Actionable data to improve care Children’s clinical database supports real-time alerts for clinicians, and provides a tool by which the organization understands, communicates and improves ongoing processes. The system addresses operations from a reporting standpoint, meeting the need for both internal projects as well as external demands, including regulatory compliance. The system provides reporting for quality initiatives, outcome measurements and research in the generation of new pediatric knowledge, including real-time disease surveillance and antimicrobial stewardship. “With all of our records available electronically, we have the ability to mine the data to drive toward significant improvements,” Gessner said. “The system empowers us to reach outside of our campus to clinicians caring for these children in other venues and across time.” HIMSS Stage 7 and beyond In 2009, Children’s Hospital of Pittsburgh of UPMC joined an elite group of 28 hospitals in the United States recognized for the advanced use of a comprehensive EMR. Children’s was the first pediatric facility in the nation to earn the distinction from HIMSS Analytics, a branch of the Health Information and Management Systems Society. Case Study HIMSS Analytics certified Children’s as a Stage 7 hospital, according to its EMR Adoption Model, for its adoption of computerized charting, recordkeeping, order-entry and documentation. In the HIMSS Analytics EMR Adoption Model, stages range from 0, indicating some clinical automation exists, to 7. At Stage 7, a hospital is designated as being fully automated and able to exchange electronic records with all entities within a regional health network. The Most Highly Valued Children’s Hospital Children’s Hospital of Pittsburgh of UPMC In addition to the recognition from HIMSS, Children’s was also one of eight children’s hospitals to receive The Leapfrog Group’s 2009 Top Children’s Hospital award. To be included in the list, top pediatric hospitals had to achieve a quality score of at least 95 through Leapfrog’s Hospital Recognition Program. “The Cerner relationship has been pivotal to accomplishing Children’s goals to improve patient safety and reduce paper-based clinical processes,” Dailey said. “By partnering with Cerner, we have been able to achieve a level of care that goes beyond many of our colleagues in pediatric care.” “We look forward to our continued work together, as we analyze the data available to us and continuously strive to improve the care of our patients and workflow of our staff,” Gessner said. Client at a Glance Location: Pittsburgh, Pa. Beds: 296 Cerner solutions: Electronic medical record (acute, emergency department, ICU and ambulatory), CPOE, pharmacy, decision support, nursing, eMAR, prescription writer, structured documentation, document imaging, medical records publishing, immunizations, PPID and I-View From the paper-free care areas to the fireplace-lit library, Children’s Hospital of Pittsburgh of UPMC enhances the healing process for its pediatric patients and their families. In 2002, Children’s Hospital set out to integrate clinical workflow and improve the safety and quality of patient care system-wide with healthcare information technology. Children’s implemented 19 Cerner solutions and upgraded to the Cerner Millennium® healthcare computing platform to create a system they call Children’s eRecord. Building on the initial focus to integrate workflow, Children’s leaders expanded the vision to create the country’s first “paperless” pediatric hospital. That vision was realized in May 2009, when a state-of-the-art, completely digital hospital opened. “The EMR is the cornerstone of our patient safety and quality care efforts,” said Jacque Dailey, vice president and chief information officer. “Computerized provider order entry (CPOE) and closed loop medication cycle are only beginning steps to advanced patient care. The opening of the completely digital hospital, use of iAware in the intensive care units, warehousing of data and implementation of a totally integrated record across all care settings, including ambulatory, has helped us become a world-class hospital.” In August 2009, Children’s was recognized with a “Highest Value Rating” for a U.S. children’s hospital based upon 2009 KLAS CPOE Digest Research. KLAS, a research firm specializing in monitoring and reporting the performance of healthcare suppliers, also acknowledged Children’s excellence and leadership in paperless operation. Children’s KLAS determination was based on a number of factors. Among them: < Percentage of possible physicians using CPOE < Percentage of possible orders submitted via CPOE (inpatient and ambulatory) Key Benefits <Medication safety events have decreased by 60% and continue to decline < Providers place more than 94% of all orders directly into the system < utomatic documentation throughout A the care process creates 99.4% of the patient record < Percentage of physicians entering notes and documenting using an electronic medical record (EMR) (inpatient and ambulatory) < Sharing a comprehensive record between inpatient and ambulatory < Percentage of hospital beds where barcode technology is used for medication administration < Percentage of nurses charting and documenting electronically (inpatient and ambulatory). “Cerner is a valued collaborator, and truly shares our vision of using technology as an enabler for our clinicians to provide better, safer care for cs03_123_10_v2 Cerner Corporation 2800 Rockcreek Parkway, Kansas City, MO 64117 866.221.8877 www.cerner.com Cerner Corporation 2800 Rockcreek Parkway, Kansas City, MO 64117 866.221.8877 www.cerner.com “We needed a tool to help each clinician orient quickly to the condition of the patient,” said Levin. “This was particularly important when physicians were called to the bedside of a child with a changing status. We needed to view several pieces of information simultaneously to fully understand how the situation was progressing. CareAware iAware has met that need.” Information visible within the CareAware iAware critical care dashboard is in the EMR. The innovative view allows relevant information to be compiled so that it promotes rapid interpretation of and reaction to a patient’s condition. “The Cerner relationship has been pivotal to accomplishing Children’s goals to improve patient safety and reduce paperbased clinical processes. By partnering with Cerner, we have been able to achieve a level of care that goes beyond many of our colleagues in pediatric care.” Jacque Dailey Vice President Chief Information Officer Children’s Hospital of Pittsburgh of UPMC ICU physicians use computers at multiple workstations during their daily rounds, often making orders as they move through a floor. A nurse can start processing the electronic orders while the physician is still on the unit. CareAware iAware eliminates doctors from having to page through multiple tabs to pull up X-rays or lab results in the EMR. our patients,” said Christopher Gessner, Children’s president. “Being named the No. 1 hospital in the nation for use of healthcare IT reflects the incredible dedication exhibited to improve patient care by our IT teams, our clinicians, employees and our partners, particularly at Cerner.” Completely digital hospital Children’s is one of the first pediatric hospitals in the nation built from the ground up to support an EMR. The 296-bed facility serves 13,000 inpatients and 500,000 outpatients annually. It features a patient- and family-friendly, quiet environment supported by technology. The hospital offers parents overnight, in-room accommodations, replete with wireless Internet access and wider cell phone use. To reduce frequent alarm noise, typical to many pediatric hospitals, nurses are wirelessly linked to patient monitors. Data from the monitors automatically map to the EMR, allowing clinician review without interrupting the parents at bedside. Nurses also use wireless medication carts, including barcodeformat positive patient identification (PPID) and lab label printers, as mobile workstations. “The eRecord technology and wireless medication carts help keep nurses at the bedside,” said Sue Park RN, director, clinical and operational informatics. “Patient information and medications are readily available at the nurse’s fingertips. Medications can be scanned and lab labels printed at the bedside.” All Children’s clinicians complete their documentation online. More than 45,000 PowerNotes™ are entered electronically each month. Dr. Jim Levin, chief medical information officer, lauded the new environment. “It’s what you don’t see that’s remarkable … the e-record technology now blends into the background. There are no chart racks, no clinicians huddled in a noisy nursing station, and no crowded medication rooms. This creates a more personal, caring environment,” Levin said. The technology is supported by a state-of-theart hospital infrastructure of more than 4,000 computers, including mobile monitor carts; 400-plus miles of cable in the main hospital; 2,000 wireless access points and 100 percent coverage for most wireless technologies. Support is provided by desktop technicians who work directly with the clinicians on the units to ensure maximum equipment availability, including preventive maintenance. Immediate access to information in the ICU CareAware iAware™ critical care dashboards are at each bedside in the intensive care units (ICU). The dashboards provide clinicians immediate access to view cohesive patient information. The “always on” display is the same in every room, refreshing every 5 minutes automatically or more frequently on user demand, to provide consistent viewing of information in critical situations. “Cerner technology enables nurses to download and confirm information before it flows directly into the EMR,” said Karen Bondi RN, intensive care nurse. “This is a real time saver in intensive care especially, where nurses are sometimes asked to record vitals every five minutes.” Integrated eRecord across the continuum In spring 2009, Children’s relocated their ambulatory care center to within the hospital. To integrate workflow between the hospital and physician offices, 36 specialty physician practices and ancillary services were phased into using PowerChart® over two weeks. “We wanted a system in which a clinician could see the complete patient’s picture, across venues, without logging onto different systems,” said Dr. Steven G. Docimo, vice president of medical affairs and chief medical officer at Children’s. “We also wanted families to experience a seamless transition between their child’s inpatient admission and their outpatient visit, or vice versa. Using an integrated record eliminates the need to ask the patient/family to repeat pertinent information such as medication history, allergies, problems and other details important to their care. “In the emergency department, the operating rooms, critical care and medical inpatient units, outpatient suites and ancillary service areas, Children’s runs on a single, integrated electronic medical record,” Docimo continued. “This approach largely eliminates the risks inherent in handwritten and verbal orders.”