Unified Solution Offers Health Care Industry Efficient Electronic Chart Completion and Archiving
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June 2009
Background
The George Washington University Hospital has been providing medical care to patients in the Washington, DC area for more than one hundred years. A 371 bed facility, the hospital treats more than 150,000 patients (on inpatient and outpatient basis) each year. An acute care facility and an academic medical center, The George Washington University Hospital employs over 820 physicians on the hospital medical staff as well as a 280-member multi-specialty physician practice group.
Salar, Inc. specializes in providing comprehensive electronic clinical documentation and charge capture solutions to the health care industry. Salar’s suite of products is designed to transform traditional physician paper-driven documentation into electronic format to boost clinical productivity, operational efficiency and care team collaboration. Founded in 1999 and headquartered in Baltimore, Salar provides solutions to many of the nation’s leading hospitals.
The Challenge
The George Washington University Hospital administration, together with the Information Technology (IT) department, first began looking for an electronic clinical documentation solution because the hospital’s residents expressed a desire to move away from the use of paper and find an easier and more efficient process for creating and managing their patient notes. So in early 2008, hospital executives set out in search of a better electronic clinical documentation system.
They were then introduced to the team at Salar, Inc., who presented their electronic clinical documentation solution, known as TeamNotesTM, which allows clinicians to create medical forms, such as daily notes, admission notes and discharge notes electronically on desktops, laptops, and tablet-style computers, eliminating the use of paper and the need to transcribe information by hand. TeamNotesTM enables more complete patient records and more seamless information sharing to promote better care team collaboration and enhance the performance of existing electronic medical record (EMR) systems.
“We went into that initial meeting with Salar not really knowing what was going to be presented to us, but once we saw all that TeamNotes™ could do, we recognized that this was the solution we were looking for,” said Gretchen Tegethoff, Chief Information Officer, The George Washington University Hospital. “We were impressed with how an existing paper form could be recreated exactly in an electronic format for online use. Also, this wasn’t a system that replaced any of our current tools. It would be designed to act as an overlay to our existing system structure and interact with those applications.”
In March 2008, The George Washington University Hospital signed a multi-year agreement with Salar to implement TeamNotes. Under the agreement, Salar agreed to utilize their solution to build a new system that would enable the hospital’s clinicians in the internal medicine department to document all of their patient encounters electronically, eliminating the use of paper and allowing for compliance with industry-wide clinical documentation standards.
Implementation
In May 2008, Salar’s team began the process of implementing its clinical documentation solution at The George Washington University Hospital. First, a kickoff meeting was held between Salar representatives and hospital staff to go over all aspects of the process and develop a strategic plan to execute the transition smoothly. Implementation teams were formed of clinicians and representatives from departments throughout the hospital, including billing, coding, health information management, IT, compliance, risk, quality, administration as well as the forms committee and the hospital’s physician practice group.
“Adopting TeamNotes involved a lot of different people in the organization, and Salar provided us with a great binder of implementation guidelines to help us build our project plan and project teams,” said Tegethoff. “Salar advised us ahead of time on everyone that would need to be involved, which I think really helped us not to miss including anyone as we moved through the process.”
September 15, 2008 was set as the launch date to have an initial 60 of the hospital’s internal medicine clinicians – nine teams of attending physicians, residents, interns, physician assistants, nurse practitioners and medical students, each overseeing 10 to 20 patients at a time – transition to using TeamNotes for all of their patient documentation.
TeamNotes is a highly-customizable solution, and as a result, Salar team members became very involved with the physicians so they could learn first hand how the clinicians wanted the system to function. This allowed Salar to create interfaces and servers and build forms to meet their specific needs.
“With Salar, our physicians knew that they really had input and influence to build the tools they needed, which really encouraged their participation in the process,” said Renee Patrick, project manager – physician IT services, The George Washington University Hospital.
When the launch date arrived, each team was provided with laptop computers mounted to rolling carts to use to record patient notes during rounds and a training schedule was established to teach the staff how to use the new tools. During the week of the go-live with TeamNotes, a command center was staffed from 7am-7pm daily with one hospital IT staff member and two Salar team members. By the end of the week, 145 notes were being completed daily in TeamNotes.
“Our doctors really appreciated how easy the new system was to use and how little training was involved,” said Patrick. “Many clinical systems require hours, sometimes days, of training. By comparison, it took just 45 minutes for our physicians to learn the basics of Salar’s product.”
Results
On September 15, the hospital successfully transitioned to the use of TeamNotes as scheduled. Rather than the initially planned 60 users, upon implementation 85 hospital clinicians began using TeamNotes to generate all patient notes electronically. Unlike the hospital’s former system which still required forms to be printed from a computer and completed on paper, TeamNotes enables all patient notes to be captured electronically and automatically transcribed into a final version of a legal medical record stored by the hospital’s EMR system. The information collected by TeamNotes is immediately available to any user throughout the entire hospital that may need to access the patient’s information.
“Our residents took to Salar’s system immediately, because it has made their lives a lot easier,” said Patrick. “They no longer need to record repetitive information into a chart for each new patient because any prior collected data is already in the system. Processes that were previously done manually, such as lab and pharmacy orders, are now delivered automatically. Our attending physicians that work directly with our residents have also been pleased with the system because now they have more complete information to review when assessing a patient.”
Since implementing TeamNotes, hospital staff has experienced many advantages of the electronic system, including being able to easily read what has been written about a patient and who recorded the information without having to decipher handwriting. Clinicians are more conscientious about how they write their patient care notes, because they know it is now more likely to be read. Also, since notes are automatically saved into the system, more progress notes are making it into the final medical record and less are being lost in physician’s pockets, falling out of written charts or being lost in transcription, resulting in more complete and secure patient records. George Washington University Hospital physicians are currently using TeamNotes to generate more than 7,000 patient notes each month.
Salar’s team remains engaged with the staff to ensure the solution is meeting all of its needs to enhance the hospital’s workflow.
“It has been an excellent experience working with Salar,” said Tegethoff. “Someone from their staff is still onsite at the hospital regularly to work directly with the physicians – and he knows how to work with them and listen to their concerns or ideas and make the system work for them. He is able to make small changes and tweaks to the solution on the spot. Getting that kind of service from other vendors can be challenging. Usually there’s a pretty good time lapse between requesting changes, acceptance of the requests and actually getting the changes done. With Salar, I haven’t heard any instance of anything not being done in a reasonable timeframe.”
Currently, The George Washington University Hospital is utilizing TeamNotes exclusively in its internal medicine department, but future rollouts of the system in other departments are planned.
“Salar offers many other features that we aren’t even taking advantage of yet,” said Patrick. “We see this becoming an even bigger and better solution for our physicians in the future.”
“Salar has tapped into an area of healthcare IT in physician documentation where a lot of the other EMRs and clinical systems fall short,” said Tegethoff. “I really think they’ve hit on a solution that will be very beneficial to getting a truly complete medical record.”
