CNE electronic records change clinical practice
New moms can be jittery – especially if their baby was born prematurely or with health problems and had to go into the neonatal intensive-care unit.
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Watching over their sons and daughters, the moms want to know what’s going on. Are they getting better? Many will wonder how they will manage when the baby goes home. Are they ready? Can they handle it?
The nurses at Women & Infants Hospital always have done their best to answer the questions and assuage the fears, said Barbara Gallagher, who works in the NICU. But a new electronic patient records system allows them to do much more.
Developed with Kansas City-based Cerner Corp. over the last two years, the system serves Women & Infants, Kent Hospital and, to a limited extent, Butler Hospital. The hospitals’ parent, Care New England, enlisted about 120 people from the three institutions and the corporate IT team to build a shared network and applications together.
The result, dubbed “CNErgy,” went live at Women & Infants in June and at Kent in October – though it’s being phased in, so while many features are already in use, others won’t be added for months or even a couple of years.
Computerized physician order entry, for example, won’t be implemented until this year, said Dr. Cedric J. Priebe III, chief medical information officer for Care New England and a pediatrician at Women & Infants.
“Right now, a physician handwrites an order and the unit secretary or clerk enters the order in the system,” Priebe said. “We chose, I think wisely, not to try to take that on in our initial implementation, because that would be too much change at once.”
Also slated to begin this year is a bar code system to control the administration of drugs; such systems, which include checks to ensure it’s the right drug, at the right dose, for the right patient, have been shown to reduce medication errors.
In addition, the hospitals this year will start scanning key documents – such as patient consent forms – so they can be called up easily when needed, Priebe said. And in the NICU and in Kent’s intensive-care unit, a new feature is to be added that plugs bedside medical devices such as ventilators, heart monitors and IV pumps into the Cerner system, so all the data they generate is automatically logged and just needs to be verified by the nurses.
But just because so much lies ahead doesn’t mean Care New England hasn’t already accomplished a great deal.
Mark E. Crevier, now president and CEO of Kent and previously chief financial officer at Care New England, said the hospital system waited for a long time to implement a clinical IT system because for years, it wasn’t clear what lay ahead for the hospitals.
There had been talk of an acquisition and then a merger, and it made no sense to adopt technology that might have to be overhauled soon after, Crevier said.
Once those considerations were set aside, Care New England began to play catch-up. It merged the hospitals’ IT departments and began building joint systems for financial reporting and other functions. It built a new data center on the Kent campus.
“All those things had to take place before we could take the next step of doing CNErgy,” said Crevier, who was the project’s executive sponsor at the corporate level.
Before choosing a vendor, the company had to choose a strategy: either pick the best vendor for each major function and then connect the systems, as Lifespan did for its implementation, which includes features like computerized physician order entry, or pick a single vendor to do it all – or most of it, since Butler’s mental-health records are kept completely separate.
Care New England chose the latter, Crevier said. And in June 2004, it hired Cerner for the job and then put together the staff team to work with the vendor.
“They just did an amazing job over a two-year period,” Crevier said. “They had to design the system, they had to build it, they had to actually, table by table, make decisions like how are we going to number our physicians? … And then they had to test the system, and eventually train everybody to use the system and actually go live with it.”
The team had to strike a delicate balance to provide helpful tools for Butler while complying with the very strict patient confidentiality rules imposed by state and federal law, Priebe said.
Even at Kent and Women & Infants, strong privacy protections were built in throughout the system, he said, so users have to establish a “need-to-know relationship” with each patient to access a specific piece of information. A doctor or a nurse, for example, will be able to access crucial medical information, but a billing secretary won’t see it – but she will see the data she needs, such as the patient’s insurance coverage status.
At the basic level, the system helps clinicians by providing comprehensive information, collected at multiple sites, if applicable, and from multiple encounters with the system, such as if a baby is born at Women & Infants and then goes into the Kent emergency room with a fever.
In the future, Priebe said, more and more “decision support” features will be used, so doctors can ask the system for guidance in trying to pick the best drug for a patient, or determine which of several possible tests will work best to diagnose a specific condition.
Gallagher, who was part of the CNErgy team, said she drew on her experience as a nurse – both in the NICU and in obstetrics – to help make the already in use more comprehensive and more reflective of what nurses like herself do.
She knew, for example, that when a nurse evaluates a patient’s breathing, she might make a mental note of where there appeared to be congestion and what it sounded like, but just describes the breathing as “coarse” on the chart. Now, with CNErgy, there are boxes to check off and other time-saving tools to document more information faster, she said.
Before CNErgy went live, each hospital hosted about 20,000 hours of training, Crevier said, teaching the staff in groups of no more than 15 over the course of six weeks.
Ironically, Gallagher said part of why she got involved was that she barely knew how to use computers – she could do e-mail, yes, but Google searches overwhelmed her. By being part of the CNErgy effort, she said, “I felt if I could learn the system from the bottom up, I could know it well enough and help my colleagues not be as intimidated as I would have been.”
But there was something else even more important, Gallagher said, and it’s turned out to be as she expected. By giving nurses access to key data on computers right at the bedside, she said, CNErgy helps them minimize their time away from patients and gives them more opportunities to talk with the moms, assess their needs and ease their concerns.
That’s particularly helpful in the NICU, she said, where parents are eager to see evidence of their babies’ medical progress – and now she can show them on the computer screen.
“They really like that,” she said. “I think they feel as if they are more of a partner in the care of their baby, rather than just being a bystander.”
“It relieves their anxiety, which I think is important here,” Gallagher added. “And when we have more time, we’re able to think about and improve patient care. That’s what it’s all about.”
