New Tools for Doctoring
By Dale Glenn, MD, Straub Clinic and Hospital, Oahu, Hawaii
When patients move through the health care system faster than their
chart of critical patient information, frustration can occur and much
worse-medical error. Straub Clinic and Hospital in Hawaii recently
took a new approach to managing patients' charts. We automated the
delivery of patient's results to their physicians to avoid the costly
and sometimes life-threatening asymmetry between patient information
sharing and patient needs.
Straub Clinic and Hospital is a fully integrated health care system
based in Hawaii with nearly 200 physicians in 32 specialties
practicing in fourteen neighborhood clinics and at the 159-bcd Straub
Hospital. Each Straub patient is maintained with one chart, which
means that if a patient has an appointment in Kailua one day and in
Kona the next day, the chart must travel from one place to the
next—there are cases where the chart does not always make it there in
time.
Since the practices are quite scattered and the need to exchange
information between sites is critical, Straub implemented Elysium
Clinical Messaging from Axolotl to deliver results electronically.
Streamlining workflow, reducing the burden of administrative tasks,
and managing clinical data more efficiently were key issues in the
decision to adopt Elysium, and the benefits to Straub have been
enormous.
Repetitive workflow processes are automated by allowing physicians to
send a result to their medical assistants or other physicians with a
one-button mouse click. Physicians arc also using the system to
electronically sign transcriptions and deliver them to their Health
Information Management Department (t IIM) for filing into medical
records. Formerly this was a lengthy manual process, but now signed
documents are delivered within minutes and are available for viewing
by others needing access to the information. The transcription and
billing departments are saving money with faster turnarounds and are
able to provide information more quickly to their patients.
Every time something has to be repeated by another physician that has
already been done in the past, it is a delay in care and time. Since
current patient information is now available on a secure Web site,
Straub physicians can access the data anytime from anywhere they have
an Internet connection. This can speed up the treatment process,
improve accuracy, and potentially prevent problems that could occur
without knowledge of patient allergies and medications.
Overcoming Barriers
As with any process, when you make a change in the way that
people have been doing things for years, there is going to be
a transition period as people learn to use the system. Straub
expected and realized that there was going to be some resistance
from the more established doctors, but knew in order to have
an effective system it would be imperative that all physicians
become comfortable with a new way of receiving results.
Straub's hospital staff really runs the gamut from the vet)' young to
those who are retiring. There have been some physicians who have said,
"Look, I am retiring in a year, I am not going to waste my time
learning this system." However, most of these physicians who were
resistant to using the system have discovered that it really can
simplify the workflow process.
Leadership is very interested in computers and sees them as a real
benefit for both physicians and patients. Straub saw some immediate
benefits just in the first day or two that we were using the system.
However, for someone who is not familiar with computers at all,
putting down a keyboard and expecting them to correct their own
transcriptions or do anything other than typing, is really a burden on
them. Many of them are just afraid of the whole idea of learning to
use a computer.
Implementation
Each physician in the group was supplied a computer
and one by one each office was set up with Elysium and trained
onsite. After a brief introduction was given to tile system,
Straub found that the physicians and staff appreciated that
they were able to see and access their transcriptions, lab
reports, and radiology results electronically, with ease.
The system's workflow capabilities enable Straub physicians
to electronically receive and annotate lab and radiology results
and sign transcriptions online. They found that it was simpler
to look up patient records online rather than sorting through
piles of paper-based charts.
The Benefits of Automation
Doctors are finding that they can manage their patients
more efficiently because patient information is always right
at their fingertips. What the physician sees on his or her
desktop, even if it is not critical, may change the course
of therapy or influence thoughts on treatment options. There
have been a couple of times when the system has surprised
me with its benefits. For instance, I have had a patient come
in to test for strep and I had their culture on my desk in
12 hours instead of 24. In this instance, I was able to call
the patient up and say, "By the way, you do have a positive
culture," and then we got them on antibiotics faster.
As things change throughout the day, we don't always have time to play
phone tag with the nurses to find out what the lab results were. Now I
just sit at my desk, and when results are in, it shows up in my
in-box. Critical issues can be addressed immediately. In the past,
since my group works in the office several miles away from the
hospital, I had no contact whatsoever with my hospital patients, but
now the results show up directly on my computer screen, and I can call
the hospital to make adjustments to their medications.
The old paper-based system was so tedious—a lab prints out on a
nurse's printer while she is busy with three other patients. It may
take her an extra two or three hours to get around to looking at the
result and depending on how critical it is, she may or may not call me
with the results. If she thinks it is urgent, she will give mc a call
and I may or may not be available. She will leave a message with my
nurse, then it is going to be another 10 to 20 minutes before I see
it, then I have to respond to it, so there is a minimum las time of
several hours.
Our computers have not only alleviated burdensome tasks but also
improved our interoffice communication. Now, instead of writing
post-it notes and sticking them on the chart and leaving them for tile
nurse to find or process, I can now immediately action and send a
message to my staff to deal with the problem.
Patient Benefits
Beyond the obvious benefits of connecting physicians
and hospitals with the entire health care continuum, there are
intangible benefits to the savvy, health care consumer as well.
These consumers and our patients are well aware of the medical
errors that occur, as they are reported by the media. By letting
patients know that we are implementing tools that will help
prevent those kind of things and improve the qualit3, of their
care, we go a long way in bolstering their confidence and speeding
up the recovery process. For us, electronic clinical messaging
has simply made our lives at Straub a lot less stressful and
put the focus back where it belongs—on the patient.
Dale Glenn, M.D., practices at Straub Clinic and Hospital in Oahu, Hawaii
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