From Paper To Plastic

June 6, 2005
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GRAND RAPIDS — When hospital officials inaugurated Project Genesis four years ago, they really weren’t sure when it would go live.

But that happened last October, on the 15th to be exact, when Saint Mary’s Health Care took a big — and some felt risky — step and transferred its valuable patient-registration system from paper to computers wrapped in molded plastic.

Most everyone involved held their breath back then and hoped that the other virtual shoe wouldn’t drop. It didn’t. Nothing crashed and no records were lost.

So after a collective sigh of relief, nurses began documenting their work and physicians started making order entries directly into the new electronic system just two days later.

The name Project Genesis, though, has since slid into a state of semi-oblivion at Saint Mary’s. Visitors may still see it on something here and there if they look hard enough, but hospital officials seldom refer to the name today. The project’s name is fitting, though, as Saint Mary’s became the first local hospital to have its medical staff directly input daily orders and outcomes into an e-system, a claim that fewer than 10 percent of all U.S. hospitals can make today.

“We were told that when we went live, we should expect somewhere between 30 and 40 percent of all the orders would be entered by physicians. They said that would be a good result,” said Phil McCorkle, Saint Mary’s president and CEO, of the estimate of physician participation that Cerner Software, the system’s provider, gave the hospital.

“It ended being that we have consistently averaged 75 percent. It was 30 to 40 (percent) and here we are at 75 percent. And in the emergency room it’s at 93 percent. I mean, it’s unheard of. The president of Cerner flew out here in January, and before our whole team asked how in the heck we did it,” he added.

McCorkle said one reason Saint Mary’s was able to go digital so smoothly is that the Advantage Health physicians who are affiliated with the hospital are about the best group of doctors that a medical center could ask for.

“They’re very loyal to Saint Mary’s. They’re very interested in what we’re doing. They like being involved, and we’ve included them,” he said.

Training was another reason. McCorkle said the medical staff went through two years of training on a system loaded with practice patients before “Power Chart” — the market name of the Cerner-produced software the hospital uses — went live.

“We were the third Trinity Hospital to go live. And to this day, we’re still able to sustain this endorsement from the physicians,” he said.

Gregory Forzley, the medical director of systems development and an Advantage Health family physician, heads the training effort. He and his five assistants meet with medical staff in the second floor training lab in the main hospital building to help with any problems they may encounter in grasping the nuances of the system.

“Eventually we will place all of our orders live on the system, but some physicians will need a little bit of help in doing this,” said Forzley, who now devotes all of his time to the training project and no longer practices family medicine.

Forzley wasn’t certain how much money Saint Mary’s has invested in the system, which has Power Chart seated in the Microsoft Office suite, but he guessed it was near the $10 million mark.

Saint Mary’s purchased 500 computers and made wireless access the norm. Machines are located on every floor near patient rooms, and some can be wheeled from room to room on a cart that also has space for the traditional paper records. Doctors also can access the system from their offices and homes. A laptop is available for any physician who wants one. None, however, are required to participate.

Forzley added that Trinity Health, the hospital’s parent firm, has spent close to $200 million on e-upgrades to its 45 medical centers. Six of those 45 are now live.

At Saint Mary’s the system’s order profile totals 14 and orders can range from allergies to consults to medications to radiology and most everything in between. Orders also are listed by 19 specialties that include cardiology, neurology, oncology, surgery and orthopedics. The system is doubly secured, as two passwords are needed for access.

“There is nothing less secure than this,” said Forzley as he held up a piece of paper.

Forzley said the system gives Saint Mary’s three distinct advantages for patient care. First, an electronic order ensures that the information is easily readable and accurate. A nurse or pharmacist doesn’t have to double-check or second-guess an order.

Second, when a medication is ordered for a patient, a physician can know immediately whether the drug is in stock instead of hoping that the pharmacy has it on the shelf.

“The third thing is, obviously, the ability to sign and track information electronically. The history of everything that has happened with that is now recorded in the chart,” said Forzley.

“So if I put in an order and a partner of mine changes that order and if I come back after not being here for a couple of days, I can go back and easily look at what’s been happening with that patient on the electronic system. All the history of those orders is right there in front of me.”

Having a patient’s history in the system becomes priceless when that patient is taken to the emergency room while his or her physician is away. Now the ER attending physician can get all that vital information with just a few clicks of a mouse and begin treatment faster.

The system also tracks a patient’s daily progress by charting vitals on a daily basis, and lets doctors know whether potassium levels, for instance, are headed in the right direction in an easy-to-read graphic. Physicians can also learn, almost instantly, whether a prescribed drug will interact badly with a patient’s current medication or set off an allergic reaction.

But Project Genesis isn’t a finished mission yet, as Forzley said there was more to be added to the system. Next is to allow the medical staff to read X-rays and other diagnostic graphics online. He felt they would be doing that next year.

“It’s a building process, an evolution,” he said. “We think it’s going to improve patient care and safety significantly.”    

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