"Hospitals around the country have been actively pursuing electronic ordering for many years," explained Dr. Michael Algus, the medical director of the hospital's Quality Department, who led the hospital's effort to implement the new system. "A robust electronic ordering system provides an additional layer of safety in a hospital. It automatically checks medication orders against the patient's allergies, preventing potentially serious medication errors. In addition, computerized order sets help physicians stay on top of the most current treatments for a variety of conditions."
The new system comes with a number of benefits for patients, physicians, and the hospital. For patients, it bolsters safety by reducing errors related to legibility or transcription of handwritten physician orders, and by giving physicians access to best practices in patient care. For physicians, the new system gives them quicker access to evidence-based medicine. It also supports their clinical decision-making through automated alerts and reminders. For the hospital, it will improve efficiency by reducing rework caused by illegible or incomplete orders. In addition, it has the potential to reduce redundant orders for tests and treatments.
The project's successful completion comes after nearly four years of hard work by the hospital's Information Systems Department, physicians, pharmacists, nurses, and other clinicians. The work included extensive upgrades to the hospital's medical records database and its computer infrastructure on which the entire system functions. It also included creating new or improved connections between the database and computer systems in the hospital's imaging department, pharmacy, laboratory, and operating rooms.
"To begin a project like this, we first had to assess and upgrade our infrastructure," explained Gail Balch, director of information systems. "That included things as mundane as ensuring that we had adequate power supply and cooling systems for the additional servers the project required. Once we completed the necessary infrastructure upgrades, we were able to turn our attention to creating more than 100 new order sets, such as admission to the hospital for care after orthopedic surgery."
Hospitals are set up to care for patients with a wide range of diseases, from pneumonia and heart disease to hip replacements and gastrointestinal surgery. As a result, there are thousands of combinations of medication, diet, rehabilitation, surgical, and other orders that physicians can prescribe for patients. To simplify the system, the implementation team worked with physicians and other clinical experts to create standard orders for the most common types of conditions treated in the hospital. By standardizing the orders, the team simplified ordering for most physicians. At the same time, the standardized orders help physicians provide the best, most up-to-date care by including the best practices.
"Without creating standard order sets, physicians would be left to wade through hundreds of different order choices each time they treat a patient," explained Dr. Ann Marie Swann, a hospitalist who was responsible for implementing order sets and training other physicians. "However, creating these standard order sets was a Herculean undertaking. It required researching best practices for each condition and working with physicians to ensure that our research was correct. Once we were able to identify and confirm the elements of each order set, our information systems experts then created the order set in the computer system."
Last month, the hospital reported that approximately 80 percent of all of the orders for inpatients were completed electronically. In addition, the hospitalist group, which treats most of the hospitals inpatients, were using electronic ordering more than 90 percent of the time.
"The physicians who care for patients in the hospital most frequently are using computerized ordering extensively," Dr. Algus added. "Occasionally, particularly when phoning in orders, the physicians are unable to use the electronic ordering system and must rely on a nurse to place the orders for them."
As SVHC completes one electronic ordering project, it is scaling up to implement a similar system in its emergency department. In the emergency department, the new system will integrate electronic nursing notes as well as electronic physician ordering. In addition, the emergency department system will be tied more closely to the electronic medical record system currently in use in the rest of the hospital.
Despite the promise of better care in the hospital and in other care settings, adoption of electronic health records has been relatively modest. According to Health Affairs, a trade journal covering the health care industry, in 2011 only 27 percent of hospitals were using any form of electronic health record. Moreover, only about nine percent of hospitals nationwide have a comprehensive system, with small, rural hospitals having the lowest adoption rate of electronic health records.
"When we complete the emergency room electronic system, we will have comprehensive system for our hospital," Balch added. "Our long-term goal is to electronically connect the hospital, our medical practices, our visiting nurse association and hospice, and our nursing home and subacute unit. Such a broad-based system would enable us improve care in all of our locations, helping us keep patients healthier, while reducing costs."
The Southwestern Vermont Medical Center is part of Southwestern Vermont Health Care (SVHC), a non-profit integrated health system that serves communities in Vermont, New York, and Massachusetts. SVHC also includes the VNA and Hospice of SVHC, the Centers for Living & Rehabilitation, the SVMC Northshire and Deerfield Valley Campuses, Southwestern Vermont Regional Cancer Center, and the Southwestern Vermont Health Care Foundation. Southwestern Vermont Medical Center is Vermont's first Magnet hospital for nursing excellence and home to the region's only breast care program fully accredited by the National Accreditation Program for Breast Centers.