News @ MCRHC
July 31, 2009
Electronic Health Record Continues to Evolve One Year After Implementation
Nearly one year after seven rural hospitals helped launch America’s first rural integrated electronic health record (EHR) system, the group has continued to expand the technology used in providing patient care. Earlier this year, the hospitals in the Mercy Health Network – North Iowa, including Mitchell County Regional Health Center, implemented the Caremobile medication barcoding system and a Radiology Picture Archiving and Communication System (PACS). These new technologies will continue to improve health care and patient safety in North Central Iowa.
On July 25, 2008, Mitchell County Regional Health Center was one of seven hospitals to implement an integrated electronic medical record – a shared database amongst the seven hospitals and Mercy Medical Center – North Iowa. Replacing a paper chart that could only be in one place at a time, the electronic record is viewable through network connections, meaning that doctors can view patient’s charts right from the doctor’s desk while nurses are using the chart in the patients room.
Any provider in the Mercy Health Network – North Iowa can view hospital medical records from all of the hospitals in the network. If someone is treated in the emergency room at Mitchell County Regional Health Center and is transferred to Mercy Medical Center – North Iowa, the physicians there have immediate access to the records of the emergency room visit here. Likewise, physicians at MCRHC have access to the medical records for that patient at Mercy. This helps to reduce the duplication of lab and radiology tests taken at different facilities, keeping health care costs down.
In February of this year, these hospitals activated “CareMobile,” a point-of-care medication tool that works within the electronic health record system and utilizes bar code technology. But unlike stand-alone bar-coding systems, the use of CareMobile with the electronic health record combines the safety features of computerized physician order entry (CPOE) at the time a medication is ordered, with the safety of bar-coding at the time a medication is administered.
“The combination of these tools provides safety from the time an order is placed until the medication is administered,” said Marlin Duren, Pharmacist at Mitchell County Regional Health Center.
CareMobile conveniently works at the patient’s bedside. Using a small, hand-held device, a nurse selects the patient’s medication profile to view the medications to be administered. Next, a bar-coded medication is scanned to ensure it’s the same drug ordered by the doctor via the electronic health record system.
Finally, the nurse scans a barcode on the patient’s identification wristband to ensure patient identity. Once the medication is confirmed, administered to the patient, and signed, the information is electronically transferred to the patient’s EHR. The small but significant step of using CareMobile allows nursing staff to verify the “Five Rights” of medication administration: right patient, right medication, right dose, right route and right time.
Results of the most recent national survey by the American Society of Health-System Pharmacists, which was conducted in 2005, indicate that this type of bar-code medication administration (BCMA) is used in only 9.4 percent of hospitals throughout the country. Of that, only 6 percent of hospitals with 55-99 staffed beds used BCMA. No hospitals in the study with fewer than 50 beds reported using this “Five Rights” technology. Additionally, only 3 percent of hospitals with fewer than 50 beds have fully implemented EHR systems, which includes CPOE.
Research proves that medication errors that occur during administration are fairly preventable. “Our network of hospitals are serious about extending superior clinical quality to our patients and by working together, we were able to implement technology to achieve our goal of reducing adverse drug events and ensure patient safety,” said Christy Syndergaard, Chief Nursing Officer at Mitchell County Regional Health Center.
In April the network of hospitals implemented a new Radiology tool known as a Picture Archiving and Communication System or PACS. PACS has eliminated the need to print x-rays on film. Just like a patient’s paper medical record, an x-ray film can only be in one place at a time. The PACS is a way for the x-rays to be stored and transferred electronically so the images can be viewed from any computer connected to the electronic health record.
By implementing PACS, providers are now able to get results of radiology tests up to three times faster. The Radiologists in Mason City can examine the images within minutes of the test, rather than waiting for the film to be printed and delivered to Mason City. With the electronic health records connection to the other network hospitals, providers can view images and Radiologist’s findings for tests taken at the other hospitals.
“PACS is a very important part of our electronic system,” explained Julie Brown, Radiology Supervisor at Mitchell County Regional Health Center. “X-Ray films are cumbersome and can get misplaced when they are getting transported to other facilities. It also takes valuable time to print and deliver the film. With the electronic system, our doctors can look at the image as soon as the picture is taken. It really speeds up the treatment for our patients.”
The implementation of these new technologies has not been without its challenges. With expanded access to the medical records, MCRHC had to implement strict confidentiality policies and a high level of access security to prevent improper viewing of the electronic record. Only caregivers who are providing direct care to a particular patient are allowed to view the electronic record. MCRHC medical records staff regularly run reports showing who has accessed patient charts. If an employee inappropriately accesses a chart, harsh disciplinary action is taken.
MCRHC staff spent many hours preparing for the implementation of each phase of the electronic record, from helping to create the system and procuring the equipment to training on how to use this advanced technology.
“The electronic health record and all of its components have really changed the processes we use to care for our patients,” said Sandy Leggett, CEO at Mitchell County Regional Health Center. “I can’t say enough about what a great job our staff has done in embracing the new technology.”