Five years ago, the
Henry Ford Wyandotte hospital emergency department (ED) was drowning in paper. “You couldn’t find an EKG. You’d be waiting for a lab result that had been sent two hours before, but was on somebody else’s chart,” recalls Lois Vandercook, the ED information systems coordinator. Today, HFW’s ED is vastly more efficient and the digital documentation technology used to drive that transformation is being rolled to the remaining six hospitals in the
Henry Ford Health System.
“We are getting as complete a documentation as you can get, with nursing and physician documentation combined in one place, with order entry, medication services, and [lab] results that feed back into our system,” says Vandercook who participated in the two-year process to evaluate, select, and implement Picis ED PulseCheck software.
All together, the hospital spent about $500,000 on the software and another $500,000 on implementation. The system went live in October 2005, paid for itself in just six month, and has since been deemed robust enough to be rolled out further, says Vandercook, though a few surprises were encountered along the way.
PulseCheck is a browser-based emergency department IS that eliminates paper records in such areas as triage, patient tracking, physician and nursing documentation, charge management, and other areas. By reducing the number of lost charts and resulting missed charges, HFW increased its billing charge capture by $58,655 per month. The hospital also cut $7,000 in monthly dictation costs.
Notably, part of the implementation cost went to cover additional staffing when emergency department doubled its staff coverage during the first weeks of implementation. The idea was to free up staff for training and to alleviate some of the general worry surrounding the switch from paper to computers by making sure enough people were available to accommodate the temporary burst of activity.
“I would find pieces of paper laying around, people trying to get back to their comfort zone,” Vandercook says. “It was the culture shock, the whining of the staff, just the idea of getting them to buy into the idea that in two weeks, this would all work.”
Still accomplishing such a major change in two weeks can’t have been easy. Vandercook says simply, “We decided to go with a big-bang approach.”
The plan was to roll out seven modules in a single day, rather than draw out a training process that could have left the department’s 200 employees in flux for months. “When you look at taking the staff off the floor every six months to train them on a new module, this just seemed like the better idea,” Vandercook says. Throughout the crunch, there were 30 PCs running 16 hours a day and training times varied from two hours for secretaries to as many as eight hours for physicians.
Even Picis recommended against the full-throttle approach, but Vandercook says it worked and she’s ready to repeat the exercise at the next facility. “ER people tend to be a little ‘Type A.’ We don’t want to wait around for stuff,” she said. “Let’s get it done and over with.”
Not that fast means sloppy. Consider the breadth of the decision-making team, which included the director of nursing for the ED, the director of emergency medicine, half a dozen nurses, a nursing educator, a handful of emergency physicians, plus two IT people charged with ensuring the software would work on their hardware.
Vandercook says the team sought a solution that offered simple and effective support and she adds that Picis’ web-based structure won high marks in this regard. While the hospital runs the software on three of its own servers, Picis support staff have ready access to provide help when needed.
“No one has to come to my site to fix my system,” says Vandercook. “Picis can service my site from Chicago or Massachusetts or wherever and help me work through problems remotely. It makes changing and updating the system easy.”
Planners intended to keep the initial configuration in place for 30 days before making changes. They also wanted a centralized work flow with all data moving through the secretaries.
“Within the first 37 minutes, all of that was out the window,” Vandercook says. Doctors in particular began immediately rearranging elements of the work flow, literally unplugging printers on the first day to suit their tastes.
Next time, Vandercook says she will hold her ground. She still thinks a centralized system works best and that a 30-day trial period is useful. “Until you really work in [the system], you can’t do a good evaluation,” she says. Make changes too fast and “You end up with bad habits or things being built that you can’t tear out.”
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