TGH Medical Records Make Epic Digital Conversion

It's a massive undertaking.

Tampa General Hospital recently converted all of its records from paper to digital. They didn't do it piecemeal, either.

"We have implemented it as a big bang all at one time,'' says Elizabeth Lindsay-Wood, senior VP and chief information officer at TGH. "Not just with all of the clinical applications, but with revenue cycle applications. In addition, we also rolled out the patient portal so patients can get access to their information.

"We’re also offering the product to community physicians so that they can be on the system with us; their clinic would be automated and they would have all the patients in the same database,'' Lindsay-Wood says.

The $128 million conversion launched on Oct. 1, 2011 took about a year and a half. Tweaks, inevitably, are ongoing. In fact, they were part of the plan.

"You can take three, four, five years and still do the same tweaks,'' Lindsay-Wood reasons, “because until you actually use it, you don't know.

"We decided to do this as quickly as we could and then optimize it,'' Lindsay-Wood says.

About 900 devices, including those that check vital signs, radiology equipment and automated anesthesia monitoring are integrated into the Epic system, which is housed at an offsite data center. A back-up data center is located at the hospital.

The transition has eliminated some positions at the hospital and created new ones. Lindsay-Wood says work need changes were handled by retraining and attrition, and no employees were laid off as a result of the switch.

The advantages for doctors are obvious. Physicians will have instant access to all of a patient's charts, anywhere there's an Internet connection.

Dr. Richard Paula, TGH’s chief medical informatics officer, adds that an application for iPad and iPhone will be rolled out in a few weeks.

"If you're at a restaurant and get a call from a nurse, you can look at the data on your phone,'' Paula says. "You can see the lab results in real time.''

''Physicians can enter orders right there from wherever they are,'' Lindsay-Wood says. ''The patient gets the care faster.''

Increasing Patient Involvement

Paula also touts other benefits for patients.

"Patients are now going to be able to engage the physician and the practice through the portal,'' Paula says. "They're going to be able to look at recent surgeries, medications and lab results. I think it's going to get the patients more involved in their care.''

Dr. Anthony Schuster, chief medical information officer at Moffitt Cancer Center, concurs.

"As we use information technology as a tool, it will help improve access to information, help decrease the cost of care and facilitate access to care and access to information between different providers,'' Schuster says.

More basic benefits include saving the patient time and anxiety.

"When a physician would write a prescription, by the time the patient got that medication it could take eight hours or more,'' Lindsay-Wood says. "Now it’s in minutes. The process is all automated.''

Lindsay-Wood has first-hand experience as a patient.

"I used the portal with my doctor,'' she says. After having some lab work done, "I went on the portal that same afternoon and all my lab results were there.

"You know how it is when you have lab work done -- you never know when you're going to hear back,'' Lindsay-Wood says. ''Now the results are available without waiting for them to have to go through all the manual processes.''

Monitoring Access, Improving Security

Despite concerns about security breaches, Paula believes that electronic records are actually more secure than paper.

"With EMR (electronic medial records), we can monitor who looks at your chart,'' Paula says. "With paper records there’s no way to do that.

"When breaches do occur, they‘re isolated incidents and it's usually human error,'' Paula says. An example: "Someone who had information on a computer or hard drive that they shouldn’t have taken home.''

Paula cites actor George Clooney, whose medical records were leaked in 2007.

"The hospital was able to track who accessed his charts and take disciplinary action,'' Paula says. "With a paper chart, you don’t have any way to follow that.''

Lindsay-Wood says TGH began its automation process later than other area hospitals but that it has "leap-frogged'' ahead of them with its comprehensive rollout.

TGH is now part of a small percentage of U.S. hospitals with comparable systems.

"Less than 7 percent of the hospitals in the country have fully integrated systems,'' Paula says.

"It takes a long time and it's a big investment. That’s why a lot of smaller hospitals can’t afford to do it,'' Lindsay-Wood says.

Also, different hospitals use different systems, and therefore aren't always compatible.

"There’s a regional effort to look at putting middleware in there to help translate information back and forth,'' Lindsay-Wood says.

Patients are identified differently by hospitals and physician practices, which makes the effort more difficult. The middleware, she says, likely will use some standard means of identification, such as date of birth.

"We'll be able to send PDF files with the patient's last doctor visit, allergies and so on,'' Lindsay-Wood says. "It's viewable, but it's a moment in time, not real live data.''

Still, TGH's move is a great leap forward in terms of convenience and accessibility for both doctors and patients.

"What we're seeing is great adoption of the technology by doctors and nurses,'' Lindsay-Wood says. "They're so excited to see all the information in one place.''

Curtis Ross of St. Petersburg is a freelance writer whose work has also appeared in the St. Petersburg Times, The Tampa Tribune, Creative Loafing and BetterRVing magazine. Comments? Contact 83 Degrees.
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