Shared EHR connects three Ontario hospital systems

KINGSTON, ONT. – Providence Care, a multi-site provider of aging, mental health and rehabilitative care, has joined a shared electronic patient record (ePR) system with Kingston General Hospital, an acute-care facility, and Hotel Dieu Hospital, which specializes in ambulatory services.

The shared system runs from a data centre at Kingston General Hospital, and with the addition of Providence Care, the joint electronic record covers perhaps the widest spectrum of activities among regional EHRs in Canada.

“The new ePR contains of a very wide mix of services – acute, mental health, community care, complex care, palliative and rehab,” commented Gillian Price, national director of projects for QuadraMed Canada, the company providing the clinical software. “It’s unlike anywhere else in Canada, and it’s quite an amazing story.”

For its part, QuadraMed was recently acquired by Harris Corp., which is in turn owned by Constellation Software of Canada. Harris also owns MediSolution, which is contributing its financial, ADT and procurement software to the solution in Kingston.

In joining the shared solution, Providence Care is switching from a Meditech electronic record to the Quadramed system, which is also used by the other partners in Kingston.

“Over 90 percent of the patients at Providence Care also have a relationship with Kingston General and Hotel Dieu Hospitals,” said Dan Coghlan, Vice President Operations & Chief Financial Officer  at Providence Care. “And the majority of our physicians also practice at Kingston General Hospital and Hotel Dieu Hospital.”

Coghlan said it would boost patient care and efficiency for all of the organizations if they used a shared electronic record. “Just think of the example of an emergency or trauma patient who can’t speak for himself,” commented Coghlan. “If we can access his record, the information can reach the hospital even before the patient gets there. That’s the kind of thinking that was involved in our decision-making process.”

Coghlan added that this scenario could be accomplished with other electronic records, but the integration wouldn’t be as seamless.

Guy Bujold, account executive for QuadraMed, noted the regional system means the major healthcare providers in Kingston all share a common platform, which will offer physicians and other clinicians quick access to the latest information about their patients. “The chart travels electronically,” said Bujold, saving time and trouble for patients and providers when data about previous tests, medications and encounters are needed.

Overall, the shared ePR is expected to provide multiple benefits:

• The right information at the right time, for the right person, in the right format.
• Reduction in medical errors, due to better access to accurate and up-to-date information.
• Reduced need to transcribe orders, also resulting in improved patient safety.
• Better aggregation of data for management decision support.
• Increased patient satisfaction through improved quality of care.

Providence Care went live with the shared solution in October at its St. Mary’s of the Lake site, which delivers complex care, specialized geriatrics, palliative care and rehab. A second site, specializing in mental health, was scheduled to go live in January 2014.

The mental health facility, noted Price, had been keeping records on paper, so the transition to electronic charts will be a major change – one that is expected to produce major gains in productivity and improvements in patient care.

A major component of the ePR is computerized provider order entry (CPOE), which means the mental health facility will automatically move from 0 on the HIMSS Analytics EMRAM ratings scale to 4. In comparison, most Ontario hospitals are at the HIMSS Analytics 2.5 level, and have yet to implement CPOE.

The HIMSS Analytics Electronic Medical Record Adoption Model measures EMR or EHR adoption and usage on a 0 to 7 scale.

The goal for the Kingston-area hospitals is to reach the highest HIMSS levels, 6 and 7. “That’s where they will see the real gains in productivity,” commented Price.

Clinicians using the shared solution at Kingston General Hospital and Hotel Dieu Hospital have been pleased with the system, which gives them easy access to patient data while working at either site. Many of the clinicians are cross-appointed at two or three different organizations, and the common platform means they can obtain the information they require, when they need it.

Interfaces have also been built to outside physician clinics, enabling referring physicians to gain access to test results and other information about their patients. An expansion of this secure system is expected in the future.

The shared system could easily accommodate additional regional or provincial partners, as the software is scalable. Some organizations have already made inquiries about joining the shared platform, to obtain lower IT costs and improved functionality through a joint solution.

By adopting a common platform, clinicians throughout the region will be able to standardize many of their practices, creating commonly accepted terms and standards of care. Standardization is also expected to raise quality and productivity.

In addition to CPOE, the electronic charting system includes nursing documentation and assessments, physician access, and clinical decision support.

Interfaces to third-party solutions have also been built, as the system makes use of Sunquest and LifeLabs for laboratory information, Nuance for dictation and transcription, Computrition for dietary services, and MediSolution (which itself acquired Ormed) for financial and inventory control applications.

MediSolution’s Virtuo MIS AR is integrated with the ADT for accounts receivable processing and OHIP billing. “We are pleased to be an integrated technology partner of Providence Care, offering solutions that automate and streamline administrative workflow,” said Michael Conn, national account manager for MediSolution.

Advanced financial tools, available to all of the partner organizations, will enable them to perform improved case costing. It’s expected that the Ontario Ministry of Health will in the future require more extensive case costing information from all healthcare facilities.

Price observed that the consolidation of electronic systems in Kingston wasn’t mandated by any government or health authority, but came from the partners themselves to improve the delivery of care. “There is a special spirit of collaboration among the partners,” said Price. “It wasn’t legislated. It was born out of a common commitment to improving service delivery throughout the continuum of care.”

While the project involved a considerable investment, Coghlan noted that change management and staff training has been critical. That’s to ensure the system is well-understood, and used effectively, by clinicians.

In conjunction with implementing new software, Providence Care also went through an extensive re-engineering review, using a methodology called the “PaJMa” models. Short for Patient Journey Modeling Architecture, the methodology was obtained from the University of Ontario Institute of Technology; Providence Care is one of the first institutions to use it.

“PaJMa has enabled Providence to map out the workflow of various departments, and to identify areas where things could be changed for the better, and where they should remain the same, commented Robin Saunders, Director of Decision Support and Director of the ePatient Record Project. The models show who a patient interacts with, when and where healthcare professionals obtain patient information, how it is recorded, and whether paper, fax machines, telephones or computers are required in the process.

Saunders pointed out that by involving staff in the creation of huge process maps, they could help spot the bottlenecks and help management improve many processes. They also gained a better understanding of the bigger picture – of how patients should ideally move through the organization during a stay, from admission to discharge.

As well as seeing the big picture in the abstract, staff members could also see it right on the wall. “The models were printed out on paper, documenting the patient journey,” said Coghlan. “The maps were posted on the walls of various units, outlining the steps in the patient journeys. When we started, some were 15 feet long. When we finished, they were considerably shorter.”

He said some units have kept the older maps up on the walls, just to remind themselves of how cumbersome and involved some of the older processes were.

Importantly, the new and improved steps and processes are being built into the workflow of the new software as it is rolled out through Providence Care’s facilities. “The process re-design is proving to be as valuable as the hardware and software,” said Saunders.