e-VOLVE modernizes electronic records at SW Ontario hospitals

Four hospitals in Southwestern Ontario are well on their way toward completing a transition to a region-wide, state-of-the-art hospital information system (HIS). Erie Shores Healthcare in Leamington went live with Cerner Corporation’s Millennium HIS September 27th and the Chatham-Kent Health Alliance and Hôtel-Dieu Grace Healthcare in Windsor flipped the switch November 1. Windsor Regional Hospital is currently scheduled to go live in April.

Once Millennium is fully rolled out, “the past history of patients will follow them regardless of which hospital they go to in the region,” said Hôtel-Dieu Grace Healthcare’s CIO, Dr. Vince Ruisi.

Accessing information about patients transferred from another hospital in the Windsor-Essex region was problematic in the past.

“Before Millennium, we had a combination of a few different systems,” said Dr. Ruisi. “We had SolCom, which was essentially a PDF viewing software. We also had McKesson and a separate PACS viewer, so there were times when we would have to enter three different programs to get all the information we were looking for.”

Much of the historical information was hand-written and difficult to decipher, added Dr. Ruisi, noting, “It could do more harm than good.”

The four healthcare organizations joined forces through the e-VOLVE Program, an initiative of their TransForm Shared Service Organization to manage the transition, relying on the Millennium HIS Canadian build pioneered at Kitchener-Waterloo’s Grand River Hospital.

Completing the transition in the midst of the COVID-19 pandemic added a bit of a wrinkle to the project, “forcing us to think differently about how we go about an implementation,” noted Cerner Canada president Jim Shave.

Faced with restrictions on cross-border travel and requirements for quarantines, Cerner and the participating hospitals had to rely on Microsoft Teams for virtual meetings and consults.

“A year and a half ago, we would have had dozens of people on site for a go-live, but we all realized that wasn’t possible,” said Shave. “We just honed our skills in terms of being able to educate remotely and were all pleasantly surprised about how smoothly it went. When Erie Shores went live, it was almost anti-climactic.

Impressed by the efficiency and success of virtual engagements, “going forward, we will be working differently than we did two years ago,” Shave predicted.

For go-live training at Hôtel Dieu Grace, the e-VOLVE team operated a command centre and had super users out on the floor providing healthcare staff with “at elbow support.”

The new HIS boosts efficiency and enhances patient safety.

“The patient’s medical history and the latest medical information are easily and instantly available, so it positions our healthcare providers to deliver the best possible care,” said Barb Colaizzi, technology transformation manager and e-VOLVE site lead for Erie Shores Healthcare.

Dr. Luther Heys, chief medical information officer at Erie Shores notes that when patients are seen in the ER in Leamington and then transfer to Windsor, all of their information is there when they arrive.

Prior to the transition, said Colaizzi, we had to make copies of documents and either fax them or send them along with the patient.

Nurses are now charting electronically, “so instead of having to track down a chart, I can see all the vitals and all the labs in one place, making my life quite a bit easier,” said Dr. Ruisi. “Before, I would have to flip to the bedside chart if I wanted to find their meds and their vitals, then go to their regular chart to find out their blood glucose results, so it was very inconvenient.”

Doctors also like Millennium’s communication functionality, which allows them to message nurses with questions for a specific patient.

“For example, I wanted the phone number of a patient’s family member the other day, so I messaged the nurse and the next time I opened the chart, the number was there,” said Dr. Ruisi. “They can also leave me messages if a patient has issues overnight. Previously, I might get an unsigned note and not know who to go to for more information. Now, everything is signed off and documented.”

Doctors are also able to see all of the documentation from the allied healthcare professionals, including physiotherapists, occupational therapists, speech language therapists and dietitians.

“It’s easy to find everything you’re looking for,” said Dr. Ruisi. “The layout is very user-friendly. I can even see the times that medications were administered. It’s making my rounds faster than ever.”

And whenever a new medication is ordered, the system automatically performs a real-time check for adverse reactions.

Dr. Ruisi, a family physician and hospitalist when he’s not acting as the hospital’s CIO, also likes the Millennium functionality that auto-populates a patient’s health issues into his notes.

“When I’m ready to document, I have all of the issues that have already been identified as problems to be addressed, so my notes are much more complete, compared to previously, when I had to remember these things. Millennium does so much extra work for us.”

Another major benefit for physicians, said Dr. Heys, is that the HIS can now be accessed remotely from home. “Before, we had some access, but it was only partial and not in real-time.”

The integration of Dragon Naturally Speaking software is another huge improvement. Prior to the transition to Millennium, doctors used a back-end transcription service that could take days for the notes to appear in the chart.

“Now, everything is up front. We have our notes instantly and we can edit as we go,” said Dr. Ruisi. “This is especially important in acute care if a patient becomes unstable and an attending doctor needs to have access to the most current information.

“The meds, vitals and labs auto populate into our notes, whereas before we had to dictate all of that. Now, we are only responsible for dictating the history of present illness, the physical exam and the assessment of plan. All of the other objective data are pulled into the final note, so there’s less dictating than previously. The only downside is that we can’t speak as fast as we want.

“If a patient has multiple issues – for example, hypertension, diabetes and atrial fibrillation – they are now maintained in the patient’s chart, so the next time they’re admitted, they are already there. We just have to confirm that we’ve reviewed them. It’s the same with their social history and allergies. It’s all pulled forward.

Pre-Cerner, we had to look through scanned documents and old dictations, question the patient and get histories from scratch over and over again.”

Hôtel-Dieu Grace is a 313-bed post-acute hospital offering rehabilitative care, complex medical and palliative care, as well as mental health services. The Chatham-Kent Health Alliance operates a 200-bed community hospital, and Erie Shores serves its community with 58 beds. Windsor Regional Hospital, the region’s full-service acute care facility, operates on two campuses with a total of 595 beds.