Ambulatory Electronic Medical Record and Shared Access (Illinois)

Project Final Report (PDF, 305.67 KB) Disclaimer

Ambulatory Electronic Medical Record and Shared Access - 2009

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    RFA: HS05-013: Limited Competition for AHRQ Transforming Health Care Quality Through Information Technology (THQIT)
  • Grant Number: 
    UC1 HS 016128
  • Project Period: 
    September 2005 – September 2009, Including No-Cost Extension
  • AHRQ Funding Amount: 
    $1,500,000
  • PDF Version: 
    (PDF, 423.21 KB)


Target Population: Medically Underserved

Summary: This project aimed to implement an ambulatory electronic medical record (EMR) across multiple and varied health care settings in a medically-underserved region of East Central Illinois. Sarah Bush Lincoln Health Center (SBLHC), a nonprofit community health care corporation, served as the fiscal agent and lead organization of a collaborative partnership. The goal of this implementation was to improve patient safety and assess provider and patient attitudes about health information technology by: 1) providing access to patient records across hospital services, home health, hospice, physician practices, and nonhospital provider settings and 2) integrating electronic tools for prescription orders and management of medications. The project used a Certification Commission for Health Information Technology-certified EMR, the Medical Practice Management suite of software developed by LSS Data Systems. Project partners included two private practice organizations and the Health Services Division of Eastern Illinois University. The purpose of the EMR was to facilitate coordinated care across services by sharing pertinent patient information with the emergency department and home health, hospice, family, internal medicine providers, and other specialists throughout the rural community. The ambulatory EMR provides a means to share a longitudinal medical record that contains, at a minimum a patient problem list, medication list, allergies, radiology images and data, laboratory data, and a patient care plan.

The SBLHC implemented the software, modified it to their specifications, and piloted it in the organization’s ambulatory clinic in Neoga, IL. During the pilot, the information systems team analyzed what worked well and what needed improvement. A spectrum of factors was evaluated, from the training manual format and training environment to followup support. The system implementation’s success was measured through direct user feedback.

Specific Aims:

  • Upgrade broadband network infrastructure at implementation sites. (Achieved)
  • Customize system software for implementation sites, including data dictionaries, analogs of paper forms, a billing module, and backup procedures in case of system failure. (Achieved)
  • Implement the system at 20 clinics in the local area. (Partially Achieved*)

2009 Activities: At the end of the project term the EMR was being used by 16 physicians and mid-level providers; approximately one-third of the planned providers. However, by the end of 2010, there were 20 providers in 10 clinics fully implemented. Software is installed by a standard process and standard dictionaries with some personalized templates. The system has a complete billing module including electronic billing. Data backup systems have been improved with a new “de-duplication technology” that backs up and restores patient data in a fraction of the former time.

Grantee’s Most Recent Self-Reported Quarterly Status (as of September 2009): Project momentum was interrupted due to technological delays, including system functionality development and compatible point-of-care tablet PC device availability. Efforts to expand system implementation beyond the initial 10 clinics to 10 other practices continue.

Impact and Findings: The project team found that emergency department (ED) and inpatient caregivers benefit from having electronic access to the patients’ ambulatory medications. Moving from paper to electronic charts can overwhelm busy clinics, and most physicians, mid-level providers, and nursing staff concluded that the system will not increase productivity until the charts are more established. However, although the users do not view the system as ideal, they would not choose to return to paper charts.

In 2006, the implementation team conducted a survey of ED caregivers. The initial survey results indicated that the caregivers were not always able to obtain a complete list of medications for patients because the patients could not communicate or simply did not understand their medications. When ED caregivers were polled again in 2009 to see if the ambulatory EMR implementation influenced their ability to provide care, all respondents stated that their ability to access patients’ ambulatory medications was enhanced and looked forward to having more information available when the remainder of the clinics implemented electronic records.

The project team learned many lessons that will help them implement the program in future clinics. For example, prior to the first implementation, a group of providers met and decided that anything that did not exist within the Enterprise Medical Record should be scanned into the system. The team discovered that scanning is extremely labor-intensive and should be started well in advance of implementation. They also reported that transcription into the system should be done at the earliest opportunity—even if the clinic will not be electronic right away. More detail on the project findings is included in the project’s final report: DeLuca 2009 Final Report.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care, and the electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

*One aim was not completed prior to the scheduled conclusion of the grant. By the end of 2010, there were 20 providers in 10 clinics fully implemented. Another 10 clinics are pending implementation.

Project Details - Ended

Project Categories

Summary:

This project aimed to implement an ambulatory electronic medical record (EMR) across multiple and varied health care settings in a medically underserved region of east central Illinois. Sarah Bush Lincoln Health Center (SBLHC), a not-for-profit community health care corporation, served as the fiscal agent and lead organization for a collaborative partnership to deploy an ambulatory EMR. The goal of this implementation was to improve patient safety and assess provider and patient attitudes toward health information technology (IT) by: 1) providing shared access to patient records across hospital services, home health, hospice, physician practices, and non-hospital provider settings; and 2) integrating electronic tools for prescription orders and management of medications. Project partners included two private practice organizations and the Health Services Division of Eastern Illinois University, a regional, residential university. The purpose of this project was to offer providers and patients a seamless coordination of care across a continuum of services by sharing pertinent patient information between the emergency department, home health and hospice, family and internal medicine practitioners, and specialists throughout the rural community.

The ambulatory EMR, implemented at approximately one-third of the SBLHC practices by the end of 2009, provides a means to share a longitudinal medical record that contains, at a minimum, a patient problem list, medication list, allergies, radiology images and data, laboratory data, and a patient care plan. The long-term goals of the partnership are to:

  1. Successfully deploy an ambulatory EMR with shared access to patient records across hospital services, home health, hospice, and employed and independent physician practice settings.
  2. Use computerized provider order entry and clinical decision support systems to reduce medication errors and increase patient safety.
  3. Provide a method to utilize the EMR for data collection, analysis, and reporting of the number and types of medication errors and adverse events that occur.

The principal findings for the ambulatory EMR implementation show that both the emergency department and inpatient caregivers benefited from having access to the patients' ambulatory medication lists electronically. Overall, physicians, mid-level providers, and nursing staff in the SBLHC clinics believed that the system did not increase their productivity up front; however, the users will most likely appreciate efficiencies once the charts are more established. The users stated that they would prefer the system's shortcomings be enhanced rather than revert to their old processes.

Ambulatory Electronic Medical Record and Shared Access - Final Report

Citation:
DeLuca M. Ambulatory Electronic Medical Record and Shared Access - Final Report. (Prepared by Sarah Bush Lincoln Health Center under Grant No. UC1 HS016128). Rockville, MD: Agency for Healthcare Research and Quality, 2009. (PDF, 305.67 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Principal Investigator: 
Document Type: 
This project does not have any related resource.
This project does not have any related survey.

Sarah Bush Lincoln Health Center Connects Hospital, Clinics Through EMRs

Michael DeLucaImagine the following scenario: a patient experiencing shortness of breath and difficulty breathing visits a primary care provider and is prescribed one medication. The following week, the patient visits a cardiovascular specialist for high blood pressure and heart disease and is prescribed another medication. The patient regularly takes sleeping aids at night and takes ibuprofen for occasional headaches. Within days, the patient has a reaction to the medications and visits the emergency room.

Without knowing all the dosages of medicines a patient is currently taking, it can be difficult for attending clinicians to determine which medicines could be causing a drug interaction and how to treat it. This type of scenario could lead to a potentially life-threatening situation. In today's health care delivery system, it is not uncommon to be seen by a primary care provider in one physician office, a specialist at another office, or even to make routine emergency room visits.

The Sarah Bush Lincoln Health Center in East Central Illinois has implemented an ambulatory electronic medical record (EMR) software application that provides shared access to computerized patient health information across hospital services, home health organizations, hospice, and physician practices to prevent this type of medical error. Sarah Bush Lincoln Health Center is a not-for-profit community healthcare corporation that serves rural communities in east central Illinois. A significant number of the region's population lives below the federal poverty level, and a significant percentage of Sarah Bush Lincoln's patients are uninsured. Sarah Bush Lincoln has developed a network of employed physicians and mid-level providers over a seven-county area.

By 2003, the regional hospital operated a centralized EMR application that captured all patient health information resulting from hospital-based care. But area clinics had yet to do the same. With help from a $1.5 million grant from the Agency for Healthcare Research and Quality, the hospital began implementing a variety of technologies, including an EMR system, computerized physician order entry (CPOE), and e-prescribing in regional clinics and home health practices. To date, six clinics have implemented all of these electronic health systems. Sarah Bush Lincoln plans to implement EMR, CPOE, and e-prescribing systems in a total of eleven clinics, making it possible to share longitudinal electronic medical records for every patient that is treated in the hospital or these participating clinic locations. These records will contain, at a minimum, a patient problem list, medication list, allergies, radiology reports and images, laboratory data, and treatment plans.

Before the system was installed, hospital staff could not access any patient records during clinic off-hours, despite the fact that the emergency room treats patients on a 24/7 basis. Clinicians who treated patients in the emergency room during these times were not able to access critical patient information such as current medications or health history. As part of the new EMR system, each patient has a "problem list," to let emergency staff know if they have high cholesterol, joint problems, or any other diagnosis that clinicians may need to know.

"The interesting thing about the clinic setting is that the patient only has one medical record," said Michael DeLuca, vice president of information systems at Sarah Bush Lincoln Health Center. "If you go to a family practice clinic, then to an orthopedic clinic, it's a continuous patient record from all the clinics integrated into the patient's medical record."

Although the system provided many benefits to physicians and patients, one of the biggest challenges with implementing the EMR system was finding a way to afford the technology costs. Software license fees and changes in the supporting technology hardware were the biggest expenses followed by the purchase of new equipment. Clinics purchased laptop PCs for all physicians. Increased network capacity was needed to hold all of the newly generated patient data. To help offset costs, Sarah Bush Lincoln matched each dollar provided in the AHRQgrant to fund the project. Total project costs to date are $3.5 million, and DeLuca said he expects to spend another $2 million implementing additional system after the grant runs out.

Another challenge to implementing the EMR system was the learning curve presented to physicians in using the system. To make the transition easier for clinics, the project team tested all new systems before using them in a "live" environment. In addition, they regularly consulted physicians, nurses, and technology support staff during the planning process. During the implementation phase, the project team reduced the physicians' patient loads for three to four weeks, and worked with physicians on a daily basis to implement the new information systems. For example, the team reduced patient loads per physician by 50 percent during the first week the system was "live," so that the clinical staff could have more time to adjust to using the new computers and software.

"Having all of the information from the different clinical locations is really powerful for patient care," said DeLuca. "There was a tremendous amount of treatment time saved, care was provided faster, and clinicians had better access to radiology images. Minimizing all these steps enables better health care in the end."

Future plans to expand the implementation of the EMR system include a women's clinic and information technology applications to support better medication ordering processes and related clinical documentation as they search for more direct methods to electronically connect with pharmacies. 

Technology: Computerized Provider Order Entry System