Lehigh Valley Hospital recently embraced a philosophy of "Patient Centered Care." Its goal is twofold: one, to provide as many services as possible at patient bedsides. A second goal is to help nurses and other caregivers provide those services as efficiently as possible. Lehigh Valley, a 770-bed teaching hospital in Allentown, PA, is meeting those goals through technology like mobile computing. For example, nurses now record information with wireless, laptop computers and portable data terminals - as opposed to paper forms - when treating patients at their bedsides. The laptops and terminals have allowed staff to treat patients more efficiently, says Jan Wilson, the hospital's manager of patient care services.
In addition, the hospital is in the process of implementing a document and image management (imaging) system. (Imaging systems convert paper documents to electronic format. That way, end users can pull up electronic images of documents on their desktop computers).
"Lehigh Valley has always sought to use technology as a way to free up employees to do their jobs more effectively and efficiently," Wilson says. "Imaging and laptop PCs are two primary examples."
Paper-Based Record Storage Bogs Down Employees
Three years ago, Lehigh Valley moved its medical records to an off-site storage facility in order to create additional clinical space at the hospital. Once the hospital moved its records - to a facility five miles away - employees encountered unwanted bureaucracy when they needed to review a patient's records. Zelda Greene, director of medical records, describes what transpired when patients came to the emergency room, for example.
First, a clerk in the emergency room would send a records request to the storage facility. The request would be sent over the hospital's wide area network (WAN), and automatically printed at the storage facility. (Employees monitored the printer, so requests could be processed quickly).
An employee at the storage facility then would pull the file. The most important parts of the file would immediately be faxed to the hospital. Within an hour, a courier would drive the rest of the file to the hospital. "The emergency room usually doesn't need entire files immediately," Greene says. "The drivers try to transport as many records at a time as they can. Essentially, their day is spent transporting records to the hospital."
Imaging To Expedite Document Access
Greene adds, "It was time-consuming for staff to request records for every patient who came to the emergency room. The hospital processed more than 107,000 medical records last year."
Even before the records were moved offsite, accessing documents at Lehigh Valley was anything but smooth. For example, employees/clinicians had to wait for coworkers to finish using records before they could access them. However, this was problematic in that several employees often needed the same records simultaneously. For example, physicians review medical records to learn how patients had been treated for specific conditions. Documents are also needed for billing and research purposes.
In addition, records could be misfiled, making it difficult for the next person to find them.
"We wanted the employees to have rapid, simultaneous access to records," she adds. "We've always tried to use technology to increase efficiencies."
Because of those types of problems, Greene had been researching imaging even before the record storage department was moved off-site. Specifically, she read trade publications. She also worked with the hospital's in-house management information systems (MIS) department to select an imaging vendor. Greene and the MIS staff went to several imaging trade shows to evaluate different products.
Overcoming Employee Reluctance With New Technology
Ultimately, Lehigh Valley adopted an imaging system from Imnet. Greene and the MIS staff liked Imnet's system partially because of its workflow capabilities. (Workflow is the automatic routing of electronic documents to the appropriate workstations or storage areas). Lehigh Valley will use the imaging system to route patient documents and files to the appropriate hospital employees.
Lehigh Valley has begun converting its paper records to electronic format. Once the emergency room records have been scanned, in-patient documents from departments like psychiatry and gynecology will be scanned. Greene estimates it will take the hospital about a year to fully implement document scanning as well as train employees on the system.
According to Greene, even though imaging will make employees' jobs easier, some of them are reluctant to use it. "They fear change and doing things differently," she adds. "Overcoming that reluctance will be one hurdle to making this project work."
Consequently, the administration has involved employees in the implementation as much as possible. "Whenever we make an important decision, we meet with the employees who will be using the system," Greene says. "And, we tested products in-house, so employees could see which ones they liked. We valued the clinicians' and employees' input because they will be using the system. If they weren't happy with it, they wouldn't use it."
Nurses' Stations Prove Inefficient
Previously, Lehigh Valley Hospital had "nurses' stations" on each floor, according to Wilson, manager, patient care services. Each nurses' station had one or two stationary personal computers (PCs). (Some areas of the hospital only had one nurses' station for 30 patient beds).
Previously, nurses would write down patient information and orders - such as a request for a patient to have X-rays - while treating patients at their bedsides. They would then walk to one of the stations and log on to a PC. Nurses then typed in the information they had written down. Nurses also could use these PCs to access information, like the date patients were admitted.
Says Wilson, "Some of the nurses and other care-givers were wasting an hour every day walking back and forth from patient rooms and the nurses' stations. And, they couldn't always find an open PC, especially at peak times. That led to more wasted time that ideally should have been devoted to patient care. In addition, there was a small percentage of errors in the nurses' data entry."
Handheld Devices, Wireless Network Automate Care
Now, Lehigh Valley's nurses and caregivers carry portable, laptop PCs as well as Symbol Technologies' PPT 4340 handheld data collection terminals when treating patients at their bedsides. Symbol (Holtsville, NY) is a manufacturer of automated data collection equipment. By carrying the small laptops with them, nurses can enter information while at patients' bedsides. As a result, they don't have to constantly walk to and from patient rooms and nurses' stations. Lehigh Valley is using a wireless LAN from Symbol in conjunction with the laptops. Symbol's Spectrum24 network serves as a wireless (radio frequency) connection from the laptops to the hospital's existing local area network. For example, information entered on the laptops is automatically transferred to the LAN. (The laptops have displays and keyboards that are similar to, but smaller than, those for desktop PCs). "We had been concerned with the time nurses were losing by walking around so much," Wilson says.
Nurses and caregivers only recently began using Symbol's PPT 4340s. These terminals are used similar to the way the laptops have been used, according to Jim Brennan, Symbol's director of healthcare sales and strategic alliances. (Symbol's PPT 4340s have miniaturized keyboards and touchscreen displays). Lehigh Valley's nurses and caregivers can use the 4340s to enter and access patient data with the keyboard or the display, which is both pen- and touch-based.
Wilson likes the PPT 4340s because they are lighter and are sealed to protect against damage from fluids. In some cases, the PPT 4340s have replaced the laptop computers.