[NYAPRS Enews] MHW: Raid Implementation of Electronic Records Pays Dividends for BH Facility

[Harvey Rosenthal]

Rapid Implementation Of EMR System Pays Dividends For BH Hospital

Mental Health Weekly  October 31, 2011

 

Mary Kay Shibley's advice about implementing an electronic medical
record (EMR) recalls the motherly wisdom about taking bad-tasting
medicine: One full taste of going electronic can be infinitely
preferable to several staggered samples of the remedy.

 

Shibley, a registered nurse by training, is the behavioral health
clinical informaticist for the seven hospital organization Sharp
Health-Care in San Diego, and works out of the 149-bed behavioral health
hospital Sharp Mesa Vista. On June 9, 2010, the private psychiatric
hospital essentially experienced a "flip-the-switch" moment, going from
being a completely paper-based operation the day before to becoming
fully electronic. Legal documents currently constitute the only
paper-based exception in Sharp Mesa Vista's operations, according to
Shibley.

 

"It felt so easier for the staff to go from 100 percent paper to 100
percent electronic," Shibley told MHW. "We did this instead of having 

broken pieces where you have some of each; that doesn't work as well."

 

Shibley credits the smooth implementation process to a number of
factors, from executive-level buy in at the hospital to the momentum
gained in identifying enthusiastic members of the medical and nursing
staffs to influence other more reluctant adopters in the organization.

 

Coordination challenges

As part of a larger hospital system that covers all medical disciplines
except for pediatrics, Sharp Mesa Vista had to make sure that the
organization-wide implementation of an EMR satisfied its particular
needs in working with patients with mental illness.

 

"All seven hospitals are on the same record. We had to get creative in
protecting our records, but still allowing the emergency room doctor to
do his job," Shibley said. 

 

Shibley explained that because of the sensitivity of behavioral health
information, only the ER physician and a handful of other specific
medical titles are allowed full access to the behavioral health record.
The hospital also has a process by which administrative liaisons can
grant another staff member, such as a nurse, to have full access to a
patient's behavioral health record in individual circumstances where it
is warranted.

 

The hospital also maintains cross-check systems so that it can monitor
activity with electronic behavioral health records on an ongoing basis.
"We're constantly concerned about breaches," Shibley said. She explained
that if a particular staff member accesses behavioral health records
with great frequency, that will trigger a flag in the system.

 

Productive results

Moving to an electronic record has generally met with staff approval
because of the numerous benefits it has afforded in the process of care,
Shibley said. 

 

In the past, for example, a Polaroid picture of a client was attached-
to his/her medication record, and this paper-based record would be

referred to during medication rounds to ensure that there were no errors
in identifying patients. Now with an EMR, the patient's photograph

is permanently affixed to the banner for each record electronically,
making the process more reliable, Shibley said.

 

Many everyday benefits become apparent with the EMR, she said. Multiple
staff members can review the same patient chart simultaneously. Orders
to the pharmacy can be received and processed immediately. In treatment
planning, a professional not physically present in the planning session
still can participate in the process, and feedback from the session is
immediately available for others' review.

 

Shibley said the difference between paper and electronic systems is
readily apparent with continuity of care among various branches of the
larger hospital system. "If someone is in the ER and is in crisis, our
staff here can pull up the chart and can look at medical records from 2,
3, 5 years out," she said. "There is more continuity between
facilities."

 

One system

Sharp Healthcare's work to implement one EMR system for the entire
multi-hospital organization dated to 2008, when executives concluded
that a number of niche products that were being employed to establish an
electronic record weren't working optimally. "In the background, the
interfaces looked like spaghetti," Shibley said.

 

Implementation started with Sharp Healthcare's flagship hospital, Sharp
Memorial Hospital. Sharp Healthcare elected to acquire an EMR system
from Cerner Corp., a leading information technology company but one that
does not have a specific behavioral health product.

 

This required Sharp Mesa Vista, which opened in the 1960s, to make sure
that the new system would be equipped to handle the behavioral health
hospital's specific procedures in areas such as assessment, legal
protections and patient holds, Shibley said.

 

This was made possible because behavioral health was involved in the EMR
design from the beginning, well before its own implementation would go
live. This would ensure that some key decisions would be made with
behavioral health's needs in mind.

 

Asked how she would advise other behavioral health facilities
implementing electronic records, Shibley said the most important factor
is to "go 100 percent." Otherwise, if you try to phase in an electronic
system and maintain paper systems, "You break people's process and
double people's workload," she said.

 

Instead, a full implementation allows all staff members to struggle
together but to learn together, she said. Shibley added that it is
important

for an organization's highest level executives, including the CEO and
the chief of medicine, to buy into the conversion. "Then you find it in
a group of physicians and nurses who are enthusiastic about it, and then
they infect other physicians and nurses," Shibley said.

 

Also, Shibley has advised that an organization try to log on with most
of its physicians a day or two before going live, in order to identify
any potential system problems before the official implementation. *

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