CONVERTING INPATIENT HOSPITAL DEPARTMENTS FROM PAPER TO ELECTRONIC DOCUMENTATION USING ECLIPSYS' SUNRISE
CLINICAL MANAGER (SCM)
By Cathy Geibel
The ultimate goal of the conversion from paper to electronic clinical documentation is to facilitate the
retrieval of patient information from the medical record by authorized providers, from any location, at any
time, with a click of the mouse. The significant advantages are witnessed in the reduction of patient
errors, the improvements in patient safety and patient outcomes, and the maintenance of patient
confidentiality. Analysis, design and configuration, and user training of the electronic documentation
system are all critical to successfully achieving these results.
In the analysis phase, time and emphasis needs to be spent on identifying work flow processes in both
their current and future states. Putting together a dynamic team of clinicians, who are knowledgeable about
their practice area and have the ability to “think outside of the box”, along with clinical informatics
specialists, configuration analysts and consultants who have knowledge of the Eclipsys’ SCM product and are
experienced in this process is the beginning step. Together, this team will create the vision of how the
department’s practices will change as the clinicians move from paper to computerized documentation.
Pertinent questions that will need to be addressed by the team with guidance from the consultants in this
analysis phase include:
- What standards must be met with the documentation (e.g hospital policy, regulatory, professional
practice, accrediting organizations)?
- How will the documentation be done (one time or ongoing, at the bedside, with a portable or
stationary device)?
- Who else relies on this documentation (other clinical departments, medical records, revenue
integrity, physicians)?
- How will the quality of patient care be improved? How will productivity be improved? What data can
be measured now to validate these improvements in the future?
During the design and configuration phase, the clinicians on the team continue to play an active role,
beginning with the initial build and continuing through the review and final approval process. If the
documents will be used at multiple sites within the enterprise, it is essential that all of these sites
and/or programs be represented. This can be accomplished through net meetings and conference calls if travel
poses a problem.
It is during this phase that the users will begin to visualize the Eclipsys’ SCM structured notes or flow
sheets and start to conceptualize how they will be used in their work environment. As their understanding
grows, so will their ideas and suggestions for content and format changes. The analysts can expect to make
several series of configuration revisions during this time.
During this phase, some of the many design configuration issues that the team and consultant will address
include:
- Is this documentation better suited for the flow sheet, the free text or the structured note
format?
- Should copy forward or auto entry of the data be allowed? Should the flow sheet observations be
linked to orders/tasks? What are the pros and cons of allowing these functions?
- Are there any significant indicators or mandatory observations?
- Who will be able to enter data? Correct entered data? View the completed document?
- Will the care providers enter the documentation directly or receive it from an external source
using an interface?
- Where else are similar patient observations collected? Should these observations flow to this
document?
Including other stakeholders during the design and configuration time can also be quite beneficial. These
stakeholders may be required to sign off on the final document, and obtaining their input in the development
process can prevent “re-dos” at a later time. Examples of these stakeholders include Regulatory and
Compliance, Risk Management, Health Information Management, Quality Management, Revenue Integrity or various
Information Services advisory councils. In addition, final approval from each department’s or division’s
leadership will need to be obtained before moving forward with the implementation.
When the design and configuration phase comes to an end, staff training can be started. The involved
clinical departments can be asked to provide an education plan (this can be developed in collaboration with
the Eclipsys’ SCM consultant) along with a timeline for completing the education and abandoning the paper
and moving to the electronic documentation.
To facilitate the process during the staff training, it is advisable that a key clinical contact be
identified. This key contact will be responsible for gathering, compiling, prioritizing and addressing all
the users’ comments and concerns. The key contact should be able to differentiate the “show-stoppers” that
need configuration changes before implementation from the “would be nices” that could possibly be addressed
at a later date, and they should be able to communicate these differentiations to the clinical staff.
To successfully roll out the new electronic documentation, the communication to physicians and all other
involved care providers cannot be over emphasized. This can be done through meetings, newsletters, flyers
and/or notices on the paper medical record directing the provider to the document’s new location in the
electronic record. It is the opportune time to educate care providers on the advantages (e.g. availability,
legibility, standardization) that electronic documentation brings to them.
At an established interval after the implementation is completed, it will be time to collect data on the
performance metrics that were identified in the analysis phase. Were the improvements in patient care and
staff productivity realized? Also, how satisfied are the end users and the stakeholders? What lessons were
learned that can be carried forward to other areas or programs within the organization as they move toward
electronic documentation?
Finally, it is the time to recognize and celebrate the accomplishments of the dynamic team of clinicians,
analysts and consultants that made the change to electronic charting actually happen. Each member brought
their own unique combination of knowledge and skill sets to this challenging undertaking and together they
were able to achieve the desired outcome of a successful conversion from paper to computerized clinical
documentation.