Cornwall Community Hospital reaches Level 6 on HIMSS EMRAM scale

CORNWALL, ONT. – Cornwall Community Hospital recently stepped up to Stage 6 on the HIMSS Analytics EMRAM ladder. The adoption of a leading-edge Electronic Health Record (EHR) has provided significant clinical and operational benefits.

The hospital undertook a 20-month project to install a fully integrated Healthcare Information System inclusive of the majority of modules available to an acute care hospital. Cornwall Community Hospital successfully went live with the fully integrated electronic health record in December 2016, with official accreditation in April 2018.

The transformation to the electronic system required collaboration of the entire organization, from senior leadership to front line, from housekeeping and porters to physicians.

The silo approach of building out individual applications was removed and integrated, with cross-departmental teams formed. The assessment of approximately 136 current state workflows, transitioned to 257 future state workflows, with the goal of improving patient care and efficiencies.

The custom of maintaining historical processes and practices was discouraged without adequate review of their appropriateness in the digital world. A much more sophisticated maturity model was used in the build out of processes in the digital workflow for the clinicians.

With that, the review of efficiency, quality, risk, and mandatory data collection was incorporated within each functional build. Cornwall clinical staff now have a better understanding of the system they helped build and the rationale behind much of its design approach.

A secondary organizational benefit realized from this cross-functional team philosophy was the growth of relationships and awareness of departmental processes affecting the delivery of service and quality of care a patient receives.

Of great benefit are the clinical decision support tools that were built. Comprehensive screening tools and prompts to mitigate risks for (VTE) clotting, delirium (CAM), Influenza, and others were designed to assist the clinicians to use a best practice methodology to treatment.

Together with Zynx Healthcare, Cerner Corporation, and Think Research, Cornwall Community Hospital employed evidence-based practices to improve patient outcomes using Computerized Physician Order Entry (CPOE).

Cornwall Community Hospital developed approximately 300 ‘powerplans’ (electronic order sets) across clinical disciplines and effectively addressed the assessment, monitoring and treatment of the many of the Ontario Quality Based Procedures (QBP). Most broadly used are plans for COPD, heart failure, hip and knee arthroplasty and stroke.

The ability to report on the utilization of the powerplans and clinical support tools provides the organization an opportunity to analyze and address any shortcomings with corrective actions.

Dashboard reports include metrics outlining compliance with best practices and clinician use of the powerplans, thus ensuring that patient outcomes are at the forefront of orders.

Prior to the electronic health record, and working with paper tools, the organization was not able to analyze the adoption of its quality-based procedure metrics and patient outcomes effectively. Inclusive in the powerplans created, approximately 30 Quality Based Procedures incorporate thousands of clinical categorized standards that can now be monitored. Cornwall Community Hospital continues to revise the QBP powerplans as new handbooks are published, and is refining the analysis and utilization of the QBP metrics. The transition from paper to a fully integrated electronic health record has resulted in a clinical transformation for Cornwall that continues to evolve and improve the medical outcomes for our patients.