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The Electronic Medical Record at Carilion Clinic

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Presentation on theme: "The Electronic Medical Record at Carilion Clinic"— Presentation transcript:

1 The Electronic Medical Record at Carilion Clinic

2 Tools for building the Clinic
Plan Leadership Board Governance Physicians Standards Infrastructure Integrated Electronic Medical Record

3 An Integrated Electronic Medical Record (EMR)
Same look and feel inpatient and outpatient Ability to share records across the enterprise True continuum of care delivery with a single record Universal view of problems/medications/allergies Patients are not repeatedly asked the same questions Facilitates patient access through our system Higher patient satisfaction Better clinical outcomes

4 Electronic Clinical Tools at Carilion
1990 Radiology Management – Siemens 1990 Pharmacy – Siemens 1992 Cardiology – GE Muse 1999 Ambulatory EMR – Logician 2000 Emergency Department – EDIS 2000 OR – ORMIS 2001 PACS – AGFA 2003 Bed Scheduling – TeleTracking 2003 Transcription - MedQuist 2004 Medication Authentication – Siemens 2005 Acute EMR – CPSI

5 Carilion’s Commitment to Clinical Technology
Operating:75th percentile among peers Capital: 95th percentile among peers

6 Clinical Technology at Carilion
US 50th Percentile Time

7 The Challenge Integration Technology US 50th Percentile Time

8 Alignment within applications
Carilion Clinic Today is Best of Breed EMERGENCY DEPARTMENT Roanoke Memorial Franklin Memorial New River Valley Giles Memorial Bedford Memorial Stonewall Jackson Wellsoft EDIS CPSI Alignment within applications

9 Carilion Clinic Today is Best of Breed
Orders Management Siemens Invision EMERGENCY DEPARTMENT Siemens Soarian Siemens RMS AGFA PACS Radiology Roanoke Memorial Franklin Memorial New River Valley Giles Memorial Bedford Memorial Siemens MAK Pyxis Siemens Pharmacy Pharmacy Cardiology GE Muse Stonewall Jackson OR GE ORMIS ED Wellsoft EDIS Wellsoft EDIS CPSI Document Imaging AMS Sovera Portal Medicity Alignment within applications Alignment across applications

10 Imaging ED Primary Care Pharmacy OR Lab Inpatient Care

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12

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14 Total Interfaces: 509

15 Integration of Patient Information
The Challenge Integration of Patient Information Technology US 50th Percentile Time

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17 Benefits of an Integrated EMR
Patient Safety Checks for conflicts “Hard Stops” for safety Common Allergies List Common Medication List

18 Imaging ED Primary Care Pharmacy OR Lab Inpatient Care

19 Benefits of an Integrated EMR
Patient Safety Conflict checking “Hard Stops” for safety Common Allergies List Common Medication List Reduce Variation and Improve Quality Paper orders – order sets Protocols management Standardized Formulary “Soft Stops” for Best Medical Practices

20 Benefits of an Integrated EMR
Patient Safety Conflict checking “Hard Stops” for safety Common Allergies List Common Medication List Reduce Variation and Improve Quality Paper orders – order sets Protocols management Standardized Formulary “Soft Stops” for Best Medical Practices Reduce Overutilization CT Head Creatinine

21 Benefits of an Integrated EMR
Patient Safety Conflict checking “Hard Stops” for safety Common Allergies List Common Medication List Reduce Variation and Improve Quality Paper orders – order sets Protocols management Standardized Formulary “Soft Stops” for Best Practices Reduce Overutilization CT Chest Creatinine Facilitate Research Standardize data fields Create searchable data Support the Research Institute

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24 Benefits of an Integrated EMR
Patient Safety Conflict checking “Hard Stops” for safety Common Allergies List Common Medication List Reduce Variation and Improve Quality Paper orders – order sets Protocols management Standardized Formulary “Soft Stops” for Best Practices Reduce Overutilization CT Chest Creatinine Facilitate Research Standardize data fields Create searchable data Support the Research Institute Improved Practice Coordinated Referrals Coordinated Scheduling

25 Experiences of other Hospitals post Integrated EMR Implementation
Radiology turnaround time reduced Pharmacist interventions reduced by 50% Duplicate ancillary tests reduced by 48% Number of delays in administering medication has fallen by 70% Omitted administration of drugs reduced by 20% Test results for mammograms take one day, down from as long as three weeks New medication procedures can be introduced in hours

26 Carilion’s EMR Selection Process
Fast – Four Months Broad – Due diligence on four systems Deep – Participation of more than 300 Carilion employees All hospitals All therapies All administrative and support services Thorough – More than eight site visits

27 The Slippery Slope

28 Scope Acute EMR – CCMC (but not Pharmacy)
Acute EMR – CCMC and CNRVMC (but not pharmacy) Pharmacy and Acute EMR – CCMC and CNRVMC (but not ED) ED, Pharmacy, Acute EMR – CCMC and CNRVMC (but definitely not Ambulatory EMR) Ambulatory EMR, ED, Pharmacy, Acute EMR – CMC, CNRVMC, CGMH, CFMH (but not CPSI sites) Ambulatory EMR, ED, Pharmacy, Acute EMR – All Hospitals and practices Ambulatory EMR, ED, Pharmacy, Acute EMR, EMPI – All Hospitals and practices Ambulatory EMR, ED, Pharmacy, Acute EMR, EMPI, Registration – All Hospitals and practices (but not scheduling or billing) Ambulatory EMR, ED, Pharmacy, Acute EMR, EMPI, Scheduling – All Hospitals and practices (but not billing) Ambulatory EMR, ED, Pharmacy, Acute EMR, EMPI, Scheduling, Billing, Registration – All Hospitals and practices

29 Scope (but not lab)

30 Clinical Information System Evaluation Process
On Site Demos By 4 Vendors Selected Two Vendors Evanston, IL (Vendor 1) Somerset, NJ (Vendor 2) Baystate, MA (Vendor 2) Cleveland Clinic (Vendor 1) Vendor 1 Corporate Visit 1st Vendor 1 Contract Call Contract Signature Began Selection Vendor 2 Deep Dive Vendor 1 Deep Dive Vendor 2 Corporate Visit Vendor 1 Selection 2 8 – 1 23 August September October November December

31 Magic Quadrant for North American Enterprise CPR 2006
Source: Gartner December 2005

32 Selection Preference Summary
Vendor 2 Vendor 1 PHYSICIANS NURSING PHARMACY ED THERAPIES HIM IT INFORMATICS

33 MAK

34 INTEGRATED EMR

35 Carilion Clinical Application Integration
INTEGRATED EMR Technology Time 2007 2008 2009 2010

36 Immediate Benefits – Carilion Clinic
All physicians have immediate access to a patient’s entire record From any location Standardization of order sets Best practice adoption Tracking referral patterns

37 Accomplishments to-date
Created and trained 125-person EMR team Built physician practice content and training Converted 9 years of Centricity records to new system 780,000 patient records 43 million data fields

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40 2008 2009 2010 J F M A M J J A S O N D J F M A M J J A S O N D J F M A
Roanoke Primary Care

41 2008 2009 2010 J F M A M J J A S O N D J F M A M J J A S O N D J F M A
Roanoke Primary Care 2/20 Daleville 3/26 Blue Ridge 4/2 Vinton 4/9 North Roanoke 4/16 Colonial Avenue 4/16 Urgent Care Roanoke 4/30 Crystal Spring 5/7 Northwest 5/14 Southeast 5/21 Roanoke Salem 5/28 Brambleton

42 2008 2009 2010 J F M A M J J A S O N D J F M A M J J A S O N D J F M A
Roanoke Primary Care RMH Clinics Peds Surgery Specialty OB / Gyn

43 Franklin Area Practices
2008 2009 2010 J F M A M J J A S O N D J F M A M J J A S O N D J F M A M Roanoke Primary Care RMH Clinics Peds Surgery Specialty OB / Gyn NRV Area Practices Franklin Area Practices Giles, Lexington, Bedford Practices

44 Franklin Area Practices
2008 2009 2010 J F M A M J J A S O N D J F M A M J J A S O N D J F M A M Roanoke Primary Care RMH Clinics Peds Surgery Specialty OB / Gyn RMH Peds CPOE All CPOE NRV Area Practices CNRVMC All CPOE Franklin Area Practices CFMH Giles, Lexington, Bedford Practices CGMH CSJH BMH

45 Practice 1 Go-live February 20, 2008

46 Franklin Area Practices
2008 2009 2010 J F M A M J J A S O N D J F M A M J J A S O N D J F M A M Roanoke Primary Care RMH Clinics Peds Surgery Specialty OB / Gyn RMH Peds CPOE All CPOE NRV Area Practices July 26 CNRVMC All CPOE Franklin Area Practices CFMH Giles, Lexington, Bedford Practices CGMH CSJH BMH

47 Roanoke Memorial Go-Live
July 26, 2008 159 Inpatient Order Sets being built Trained Staff 5,000 clinical, financial, and administrative staff More than 1,000 classes Installed more than 500 new computers Created command center

48 Physician Training eLearning – Self paced
Classroom – Two 4 Hour Sessions Simulation Sandbox – Practice on own Findings – Leadership first is significant to ensuring compliance – Physicians who spend more time in preparation are most effective Day 1

49 5/5 – 5/16 Train Physician Leaders 5/26 – 7/19 Train All Physicians
Go-Live at Roanoke Memorial 10/18/08 CPOE Pediatrics 11/18/08 CPOE All 5/5 – 5/16 Train Physician Leaders 7/26/ CRMH Go-Live 5/26 – 7/ Train All Physicians March April May June July August September October November 7/14 – 7/18 Dress Rehearsal

50 Carilion Clinic Technology Capital
$30 M $20 M $10 M * * - Total budgeted capital spend for new EMR is $65.8 M

51 Integrated EMR Data and control for Best medical practices
Reduced variance Improved quality

52 Integrated EMR Data and control for Integrated system
Best medical practices Reduced variance Improved quality Integrated system Every patient Every physician All locations

53 Integrated EMR Data and control for Integrated system
Best medical practices Reduced variance Improved quality Integrated system Every patient Every physician All locations Improved practice Referral management Coordinated scheduling

54 Thank you

55 - Is now the time for an integrated EMR?
Personal Health Record Enterprise Patient Scheduling Next-Generation Patient Financial System Emergency Department Information System Computer Physician Order Entry Generation 3 EMR Ambulatory EMR Peak of Inflated Expectations Technology Trigger Trough of Disillusionment Plateau of Productivity Slope of Enlightenment - Is now the time for an integrated EMR?


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