Going digital: How electronic patient records are improving care

Spring 2016

A patient with a long history of illness arrives at an Emergency Department. As health-care workers assess her condition, they learn that both her home and family doctor are several hours away. Large folders of her patient history comprising allergies, medications, past lab results, and various test results need to be sifted through. To make matters more complex, her records are stored at several care facilities across the region in different physicians’ offices, pharmacies, and other hospitals. To deliver the best possible care for the patient, doctors need to have parts of her record faxed over from different facilities. Chances are her record contains gaps in information.

With the significant volume of paper-based records that fill Ontario’s hospitals and care facilities, this is not an uncommon scenario. Across the province, hospitals face scattered information points, redundancies in testing, and difficulties in coordinating information about patient allergies. Hospitals are addressing these problems by implementing a number of information systems that are contributing to the development of a more complete electronic health record.

London Health Sciences Centre (LHSC) has made strides towards implementing electronic systems that make aspects of the patient medical record digital. Why are these electronic systems valuable for anyone who comes to the hospital? How does technology allow for more informed health-care decisions? We explore three electronic systems that LHSC has implemented and the benefits and future opportunities they create.

OneView – Radiology imaging viewer

The problem

Patients across southwestern Ontario rely on radiology specialists at LHSC, often traveling hours from home for treatment. Without a standardized medical image system, diagnostic images were stored at different facilities and had to be faxed to where the patient was receiving care. Often, patients or their family kept a collection of images on a CD, or physical copies of their film X-rays to bring to each appointment to ensure their specialist would have access to their most current images.

The solution

OneView is a medical imaging viewer used by 70 hospital sites in southwestern Ontario as well as several independent health facilities. OneView is used by health-care providers to view radiology reports and images from across the region, such as hospital-based CT scans, ultrasounds, MRIs, mammograms and X-rays.

How does it allow for better care for patients?

Out-of-town patients can be saved the inconvenience of traveling a far distance to have diagnostic tests completed. Patients can visit a facility closer to home to have a test done, which can then be accessed by their physician at LHSC. Additionally, family physicians are able to call the patient’s specialist at LHSC if they have questions or concerns about the patient’s diagnostic images or reports. The system also takes pressure off of the patient to keep an up-to-date record of all their scans and results.

OneView has reduced redundant tests because patient images and reports are current and easily accessible. For patients undergoing radiation treatment, OneView prevents unnecessary exposure. This in turn reduces wait times for other patients awaiting tests and treatments.

Linda Heidenheim, a registered nurse at LHSC, says that using OneView allows patients to have some peace of mind at a critical time, and can expedite care decisions.

“If a patient comes in with a collapsed lung, for example, I can go into OneView and see images of when it started, how it was treated, and when it got better,” she explains. “I can see what’s going on before they even step into the clinic. This means their clinic time is focused on treatment rather than trying to figure out what the problem might be.”

What are the next steps?

Ontario’s four Local Health Integration Networks use a different diagnostic imaging viewer to access images and reports.  In order to standardize the system across the province, eHealth Ontario is working to implement a common diagnostic imaging service. This will allow every Ontario hospital and community-based health-care provider to have access to the same diagnostic images and reports. For more information, visit eHealth Ontario’s website.

Electronic medication order entry

The problem

In a busy acute care hospital like LHSC, relying on handwritten prescriptions presents several challenges and inefficiencies, beginning with being difficult to read. They can take time to reach the pharmacy, and in turn, the patient.

Reliance on paper-based medication ordering can result in medication errors such as the wrong medication reaching a patient, too high or too low a dosage, or a lack of knowledge regarding a patient’s allergies.

The solution

In 2012, an electronic medication ordering system (HUGO) was implemented at LHSC and nine other participating hospitals in the region. Each patient now wears a barcode bracelet throughout the length of their hospital stay. Their physician enters medication orders into the computer, which is immediately received by the pharmacy and the resulting medication is blister-packed with a barcode on the front of the package. The patient’s nurse is able to scan the barcode on each patient’s bracelet, and then scan the blister pack. If the medication type and dosage match up with what the physician has ordered, the patient receives the medication and the event is logged into the patient’s medication history.

How does it allow for better care for patients?

With barcode scanning, the nurse is able to tell if the wrong medication has reached the patient. The system alerts the nurse if the patient has allergies to a medication, or potential drug interactions that could be harmful.

“We know from data that this has resulted in quite staggering decreases in medication errors,” says Dr. Robin Walker, Integrated Vice President of Medical Affairs and Medical Education. “Overall, errors are down by 30 per cent.”

Significantly, certain types of medication errors have been nearly eliminated at LHSC. “In some categories, particularly the category of wrong patient, wrong drug, we’ve now come close to eliminating that problem,” says Dr. Walker.

The health-care team is able to build a thorough medication history during a patient’s hospital stay that is logged into the system. Having such a record of how a patient has been treated allows for better decisions if care is needed in the future.

What are the next steps?

Several measures have been taken to optimize the system to improve usability across the 10 hospitals in the region that use the system. Plans to implement the system in more hospitals in the region are currently being discussed. Eventually, there is potential to move to a completely paperless clinical documentation system.

ClinicalConnectTM:  an Electronic Health Record viewer

The problem

A paper-based medical record contains a substantial amount of information over a patient’s lifetime, and may be stored in different care facilities. Health-care providers would have to sift through each available report and could still not be certain that the health record was complete.

As a result, patients would often undergo the same tests more than once. Patients would also wait for reports to be faxed from different care facilities in the region, or might spend a large amount of their clinic time waiting for test results and reports to be tracked down or interpreted.

The solution

LHSC now utilizes clinical viewer called ClinicalConnect. Deployed by the connecting South West Ontario (cSWO) Program, the system enables over 37,000 doctors, nurses, therapists, and other health-care professionals across southwestern Ontario to securely access electronic patient information from the region’s 67 hospitals, four Community Care Access Centres (CCACs), four regional cancer programs and provincial clinical systems for laboratory tests and results, and diagnostic imaging.

For the first time, patient health information from across the continuum of care can be accessed in seconds from organizations using eHealth technology. The integrated electronic health record provides secure access to a comprehensive patient health record that includes allergies, medications, past lab results, radiology images, biopsy test results, and microbiology test results.

How does it allow for better care for patients?

Access to a more complete electronic medical record across the region means the elimination of redundant tests, the ability for patients to get tests done as close to home as possible, and for their clinic times to be spent discussing care plans rather than waiting for results.

Dr. Karin Hahn, a medical oncologist at LHSC’s London Regional Cancer Program, explains that the more that can be known about a patient’s tests and reports, the better support she has to make decisions about their care.

“In the past if a patient showed up in hospitals that weren’t connected on ClinicalConnect, that hospital would have no information on that patient’s story,” she says. “When was their last dose of chemotherapy? Where is their cancer? What could be explaining their symptoms? Having that information is crucial and it has improved care tremendously.”

Susan Rybanksy, a nurse clinician in paediatric endocrinology, has seen the impact that prompt access to medical information can have on patients in her care.

 “Adults might find a blood test routine,” says Susan. “But children often have an emotional response to any test. So to be able to say to a child, ‘That’s alright, we have that result; no needles today!’ – you wouldn’t believe how happy they are and what a difference it makes.”

What are the next steps?

The cSWO Program, funded by eHealth Ontario, continues to work with clinicians and health-care providers to identify other electronic data that would enhance the patient information currently available through ClinicalConnect. To learn more, visit the cSWO Program page on eHealth Ontario’s website.

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