By Gregg T. Martin, MBA, CPHIMS

ARNOT HEALTH INCLUDES ARNOT OGDEN MEDICAL CENTER, AN INDEPENDent, not-for-profit, 256-bed tertiary medical facility, as well as an affiliated group of approximately 70 multi-specialty providers in 20-plus offices throughout the southern tier of New York and the northern tier of Pennsylvania. Located in Elmira, New York, the 250-bed Arnot Ogden Medical Center is very focused on using information technology throughout the medication dispensing and administration process, as evidenced by the implementation of our first clinical information system in 1982. Our strategy for implementing information technology is directly tied to how the technology in question can help support our mission or the organizational systems that support our mission. If technology does not address these fundamental requirements, it seldom—if ever—gets funding. So, when it came to looking for electronic health record solutions, the mandate given to the search and selection committee was based on the following goals:

1. Acquire a system that provides our end-users with demonstrable value, and that compliments and supports their work—rather than complicating it—thus encouraging them to be stakeholders in the system’s success.
2. Acquire a system that offers a “closed-loop” medication-use process, with imbedded and integrated—not just interfaced—nursing and provider interaction, providing every care provider with instant, real-time access to pertinent information. We did not want to create silos of information that might not be in sync.
3. Acquire a flexible system with a tool set that would allow us to meet the needs of a dynamic environment and make changes relatively rapidly.
4. Work with a trusted vendor that shares our vision, acts as a partner in the process, and is committed to our success.

Implementation
At the end of our search and vendor analysis, the Misys CPR system became our selection committee’s unanimous choice, because it scored the highest in both our quantitative and qualitative scoring matrix, and Misys was judged to be the vendor we most wanted to do business with. Our decision has been reaffirmed time and time again.

For the implementation, we established three major milestones. The first was to implement an EMAR, which would be the cornerstone of our subsequent efforts to implement CPOE and, lastly, bar code medication administration (BCMA). We decided to make medications available at the patient bedside, and run our medication charting and nursing documentation systems off of computerized workstations. This approach, while more expensive than using medication carts, for instance, was primarily selected because we wanted our nursing staff to spend more time at the bedside, where they could develop a closer bond with the patient, and we felt it would facilitate more timely and accurate information collection, as well as support our plans for BCMA. Our preand post-go-live measurements indicate that our nurses are spending, on average, 23% more time in the patient’s room. And while some documentation is still being done at the central nursing station, most patient-assessment and medication-administration documentation is being done at the bedside.

While MIS coordinated the project, the implementation team was instrumental in designing the process. This team included a pharmacist, trained to be a pharmacy analyst for the system, and several nurses, who became nursing analysts for the system. Deemed an essential strategy for supporting our objectives and gaining pharmacy and nursing enduser acceptance, this approach continues to pay dividends today, as the analysts continue to combine their clinical expertise and workflow knowledge with their newfound IS knowledge to help us meet ever-changing patient care requirements.

Results
Looking back at how our efforts have translated into demonstrable benefits, we have found some interesting results. For instance, once the EMAR was established, we initiated our CPOE efforts. Roughly 50% of our most active providers enter, on average, 56% of their medication orders directly via CPOE. With these orders, we have completely eliminated the potential for transcription/legibility errors. In addition, our medication error rate dropped by 2% in the study period, and our average length of stay decreased by almost a half day, while patient acuity increased. Furthermore, we found that our average order-process time, when entered via CPOE, decreased by 56 minutes.

Also, using CPR’s tool set, the nursing and pharmacy system analysts created an electronic communications system for nursing and pharmacy, so instant messaging could be sent directly from the bedside to pharmacists for missing doses or questions related to a medication. The result was a decrease in the number of telephone calls to pharmacy, by an average of 800 per month during the study period, saving the staff an estimated 1,200 hours a year.

After placing medications at bedside, we have discovered anecdotal evidence that certain drugs, like NPO and pain meds, have been given faster and more reliably. We have also been able to create conditional orders for medication administration, which provide nurses with customized prompts, such as “Hold Lopressor if heart rate less than 60 or SPB less than 90.” These orders reinforce our medication administration policy, and clearly label conditional medications in the EMAR. The use of the Misys pharmacy module has also led to better documentation for medicationrelated information, like patient allergies and weights. Documentation of this information is required, and reminders are sent to nursing staff when it is not present.

We continually review our patient care processes to uncover the improvement opportunities Misys CPR can offer. We are now implementing a Misys outpatient EMR system, and connecting the ambulatory and inpatient settings electronically so caregivers have a more complete picture of a patient’s care. This will help us meet medication reconciliation requirements and support our efforts in providing quality patient care, which—at the end of the day—is why we are in business.

Gregg T. Martin, MBA, CPHIMS, is the chief information officer for Arnot Ogden Medical Center, a post he has held for 10 years. He received a BS in business administration from Elmira College and an MBA from Syracuse University.