REPORT TO OUR COMMUNITY
ONECHART – AN UPDATE OneChart, the first comprehensive electronic medical record system in Southern Arizona, is nearing a year in operation at Tucson Medical Center, evolving with the physicians and staff as they make the official transition from paper to computerized patient information.
“The entire hospital worked collaboratively to use the new tool while continuing to deliver outstanding
“OneChart has brought meaningful change to Tucson Medical Center,” said Dr. Brian Cammarata, an anesthesiologist and medical director for informatics.
patient care.”
TMC has invested at least $20 million in OneChart to redefine patient care, synthesizing prescriptions, post-treatment and surgical orders, lab and imaging results, medical history and clinical notes into one, all-inclusive computerized system. Fewer mistakes, better communication, more effective care—they are the ultimate goals of OneChart. Prior to its June 1, 2010 official launch, each TMC department was involved in myriad meetings, tests and training sessions to master every element of the system. Like medicine itself, physicians and staff were devoted to finessing the details. From debating a login time, to rules on data entry, the use of codes, usernames, passwords and templates, nothing was left out. “As an organization, we benefitted from overwhelming medical and hospital staff support,” said Cammarata, who is also a physician champion of OneChart. “Despite their busy schedules, medical staff participation was outstanding. Their commitment was instrumental to the project’s success.
Brian Cammarata, M.D.
“The go-live date was both exciting and a little intimidating,” adds Cammarata. “The entire hospital worked collaboratively to use the new tool while continuing to deliver outstanding patient care. Over the days and weeks to follow, the familiarity with OneChart rapidly rose.” It is fast becoming the technological spine of TMC’s daily patient care. “Physician notes are available at any location in the hospital,” said Dr. Moira Richards, TMC’s medical director of children’s services. “I can be sitting in one unit, get a call about a patient on another unit, open their chart and deal with whatever is needed without having to move to the other unit. Since I am now frequently at the computer, lab values, X-ray results and follow-up are all there. And I don’t have to worry about being able to read someone’s handwriting.” To that end, all medications dispersed throughout TMC are now bar-coded, so if any conflicts emerge or the dosage seems incorrect, the computer sends out an alert. “Objectively, we have observed a decline in medication errors since going live with OneChart,” said Cammarata.
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“As I have said to some people, the benefit of OneChart is the flexibility of the program, but this is also one of its disadvantages—too many different ways of doing workflows,” said Richards, but adds that TMC is managing the challenges, offering tip sheets and guidance. That said, the promise of OneChart is moving forward. “I have asked physicians, nurses and staff if they would go back to paper,” said Richards. “I have not yet had one say yes.”
With OneChart, TMC is among only 3.2 percent of all hospitals to reach Stage 6 on the HIMSS Analytics Database. TMC expects to reach Stage 7 this year.
EMR Adoption ModelSM Q3 2010 – 2010 Final Stage 7 Stage 6
2010 Q3
Stage 5
Closed loop medication administration
Stage 4
CPOE, Clinical Decision Support (clinical protocols)
Stage 3 Stage 2
Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable
Stage 1
Ancillaries – Lab, Rad, Pharmacy – All Installed
Stage 0
All Three Ancillaries Not Installed
Data from HIMSS AnalyticsTM Database
3.7%
FROM 166 MINUTES TO 10 - IMPROVING THE TIME IT TAKES TO GET MEDICATIONS TO PATIENTS In 1995, before pharmacy automation was introduced at Tucson Medical Center, medication turnaround averaged 166 minutes from the time a doctor wrote a prescription for a patient to the time Pharmacy delivered the drug to Nursing for administration. TMC introduced its automated dispensing machine, Pyxis, in 1996 and by the next year saw the average turnaround time drop to 117 minutes. In 1997, TMC implemented scanning devices, which allowed physician orders to be scanned and sent directly to Pharmacy. This improved turnaround to an average of 82 minutes. Now with OneChart, a review of 5,000 medication administrations found an average turnaround time of 9.96 minutes, with more than 60 percent of all medications released and available to Nursing in 5 minutes or less.
2010 Final
Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 1.0% 1.0% Physician documentation (structured templates), full 2.8% 3.2% CDSS (variance & compliance), full R-PACS 4.5%
10.3% 10.5% 49.7% 49.0%
REPORT TO OUR COMMUNITY
The future of OneChart is to optimize it for best use, he said. “TMC will continue to improve the efficiency, safety and cost-effectiveness of our care,” Cammarata said. “We have organized over a dozen specialty areas to guide improvements for each care area.”
Medication Turnaround Time (in minutes) 180 160 140 120 100 80
15.4% 14.6%
60
6.7%
40
7.1%
20 10.5% 10.1%
N = 5233/5281 2011 HIMSS Analytics
0 1995
1996
1997
2004
2011
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