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Jim Stalder, Senior Vice President and Chief Information Officer at Mercy, notes impact of TouchWorks Electronic Health Record on hospital operations.

Mercy Physicians Use Electronic Health Records To Increase Patient Safety and Satisfaction, While Cutting Costs

With the percentage of physician offices benefiting from Electronic Health Records barely in the double digits, Mercy Health Services is leveraging the technology innovation across a significant number of its physician practices. The benefits to physicians and patients are substantial.

"Interacting with patients will take on a whole new dimension over the next few years – as more patients and family members expect to communicate with their medical providers online," said Jim Stalder, Senior Vice President and Chief Information Officer with Mercy Health Services, Mercy Medical Center.

The banking industry has seen this revolution already and the insurance industry is now seeing it. Healthcare is next and Mercy is poised to take full advantage of the trend as Mercy partnered in spring 2006 with Allscripts to implement a web-based, electronic health record--.the TouchWorks™ Electronic Health Record (EHR), which allows Mercy physicians and other caregivers to instantly retrieve patient medical records from any location where they have an Internet connection. Mercy patients and physicians benefit from the accuracy and efficiencies that will be realized by using an electronic health record.

According to Stalder, there are many aspects of this innovation that make it unique:

• Point-of-Care Note Entry – Primary care and multi-specialty templates allow physicians to efficiently enter data into a patient’s chart at the point-of-care. Using wireless tablet PC’s, physicians are able to quickly record data into the note with just a few clicks. Physicians can customize how they enter data into their notes in order to meet their needs. Methods of input include the use of templates, dictation, voice recognition and typing. Important elements of the note templates, such as medications, allergies and problems, are structured, meaning that they can be automatically included in the note and reported on later.
• Patient Health History – Summaries of each patient’s medications, allergies, problems and procedures can be printed out for a patient to take with them in a matter of seconds.
• Electronic Orders/Results Management – Mercy physicians now have the ability to electronically place orders and receive results into the EHR. Orders and results can now be reconciled to ensure patient adherence and results can be trended, graphed and reported on.
• Health Maintenance Reminders – Physicians are reminded about health maintenance activities such as colonoscopies, mammograms, Hemoglobin A1C’s, etc., each time they access a patient’s health record. Physicians can now proactively schedule exams, or at a minimum, remind the patient that routine exams are due.
• Electronic Workflow/Tasking – Electronic workflow within EHR facilitates efficient office communications through secure electronic messaging, telephone triage, and message routing. Inter-office communication, as well as physician-to-physician communication is now being achieved. The messages are all a permanent part of each patient’s EHR.
• Document Imaging – To further reduce paper handling, Mercy practices are scanning all incoming documents that would typically go into the patient’s chart. Documents are then indexed and are available from anywhere the physician has an Internet connection. Mercy’s practices are already seeing a large reduction in document storage and printing costs, as well as the labor involved with filing and pulling charts.
• Electronic Prescribing (eRx) – Using the SureScripts® network, physicians can now electronically route or fax prescriptions directly from the exam room to a patient’s pharmacy. Pharmacies that are enrolled in SureScripts® are now able to request prescription refills electronically, saving time and phone calls between the practice and the pharmacy. eRx tools are also capable of drug interaction and allergy checking as well as prescribing to plan-specific formularies. (SureScripts is interfaced with Allscript’s Touchworks product. It’s relatively seamless for physicians and allows prescriptions, to be either faxed, printed or sent electronically.)
• Electronic Charge Capture – Physicians will be able to efficiently capture charges for all services at the point of care. By automating the paper encounter form, charges are recorded and submitted to the practice management system promptly. EHR systems also contain built-in Evaluation & Management (E/M) coding assistance, medical necessity checking, and subsequent Advance Beneficiary Notification (ABN) collection. The system actually tracks what the physician is entering into the note and then recommends an E/M code when the physician is done with the note. The physician then has the option to up-code or down-code depending on the complexity of the visit.
• Decision Support and Reporting – Through accurate and detailed chart note data capture, physicians are able to quickly analyze past medical history and report on data about a patient or group of patients. This will aid physicians in making decisions about their practice and patient population. The organized structure of the data captured in the EHR templates allows for physicians, Mercy Administrators and Executives to easily run reports without MHS/IT intervention.
• Personal Health Record – With the advent of Personal Health Record (PHR) tools like Medem’s iHealth Record (http://www.ihealthrecord.org/) and ONCHIT’s push towards empowering individuals to play an active role in managing their own personal health history – it is only a matter of time before it will be necessary to enable clinicians and their patients to access the same information online. Mercy’s EHR system paves the way for this two-way interaction. Activities such as prescription renewal requests, appointment requests, lab result communications and even online consultations will be available to Mercy patients. Valuable patient educational materials will also be available to patients directly from their physicians.

Benefits to the Patient

• Patients can elect to have their physician electronically send their prescriptions to any regional pharmacy so that their prescriptions are ready for them when they arrive;
• Pharmacies can communicate electronically with the practice to request prescription changes and refills on behalf of the patient;
• Accurate and legible prescription and lab orders in either paper or electronic format;
• Instant access to medication, allergy and problem lists. Mercy practices can print or download this information for a patient with just a few clicks of the mouse;
• Confidence that their medical history is secure, yet accessible by any physician within the Mercy organization;
• Potential to access and manage their own personal health record from anywhere they have an Internet connection.

Benefits to the Physician

• Point-of-care chart note entry closely mimics the paper chart-noting process that physicians are used to following with their patients today;
• Priority notifications for lab results and other health maintenance alerts;
• Ready access to patient data regardless of location;
• Lab and radiology results available and immediately integrated with patient data as soon as results are compiled. No waiting for faxes or phone calls or returned pages;
• Electronically place lab orders and receive patient results with regional laboratories;
• Easily report on patient and practice information;
• Accurately capture charges at the time of the patient visit.

Benefits to the Practice Staff

• No more chart pulls;
• Similar office workflow experience, regardless of physical location;
• Workflow automation, task lists, reminders, electronic phone messaging, etc, provide more efficiency within the office;
• Paper-chart related costs – stamps, paper, copying, staffing and paper chart storage costs would all be significantly reduced through the use of EHR;
• Staff efficiency – searching for charts, manual charge entry, etc. can be eliminated with EHR.

Mercy has been using electronic health records for the past several years, noted Rob Horst, Director, Physician IT Services at Mercy.

"However, the “breakthrough” came in Spring 2006, when we partnered with AllScripts to implement a web-based, electronic health record in the practices of 100 of our physicians. The success has been tremendous. Mercy is systematically converting each of its physician practices to a paperless enterprise – complete with electronic prescribing, online lab results, and secure access to patient information by the physician from any location," Horst said.

The success of this project is due to a team effort across several different disciplines. Collaboration between physicians, Information Technology, physician practice staff and sponsorship by the leadership team of the hospital has been a vital part of the success.

This innovation helps Mercy to continue to fulfill its mission of taking care of the citizens of Baltimore. Mercy is taking a lead role in providing physicians in Baltimore with state-of-the-art technology. As a result, citizens of Baltimore will receive the highest quality care available from Mercy’s physicians.