Less Paper, Better ER? One Rural Hospital's Bid

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Despite being rural and relatively small, Duncan (Okla.) Regional Hospital has been a leader in health IT for years, first installing Meditech financial and clinical systems for acute care nearly 20 years ago. The latest IT project for the 167-bed facility in southwestern Oklahoma is to improve workflow and quality in the emergency department (ED) and better coordinate emergency care with care delivered elsewhere.

This summer, Duncan Regional is deploying T SystemEV Stat, an upgrade to an earlier management system from Dallas-based health IT vendor T-System, because the hospital has had problems managing paper records that came from other providers. The hospital also has been experiencing a steep increase in ED volume, according to Roger Neal, Duncan Regional's VP and CIO.

"We decided it was time to do a little something different in the ED," Neal said.

According to the vendor, T SystemEV Stat applies analytics and predictive modeling to real-time data aggregated from multiple sources in order to optimize patient flow. It also can produce alerts when the ED is close to capacity and help with disease surveillance.

Duncan Regional actually has used T-Systems paperwork templates for several years. "It wasn't as near as proactive as it ought to be," Neal said, and staff wanted to automate patient flow for clinical processes. Neal said physicians enter close to 85% of orders on a computerized physician order entry system that covers the ED and all inpatient areas.

"We have spent the last several years trying to tie systems together," Neal said. "I guess it's kind of the pinnacle of the entire project to manage flow in the ER from one place."

The ED is on the opposite side of the campus from the administration department, and the new system allows the nursing manager to track throughput from anywhere in the building and see where things may be bogging down, Neal said.

T-Systems has had a presence at Duncan for nearly eight years for administrative reasons. "The STAT System came around more for patient safety," Neal said. The new technology helps assure triage is handled properly and that staff follow clinical protocols such as giving aspirin to anyone with a heart attack and checking for drug allergies.

The technology also aggregates information from multiple information systems. "The nice thing is, everybody is working off the same record," Neal said. "We're affecting patient care and providing better-quality patient care because we do have the integration of our systems."

In the paper world, "it really is a nightmare trying to coordinate all that," according to Neal. Before this technology, practitioners and managers did not always know if everyone was receiving proper alerts, such as a patient being allergic to the iodine contrast agent for computerized tomography. "It's a much more fluid continuum of care," Neal said.

Once a patient is admitted to the hospital, the system automatically sends a full electronic copy of the chart to the appropriate department. "They can read the chart before the patient ever hits the floor," Neal said. "It's a more seamless and safer process."

For those discharged directly from the ED, primary care physicians can receive a copy of the record, too. Duncan Regional can send HL7 messages directly to external EHRs, and those without an EHR can receive a PDF copy of patient records through a secure messaging portal. "We try to make it as technically feasible for them to get those records as we can," Neal explained.

This essentially creates a health information exchange with Duncan Regional at the hub, giving the hospital a competitive advantage. Though the hospital is rural, many patients in need of specialty care will go to Oklahoma City, about 70 miles away, or to one of two hospitals in Lawton, Okla., about 30 miles from Duncan, Neal said.

The Healthcare IT Leadership Forum is a day-long venue where senior IT leaders in healthcare come together to discuss how they're using technology to improve clinical care. It happens in New York City on July 12. Find out more.