Bringing the EHR to the Bedside

Lancaster General Health – a 623-bed not-for-profit health system with two hospitals, outpatient centers throughout the region and a physician group comprised of more than 100 physicians – has more than a century of history in southeastern Pennsylvania. With a Level II trauma center, Level III NICU, and nationally recognized orthopedic, cardiology and oncology service lines, the system’s Lancaster General Hospital (LGH) has also been designated as magnet hospital for nursing excellence three consecutive times.

Patient-centric EHRs accessed and updated at the point of care lie at the center of our interdisciplinary approach to patient care. However, bringing the EHR to the bedside to improve care requires more than just the implementation of technology. Successful interdisciplinary documentation requires a transformation from pockets of information filed by discipline to an integrated EHR that brings all practitioners’ contributions to one location.

Siloed Information
At one time, LG Health had an electronic record that essentially linked dozens of applications together to provide documentation and patient information. In May 2011 LG Health took the initial steps to remedy this by launching an EHR for nurses and allied health professionals. This phase also included new equipment and workflows for patient care and data management.

Prior to adopting the new EHR, nurses already collected data at the patient’s bedside through the use of computer carts and mobile workstations. This practice was designed to increase nurses’ one-on-one time with patients, improve data quality and provide advantages related to time management and efficiency. While nurses appreciated the advantages of beside computers, information was still maintained in distinct silos.

Compounding this problem, some of the equipment and processes related to the initial data collection efforts proved to be unwieldy and created obstacles at the point of care. For example, computer carts initially used to bring documentation to the bedside lacked height adjustments and other ergonomic features that are a benefit to nurses. This made it difficult for nurses to see around computer monitors as they rolled carts down the hallway. More importantly, however, it often created a physical barrier between nurse and patient during interactions, leading to a sense of discomfort and preventing open dialogue. Workflow was further impeded by the fact that the battery life of the mobile workstations was too short to accommodate nurses as they went about their rounds.

Rather than view these challenges as a threat to bedside EHR adoption, LG Health saw them as an opportunity to create best practices.

Technology Investment
To ensure that staff and patients alike felt comfortable with the use of the EHR at the bedside, LG Health made significant investments and purchased computer carts (e-carts) that featured longer battery life, ergonomic adjustments, larger monitor screens and more workspace. In addition to making investments in resources and technology, LG Health understood that getting staff and patients on board with the initiative would be critical. Nurse training and patient education was a top priority; in fact, adjustments were made to EHR processes based on staff feedback that encouraged buy-in and adoption.

Recognizing that there would be a learning curve for nursing staff and patients, the new e-carts were installed a few months before the launch of the new EHR so that staff could get comfortable with the new workflow. The e-Health team also created a suite of training materials, including a “how-to” video that demonstrates proper e-cart use when interacting with patients.

The video was created by our team and illustrated how best to bring a computer to the bedside to promote a positive patient experience. The team included staff from nursing and physical therapy. It demonstrated how to introduce the Rubbermaid Medical Solutions computer cart into the patient space, as well as how to adjust the cart height to allow nurses to sit at the bedside and maintain eye contact with their patients while documenting. The goal was to help staff understand how to educate patients about the benefits of the EHR and to promote better dialogue and interaction at the point of care.

Model of Success
The response from staff and patients has been overwhelmingly positive. The new system and equipment have streamlined workflow and documentation while improving the nurse/patient relationship at the bedside and beyond.

Patients enjoy more one-on-one time with their care providers. They now can be sure that their conversations with nurses and doctors are accurately documented, and can even view their own test and lab results onscreen to further their engagement in the treatment process. The care team has all the information they need to accurately report test results and develop plans of care, as well as answer patient questions.

The interdisciplinary sharing of data at the bedside has let us create a truly patient-centric and transparent care process. That transparency gives patients added confidence that all of us are working together on the same team.

LG Health has learned that undertaking the full development of an EHR requires more than just an information technology strategy to support data exchange. By encouraging providers to think differently about how they use patient information at the bedside, organizations can enjoy improved patient care and safety, workflow efficiency and enhanced coordination of care.

Lanyce Horn, MSN, RN, is director of nursing at Lancaster General Health.

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