Hospitals ditch paper, double down on digital


Spurred by fast-approaching federal penalty deadlines, some of the Upstate’s largest hospitals are investing hundreds of millions in electronic health records systems that can require thousands of training hours and dozens of new staff to implement and maintain.

While single record systems can increase efficiency and reduce overhead for providers, ultimately the investment pays off through increased patient transparency and fewer data errors, redundant tests, lost files and administrative time, they say.

“The patient is going to be the winner,” said Bon Secours St. Francis Director of Clinical Informatics Becky Carter, who said increased workflow efficiency and real-time information updates help physicians make better decisions. Implemented in 2008, Bon Secours was one of the first in the Upstate to switch to a one-patient, one-record electronic medical records (EMR) system, but many in South Carolina have already followed suit.




Pulling it together


The move preceded a 2009 federal law designed to encourage EMR use in U.S. hospitals, an act that included incentives to make the switch and will eventually impose penalties for systems that don’t achieve certain levels of meaningful use of EMRs. While many providers use some form of EMR system, patient records have historically been spread across multiple systems and interfaces.

In South Carolina, 63 percent of non-federal acute care hospitals had at least a basic electronic health records system in 2013, according to a report from the Office of the National Coordinator for Health Information Technology. While South Carolina’s adoption rate is higher than the 59 percent national average, the changeover is complete across the board, said South Carolina Hospital Association Director of Federal and Member Advocacy Elizabeth Burt.

“Ultimately it is a pretty significant shift in improving how we care for our patients and communities as a whole, in trying to improve the health of everyone,” she said. “Hospitals in South Carolina have done great things in the quality arena in trying to improve patient care. … It was a lot to ask of the industry to do this in such a short amount of time, and man, they’re making good time with it.”




Improving confusing systems


Some – such as Bon Secours, among others – are working on the third stage of proving meaningful use of its EMR system, while others are in various stages of selecting, negotiating contracts or implementing them.

Greenville Health System approved $97 million to implement a single record system across eight hospitals and close to 1,000 physicians, according to GHS VP of Information Services and CIO Rich Rogers. The near three-year process will consolidate 50 systems into one to “ultimately lower the costs of healthcare for the Upstate community,” he said. The system will go live in six pilot physician practices next month, followed by 130 practices in July and the entire system in February of next year.

AnMed Health is in the final stages of selecting a vendor that could cost $75 million over five years, according to the center’s CEO Bill Manson. The investment could be AnMed’s largest non-building investment to date, he said.

Shifting from multiple systems cuts down on overhead costs, increases efficiency and minimizes delays, said Spartanburg Regional System VP and Chief Information Officer Harold Moore, who hopes to have their EMR system – called Epic – fully up and running by October 2016.

“It was confusing and time-consuming,” said Moore, who said it took a year to sift through vendor options. “This is going to help automate some processes and workflows that happen manually right now.”

A prescription, for example, historically had to pass through multiple hands – such as nurses, unit scribes or other staff – to be recorded and processed. “If five doctors do that at the same time, it backs up,” said Carter. With a certified EMR system, the doctor can input the information and it’s instant, she said.


Team effort


But consolidating from three to one system takes more than purchasing the software and installing it, said Moore. Spartanburg Regional hired an additional 50 staff members last month from all over the country to help implement and maintain the EMR system long term, he said, and the bulk of his 6,000 existing staff will need three to four days of training to use it.

In fact, Moore said Spartanburg Regional plans to renovate and increase the footprint of its training facilities in order to squeeze training into the month before the system goes live. After that, the space will be used to help refresh and update staff on regular system upgrades, scheduled every 18 months, he said.

Carter said Bon Secours has architect and IT teams in Richmond, but maintains a Greenville staff of 12 application coordinators, four physician support technicians and three onboarding and training nurses to support its four local campuses.

“When you turn on electronic records from a paper process, it changes everything,” she said. “It changes all the workflows, how different departments communicate with one another, different interfaces. There’s just tons and tons.”

New challenges will of course include when the system or Internet networks go down, said Carter, but the 24-hour IT support team has thus far kept downtime to a minimum. Keeping patient information limited to “one patient, one record” – as well as giving the patient access to his entire medical record through an online portal – is worth it for a variety of reasons, she said.

Health care centers that use the same vendor can request and share a patient’s medical record much more easily than before, she said. Instead of calling or faxing requests and patient records across systems – say, when a patient gets hurt during vacation in Charleston, for example – clinicians can more quickly see a patient’s conditions, allergies, procedures and tests.

“With all hospital systems using different things, there’s not an easy way to do that,” she said.



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