IT/EMR: VANDERBILT COMPARED TO HCA Aleigh Newton and Davis Wedgworth Advised by: Mr. Jim Easter, VP Healthcare Planning, HFR Design Mr. Ray Erlandson, Computer Systems Administrator, VUSE
HFR Design • Hart Freeland Roberts is an architecture and engineering company based in Nashville. • Has a branch of Healthcare Architecture, which includes Healthcare Planning. • Jim Easter is the Vice President, Principal and Director of Healthcare Planning for HFR. • Healthcare related systems and technology • Facility planning and programming
Background • Patient Protection and Affordable Care Act • Includes provisions to implement a new system of electronic record keeping, involving EMRs and EHRs. • An EMR is composed of clinical data, clinical decision support, computerized provider order entry, pharmacy, and clinical documentation applications • The legal record of what happened to the patient during a single experience. • The EHR contains patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. • Follows the patient to new care facilities.
Purpose • To design a procedural guide of the steps necessary to convert a hospital from its current IT practices to those required in the new health care legislature.
Objectives • Determine the 7 steps to reforming medical records outlined by the government, to be completed by 2014. • Determine how these steps/applications apply to biomedical engineering. • Compare and contrast a biotechnological endeavors and explain the automated factors that compare and contrast Vanderbilt, a public, not for profit program, to HCA, an investor owned, for profit program.
Seven Steps • Stage 1: All 3 of the major ancillary systems (laboratory, radiology, pharmacy) are installed • Stage 2: Major ancillary clinical systems feed data to a CDR that provides physician access for retrieving and reviewing results. • Stage 3: Clinical documentation (i.e. vital signs, flow sheets) are required; nursing notes, care plan charting and/or the electronic medication administration record (eMAR) system are scored with extra points, and are implemented and integrated with the CDR for at least one service in the hospital.
Seven Steps • Stage 4: Computerized Practitioner/Physician Order Entry (CPOE) for use by any clinician is added to the nursing and CDR environment along with second level of clinical decision support capabilities related to evidence based medicine protocols • Stage 5: The closed loop medication administration environment is fully implemented in at least one patient care service area • Stage 6: Full physician documentation/charting is implemented for at least one patient care service area • Stage 7: The hospital has a paperless EMR environment
Emergency • Admit • Triage • Treat • Discharge • 2 major questions: • Why do you want to do this? • What are you trying to fix?
Meetings • Col. Jeff Holmes • Dan France • Center for Perioperative Research in Quality • Bubba Williams • IT leader at HFR • Brian Hutson • Director Technology Planning at APM, LLC. • Bill Stead • Associate Vice Chancellor for Health Affairs, VUMC • Jim Easter
Where we are 1st Half (2010) 2nd Half (2011) ID Task Oct Nov Dec Jan Feb Mar Apr Research the Patient Protection and 1 Affordable Health Care Act Determine the 7 steps outlined by the 2 government to be accomplished by 2014 Determine how these steps apply to 3 biomedical engineering Choose a biotechnological endeavor based 4 on these steps Research the implementation of EMR and 5 EHR in a public hospital ( Vanderbilt) Research the implementation of EMR and EHR in a private hospital (HCA/St. 6 Thomas ) Compile this information into a guide for 7 health care facilities to use.
Future work • Meet with VUMC Emergency room to see how Star Panel is used and how they maintain records for a single patient from start to finish. • Meet with HCA IT to find out what program they chose to implement and why. • Meet with HCA Emergency to see their process in action.
References • Burton, Gene. “Managing Medical Technology During Planning, Design, and Construction.” Healthcare Design 2010. Vendome Group. MGM Grand Hotel, Las Vegas, NV. 16 November, 2010. Conference Presentation. • Blau, Michael L. and C. Frederick Geilfuss, editors. Transforming Health Care Through Accountable Care Organizations: A Critical Assesment . Chicago: Foley & Lardner LLP, 2010. • Yeager, Rusty. “Strategic IT Issues.” AAMA Annual Conference . American Academy of Medical Administrators. Riviera Hotel and Casino, Las Vegas, NV. 17 November, 2009. Conference Presentation.
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