Case Study: St. Vincent Healthcare Benefits from an "EHR within an EHR"

Customer Profile: St. Vincent Healthcare

Located in Billings, MT, St. Vincent Healthcare (SVH) is a not-for-profit organization sponsored by the Sisters of Charity of Leavenworth Health System. Comprised of a 286-bed hospital and 30 clinics, SVH is an award-winning regional destination hospital with a comprehensive list of services and specialties.

Modernization of health IT has been a core value of SVH in meeting the needs of patients. The healthcare system offers a cutting-edge telemedicine program and continuously looks for new ways to improve patient care through efficiencies and automation.

The Challenge

SVH's business plan called for the opening of an offsite gastroenterology (GI) center. As the plan began to unfold, the organization sought ways to build the most efficient and effective program from the ground up, looking to advanced technology and automation to form the foundation. A project team was assigned to review potential vendor products and identify the most crucial elements a system would require to efficiently and effectively meet the needs of the center in the future.

While digital imaging was identified as a core component for any system to be a viable consideration, the team also wanted an application that was designed to eliminate the inefficiencies inherent with paper-based processes, like dictation and transcription, data duplication, manual charting and handwritten notes, which were added to charts post-procedure and pre-dictation.

At the same time the review process was underway for the GI Center, the hospital system itself was moving forward with implementation of the Centricity EMR. "We knew that the Centricity EMR would not be adequate to meet our needs in GI because it doesn't offer digital imaging," said Julie Larson, operations nurse manager for peri-anesthesia services, ambulatory prep and recovery, PACU, incision unit and GI. "We were essentially looking for our own EHR that could meet the very specific needs of a GI center and provide a user-friendly transition for physicians."

That is why, after careful consideration, SVH decided to move forward with the deployment of two applications designed specifically for the GI environments - ProVation® MultiCaregiver and ProVation® MD for Gastroenterology.

Identifying the Solution

During the selection process, the project team narrowed the products down to two vendor options, and while both company presentations revealed that digital imaging needs could be met, it became evident that ProVation® Medical products could provide a much broader application to address workflow needs.

"GI is just one of many modules," Larson noted. "It's so robust. It was the whole package whereas the other solution only had imaging."

Amanda Hill, clinical informaticist and SVH's application administrator for ProVation Medical, added that the application needed to support functions including the initial patient call, pre-op assessment and documentation of History & Physical (H&P). It also needed to provide intuitive navigation throughout the process to enable more timely completion of physician notes, ultimately equating to better physician and patient satisfaction.

"The greatest benefit we have found is that all documentation is in one place," Hill emphasized, pointing out that ProVation MD offers the foundational framework to address the specific requirements of the GI workflow. "For example, if a patient has a post-op bleed, we can look in one place to see everything that happened," Hill said. "The ability to have a smaller GI-specific EHR within the larger facility-wide EHR was really the selling point."

The project team did its homework, completing a site visit with another ProVation Medical client in Salt Lake City. The benefits and simplicity were clearly evident in that processes flowed easily from the initial phone call with a patient to the onsite history and physical and more. Charts were all electronically signed, dated and time-stamped, creating additional efficiencies to workflow.

By eliminating dictation and transcription, ProVation MD software allows physicians to efficiently document procedures at the point of care. It produces complete, coding-ready and image-enhanced documentation and ultimately results in higher profitability and clinician satisfaction. In a complementary fashion, ProVation MultiCaregiver software addresses the nursing documentation needs found in a GI center by eliminating the inefficiencies of paper charting and automatically collecting information on vitals.

Realizing the Benefits

Today, SVH's GI center operates in a purely electronic environment. As a result, it has eliminated paper costs to the tune of more than $7,400 annually, and transcription costs of $39,000 - conservative estimates according to Larson.

"We've saved about $46,450 a year just on the image printing and transcription," she added, noting that the estimates are based on 2009 data and would likely be much higher today based on increased patient volumes.

The data reporting tools are fully utilized, including a monthly review of inpatient and outpatient stats, as well as procedure types. Larson pointed out that efficiencies created with report building have enabled more analysis for improvements.

"The differences with report building are night and day," she said, pointing to a drop in time required to build monthly reports from one hour to three minutes. "I've done physician audits, and it's been really convenient. I sat down with one physician and reviewed documentation, pinpointing what needed follow-up very quickly. A large amount of data is available through the reports."

Reporting tools provide quick and easy views of per-physician case numbers, medications utilized, and physician-to-physician comparisons of key data to identify outliers that may need to be addressed, such as scope withdrawal time, adenoma detection rate and rate of cecal intubation.

Another benefit to SVH is the rapid reporting available for referring physicians, which allows items such as pathology and lab reports to be sent automatically. Post-op reports are also faxed directly to referring physicians with delivery automatically confirmed.

Satisfaction and ease of use for staff and physicians proved to be a huge asset for making the transition, and strong confidence in the availability of technical support boosted confidence in the new products and workflow. Patient satisfaction has also increased because intelligent interfaces keep clinicians from asking the same questions over and over again.

"Between the pre-live presentations and the power user training in Minneapolis, our expectations were quite high," Hill expressed. "They were all met - we couldn't have been happier.

"What the product brought to the table was huge," she added. "Daily use of ProVation software has made an incredible difference in our efficiency and our ability to deliver effective patient care."