A New “Millennium” in EMR

With a new hospital on the horizon, Sharp HealthCare is launching a comprehensive electronic medical record system (EMR) in its hospitals and medical groups. “EMR is an emerging national trend and a necessary next step to advancing patient care,” said Rick LeMoine, MD, medical director of Sharp HealthCare. “Not only does our position as a market leader insist that we unify our systems, but so does our goal of quality care.”

The “Millennium” application suite by Cerner Corporation will unify core clinical information systems across Sharp’s hospitals, and Allscripts “Touchworks” will achieve the same in outpatient settings for Sharp’s medical groups. The applications will reduce medical errors and improve Sharp’s ability to collect data for public reporting and best-practices measures.

“Designing and building the new Sharp Memorial Hospital gave us the opportunity to evaluate all aspects of care delivery,” said Dan Gross, executive vice president of hospital operations at Sharp. “A major element of that evaluation included our information systems and how we use and share data. We chose Cerner because we felt their system would provide an opportunity for the entire healthcare team to take advantage of an array of automated systems that provide more data for better clinical decision making, as well as provide information for continuous quality improvement.”

The new Sharp Memorial Hospital will open in the summer of 2008 as a “paper-light” facility. This means that the design doesn’t even include space for the arcane practice of storing paper medical records.

After debuting Millennium at the existing Sharp Memorial Hospital this November, Sharp will go systemwide, beginning at the new hospital the following year. By 2009, Millennium will be active across the health system, including Sharp Memorial Outpatient Pavilion, Sharp Grossmont Hospital, Sharp Chula Vista Medical Center, Sharp Mesa Vista Hospital, Sharp Vista Pacifica Hospital, and Sharp Cabrillo Skilled Nursing Center.

The application suite will not only replace Sharp’s existing software but also retool its view of IT systems, according to Bill Spooner, senior vice president and chief information officer at Sharp. Previously, Sharp took a “best-of-breed” approach, with many of the applications coming from different vendors — and they weren’t often compatible.

Cerner’s integrated Millennium includes computerized physician order entry (CPOE), results viewing, and clinical documentation, as well as for pharmacy, emergency, laboratory, and radiology departments.

It will replace several existing computer applications, including GE/IDX Carecast orders and pharmacy, Clinicomp Essentris documentation, Allscripts/A4 Emstat emergency department, GE/IDX IDXRad radiology, and Cerner Classic Pathnet laboratory applications.

“Combining multiple systems has been difficult,” Spooner said. “Together, the existing applications just didn’t work toward our vision of intelligent, integrated clinical information, and our ultimate goal of supporting patient care as best we can.”

Sharp’s IS department, he said, has been trying to integrate applications since implementing Carecast four years ago, but the clinical workflow wasn’t as optimal as hoped.

According to Spooner, primary advantages of EMR are quality improvement and error reduction. CPOE, for example, will make physician orders instantaneous and direct from the physician, rather than having a nurse struggling to read illegible handwriting. The process is structured with drop-down menus and required fields, all designed on best-practices standards. The system will also test proposed orders against the patient’s known conditions and evidence-based criteria.

On the other end, every order and action by administrators and clinicians will be recorded, which will create more data to evaluate and create best practices, according to Spooner. The data will also be important for public reporting, which is having an increasing effect on healthcare delivery through public opinion and quality initiatives, as well as pay-for-performance measures, on the outpatient side.

Sharp Rees-Stealy and Sharp Mission Park medical groups will implement Cerner’s laboratory and radiology applications in 2010, but they will also use Touchworks, an EMR tooled specifically for outpatient settings. Touchworks is live today for “e-prescribing,” document scanning, and charging. It will be fully implemented by 2009.

“We’ve had much success in the clinics and physician offices with the Touchworks application already implemented,” said Elizabeth Noll, MD, a Sharp Rees-Stealy cardiologist on the advisory board. “Once all the functions are running, we’ll be able to pull up complete charts for each patient that can be updated live and viewed that day by any authorized physician specialist or other authorized caretaker.”

Sharp Community Medical Group (SCMG) also recently committed to providing Touchworks to its affiliated physician offices throughout San Diego County. Because, SCMG is conglomerate of independent doctors, the system will provide a technically different, though functionally similar, application.

Touchworks will also have limited data exchange with Millennium.

For eight years in a row, Sharp HealthCare has been named in the top 100 “Most Wired” hospital systems in the country by Hospitals & Health Networks magazine. Only 10 other hospitals in the nation have been so regularly honored. The survey measures services for patients and technology-based safety initiatives, as well as pre-registration for services, access to test results online, online self-care resources, and prescription drug ordering and administering.

Dedication to initiatives such as Cerner and Allscripts account for this honor, Spooner said, as well as the Picture Archive and Communications Systems (PACS), a diagnostic application in all Sharp hospitals that makes X-rays, CT scans, and other imaging results more readable and accessible by doctors.

Cerner, likewise, is a leader in its field, Spooner said. Gartner Group, an IT industry researcher and consultant out of Stamford, Connecticut, lists Cerner in its “leader’s quadrant” with only one other healthcare information technology vendor. The ranking includes recognition for Cerner’s strong CPOE function, according to Sharp documents citing Gartner research.

Using Cerner’s Accelerated Solutions methodology to create a uniform model for all of the hospitals, Sharp’s implementation plan is already in effect.

A team of clinical experts and physicians spent a week in early February at Cerner’s home office in Kansas City, Mo., developing the model for November implementation at Sharp Memorial. The model will be followed throughout the remaining Sharp hospitals for total integration by 2009.

“Once fully integrated across the Sharp system, the new EMR will make patient care more efficient, more accurate, and more up-to-date,” Spooner said. “At Sharp, it is our vision to be the best place to work, practice medicine, and receive care. This advancement accomplishes all three.”