Scripps Health
“Health information technology has the potential to enable a dramatic transformation in the delivery of healthcare, making it safer, more effective, and more efficient.”
So concludes a recent report from the Agency for Healthcare Research and Quality, the lead federal agency on quality research. And while that statement may be far from a revelation, it does present a key question to physicians, clinicians, and healthcare delivery systems: How do we harness the vast potential of health IT and translate it into improved productivity and enhanced patient care across the continuum of services? At Scripps Health, the answers to these questions are taking shape on several fronts.
Building Strength Through Structure
For a health IT system to flourish and endure, it must be built on a strong organizational foundation. Scripps has developed its IT system based on a three-level pyramid model, which has proved highly effective in healthcare delivery settings. At the base of the pyramid is the basic enterprise architecture, which includes areas such as the data center, networks, servers, PCs, and phone systems. Creating this fundamental structure is priority number one, since a reliable infrastructure must be in place to make everything else work.
The pyramid’s next level up comprises information management, which is where the applications for niche requirements reside (this is the point of contact for most system users). And at the top level of the pyramid is knowledge management, which uses the data collected in the applications to foster sound clinical and business decisions. The pyramid is designed to be built from the ground up, but, eventually, the insights gleaned through knowledge management will drive decisions about applications and infrastructure back down the pyramid.
Centralizing Patient Data Through EMRs
Scripps centralized its patient data several years ago via its electronic medical record (EMR) systems, providing easy access to patient information to its caregivers, including the 2,600 members of its medical staff. Now, any authorized Scripps-affiliated physician or clinician can access patient data from anywhere within the Scripps system, including lab results, radiology images, inpatient identifiers, and outpatient history.
As an enterprise, Scripps has embraced a patient-centric approach to its EMR systems — records are kept based on the patient, not on the facility or doctor. That’s an important distinction, because if a patient is seen at Scripps Mercy Hospital Chula Vista one day and the next day is taken by ambulance to Scripps Memorial Hospital Encinitas following a car accident, all of that patient’s information is readily accessible. This is made possible through the use of a Master Patient Index, which assigns a single patient identifier to the patient, regardless of the place of service. This is the same identifier used in all of the clinical systems, EMR, PACS (picture archive communications system), and patient management applications.
Scripps continually seeks new ways to improve its information systems, and recently elected to upgrade its existing inpatient EMR program with the most current version of GE’s Centricity Enterprise application. Centricity will further enhance physicians’ abilities to document clinical interventions and share patient information throughout Scripps’ five acute-care hospital campuses and 13 clinics. The Centricity upgrade will directly impact the quality and safety of patient care in a variety of areas.
Centralized data can also help improve patient satisfaction. While the capability to schedule radiology centrally does not exist today at Scripps, the system is moving aggressively to make this scenario a reality. Consider the potential benefits in this forward-looking example: A patient in a private physician’s office needs to schedule an MRI appointment. An assistant in that office can call up Scripps’ centralized radiology scheduling system and review all MRI openings at all Scripps facilities to find the first-available appointment. For the patient, this centralized system might mean the difference between waiting a day or waiting a week for an appointment. A convenient process translates into better service and greater satisfaction, which is directed toward where that service is delivered: the physician’s office.
Access to EMRs Beyond Hospital Walls
When Scripps migrated to EMR technology several years ago, it did so with a commitment to give doctors the ability to access patient data not only at the hospital, but also remotely from their home or private office.
Scripps recently enhanced its remote access capability by adopting a new browser-based program. This approach eliminates the need to install software on doctors’ computers — a major step forward because variations in physicians’ computer systems sometimes made remote access software incompatible. Today, any Scripps-affiliated physician can access clinical patient EMR data from across the entire Scripps system remotely and securely. To protect patient privacy, all transmissions between physicians and the Scripps EMR system are secured at a high level of encryption.
On the Horizon: Standardizing Clinical Workflow
As Scripps’ new Centricity EMR system is installed over the next several months, another important process will occur on a parallel track. Scripps will move toward standardizing its key clinical workflow processes across its entire healthcare delivery system. With a standardized clinical workflow process in place, a physician who admits a patient to any Scripps facility — whether it’s in Encinitas, La Jolla, Hillcrest or elsewhere — will have the comfort level of knowing what they can expect in terms of clinical staff processes.
Standardizing clinical workflow will also enable Scripps to further grow its IT capabilities, allowing it to create new modules and functionality, without much customization needed from site to site. Scripps expects that a standardized clinical workflow process will translate into more robust automation, checks and balances, and safety features across the entire Scripps system. It will also help make Scripps “quicker to the game” in delivering the IT solutions that matter most to physicians and clinicians.