The first obstacle the IT manager had to overcome was getting staff accustomed to using a computer, no small task in that only one quarter of employees were computer literate. At the IT manager s recommendation, brief computer classes were held. As incentive to attend, training was not necessarily work-related, for example, employees were taught to create flyers in Microsoft Word. The goal of these classes was simply to get staff comfortable with using a mouse and keyboard. GRHS conducted training in this manner for approximately six months, during which time half of the nursing staff learned Healthland s Order Entry application. Physicians were taught one-on-one with excellent results. GRHS had heard from other facilities that physician training is best done this way. Classes were held occasionally at first; later, numerous classes were available. A physician champion created charts that highlighted how processes were done on paper and how they would be done using EMR. One-on-one classes and refresher courses continue to be held for physicians. In addition, all users receive formal training on specific applications by Healthland. These sessions are held at GRHS and last one week. Healthland recommended segmenting users by ability: those with solid computer skills and those who are newcomers. Healthland also encouraged dedicating a room to training, which GRHS did. Prior to the implementation of every application, Healthland sent a training timeline to GRHS where it was reviewed, possibly modified, and sent back to Healthland. In a typical scenario, the Healthland representative arrives at GRHS on Mondays and conducts training daily, including an exit meeting on Fridays. Following onsite training, Healthland representatives are available by phone and e- mail to address questions and concerns. A GRHS clinical systems coordinator is also available to assist staff with questions. Moreover, super users have been trained and are assigned to assist employees by application or department. Training opportunities include: Online keyboarding classes are available to anyone who wants or needs practice. Users have 24/7 access to a training room where they can practice with test patients. Sample worksheets and quizzes test knowledge after training. Process maps have been created for how workflow is done by department pre- and post-emr. An EMR project binder is available in each department and houses information on updates and changes to the system. All staff members are required to read and sign-off on this material. A semi-monthly EMR e-newsletter highlights accomplishments, current projects, and what s coming in the future. Hard copies of the newsletter are also placed in the hospital s various departments. Weekly EMR clinical meetings are held. EMR teams come together to discuss current concerns and issues. If problems are due to a lack in training, classes are set up. Obstacles One of the main obstacles involved getting staff on board with using technology. At the outset of the EMR initiative, reactions to using technology were mixed. Half of the physicians and nurses were excited about using technology, half were not. But regardless of where people fell on the technology continuum, everyone had to realign their thought processes and learn to do their jobs in a new way. At this point, there is no longer any doubt in anyone s mind at GRHS that EMR is invaluable in creating efficiencies and improving patient outcomes. Staffing was also an issue at the outset of the EMR implementation. GRHS simply didn t have enough IT staff to take care of the system nor did they have anyone dedicated to training. Healthland provided assistance on an as-needed basis. As IT people have been put into place and training becomes less of an issue, GRHS becomes increasingly self-sufficient.
5 Technology GRHS s hardware investment includes the purchase of two servers, approximately 100 desktop computers, two computers on wheels (COWs), and six laptops. The laptops and COWS are scattered throughout these areas and are used as the staff sees fit. No financial software was purchased but all of the clinical software was purchased. The IT manager ordered all of the PCs and installed all of the software. The clinic exam rooms, clinic procedure rooms, hospital patient rooms, ER, OR, outreach areas, laboratory, radiology, dietary, clinic nurses stations, hospital nurses stations, health information management, pharmacy, and provider offices are all hard-wired with desktop computers. A wireless network is also available, giving providers the option of taking laptops with them into the exam room. When bar coding is implemented, the scanning of bar codes will be done using hand-held devices. Both the medication and the patient s ID bracelet will be scanned prior to the administration of meds. Benefits There is complete technological transparency between the hospital and the clinics, and all facilities are realizing a number of benefits as a result of EMR. Reduction in medication errors Because medication orders are typed instead of handwritten, they re legible, which greatly reduces medication error. In addition, now that medication administration records are online, all providers have immediate access to a patient s medication history. As a result, no time is misspent looking for charts. Also, the ordering of medications that are redundant or contradicting has been vastly reduced. Physician satisfaction Physician satisfaction with EMR increases as the implementation continues: each application makes more information available, including lab and radiology reports. Once the integration of PPD is complete, physicians will see in yet another way how EMR saves time and facilitates their work. Improved patient care EMR provides a number of efficiencies that directly affect patient care, including: No time spent looking for chart, saving anywhere from a few minutes to a few hours per chart. More secure patient information. Easier to share information between GRHS s various departments and clinics. Clinicians have ready access to the latest patient information. Improved patient experience Because of EMR, all patient information is available electronically allergies, medical history, and so on. This frees patients from filling out health or insurance information forms multiple times. Also, because physician orders and lab requests are handled electronically, patients no longer have to carry reports or orders with them when going from clinic to lab to hospital and so on. The time we re saving because of not having to search for patient charts is considerable. Our providers have immediate access to current patient information from any workstation. That in and of itself makes the transition to EMR invaluable. - Lynn Flesner, Director of Nursing General efficiencies Not having to copy or file documents at multiple locations. This will ultimately reduce the number of full-time employees who currently handle this task from three to one. No need to search for patients charts. Providers have immediate access to current patient information from any workstation. Reduction in hard copy medical record pulls/requests. This will eventually be reduced to near zero. Prior to implementing EMR, charts would have to be found and pulled for every patient. To date, approximately half of patients records have been scanned. Once scanning is complete, all medical records will be available electronically. The health information management department uses document routing to autoprint transcribed documents to various locations, which is more efficient than having someone make and deliver copies. Billing is streamlined and far more accurate. Charges are transmitted immediately from any given department to accounting, vastly minimizing lost charges.
6 Cost / ROI GRHS has made a significant investment in hardware, software, and staff time, including temporary FTEs for scanning. The facility has applied for little in terms of state or federal funds, grants, and loans. To date, GRHS doesn t have enough hard data to provide specific data on ROI, although reduction in lost charges is estimated to be approximately $10,000 a month in the clinic. This will also eliminate the need to have a full-time employee dedicated to handling charges. Metrics to measure the success of solutions include: Financial days in A/R and days to bill Provider approval of transcribed documents Compliance Evaluation GRHS has made remarkable progress in a short amount of time. In less than three years, they have made the transition from not doing real-time admissions to being at the forefront of EMR. Healthland has provided assistance during our transition to EMR every step of the way, including overseeing implementation, conducting training onsite, and helping us determine best practices for undertaking scanning internally. Once the nursing documentation and physician practice documentation projects are concluded and electronic patient signature is added, GRHS will be as advanced as any medical facility can get in terms of EMR. This is due in no small part to the facility s aggressive schedule for implementing EMR and to providing dedicated internal resources to ensure success. The HIT squad continues to coordinate the involvement of all departments and deals with issues and process-flow changes on a day-to-day basis. Moreover, this team is continually learning about electronic information management and puts policies and procedures in place as issues develop. GRHS is also exceptional for its decision to handle scanning internally and for its attitude. They are completely behind the transition to EMR and believe in the philosophy of a one-vendor solution. In other words, their sense of ownership of EMR is high and because of that, they make every effort to make it work. Future plans include: Biometric sign-on Fully electronic records between hospital and clinics Paperless charts or as close as possible Completion of scanning, patient care guidelines & Physician Practice Documentation System redundancy Barcode medication administration, fall/winter 2008 Reference lab interfaced to Healthland, winter 2009 Patient photos, summer 2009 Surgery management, spring 2009 Patient signatures, spring 2009 ER documentation, fall 2009 CPOE investigation to begin in Heidi Engle, IT Manager If they can do it, you can too. To learn more about our products and services and how Healthland can help your hospital become paperless, contact us at or Healthland. All rights reserved.
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