Children’s Hospital of Pittsburgh of UPMC

• Annual revenues of $427 million
• Staff of more than 4,000 staff
• 740 medical faculty
• Renowned for its outstanding clinical services, research programs and medical education, Children’s Hospital of Pittsburgh of UPMC has helped establish the standards of excellence in pediatric care. It is the only accredited Level 1 Pediatric Trauma Center in western Pennsylvania

Challenge:
The hospital accomplished EHR implementation several years ago, despite the aging infrastructure of a building constructed in the 1920s. When Children’s staff moved to the new hospital, they already were accustomed to working completely online. The new building was designed from the ground up to have no medical record file rooms, no chart racks on the care units, and no clipboards at the bedside.

From the Emergency Department to the operating rooms, to the critical care and medical inpatient units, to the outpatient suites and ancillary service areas, Children’s runs on a single, integrated electronic medical record. Electronic means the risks inherent in handwritten and verbal orders have largely been eliminated. Integration means that each of a child’s caregivers — which average 70 per child for inpatient visits — has instant access to the up-to-date record, improving response times and coordination of care. The physician can see the results of her patient’s latest lab test or radiologic images whether she is rounding at the child’s bedside, working in an administrative office, or between visits in the outpatient care suites. This eliminates the time and resources wasted in searching for results or reordering duplicative tests and imaging.

Implementation Solutions:
Children’s closed-loop medication process dramatically improves patient safety by using technology to help ensure the five rights: right patient, right medication, right dose, right route and right time. This process is emblematic of how Children’s has succeeded by listening closely to the clinicians on the front lines and thinking through with them the detailed requirements of process and equipment necessary to meet their real-world needs. At Children’s, each nurse uses a mobile cart stocked directly by Pharmacy staff with locked drawers that contain the medications for his or her patients. A wireless computer on the cart enables access to each child’s complete medical record. A handheld computer is used to read a barcode on the child’s wristband and on the medical label before each dose is administered, simultaneously confirming and recording medication delivery. When Children’s began the journey to a closed process, our medication safety event rate was 0.10/1,000 doses dispensed; it declined with the use of CPOE, and today is 0.04/1,000 doses dispensed.

Since it was implemented in 2002, Children’s EHR system has provided data that has an impact on three key levels.  At the point of care, it provides instantaneous access to the child’s full record. At the organizational level, it supports managing for quality by enabling Children’s to mine discrete data — not scanned forms — for trends and patterns in patient care and caregiver behaviors.  At the research level, de-identified data is a valuable resource for improving the diagnosis and treatment of pediatric disease.

Recognizing the ROI of EMR Implementation

• Serious medication errors have been reduced by 92%.
• Fewer than 5% of the medication orders are verbal.
• 99.5% of all results are entered directly online, 0.5% are scanned paper.
• The reduction in transcription costs saves $42,800 per year for a single note type across six service lines.
• From 2003 to 2009, there was a 60% decrease in medication safety events at Children’s Hospital. 
• From 2008 to 2009, the amount of time from administration of two commonly-prescribed antibiotics to documentation on the patient’s chart decreased from 65-70 minutes to 10-15 minutes.

Operational and clinical efficiencies

• Providers place more than 94% of all orders directly into the eRecord - reducing the potential for human error by eliminating handwritten and verbal orders.
• Eliminates time-consuming processes such as the search for paper records, and the faxing and/or delivery of paper records between nursing units and departments.
• Eliminates the need to ask for the same information from the patient or parent.
• Mobile, wireless computers allows nurses, physicians to spend less time charting at the nurse’s station and more time at the patient’s bedside. 
• Gives caregivers real-time access to critical patient information, such as the types of care and medications that a patient received.
• Gives caregivers immediate access to lab and radiology reports as well as online access to medication formularies and medical references so that caregivers have this potentially lifesaving information before making a decision.
• Provides information needed for regulatory and compliance standards.
• Allows pediatric interns, residents and fellows to train with state-of-the-art technology.      
• The entire EHR is securely available at the bedside and from anywhere in the world.

EMR Solution:  Cerner

Lessons Learned:

• Focus on Patients and Families First:  Set priorities and make decisions based on the potential benefit to patients. Having such a focus was essential to achieving the buy-in of faculty and staff; as evidence, nearly 100% of Children’s , and all nurses, have used the EHR exclusively
• Top-Down Leadership, Bottom-Up Design:  Cross-functional teams allow clinicians and IT specialists a detailed view into each other’s worlds — the advantages and the constraints —  establishing combined ownership of the new processes and the ways in which the system would work to support the care delivered to the patient.
• Harness Technology, Data and Knowledge Capital to continuously improve the safety, effectiveness and efficiency of care

 

If you are a healthcare provider and would like more information on how to obtain your hospital’s EMR score, e-mail us or call us at 866-546-2900.