nurse in green scrubs holding ipad, standing over young white brunette girl smiling sitting on hospital bed

‘Most Connected Hospitals’ Embrace EHRs

Many of the young patients at Children’s Medical Center Dallas were born in the era of the electronic health record, or EHR. They’ve never had a paper medical chart--and they probably never will.

“All of their medical records as they advance…are going to be electronic,” said Chris Menzies, M.D., chief medical information officer.

Children’s Medical Center Dallas is one of the nation’s Most Connected Hospitals, according to the U.S. News Media Group. That means that it’s one of the leaders in the move toward the full use of an integrated electronic health record system, also known as an electronic medical records (EMR) system.

The list of Most Connected hospitals, published in U.S. News & World Report, spotlights those hospitals that are known for their clinical excellence as well as their significant digital advancements in this arena. The 2011-2012 list, which was released in July, includes 118 hospitals.

The hospitals on the Most Connected list have achieved one of the top two levels of EHR adoption, as scored by HIMSS Analytics, a division of the nonprofit Healthcare Information and Management Systems Society. Their EMR Adoption Model, or EMRAM, scale ranges from Stage 0 (no use of EMRs) to Stage 7 (full use). Stage 7 denotes that a hospital is “truly paperless,” with all entities--including both providers and patients--able to share and exchange information.

Children’s Medical Center Dallas is one of the elite Stage 7 hospitals on the list. In fact, it has already achieved certification for the first stage of meaningful use for its adoption of an integrated EHR system, as stipulated by the Centers for Medicare & Medicaid Services (CMS). It’s one of the few organizations in Texas that has done so, Menzies said, and the organization has already received its reimbursement: a check for $3.84 million arrived in May.

Stanford Hospitals & Clinics was also recognized as achieving Stage 7 on HIMSS’ EMR Adoption Model on the Most Connected Hospitals list. According to the chief medical information officer, Pravene Nath, M.D., the hospital achieved that status around the end of 2009 and is working toward meeting all the requirements for Stage 1 of meaningful use.

Stanford’s EHR allows the organization to keep better track of its patients and their information across both the inpatient and outpatient settings, Nath said. And it’s even possible, albeit complicated, to exchange data with non-Stanford providers who use the same vendor (Epic).

The University of Wisconsin Hospital and Clinics, which is based in Madison, is another healthcare organization that has already achieved HIMSS Analytics’ Stage 7 and appeared on the Most Connected Hospitals list.

Thanks to the EHR, family practice physician David Kunstman, M.D., doesn’t need to order repeat tests or lab work because previous results somehow didn’t make it into his patient’s chart.

“It’s all in one nice little package,” he said. “Patient care is definitely a lot more efficient.”

Also, he can update the chart with tests, medications, prescription orders and other relevant information so that other providers can see the most current information in real time. That has significantly helped improve communication, especially for patients who have multiple physicians caring for them. Even the providers who initially clung to the paper charts have bought in.

“Since we’ve gone from paper to electronic…the biggest thing you notice is the collaboration across the enterprise,” said Kunstman, who is also the associate medical director of information services for UW Hospital and Clinics.

Menzies agreed, saying that, when it comes to the EHR, the philosophy at Children’s Medical Center of Dallas is “The right information to the right person in the right place at the right time.”

“That’s in the end what it boils down to,” he said.

Beyond providing the ability to better coordinate care and promote collaboration, EHR systems also have a significant benefit when it comes to disaster planning.

In May, a tornado ravaged the town of Joplin, Mo., and one of the city’s hospitals was also heavily damaged. But because St. John’s Regional Medical Center had an electronic health record system in place, hospital staffers were able to set up a temporary unit where they could access those records and continue caring for patients.

Jessica Gosset, chair of the IT department for the Mayo Clinic in Rochester, Minn., noted that her organization is “well-protected in the event of a disaster,” thanks to having a comprehensive EHR system.

“It’s worse to have the paper (only) because you only have one copy, and if you have a fire, it’s gone,” she said. “Where, with a computer, you have multiple copies, in perhaps multiple cities.”

Children’s Medical Center Dallas has an aggressive disaster recovery plan in place, said Menzies. There are two data centers based in separate locations in case anything happened to the main facility or either of the data centers. The organization is even considering setting up another one, so as to reduce the potential time that it would take to get the entire system completely reloaded and running as usual.

“In medicine, you don’t always have (several) days,” Menzies noted.

Although not all the Most Connected hospitals have achieved Stage 1 of CMS’s meaningful use requirements, most report that they are working toward that goal. For example, the Mayo Clinic, which the Most Connected Hospitals listed as a Stage 7 hospital, is on track for achieving Stage 1 of meaningful use next year, Gosset said.

And in the meantime, they are always working to improve the functionality of their EHR so that it’s easy for the providers to use appropriately.

“What you really want to do--and this is a challenge for anybody out there--is to make it so they don’t have to work hard at it,” Gosset said. “It has to be part of their work flow.”

Leaders from hospitals that have achieved Stage 1 of meaningful use say that they are now focusing on their strategies for achieving Stage 2. The second stage and third stages will require hospitals to build upon the work that they did when implementing an EHR system.

The proposed rules for Stage 2 could be released by the Office of the National Coordinator for Health IT (ONC) and CMS by the end of 2011 or early 2012, and the final rules could be released next summer. However, a number of groups have opposed that timeline and called for more time. If an extra year is granted, then Stage 2 would not take effect until 2014.

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