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User survey proves value of I/S strategy.

Emory University System of Health Care surveyed clinical data repository users to demonstrate the value of a multimillion dollar CDR project.

How can you prove the value of a multimillion dollar clinical data repository (CDR) project to a new senior management team when you have no tangible benchmarks to measure the return on investment?

For Emory University System of Health Care (EUSHC), Atlanta, the answer turned out to be surprisingly simple: Survey the users.

The idea to conduct a written 15-question survey among the system's 120 users evolved about a year ago after EUSHC changed management and no viable benchmarks were available to prove the value of the CDR. Like most healthcare organizations, the departments had made isolated I/S decisions, purchasing best-of-breed systems. This practice continued until the three-site organization accumulated 70 different information systems.

In 1991, EUSHC's senior management, which included physicians, had a vision to create an electronic medical record that would span the three facilities and seamlessly tie together information from the existing 70 feeder systems.

System integration

Having invested millions of dollars in the core systems, we were not interested in replacing them to achieve connectivity. The goal at the onset was to enhance our investment by pulling the data from these disparate systems and integrating them in a single CDR. But there were two problems: No CDRs were available on the market at that time, and we did not have the resources available to create our own. So, we decided to engage a proven supplier as a prime contractor to tailor the CDR to the specifications of our multispecialty physicians.

In 1991, after an extensive search, Cerner Corporation, Kansas City, Mo., was chosen as a development partner. Cerner was selected because the company's development team included more physicians than did other suppliers. A knowledgeable physician team was essential to us because EUSHC's CDR strategy centered on providing physician access to data. The current paper-based medical records system and multiple facilities often prevented physicians from accessing critical information at the time of patient care.

Development partnering:

A brave new world

Thus began our journey into the brave new world of development partnering. A total of 23 physicians representing multiple specialties and various levels of computer literacy were selected to help develop the repository. Every six weeks Emory physicians met with Cerner physicians and project team members to assess the current version of software. After numerous releases, we went live with Open Clinical Foundation Data Repository in July 1993.

It was a year after production that the I/S department found itself reporting to new senior management who had not been involved with the development of the CDR project. The survey was proposed as a means of communication about the project's status and the value it brought to our project physicians, who had expanded from 23 to 60.

Performing a reality check

At the onset of the CDR project, physicians had requested online access to lab and radiology data, history and physicals, operative reports, discharge summaries, consultations, demographics and internal medicine notes. This is precisely what was available at CDR's current stage of development.

During the initial stages of development, data was entered into the CDR from the following 10 (out of 70) information systems:

* At Crawford Long Hospital: Atlanta-based HBO & Company's (HBOC) Health Quest registration system, CHC's LabCare and RadCare and Medifax Transcription. * At the Emory University Hospital: HBOC's Health Quest registration system, Cerner's PathNet, Burlington, Vt.-based IDX's DecRad radiology system and Cleveland-based Medical Records Corporation Transcription. * At the Emory Clinic: MedTec registration system, Hercules, Calif.-based Biovation's Lyris 90 laboratory system and Semiotix's Insight Document Management system.

Survey gauges

system's value

In October 1994, the CDR was still a development project offering limited functionality compared to what is available today. It is important to remember the CDR was undergoing updates every six months. Despite its limited functionality, we instinctively knew the CDR offered value and believed the survey would gauge the extent of that value. A sample of some questions we developed are as follows:

* Have you or others working with you realized any savings in time spent locating or retrieving clinical information since gaining access to the CDR? * Overall, has the CDR reduced your need for accessing the paper record? * Overall, do you feel that access to the CDR has improved your ability to perform your job? * Have there been times when the paper record could not be located that you were able to gain access to the information through the CDR?

To ensure a high response rate, we made the survey a simple multiple-choice questionnaire that was easy for a clinician to read and complete. One question merited a written response: If the clinical information available through the CDR today was no longer available to you, what consequences might this have on your ability to perform your job? That would determine conclusively the value of the CDR.

We also provided an area for other comments. The survey generated 62 responses, 31 from multispecialty physicians and 31 from other areas, such as liver transplant, medical records, quality improvement and anesthesiology.

86 percent cite improved

multifacility data access

The response received was so positive that it reinforced our strategic direction in continuing to add interfaces and functionality to the CDR. We also were impressed that the user base reported such a significant level of benefits, even though the CDR was receiving data from only 10 out of a potential 70 systems. For example, a pathologist said that if the CDR were removed, it would be back to the Dark Ages.

These responses reveal that healthcare organizations can receive tremendous benefits from minimal l/S functionality.

We also were impressed with the positive results received regarding ease of data access, with 71 percent citing access as improved. This was remarkable because at the time, access was not available from central areas, only through personal computers. For this reason, we expected a larger number to say they had trouble accessing the CDR.

Fifty percent of all users said the CDR had greatly improved the ability to access data from the three facilities; 28 percent said it had somewhat improved and 11 percent said it had not improved.

Thirty-one percent of survey respondents said the CDR had greatly reduced the need to access the paper record; 45 percent said this had been somewhat reduced and 18 percent said it was not reduced.

Fifty-eight percent said they were able to access the CDR at the times and locations they needed information; 34 percent said they were not able to do this.

Survey results become

springboard to the future

As a communications tool, the survey helped to reinforce the level of commitment required to continue with such a large development project. The success of the project has been validated by the tremendous user-base growth. Since the time of the survey we have increased from 120 users to more than 800.

Our future plans involve expansion to include all 2,000 EUSHC physicians and many of our 6,000 other employees. In addition, we have decided to extend our utilization of Cerner technology to automate the medication administration process.

This process includes placing orders, as well as medication administration and documentation across our health system. The products purchased include Cerner's pharmacy information system, as well as the applications for order management and provider documentation.

We plan to conduct another survey in the fall. Additional questions will include gauging users' opinions about the new Windows release (Cerner's CDR and viewer recently migrated to a Windows platform).

We are confident more surveys will be deployed as we continue to fulfill our vision of building a dynamic, viable electronic medical record.
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Title Annotation:Emory University System of Health Care demonstrates value of clinical data repository project
Author:Scott, Harold
Publication:Health Management Technology
Date:Sep 1, 1995
Words:1279
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