Patient records: 24/7 availability

The phrase 24/7--24 hours a day, seven days a week--is one the medical community lives by. And what better way to make patient records available at all times than with a knowledge management system? No more hunting for a patient file stuck in a warehouse. No more lost lab report or misfiled medication order.

Now, 24/7 access to medical records is extending beyond the confines of the hospital to the Web. Electronic patient records vendors such as MedPlus (www.medplus.com) and Axolotl (www.axolotl.com) provide access to secure patient records through the Internet.

Capturing patient information electronically at the patient's bedside is also key to easing the flow of knowledge throughout the hospital. For example, at MacNeal Health Network (Berwyn, IL), doctors and staff can capture and enter patient information, and access records from sites spread across Chicago's suburbs.

Santa Teresita

Santa Teresita Hospital (Duarte, CA) wants to start the electronic patient record right at the admitting desk. The hospital has been using electronic patient records for almost two years--scanning in a patient's chart within 24 hours of discharge.

"But we wanted to take things a step beyond providing the records online," said Mamie Hao, director of medical records for the hospital. By the end of the year, the hospital plans to install the registration module of the ChartMaxx electronic patient record system from MedPlus.

Santa Teresita has already gained significant benefits using electronic patient records, according to Hao. The hospital has about 50 authorized users on the system, which runs on an Ethernet network with a dedicated Hewlett-Packard (www.hp.com) server. The hospital began storing emergency room charts on the system in August 1995 and has added all outpatient and inpatient records as well as all records for patients in the hospital's skilled nursing facility.

"We have reduced the support staff by two full-time employees," said Hao. In addition, the staff has been able to take on the extra responsibility of coding patient records to ensure payment for services from insurance companies and government agencies.

Santa Teresita has eliminated the need to rent off-site storage space and has reduced use of an outside copy service by half. Because all the charts are available electronically, users have concurrent access to patient information.

Doctors can access patient records in under a minute, typically in 30 to 45 seconds, Hao said. The system has also improved Santa Teresita's ability to fulfill requests for patient records from doctors who might not necessarily work in the hospital. "We have received calls from physicians who told us they were surprised by the quick response to their request for patient information as compared to other hospitals," Hao said.

Fifty more terminals will be added to the system by the end of the year. "We only have terminals in about half of our nursing units," she explained. Because of the shortage of terminals right now, the hospital is making paper copies of the patient records accessible. "But once everyone is up and running and has access, we might not have to have the paper and the electronic records," Hao said.

Texas Scottish Rite

The need to provide access to multiple users simultaneously has also driven Texas Scottish Rite Hospital (Dallas) to install an electronic patient record system. The hospital, which focuses on pediatric orthopedics and child development, is in the process of installing electronic patient records and is beginning in the scoliosis clinic. Gathering and comparing data from patient records is critical.

"Our need is twofold: the need to be able to research against our patient population for clinical improvement and to allow future planning," said Hunt Gregg, director of Information Services at Texas Scottish Rite. "Also, because most of our patient visits are outpatient-based, we have always had the problem of locating and sharing the patient's chart with several caregivers at the same time. (Clinical Networx's, Waltham, MA) Clinical Master will allow us to perform our research and at the same time provide enhanced care through the ability of always having the patient chart at hand, whenever it is needed."

North Memorial

Getting physicians to enter their notes directly into the system rather than dictating them--which requires a great deal of time and expense, and can often delay the completion of a patient's chart--has been one of the benefits of electronic patient records at North Memorial Health Care (Minneapolis). North Memorial includes a 518-bed medical center, nine primary care clinics, an oncology clinic and 45 affiliated primary care and specialty clinics.

"Physicians are entering their notes into the system instead of dictating, and we're starting to see the impact of extracting information for preventative medicine and outcomes measurement," said Ron Heim, North Memorial's chief information officer.

One key issue, according to Heim, was that the system integrate with North Memorial's other client-server applications, including practice management and laboratory management.

North Memorial went live with the first clinic in January 1996 and plans to have nearly 34 networks with 250 primary care physicians on the network by the end of 1999. North Memorial is installing a system from MedicaLogic (www.medicalogic.com). "The exciting value of this initiative is the collaboration it is creating between primary care physicians and specialists,'' Heim said.

Community Hospitals (Indianapolis), also a MedicaLogic user, reports a decrease in transcription costs by 60%, according to Phyllis Reynolds, head of physician information services. They have been using the system since August 1997