Project to transform clinical care marches ahead

Team Selects Vendor, Approaches State for Approval

Plans are progressing for URMC’s Clinical Transformation Project – a wide-sweeping effort to begin building a fully integrated, patient-centric electronic medical record (EMR) that stretches across our entire acute care system. Powered by this new technology – which will complement the Medical Center’s existing ambulatory EMR platform, Allscripts – caregivers will be able to collaborate better than ever to promote patient safety, deliver care more efficiently, and better mine data for clinical research.

Since the project’s success hinges on the support of the clinicians who will adopt it, a 200-person, multi-disciplinary Provider Advisory Committee has been instrumental in steering the project, right from the start. Impressively, earlier this year, this committee wrapped up a rigorous, 6-month selection process, unanimously recommending a top-choice vendor partner. Though the partner’s name cannot be released until contract negotiations finalize – likely this coming fall – URMC’s chief information officer, Jerry Powell, says the vendor promises to be a great functional fit for URMC.

“Software was just a small part of what we were looking for; we really needed someone who would collaborate alongside us. This company’s standout dedication to customer service at a number of top academic medical centers really impressed us,” Powell said.

Like other capital projects slated to start this year, the bleak national financial forecast pressed leaders from both the clinical selection committee and Information Systems Division (ISD) to scale back the project’s scope by 20 to 25 percent. As an additional funding source, URMC hopes to secure $8 million for the project from the $19 billion pot of federal stimulus money explicitly earmarked by President Obama for revamping health care technology and recordkeeping nationwide. Under the current project financing plan, the remaining costs will be funded through a combination of cash equity and long-term debt – when credit market opportunities are identified.

“This project remains essential in order to compete for talented recruits and research funding,” said Medical Center C.E.O. Bradford Berk, M.D., Ph.D. “This is a very substantial capital investment, especially in the face of a volatile national economy that complicates financing. However, we absolutely require this degree of comprehensive integration if we are to realize the full vision of our strategic plan and achieve the high standards of service, quality and safety that we demand of our organization.”

Earlier this spring, the project team spoke to boards at both URMC and Highland Hospital, securing approval to approach the state with a certificate of need (CON) – a mandatory application step assuring that, whenever health care organizations embark on a major construction or technology project, community need warrants it. Securing the state’s CON approval could take until August or September, at which point Medical Center leaders would approach both hospital boards to secure authorization to start the implementation project (again, pending approval from Finance).

A clean, consolidated view

The project’s modified scope still showcases a single, patient-centric EMR that replaces disparate systems. The initial roll-out will be to inpatient units (where it will replace the current CIS, or clinical information system), ED, pharmacy and oncology. Additional clinical areas were originally targeted, but plans were scaled back in light of the difficult financial environment.

“As financing permits, we still plan to launch this same integrated solution in remaining key areas – including cardiology, OBGYN, transplant, peri-op, anesthesia and radiology,” Powell said. “It’s hard to settle on an exact time horizon, but hopefully in the next three to five years.”

This comprehensive view – pooling a patient’s medical information into a single system – streamlines clinical care, eliminating duplicate testing and the need to transfer paper records from one caregiver to another. The new solution also supplies clinical decision-making support, and provides a more robust means for coalescing data for translational research, tracking core measures, and conducting operations analyses and other required reports.

“This is all part of the push towards a paperless environment,” Powell said. “The technology provides an unprecedented opportunity to protect our patients.”

Now, for instance, clinicians may enter medication orders electronically and a printed paper order is re-keyed by the pharmacist. When the order and medication reaches the floor the nurse completes a paper “medication administration record,” each manual step introduces potential for error.

“Statistics show that between 26 to 38 percent of all medication errors happen during administration,” Powell said. “But our new integrated solution will close the loop, allowing clinicians to verify information on the patient wristband, medicine bottle and Smart Pump, and then cross-reference those with the computerized order-entry system. This ensures that the right patient receives the right dose of the right medicine at the right time, via the right route and from the right caregiver.”

Any discrepancies would flag an alert, prompting clinicians to review the order and potentially avoid an adverse event.

In oncology, a unique department serving patients whose status constantly vacillates between “outpatient” and “inpatient” – and the ED, which uses multiple standalone systems that must be accessed one at a time – shifting to one overarching solution will be especially dramatic in improving ability to deliver the highest quality and safety of care.

As in the original plans, the project will also include “middleware” technology, which allows the new EMR to interface (or “talk”) with the hospital’s existing information systems (e.g., Flowcast and HBOC Star), and an Enterprise Master Patient Index tool, which “matches” Strong and Highland medical record numbers for a consolidated view of a patient’s record. Plans also include community physician access to the new EMR.

Execution: Tapping Departmental Talent

“This project demands an enormous investment of talent, likely requiring that some individual departmental professionals are re-deployed to this project,” Powell said.

Pointing out that change is rarely comfortable, and that no technology is a perfect solution, Powell and his team are nevertheless encouraged by the success seen by other academic medical centers that have embarked on similar projects.

“Many of them have thrived with this same sort of rapid-implementation approach to installing these new systems,” he said.

Assuming plans progress smoothly and state approval is secured, URMC hopes to begin installation in fall ’09. From that point, it will take approximately 18 months to go live at Strong, replacing the current CIS, Pharmacy, EDIS and Physician Portal systems with the integrated solution. At “go-live,” ancillary systems – including the labs, Radiology and possibly even Food and Nutrition Services – also will be linked into the new system.

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