DHMC switches to electronic records
Dartmouth-Hitchcock Medical Center implemented a new electronic health records system on April 2, according to Director of Media Relations Rick Adams. Called eD-H, the new system replaces the 15-year-old Clinical Information System that the hospital, and its affiliates in Manchester and Nashua, previously used, and allows patients and referring physicians to access medical information through online portals, Adams said in an email to The Dartmouth.
"An [electronic health records system] is a comprehensive collection of medical information stored in a central location," he said. "It can be accessed instantly, updated centrally and quickly and provides consistent information to the entire care team."
Enacted as a result of a study of DHMC's information technology infrastructure that began in 2007, the new system is provided by Wisconsin-based Epic Systems, Inc., chosen from a group of six vendors in mid-2008, according to Adams. It will manage information for inpatients and ambulatory patients, as well as allow care providers to send electronic prescriptions directly to pharmacies for quicker processing, he said.
The system will also help DHMC comply with federal regulations set forth by the Health Information Technology for Economic and Clinical Health Act part of the American Recovery and Reinvestment Act of 2009 according to Stacy Dube, implementation coordinator at DHMC. Regulations included in the bill require hospitals to put comprehensive electronic health records systems in place by 2014 or face a reduction in federal funding, according to the bill.
Only 2.7 percent of hospitals in the United States had such a system in place in 2009, Chantal Worzala, director of policy for the American Hospital Association, said in an email to The Dartmouth.
DHMC invested a total of $80 million in the new system. Expenses included the purchase of software and hardware, configuration and customizing of the system, employee training and additional staffing for the launch, Adams said.
Like the Clinical Information System used previously, the new system displays all medical information in printed type to eliminate possible confusion from handwritten instructions, Adams said. The system also improves patient care and efficiency by allowing all the professionals involved in a patient's care including those at other health facilities to coordinate their information through one central source, as well as create a "universal patient identifier system" to ease information flow from all sources, he said.
"This will effectively join our Lebanon, Manchester and Nashua campuses together," Adams said.
Patients will receive summaries after each visit that include relevant health information, and they will be able to enroll in a "myD-H" portal to view their medical information and pay their medical bills online, according to Adams. The system will allow medical professionals to view a patient's previously-inputted "wants, needs and treatments" in situations where that patient may not be able to speak for him or herself, Adams said.
The new electronic system will offer patients "additional ways to be involved in their care," including the ability to request appointments, order prescription refills and fill out questionnaires online before appointments, Dube said.
DHMC involved a group of "30 doctors, nurses administrators and staff" in the selection process for the new system and held town-hall style meetings attended by more than 1,500 employees for vendors to display their wares to the DHMC community, according to Adams. No one expressed major opposition to the new system, Adams said.
As it is currently in a "period of optimization," the new system will be continually examined to improve usage and efficiency, according to Adams.
Dube, who also answers telephones in the transition's command center, reported no major patient safety issues during the "pretty smooth" transitions, she said. Questions from staff instead focused on configuration and features of the new system, she said.
Each DHMC staff member who requires access to the new system received a maximum of 16 hours of training and had access to a test environment to experiment with the system, Adams said. Employees had to pass proficiency tests before they could gain access to the new system, he said. Prior to the launch, over 600 DHMC employees from every area within the hospital received training to become "Local Support Staff" staff members who tested their co-workers for proficiency and who assisted them with the system after implementation.
"Since the launch, the [Local Support Staff] have been on the floors assisting with user questions and facilitating the resolution of problems," Adams said.
Because the new system is so crucial to DHMC's operations, the servers hosting the system contain four layers of backup technological mechanisms to help prevent a major failure, Adams said.
"There is also an extensive fail-over plan in place which will guide us in the event of some sort of failure," he said.