By Suzi Birz, principal, HiQ Analytics, LLC, contributor
In May 2003, Trinity Health, which operates hospitals and health clinics in seven states, launched an ambitious health information technology initiative known as Genesis, with the goal to install common computer systems and evidence-based clinical practices at every hospital in its health system.
Through this project, Trinity is making history with two advances in its rural hospitals in Iowa – an integrated electronic health system known as EHR10 and a bar code medication administration tool.
EHR10 is believed to be the first integrated network in a rural health care setting in the United States. It has been implemented in seven hospitals that are part of Trinity’s Mercy Health Network-North Iowa.
While larger hospitals are likely to have electronic health records, less than three percent of the nation’s small or rural hospitals (50 beds or less) tout a fully implemented system. Mercy Health’s hospitals implemented computerized physician order entry (CPOE) and other clinical revenue systems.
Every patient’s medical information is stored in one electronic system; everything from allergies to vital statistics, illness history, medication lists, treatment records and nurses’ notes are kept in one place and made readily accessible to doctors, nurses and therapists at the point of care and throughout the network.
“Thanks to the wireless network, all the devices work everywhere,” stated Dar Elbert, RN, MS, assistant administrator and nurse executive at Kossuth Regional Health Center in Algona, Iowa. “Patient safety is improved with immediate availability of the patient’s medical record as well as the latest evidence-based care information which is built into the system.”
Similarly, with EHR10 being integrated across the network of hospitals, patient care and safety are improved as patients move through this diverse geography from one hospital setting to another.
To illustrate the power of the integrated system, Elbert described a scenario with a patient that arrives in the Kossuth emergency department:
The patient receives appropriate care in the emergency department and is transferred to Mercy North Iowa for treatment by an orthopedic surgeon. Following the surgery, the patient is transferred back to Kossuth for rehab. “With patient consent, the patient’s medical record is made available to the treatment team at each care site,” explained Elbert. “Even the images taken during rehab are available from Kossuth to the surgeon at Mercy North to ensure proper healing.”
In April, five of these hospitals, each with less than 25 beds, implemented technology that ensures a paperless medication loop, a goal set by the government for all U.S. hospitals.
With the CareMobile technology, a nurse uses a hand-held device to scan a patient’s wristband and medication, both bar-coded, to verify what are known as the “Five Rights” of medication administration: right patient, right medication, right dose, right route and right time. Once confirmed, the medication is dispensed, and the information transfers to the electronic health record. This closes the loop, with documentation from order to administration.
“In addition to the quality checks performed by the system, having the administration documented electronically in the device and automatically updating the EMR improves patient safety as well as nurse workflow,” noted Elbert. “In the paper world, documentation occurred at the nurse station and any number of patient care activities or interruptions could occur before the nurse completed the documentation.”
Trinity continues working toward turning the federal government’s vision of health care for 2012 into a reality. In addition to the work in its rural hospitals, Trinity Health will continue its nationwide rollout with Genesis implementations at some of its largest medical centers over the next 18 months.
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