Digital chart forms an intuitive record for Calvary Bethlehem

Little Company of Mary Health Care (LCMHC) is planning to roll out clinical chart books based on Slainte Healthcare's Vitro electronic patient chart in its private hospitals following a proof-of-concept trial at Calvary Health Care Bethlehem in Melbourne.

Vitro is able to replicate the look and feel of paper-based clinical forms as a digital record, and can integrate with a range of other clinical information systems such as electronic medication management (EMM) and patient administration systems (PAS).

At Calvary Health Care Bethlehem, Vitro is used alongside CSC's iPM PAS and MedChart EMM to create what is in effect a full electronic medical record, without the expense and the major change management challenges associated with a full EMR implementation.

Brenda Ainsworth, national director public hospitals for LCMHC, said the organisation had been investigating implementing an electronic record at Bethlehem for some time, both for improved safety and efficiency reasons, but the drawback was the cost.

“Most of the EMRs around do not cater for the smaller, leaner hospital and the cost makes them almost prohibitive,” Ms Ainsworth said. “So I was looking for a solution that was easy to implement, that staff would take to easily, that was quite intuitive and that would not break the bank, and that’s what the Vitro solution was offering.”

Ms Ainsworth said she was also looking for a product that would assist the patient journey. Calvary Health Care Bethlehem is a 60-bed public hospital that provides a statewide service for people with progressive neurological disorders such as motor neuron disease, multiple sclerosis, Parkinson's disease and Huntington’s disease, as well as providing palliative care services.

One of the reasons for going electronic was to ensure the patient's clinical record could be viewed across the continuum of care and in a variety of care settings, she said.

“Bethlehem cares for many patients from when they are diagnosed to often times when they die. Along with our 60 beds, we also provide access to multidisciplinary clinics and provide community-based care.

“With our patients, because they access our services at multiple entry points, not having to have them repeat the same information is important. Feedback from patients indicate that this is one of their greatest frustrations and having staff able to access the information in a timely manner from a variety of care setting was paramount to a seamless patient journey.

“Having a record that, if one week you’re an in-patient, but the next week you are attending a clinic appointment, and then the next week you are at home and having a community nurse visit you, you are still be able to access, in real time and with the most up to date information – how great is that?”

While ruling out any of the larger EMR products due to cost and change management challenges, Ms Ainsworth said she didn't seriously consider a scanned electronic medical record. The Vitro solution had the advantage of being able to replicate the many clinical forms that had been developed over time, was intuitive to use as it resembled the workflow of paper forms, and was also able to replicate treatment pathways and protocols familiar to clinicians.

In addition to looking like the forms commonly used, the product doesn't come with the huge change management implications of a full EMR. While the organisation was planning to conduct in-depth training sessions, it has found that training for super users in association with just-in-time (JIT) training for other staff was the best method.

“We had set up to do some significant training with staff but for staff on the wards, just-in-time training was much better and we are doing that now,” Ms Ainsworth said. “We set it up as a traditional implementation of an ICT product and we thought we’d use what had worked before, but because of having some good change management strategies in place and because it was very intuitive, the just-in-time training seems to work much better and is much more cost effective in the inpatient setting. And it’s more meaningful.”

Clinical chart book

Following the introduction of Vitro, Bethlehem has been able to reduce the number of forms used to a more manageable level. Ms Ainsworth said there were in excess of 150 forms – both inpatient and outpatient – commonly used, but this has been streamlined to about 67.

The technology is able to fully replicate the look and feel of paper forms, but also has a lot of smarts under the hood that have allowed the hospital and Slainte Healthcare to build in some extra safety mechanisms.

For nursing staff, there is now the ability to automatically sum up things like fluid balance summary sheets at the end of a shift, as well as add flags for when vital signs or fluid measurements fall below or above parameters.

“You don't make mistakes adding up,” Ms Ainsworth said. “You don't have to worry about whether you have transposed the right information. It is an automatic prompt and an automatic way of adding up.

“If the urine drops to a low amount, then it will flag that for the staff so that they would see it was unusual, and they should call someone. It is a prompt to say, is this OK?

“The change to digital forms has also given us the opportunity to review and update our forms ensuring they meet Australian standards in their formatting. Everything now has the same font and the correct pantone colour. With the digital format you can get that really right.”

What Vitro has in effect been able to do is create an eClinical record or chart book at a fraction of the cost of an EMR. All clinical assessments and progress notes are in one place, and it works hand in hand with the electronic medications chart as well.

The hospital has been able to add audit trails to the system so users can see what documentation is available, what has been added or removed, and to strike out data in progress notes just as you would using a paper form.

“Obviously the progress notes are much more legible but we are also finding that people are writing more thorough assessments, because they know that you don’t have to write it twice or three times,” Ms Ainsworth said. “And if you write it, people will actually look at it. We’re finding that the quality of our documentation, particularly in the progress notes, has really improved.

“Between having iPM, MedChart and Vitro, we’ve pretty much got an EMR. We are still scanning in diagnostic results at present as these were considered low volume for the first phase roll-out, however we would like to move to an integrated model for results as well in the next year or so.”

Now the plan is to introduce Vitro to some of the Little Company of Mary Health Care’s private hospitals, where it will function as a clinical chart book, she said.

“We’re not rolling out a whole clinical record, just the types of things that would be on the end of the bed. Your observation chart, fluid balance charts, whatever would normally be on the end of the bed on a clipboard, we will have it on a tablet.”

Posted in Australian eHealth

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