CIS Implementation at Record Speed.

With the healthcare information technology industry moving at breakneck speed, proven technology solutions are at peak demand. The need for enhanced functionality and decision support at the point of care has driven the healthcare technology marketplace into uncharted territory. More and more hospitals and medical centers are looking to technology vendors to ensure that their clinical information systems (CISs) can handle high volumes of information with top performance and reliability, display data in meaningful clinical formats, and provide alerts and warnings.

PROBLEM

At Brooke Army Medical Center in Fort Sam Houston, TX, there was a distinct need for a new, fully functional, multisolution-based CIS. The existing legacy system, installed in 1996, was faulty and had repeated system failures. Clinicians within the center refused to use the system for fear of compromising medical care, and returned to traditional paper chart files. As a Level 1 Trauma Center, the only trauma center operated by a Department of the Army medical facility, resorting to paper charts was neither practical nor worth the constant administrative hassles.

Upon legal review, we determined that the legacy vendor was in breach of its federal contract and our administration approved the lease of a new system. Under my direction, a "tiger team" of Brooke representatives, including two eager participants from the Department of Nursing, Lt. Col. Brenda Mygrant, R.N., and Lt. Col. Sharon Pfiffner, R.N., set out to identify a vendor with a successful track record, proven technology and software solutions for real-time patient care.

The demand for new technology was so acute that we requited a vendor who could satisfy our stringent timeline and offer the least disruption to our clinicians, patients and overall business operations. We knew of CliniComp, Intl. through endorsements by 11 other Department of Defense (DOD) sites where their system was installed. These sites reported record success and we received positive referrals from our professional colleagues at these facilities. In addition, through these DOD sites, we were able to review and experience their technology in a variety of real-time patient care environments.

At Brooke, the goal was installation and transition to a new system in 45 days. We needed the system to be in place before June 1999, when our new wave of interns and residents would arrive. With references from our colleagues and assurance from the vendor that they could meet our 45-day timeline from contract signing to "go-live," we awarded the contract.

SOLUTION

Bravely, we incorporated into our 45-day implementation plan a transition to the new system over a single weekend. In anticipation of the transition, our clinicians discharged as many patients as medically possible, and postponed admission of new patients (such as by delaying elective surgery by one or two days) except for trauma and true medical or surgical emergencies. Despite the limited patient load and contingency plans that would be in place, we required assurances that clinicians would be able to utilize the system quickly after its activation.

During the installation period, the vendor performed custom configuration for 19 different clinical environments and provided extensive user education to prepare our staff. This training prepared our staff to perform the necessary tasks required to navigate and operate various system solutions to chart and display essential patient laboratory and physiological data. In addition to user training, the company assumed the task of installing the software and addressing hardware infrastructure issues in close cooperation with, and with the guidance of, our information management division.

To condense what is usually a 90- to 120-day implementation period into 45 days, the company built a virtual private network (VPN) connecting its headquarters with our medical center. Via the VPN, the vendor downloaded software onto our nearly 3,000 workstations. The company still maintains the VPN connection to monitor the system's performance and provide upgrades and maintenance with our system administrator's expert assistance.

The system went live at Brooke on May 5, 1999, with hardly a missed beat as documented patient care continued over the brief period of transition. Our legacy system was taken down and the vendor's CIS came to life in just one brief moment. After more than 12 months of nearly full use of the system, Brooke's administration and clinicians couldn't be happier with the performance of the technology.

TECHNOLOGY

CliniComp describes their CIS System as a computerized patient record (CPR) system that is designed to work in the inpatient, outpatient and ambulatory care environments. The system fully supports all patient care functions for charting (including patient physiologic monitored data, and ventilator settings and functional parameters in ICU environments), managing orders, and analyzing information for clinical decision-making. The CIS integrates real-time data and historical records, making them available at the point of care, nursing stations, or remote locations. Through this functionality, combined with other built-in clinical data technology, the system coordinates all aspects of care, including interfaces to financial and administrative information systems. The system operates through a simple graphical user interface (GUI) and archives to a Global Database.

BENEFITS

In today's information age of efficiency, high volumes of data exchange, and a staff that is no longer tied to the patient care unit for information entry and data analysis, this CIS has exceeded our expectations. We have experienced a wide range of benefits, including:

Improved processing: The CIS has significantly reduced incomplete, inaccurate and delinquent patient charts. Our patient administration division can submit claims for third-party billing earlier by sending supporting clinical documentation with the claim.

Enhanced documentation: Our Department of Medicine (DOM), thanks to the visionary leadership of Col. Michael A. Berry, M.D. as the chief of DOM, is using the CIS for all narrative discharge summaries instead of the cumbersome standard voice dictation/transcription method. Consultations and notes are efficiently combined and entered, and inpatient visits are easily archived. We have enjoyed a 60 percent to 70 percent drop in incomplete or delinquent patient records for those departments who have adopted the DOM example.

Access without boundaries: Our clinicians can analyze patient charts and test results, and perform research regardless of their location.

Mandated usage: In August 1999, the DOM mandated use of the new CIS system for all new admissions and all patient transfers to DOM. This was a move not prompted by Brooke administrators, but by clinical users who saw the proven advantages of the new system.

CONCLUSION

We are confident that the integrity and safety of our critical patient data and general patient record operations are sound. Even though we have not completed a formal quantitative study on return on investment, we stand by our partnership decision. The new system has provided us with a reliable, user-friendly solution with high levels of speed and performance and has been well received by the entire Brooke community.

For more information from CliniComp, circle 191

SOURCE

Col. Daryl N. Zeigler, M.D. Chief of Physical Medicine and Rehabilitation Brooke Army Medical Center Fort Sam Houston, TX 210-916-1924 [e-mail]

PRODUCT/COMPANY

Clinical Information System CliniComp, Intl. www.clinicomp.com