Title

Redesigning care processes using an electronic health record: a system's experience

Document Type

Article

Peer Reviewed

1

Publication Date

2-1-2009

Journal, Book or Conference Title

Joint Commission journal on quality and patient safety / Joint Commission Resources

NLM Title Abbreviation

Jt Comm J Qual Patient Saf

PubMed ID

19241728

Abstract

BACKGROUND: Implementation of health information technology (HIT) has encountered many difficulties and produced mixed outcomes. Yet Trinity Health, a major integrated delivery system, successfully leveraged implementation of a systemwide electronic health record (EHR) to promote process redesign and continuous quality improvement. IMPLEMENTING A SYSTEMWIDE EHR: After several years of planning, two waves of EHR implementation were launched, in 2001 and 2003. One system HIT team collaborated with each hospital team for 18 months before its 24-hour transition to the EHR. During EHR planning, the system HIT team used five principles of redesign of care processes: (1) identify and address safety problems, (2) promote evidence-based practices, (3) reduce practice variations and standardize terminologies and care processes, (4) improve communication and relationships among clinician roles, and (5) augment multiple uses of data in HIT-supported care processes. Patient-centered work flows were developed to design improved patient care processes for different types of patients, such as medical inpatients and emergency outpatients. These admission-to-discharge work flows addressed gaps in quality, safety, and efficiency and helped ensure that the EHR and decision supports reflected crucial interactions among clinicians and with the patient. By the end of 2008, 13 of Trinity Health's 17 major health care organizations ("ministries") made the transformation to using EHRs. DISCUSSION: EHR-supported care redesign requires development of substantial system capacities in clinical informatics, customization and standardization of vendor's products, collaboration and coordination between system and hospital implementation teams, quality training for clinicians and change agents, and significant clinician participation in local preparations.

Keywords

Delivery of Health Care, Integrated/organization & administration, Female, Hospital Shared Services/organization & administration, Humans, Infant, Newborn, Medical Records Systems, Computerized/organization & administration, Organizational Case Studies, Organizational Innovation, Patient Care Team/organization & administration, Patient-Centered Care/organization & administration, Pregnancy

Published Article/Book Citation

The definitive version was published in Joint Commission journal on quality and patient safety / Joint Commission Resources, 35:2 (2009) pp.82-92.

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URL

http://ir.uiowa.edu/nursing_pubs/643