Exceptional Care through Exceptional Systems

2006 Information Technology Report

Physicians need complete and accurate information when developing a patient’s plan of care. Technologists consult a patient’s medical history when conducting a diagnostic study. People want answers quickly when they are making decisions about surgery and other treatment options. It is the job of our IT professionals to develop and maintain systems that meet these needs 24 hours a day.

The Senior Leadership team takes seriously our commitment to developing systems that ensure our success. As the IT Steer-ing Committee, we meet monthly with Dr. Ludwig Eglseder, our physician liaison, and Tara Newman-Bell, Director of IT, to prioritize the many requests for IT resources. Because Shore Health System’s investment in information technology trans-lates into millions of dollars of capital and operating expense each year, the IT Steering Committee critically reviews how to invest in systems. Together, we thoroughly examine the many opportunities for process improvements and select the projects that best prepare us for operating in an increasingly complex healthcare environment.

With safety and quality of care at the core of our mission - Exceptional Care, Every Day – our IT staff focuses on giving staff access to the data they need to make informed clinical decisions. Systems users are involved in every step of a project.

Working side by side with nurses, physical therapists, pharma-cists, clinicians, and physicians of all specialties, IT analysts understand the clinical perspectives that drive the development of systems solutions.

I applaud the spirit of innovation with which our physicians and other clinical staff embrace new ways of caring for our patients. Their willingness to pilot systems initiatives and offer their ideas for enhancements makes it possible for the IT team to deliver the tools required to provide safe and efficient medical care.

Our partnership with the University of Maryland Medical System connects us to another level of IT systems and resources, which will benefit our healthcare providers and the people they serve.

As I look ahead to the next decade, Shore Health System will continue to be the Mid-Shore’s primary provider of healthcare services. Expanded services, renovated and new facilities, and additional physicians are at the heart of how we will grow along with our community. Information technology and the skills of our IT team will be central players in how we meet the opportunities on the horizon.

- Joseph P. Ross, FACHE President and CEO, Shore Health System

Joseph P. Ross

Linking the right people with the right information – that is the mission of Shore Health System’s Information Technology team.

“I applaud the spirit of innovation with which our physicians and other clinical staff embrace new ways of caring for our patients.”

- Joseph P. Ross, FACHEPresident and CEO, Shore Health System

The ITSC consists of Shore Health System Senior Leadership, a physician champion, and the

Director of IT. The members are: Joseph Ross, President and CEO; Deidra Bell, Chief Financial

Officer; Gerard Walsh, Chief Operating Officer; Christopher Parker, Chief Nursing Officer; Jeff

Johnson, Senior Vice President of System Development and External Operations; Michael

Zimmerman, Vice President of Human Resources; Patti Willis, Vice President of Corporate

Communications; Walter Zajac, Vice President of Finance; Julia Marlowe, Vice President of

Philanthropy; Ludwig Eglseder, III, MD, IT Physician Advisor; and Tara Newman-Bell,

Director of Information Technology.

Shore Health System formed the Information Technology Steering Committee (ITSC) to provide feedback and insight on the effectiveness of current IT technologies, procedures, priorities, and strategies. Through mutually beneficial collaboration and sharing of information, the ITSC influences plans for advancing technology that will have a positive impact throughout Shore Health System.

Leading Information Technology

“As IT professionals, we value the opportunity to transform healthcare and improve patient safety by leveraging information technology to improve the efficiency, accuracy, and effectiveness of our healthcare system.” - Tara L. Newman-Bell, MSM, Director of Information Technology

InProgress

Over the last year, the documentation phase of MEDITECH’s Patient Care System was completed at The Memorial Hos-pital at Easton and Dorchester General Hospital. Nurses, physicians, and other clinicians benefit from a number of improvements, including increased accessibility to patient information for clinical decision making, improved documenta-tion legibility, and the ability to standardize care across Shore Health System.

Other IT initiatives underway are designed to facilitate coor-dination of care in the Emergency Departments and to link physicians with the people and information they need to make informed clinical decisions.

Documenting Patient Care EfficientlyShore Health System’s Patient Care System (PCS) provides real-time recording of patient information, making it accessible to multiple users at multiple locations. PCS allows providers to electronically view, update, and process a patient’s plan of care.

The system’s capability to capture clinically significant data on the patient’s progress assists providers in their clinical decision making.Nurses have access to plan of care work lists and inter-ventions to guide them in day-to-day patient management.

Use of Internet technology makes it easier for employees, physicians, volunteers, and the community to stay up to date on developments in healthcare and services available from Shore Health System.

As nurses gain familiarity with PCS, they are finding new ways to use the system to streamline their work.

Physicians have the ability to customize how they view clinical information, which gives them more efficient access to data they use in delivering patient care.

Additional benefits of PCS include improved patient variance and audit reporting capabilities and more accurate recording of service charges.

Future enhancements will benefit ambulatory care providers, including Same Day Surgery, the Operating Rooms, and Post-An-esthesia Care Units at both hospitals. PCS was also implemented in the Requard Center for Acute Rehabilitation at Memorial Hospital when it opened in the spring of 2007.

Individualized training through self-directed computer-based tutorials lets clinicians learn at their own pace on their own desktop computers, even at home, through the use of a CD. As changes are made to the system, the computer-based tuto-rial can be used as a tool for continuing education, updating staff on new information as it arises.

“From the nursing standpoint, MEDITECH has improved accessibility to accurate data. Specifically, electronic documentation eliminates the issues surrounding legibility, reducing transcription time and improving accuracy. These improvements are aligned with Shore Health System’s ongoing quality initiatives.”

- Christopher J. Parker, MSN, RN, CNAA, BC, CHCQM, Chief Nursing Officer

Taking PCS on the RoadOne way of expanding the benefits of MEDITECH is to make PCS available to off-site facilities. For example, Shore Rehabilita-tion Services staff working from off-site facilities in Cambridge, Centreville, Denton, and Easton, have access to test results and inpatient records, which gives them a clearer clinical picture. As a result, they can move forward more quickly with treatments that meet a patient’s needs.

Coordinating Care in the ERConstruction and renovation at the Memorial Hospital and Dorchester General Hospital Emergency Depart-ments goes beyond bricks and mortar. Every patient care process is being examined and IT is playing a major role in the design of efficient patient tracking systems.

MEDITECH’s Emergency Department Management (EDM) appli-cation includes a Patient Tracker Integrated Desktop. This applica-tion gives staff a central point of data entry for documenting the daily treatment of patients and for managing the flow of patients through the system. When patients enter the Emergency Depart-ment, a triage nurse records the basic information needed to get them into the system quickly. Patients are then able to have orders placed, assessments performed, and documentation entered even before they are fully registered. This improved efficiency allows the triage nurse to ensure that the sickest patients receive the most immediate care.

“Our staff loves having the clinical information available to them in a timely manner as it allows them to proceed with their work. The more complete picture they have of a patient, the better clinical decisions they are able to make.” - Teresa Blem, Director of Shore Rehabilitation Services

The EDM system, which tracks patient test results, medication orders, and vital signs, serves as a communication tool between physicians, nurses, and the departments with which the Emergency Department staff interacts. Clinicians can view data from a patient’s previous visits to a Shore Health System hospital. EDM also can reconcile “at home” medications to obtain a better understanding of the individual’s chronic and acute medical conditions.

The EDM Patient Tracker Integrated Desktop includes nursing assessment tools that ensure medical record continuity. Once a patient is ready to be discharged, the system generates patient care instructions, follow-up reminders, referrals, forms, and prescriptions for the patient.

Some of the benefits of the EDM application that contribute to safety, satisfaction, and quality are

• the ability to capture the time elapsed between arrival in the Emergency Department and initiation of physician care

• standardized nursing care between Emergency Departments at both hospitals

• enhanced patient education through systematized discharge planning

• enhanced accessibility to patient data

In Progress

The Emergency Department Management system, which tracks patient test results, medication orders, and vital signs, serves as a communication tool between physicians, nurses, and the departments with which the Emergency Department staff interacts.

State of the art connectivity solutions minimize paper-based processing and improve the flow of clinical information to physicians and their office staff.

Linking Physicians and Healthcare Professionals Several IT initiatives have focused on the processes used to or-der tests and report results to members of the Shore Health System medical staff.

Online Laboratory TestingArea physician offices are now able to order laboratory tests online and receive results electronically. Benefits to the physicians and their patients include

• immediate access to test results

• enhanced data management through graphs and cumulative reports

• elimination of legibility issues, which improves safety for the patient and efficiency for the clinicians

• improved productivity by eliminating paper-based processing in physician offices

• improved insurance reimbursement with better access to diagnosis codes

• timely electronic transfer of reports to consulting physicians

Soon, testing from the Radiology and Cardiology Departments will be handled electronically as well. During the next phase of implementation, patient test results will be integrated into the physician’s electronic medical record.

Surgical Electronic Posting ToolA new, secure electronic posting tool aids surgeons in scheduling time in the Operating Rooms at Memorial Hospital and Dorchester General Hospital.

A physician’s office staff now has the ability to complete forms on-line. Notice of a surgeon’s request for OR time is e-mailed to the hospital Posting Office. The physician then receives a confirma-tion of scheduled OR time.

Surgeons can now also view online their blocks of surgeries from their offices. The new process has improved accuracy in OR schedules, decreased the amount of paper in physician offices, and created a smoother, more efficient process.

Physician LaptopsLaptop computers are currently being piloted with physicians who make rounds at the hospitals. Using a laptop provides physicians with better access to a patient’s electronic medical record.

New laptops have wireless capabilities, increasing efficiencies for physicians by giving them immediate access to the information they need to evaluate clinical records and determine appropri-ate care. The addition of laptop computers paves the way for the eventual computerization of physician order entry.

Electronic Order FormsA physician’s order for diagnostic tests can now be placed through pre-printed forms available on Shore Health System’s Intranet. The forms can be filled out electronically by physicians and their office staff, which eliminates legibility issues and standardizes care for patients. An added benefit is that forms can be more eas-ily standardized and updated, as needed. The next phase will be computerized order entry capability, which will allow physicians to place orders online from any Shore Health System location.

In Progress

“By improving physician accessibility to patient information, as well as to other clinical resources, we can improve the quality of care delivered to our patients. The quicker the information is available to the physician, the earlier treatment can begin. Today’s technology enables physicians to do their job from multiple locations without delaying patient care.” - Ludwig Eglseder, III, MD, Internal Medicine Specialist and Hospitalist

and events, charitable giving, customized health management and assessment tools.

The Nursing Department uses the website to publicize Shore Health System job opportunities for novice and expe-rienced nurses. The site also highlights links to professional nursing organizations and nursing initiatives sponsored by Shore Health System.

The Memorial Hospital Foundation maintains a web page to assist donors with charitable gift planning. Subscribers receive weekly articles and an e-newsletter. Gifts can be made online through the website.

The online Physician Directory provides information to the public on all members of the Shore Health System medical staff. This section of the website highlights recently privileged physicians and those who are taking new patients. The informa-tion can be searched by specialty and by physician name.

Physicians and Board members have secure access to web pages designed to keep them up to date on Shore Health System news and administrative issues specific to their roles in the organiza-tion. Employees can also access their work documents when they are away from the office through the website.

IntranetThe Intranet provides staff, physicians, and volunteers with ac-cess to information such as policies and procedures, pre-printed forms, employee benefits, medical staff privileges, and annual education and training schedules.

Sections designed specifically for nurses containThe Beacon, the monthly nursing newsletter, along with on-call nursing schedules. A special Nurses Journal Club is available to nurses who use the Intranet to share and discuss online medical articles.

In Progress

Dictation Transcription OutsourcingThe arrival of MEDITECH brought about new technology which led to centralized transcription services through one vendor. Moving to an application service provider (ASP) and an Internet-based company has improved transcription turnaround time so that updates to the patient’s electronic record are completed on a more timely basis.

The improved availability of diagnostics, including X-ray and car-dio-pulmonary studies, allows clinicians to quickly initiate patient care treatment and transfer information to other clinicians and facilities, when necessary. Improved voice legibility has increased the accuracy of transcription, improving overall patient safety.

An additional benefit of outsourcing transcription services is the vendor’s disaster recovery capability, which includes back-ups for files maintained at an off-site location.

The next phase of the dictation transcription project will imple-ment an electronic signature. Physicians will be able to sign tran-scribed orders electronically and from locations other than Shore Health System hospitals.

Broadening Information ChannelsThrough Shore Health System’s Internet and Intranet, the most up to date information is available to the people who need it. Because these online information networks are easy to update, they become a resource of health information, news, and resources 24 hours, seven days a week.

InternetThrough www.shorehealth.org, the general public has access to a variety of health topics, overviews of Shore Health System’s services, listings of job opportunities, news releases, and archived publications. The multifaceted site offers a large array of information on product lines and services, as well as classes

“My physician practice has been using the electronic health records for over five years. Through improved transcription times over the last year, I now have quicker access to the diagnostic test results of my patients. I am able, through a computer right in my exam room, to review these results with my patients and initiate patient care in a more timely manner. That improves the quality of medical care that I can give my patients.” - Eugene J. Newmier, DO, Rose Hill Family Physicians

In August 2001, Radiology implemented Phase I of a plan to transition to a filmless digital archiving of CT, MRI, and nuclear medicine images from Memorial Hospital and the Diagnostic and Imaging Center into the PACS system.

In March 2005, Phase II included archiving Dorchester Gen-eral Hospital’s cross-sectional images into the PACS system, as well as adding an image distribution server called Image Qube. Image Qube gives physicians and on-call radiolo-gists secure access to patient images when they are not at the hospitals. Physicians who have installed software can query a database and pull cross-sectional images to their desktops at their offices or their homes, with appropriate security, increasing their accessibility to this patient data. Physician users of this technology include general surgeons, neurolo-gists, orthopedic surgeons, neurosurgeons, oncologists, and pulmonologists.

Transmitting and Storing DigitallyIn 2007, PACS will transmit and store digital X-rays through Digital Radiography (DR) and Computed Radiography (CR), eliminating film in all areas of Radiology, except mammogra-phy, which is being reviewed.

DR adds X-rays to the full menu of digital imaging available through Radiology. Films used to produce X-rays are replaced with digital images. The time to process DR is one-half the time it takes to process an X-ray. This translates into savings for Radiology staff, who can process images more efficiently to be viewed via PACS. DR offers patient benefits by reducing the time it takes to get an appointment and obtain results. X-rays also can be performed with less exposure to radiation.

CR is used for portable X-rays and fluroscopies, which are done in locations other than Radiology. CR replaces film and wet processors with re-writable plates. Once the cas-sette-based digital plate is placed in a scanner, the images are converted into electronic digital images for viewing.

With the installation of DR and CR, physicians have access to radiographic images wherever they are treating patients.

With the phasing in of the Picture Archive and Communication System (PACS) technology over the last six years, Shore Health System has positioned itself for the future in healthcare imaging.

ComingSoon

“The PACS system provides an organized system for managing images and enables multiple users to view these images at the same time in multiple locations. Stored films are also easily accessible for immediate comparison when needed. CR/DR will extend all of the advantages of PACS to regular X-rays, creating a tremendous efficiency gain for both clinicians and physicians utilizing the system.”

- Christopher S. Levey, MD, Chief of Radiology for Memorial Hospital

Tracking Patient Information through the Electronic Medical Record To assist physicians in managing patient data, Shore Health System is developing a software system that is compatible with MEDITECH. This system will be accessible in physician offices and enable doctors and their staffs to track patient data through an Electronic Medical Record (EMR). The software will give physicians enhanced access to patient information, which will lead to more efficient and effective coordination of care between outpatient and hospital settings.

Bedside Medication Verification Bedside Medication Verification (BMV) will allow healthcare pro-viders to utilize bar code scanning technology prior to adminis-tering medications. The system will be available at both hospitals and used to confirm patient identity and medication information against data readily available via MEDITECH’s online Medication Administration Record.

BMV processes the scanned data through the “Five Rights” of medication management: Right Patient, Right Medication, Right Dosage, Right Route, and Right Time. This process will make medication documentation available in real time to all clinicians through the electronic medical record. Immediate access to a patient’s current test results and medication information greatly re-duces preventable medication errors and improves quality of care.

Computerized Provider Order Entry Computerized Provider Order Entry (CPOE) will enable physicians who originate orders for laboratory and diagnostic testing to place them elec-tronically. CPOE will eventually be expanded for medication orders.

Currently, hospital unit secretaries and nurses place these orders from handwritten order sheets. CPOE will enable physicians and clinical pharmacists to enter orders from any Shore Health System computer. This new process will eliminate the interpreta-tion of handwritten orders, which improves patient safety and expedites the delivery of patient care.

Evidence-Based Clinical Information ResourcesShore Health System is evaluating UpToDate, the web-based tool that physicians around the world choose when they need evidence-based clinical information resources. UpToDate is a clinical review service for diagnostic and therapeutic information on a variety of medical topics and health conditions.

More current than textbooks, UpToDate enables physicians and other clinicians to

• access the most current information within their specialty

• recognize the clinical manifestations of a wide variety of disorders and describe current options for diagnosis, management, and therapy

• identify optimal screening and prevention strategies

On theHorizon

Bedside Medication Verification (BMV) will be available at both hospitals and used to confirm patient identity and medication information. Immediate access to a patient’s current test results and medication information greatly reduces preventable medication errors and improves quality of care.

Transforming Cardiovascular Diagnostic TestingShore Health System completes approximately 90,000 car-diovascular and pulmonary studies a year. The menu includes sleep studies, pulmonary function studies, vascular stud-ies, cardiac ultrasound, stress testing, 12-lead ECG, cardiac rehabilitation and telemetry reports, and cardiac catheteriza-tion physiologic reports and images. Transitioning this data to a digital environment through MEDITECH will make these studies more accessible to physicians as they make decisions about the care of their patients.

The Cardiovascular Information System (CVIS) will send or-ders for cardiovascular and pulmonary studies directly to the department where the test will be conducted. Technologists performing the cardiovascular studies will be better prepared when a patient arrives because they will have access to the individual’s profile.

Images captured through CVIS and a report will be sent to physicians to facilitate the interpretation process. Physicians can review, modify, and interpret data from these studies from work stations at the hospitals and from remote locations. Pri-mary care physicians and hospitalists will have access to final images and reports electronically. In addition, CVIS will link to the University of Maryland Medical System for procedures performed there and for consultative services.

CVIS has the capability to track patient care trends and monitor accreditation standards. The system also can monitor participation in research and transfer information to participating registries.

“CVIS will help improve the accuracies of the data collected in cardiovascular and pulmonary studies. In addition, staff and clinicians will realize improved work flow and efficiencies. The result will be improved patient safety and quality of patient care.”

- Gary Jones, Director of Cardio-Pulmonary & Vascular Services

On the Horizon

With the Cardiovascular Information System, physicians can review, modify, and interpret data from cardiovascular studies at work stations within the hospital and remote locations.

Exceptional Care, Every Day. www.shorehealth.org

IT at a Glance 2,500 users in Talbot, Dorchester, Kent, Queen Anne’s, and Caroline counties

1,390 desktop and laptop PCs

102 servers

100 PDAs

500 printers

155 fax machines

80 copiers

2,800 telephones

689 pagers

226 SpectraLink telephones

55 Verizon cellular telephones

47 Nextel cellular telephones

2 mobile radio systems

6 satellite phones

219 South Washington StreetEaston, MD 21601410-822-1000