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  • February 14 2012

    HIMSS12: Improving Safety, Quality and Efficiency with an Ambulatory EHR

    As the electronic health record becomes standard for patient care organizations, providers must decide on a strategy to not only utilize these powerful tools, but to fully embrace the advantages they bring to health care.

    At VCU Medical Center, our division of ambulatory care embarked on a multi-year journey to do just that in October 2009. After five years of extremely limited EHR use in our ambulatory clinics, we set forth on a plan with Cerner to implement an integrated EHR system covering more than 60 clinics (550,000 patient visits in 2011). As we reflect back over the last two years we ask ourselves the following questions. What motivated us to initiate an Ambulatory EHR project? How did we define success? What did we accomplish?

    Most importantly, we knew a fully integrated EHR system would improve patient safety, outcomes and experiences, but our timing was driven by a few other factors as well. By starting the process when we did, we ensured our ability to benefit from MIPPA incentives for ePrescribing. We were also able to create the foundation of tools necessary for our health system to achieve Meaningful Use, with attestation planned later this year for both the hospital as well as 600 eligible providers.

    After previous less successful attempts to introduce components of the EHR into the ambulatory space, we knew success would revolve around careful planning. We started the implementation project with a clear mission statement: “Improve the patient experience for both patients and providers through the use of our EHR by leveraging the system to improve patient access, communication with patients and the integration of care for all those navigating with VCU Health System ambulatory clinics.” This helped us define our focus areas with special attention to patient safety and workflow improvements. With these ideas in mind, we were able to get into the nuts and bolts of the project: assembling the right team, planning effective communications strategies, and clarifying the scope of the project.

    Through project metrics and provider success stories, we've been able to reap both quantitative and qualitative benefits from the success of this project.

    Dr. Sue Wolver, general internist and physician co-lead of our implementation reflected on a recent busy day in her clinic, "In the midst of an especially crazy day I realized how different things were from just a year ago. I already knew everything about the patient who came in for a hospital follow-up because I was made aware of her admission and was able to read the notes in real time. In the past, I might not have even known she was admitted to my hospital. I was able to see all the ED and subspecialty notes and actually advance patient care rather than spending time on the phone trying to figure out what had happened."

    "Also, when a patient was seen by a provider outside my institution and put on "a little green pill", I was able to access her external medication history and add that new medication to her list. Overall, my patients are safer and I am better able to care for them because I now have all of the information."

    It's stories like these that keep providers vested in the EHR and why so many admit they would never go back to a paper chart.

    Though the project has had its fair share of ups and downs, each experience has been a learning opportunity and the end result, a positive one for providers, staff and patients alike.

    We invite you to attend our presentation " Improving Safety, Quality and Efficiency with an Ambulatory EMR: Can it be done?" presentation, part of the Leaders and Innovators program at HIMSS12, on Feb. 23 at 1 p.m. in the San Polo room (3404) to hear how a vision to improve patient care through the use of advanced technology across more than sixty primary and specialty care clinics has come to fruition thanks to detailed planning, a dedicated team, and committed leadership.

    Ms. Spencer served as the Project Manager for the Ambulatory Electronic Health Record project. As a project manager at the Virginia Commonwealth University Medical Center, she has led teams to success for multiple electronic medical record projects across inpatient, outpatient, and emergency department venues.

    Ms. Burgett served as Director of Implementation during the implementation of the Ambulatory Electronic Health Record. Her role has been to oversee the implementation of the electronic health record in the ambulatory clinics, working with all staff, providers, and working on all workflow changes involved in the implementation phase.

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