December 02, 2010
Client Spotlight: North York General Hospital
On Wednesday, November 17, 2010, North York General Hospital (NYGH) in Toronto, Canada hosted business partners and members of the provincial parliament to celebrate recent advancements in improving patient safety, culminating in the October 26th go-live of a project called eCare.
The original project began nearly 4 years ago, with an aggressive goal of completing everything in 15 months. This combined with internal leadership changes, seemingly ever-present funding issues, and resource challenges for both Cerner and NYGH made for unexpected delays. NYGH wanted to move far and move fast, but with a step back, a more conservative approach was adopted and the project was divided into two distinct, manageable phases. As the remaining challenges were addressed, a strong team came together and eCare Phase 1 went live in June 2008 when they implemented documentation on nine of their units.
North York forged ahead with eCare phase 2, which was all about raising the bar. At the completion of this phase, doctors are entering their own orders in the system, following standards of practice as defined by current literature. When a physician enters an order electronically, there is no handwriting to decipher or missing information. In a fraction of a second, the doctor’s clear wishes are transmitted throughout the hospital, ensuring that the best plan of care for the patient is in motion. The patients in Toronto who go to NYGH can be assured that they are receiving a high level of care based on recently published medical research. The doctors no longer have to sift through stacks of medical journals to decide on a new treatment plan. The system gives them what they need to make a sound, informed decision and then disperses the plan to everyone taking care of that patent.
Throughout the project, NYGH collaborated with neighbouring Toronto hospitals and fellow Cerner clients. Toronto East General and Mt. Sinai had gone first and second respectively with their own physician order entry go-lives. The hospitals decided early on to not only share information about the implementation, but also to share resources at each other’s go-live events. With additional super users available from these two sites, the go live at NYGH was a stellar success.
eCare phase 2 made it possible for NYGH to earn a HIMSS Level 5 certification, the first in Ontario – a distinction less than one percent of Canadian health systems have achieved. To accomplish this, NYGH’s physicians had to be entering orders and the hospital had to demonstrate a closed loop medication process. With this step, NYGH virtually eliminated the possibility of a medication error, which can save lives and get patients home sooner. Using a bar code scanner, a nurse can check the medication and also scan the patient’s wristband. This helps ensure the right patient is getting the right medication, in the right dosage, at the right time and through the right route. With the hundreds of doses a single nurse gives patients in a given day, both the nurse and the patient can be assured that the system is doing its job to ensure patient safety.
A challenge of any project like eCare is getting buy-in and acceptance from clinicians. NYGH decided that while this is a very serious subject, you may as well have fun with it. Who wouldn’t want to be an eCare Super Hero? NYGH ran a poster campaign throughout their hospital to encourage all clinicians to turn away from the dark side of paper and pen and join the electronic revolution happening at their site. The clinicians and project team members whose heads were superimposed on super hero bodies also offered sound advice and proof points from published research about how the new system would improve patient safety. The plan worked. In the early days following the October 26th conversion, Cerner observed that adoption and acceptance seemed to be higher than normally expected and the level of enthusiasm witnessed was extremely encouraging. Super Users were critical to providing “at the elbow” support and were knowledgeable and responsive. According to Dr. Jeremy Theal, within 2 weeks of the go live, MDs were already entering 95% of all orders electronically – an impressive accomplishment.