Patient Care and Technology
Toward Safer, More Efficient Care
"It's such an awesome responsibility we have. Everyone wants to do the absolute best job. We want seamless, error-free care." Shirley Salway, RN, A6-South |
If your child needed to be hospitalized, you wouldn't want to be asked the same questions over and over. Information you give once should be recorded and available to everyone who needs it. You wouldn't want your child's medical chart to be misplaced. You'd want the doctors to have the information they need to make timely, informed decisions. And you'd want the doctor's orders to be filled quickly, so your child isn't waiting for treatment to begin. Obviously, you'd want your child to get the right medicine, in the right amount, at the right time.
Safe, efficient care.
At Cincinnati Children's Hospital Medical Center we're making dramatic investments in innovative electronic clinical information systems to help us deliver the type of care we all want.
 "The system allows us to stay up-to-the-minute. We get things started early and can see new lab results and vitals as we round."
Sarah Corathers, MD, resident  "I love this system. I can take the computer into the room. I'm not running back and forth to find the chart. It doesn't matter if someone else is using the chart."
Lori Prine, RN, A6-South |
What is unique and important about our approach to information technology is that we're linking many systems and databases, bringing all relevant information about the patient's medical and surgical history together.
In the words of one enthusiast, the technology is "way cool," but from the patient's perspective, medical care is simply more natural, logical, efficient and safe. The building blocks that make this possible are almost invisible — as they should be.
An Award-Winning Approach to Clinical Information Systems
Stand-alone information systems that don't communicate with each other are common in hospitals. We've had our own, but what we're doing now is different.
The order entry system doctors use and the clinical documentation system nurses use are linked, so that doctors and nurses can easily share information about their patients. The order entry system automatically sends medication orders to the pharmacy and other orders to appropriate departments, such as X-ray orders to radiology. Lab test results, radiology images and reports, pathology reports and most other major clinical test results are available online as soon as the tests are completed.
Everyone involved with the child's care — doctors, nurses, pharmacists, respiratory therapists, nutritionists — has access to the information they need to deliver the best care possible. It's right at their fingertips.
Using web technology, we're making this information available to care givers wherever they are. "The beauty and the genius of the web is that we don't have to put a program in everyone's computer," explains radiologist Neil Johnson, MD, medical director of Information Services. Our clinicians can see current information from any computer — on wireless devices they take into patient rooms, at the nurses' station, in their offices, or with a secure internet connection, at home or anywhere in the world, if necessary.
We call it the Integrating Clinical Information System (ICIS) — and it's winning national acclaim.
This summer, ICIS won the prestigious Nicholas E. Davies Award of Excellence for improving patient care through better information management. The award committee honored Cincinnati Children's for taking the computerized patient record "to new dimensions of influence, usage and effectiveness."
 "Our president and board of trustees had the foresight to support an unusual organizational structure that brought technology, hospital management and clinicians together."
Neil Johnson, MD, medical director of Information Services "I want you to know that this type of integration of information systems into medical care instills real confidence in the parents of patients. So many mistakes are often due to the lack of information. ...So many times, in other hospitals, Gabe has had to wait entire shifts to have orders implemented because information had been parked in writing on a pad somewhere....We never experienced that at Cincinnati Children's." David C. Wehrle, New Jersey, parent |
Putting it All Together
Cincinnati Children's is the leader among health care organizations in combining technological innovation with a process improvement approach.
"Our president and board of trustees had the foresight to support an unusual organizational structure that brought technology, hospital management and clinicians together," says Dr. Johnson. "This structure created a true partnership of business discipline, clinical practice and technological expertise."
For every component of ICIS, clinicians have worked side-by-side with technical specialists and software programmers to design systems and processes that meet the specialized needs of a children's hospital. The result has been a uniquely successful implementation of information technology to improve care.
What have we achieved with ICIS? Medication errors are dramatically reduced. Orders are filled sooner. Transcription errors have been eliminated. Data is more reliable. Patient records and test results are immediately available. Pediatric-specific reference material to aid in decision-making is at the care giver's fingertips. Care is safer.
And ICIS is still evolving. Existing components are being improved, and new components, such as the operating room management system, are being added.
"Technological transformation" is how Brian Jacobs, MD, describes it. A specialist in critical care medicine who led the project to design and implement the clinical order entry system for physician ordering, Dr. Jacobs is quick to add, "But no one should think you put in a computer and everything is fixed. You can implement the technology, but you must fix processes and change an entire culture."
 "Clinical nurses were central to the design, so the product met our needs at the bedside."
Kim Burton, RN, Regional Center for Newborn Intensive Care  "You can implement the technology, but you must fix processes and change an entire culture."
Brian Jacobs, MD, Project Director, Clinical Order Entry |
With patient safety as our top priority, Cincinnati Children's has seen information technology as a process improvement tool, not an end in itself. Making the most of technology meant putting all the pieces together:
- The ability to imagine a better way of doing things and a commitment to make that vision a reality
- A willingness to analyze and change processes to improve workflow
- The financial resources to achieve technological excellence
- Continuous input from the care givers who actually use patient information at the bedside
- Training to support staff as they learn new systems
- A willingness to change work habits
Medication Safety and Turnaround Time
 "Implementation has not been without its challenges. We had to change our habits. The steps we go through now to enter an order make me think more about what I'm ordering....It's been an important step in improving the quality of care."
Jim Acton, MD, Division of Pulmonary Medicine  "Now the medicine comes much faster. Families see action faster. Technology has lifted the bar for what we will accept."
Shirley Salway, RN, A6-South |
The clinical order entry system at Cincinnati Children's lists 3,700 drugs that physicians can order. A doctor's memory is not enough to assure ordering the right medication. Just a small error – a misspelled word or misplaced decimal point – can make a big difference for the patient. So the clinical order entry system provides important safeguards.
Rather than writing the product name, physicians choose medications from an itemized list. This increases efficiency by assuring that the drug is one Cincinnati Children's stocks, and improves safety by assuring that the name is spelled correctly.
Physicians are now trained to use order sets when appropriate. An order set is a group of orders for a particular disease or procedure, representing best care practice as determined by experts at Cincinnati Children's. Over 270 order sets are available. Since the sets reflect evidence-based clinical guidelines and best practice standards, they improve the safety and effectiveness of care, while also improving efficiency for doctors writing orders.
The system includes a dose range checker for the 470 drugs that are ordered most often or are most toxic. This is a particularly valuable and unique feature in a children's hospital. There is no commercially available database of recommended medication doses for children based on age and weight, so Cincinnati Children's spent years researching and compiling this data for our pediatric patients. The data is now incorporated into the order entry system. The system automatically alerts physicians if their order is above or below the recommended dose for the child's weight and provides information to help revise the order.
Before computerized ordering, doctors would drop their handwritten drug orders at the main unit desk to be faxed to the pharmacy and transcribed into the medication administration record. Orders often sat in the patient's chart for an hour or more before being faxed, and every time an order was transcribed, there was the potential for error. Now the computer automatically sends orders to the pharmacy and orders are entered in the administration record automatically. Transcription has been eliminated.
