High-quality patient care: this has been the successful claim of Klinikum Esslingen, a central care hospital near Stuttgart. 140,000 outpatient and inpatient cases are treated each year in this esteemed hospital with 1,800 employees. Matthias Ziegler is sure that in order to continue providing high-quality patient care, the clinic has to invest in the digitalization of clinical core processes now. Ziegler has been the managing director at Klinikum Esslingen since February 2020. “After the successful kickoff of ‘Project Patient Record’ in December 2020, the first phase of the venture is being implemented now.”

This means that the digitalization program sticks to its ambitious schedule ‒ despite the enormous challenge of COVID-19 last year that threw a spanner in the works of the preparations. Michael Hedtrich, the clinic’s commercial director, adds: “As is the case with many other hospitals, the pandemic most definitely keeps us on our toes. This starts with planning and arranging ICU beds followed by adequate patient care, culminating in the organization of vaccinations for our employees.” The head of administration continues: “Thanks to i.s.h.med, the established EHR from our partners Cerner – which is deeply integrated into the SAP environment – we stay on top of things even in the face of today's challenges.”

In a modern hospital, paper-bound processes are an enormous organizational obstacle. This is why Project Patient Record has been moved to the top of the agenda at Klinikum Esslingen in 2021. This is where the management team counts on Cerner: not only is Cerner involved in implementing the processes, but they have also played a big role in the preparations ‒ this includes tasks such as supporting change management processes, examining suitability when it comes to digitalization and helping the employees settle in while the changes take place.

Acceptance is dependent on the employees

“The digital transformation aims to make our core performance – patient treatment – largely paper-free in order to initiate end-to-end, cross-departmental work processes and to use comprehensively available data to improve patient care in the future. In the end, every process is affected by this extensive digitalization project of a patient record managed by physicians,” Michael Hedtrich explains. Employees play a major role, since they are the ones familiar with daily routines. This means we’ll need their cooperation if digital processes are supposed to facilitate activities while being easy and safe at the same time ‒ through digitally supported medication planning or comprehensive nursing process documentation, one of the core functionalities of i.s.h.med. Michael Hedtrich points out that everyone in Klinikum Esslingen knows: “this is not only a ‘translation’ of the previous workflow into an electronic form.” Instead, each process must be checked for functionality at the same time. To this regard, Ziegler and Hedtrich agree with deputy nursing service manager Katharina Grjasin and chief senior physician of the hematology and oncology department, PD Dr Swen Weßendorf. For this reason, Haik Rothbart, project manager at Cerner, and her colleague Andreas Krüger focus on several priorities in the upcoming transformational change at Esslingen.

First, this means using necessary changes resulting from the implementation of IT solutions to consistently align all work processes at the clinic with a patient-oriented treatment process. Simultaneously, i.s.h.med at Esslingen will be aligned with future requirements ‒ driven by the development and usage of cloud services and the integration of artificial intelligence (AI) and machine learning. To keep track and drive forward both of these aspects, Cerner uses the iterative hospital process model i.s.h.med Model System, allowing hospitals the optimization of existing implementations and the ongoing future development of the hospital's IT aligned with technological requirements.

Another strategic focus of the team consisting of Klinikum Esslingen’s CEO, CIO and Cerner is the integration of key users, who provide the connection between IT and users on the ward. As first contacts for colleagues from their own department, they play an important part in the implementation process, and will be the first to be trained in new i.s.h.med functionalities.

Three project phases towards a fully digitalized quality hospital

Project Patient Record with i.s.h.med at Klinikum Esslingen coincides with a scheduled wide-ranging building renovation and the modernization of equipment. This poses an opportunity and a challenge at the same time. Thus, a good strategy is of the essence for the successful project progression at Esslingen. The project consists of three phases, with the last phase ending in 2022.

Faster success based upon initial quick wins…

After a dedicated review, solution packages will be identified and implemented during the first project phase that will result in a real benefit. These quick wins contain several sub-projects, like the discharge letters, surgery planning and documentation, as well as progress and wound documentation. The goal is high availability of information through fast access to relevant data and standardized processes (e.g., common discharge letters). In addition, the clinical workstation will be aligned during the first phase. Besides the digitalization of clinical basis processes, other topics during this phase at Klinikum Esslingen are the implementation of interface functionalities and future connections of sub-systems to i.s.h.med. Being a flexible EHR, it allows for retrieving pre-clinical data seamlessly into the clinical system without media disruption.

… results in the consistent digitalization of all clinical processes in i.s.h.med

During phases two and three, the project team at Esslingen will drive the digitalization of additional processes. One of them will be the medication process. It is expected to ensure an effective, safe and economic drug therapy of all patients in the hospital. Cerner supports the medication process in i.s.h.med so that it will become a closed-loop process ‒ from the admission to the administration documentation, and the transfer to the discharge process. A digitalized medication process will support the daily routine of clinical staff at Esslingen by contextualizing patient data and pharmaceutical-medical information.

An example would be the identification of potential intolerances a patient may have before the intake of various medications. Phase two focuses on the expansion of nursing process documentation, another core functionality of the digital patient record in i.s.h.med. In the context of sub-projects, all relevant applications of the patient record, partly building upon each other, will be set up step by step. With a standardized digital nursing process documentation, a significant amount of time savings are expected for the nursing staff at the clinic. Nursing plans can be easily generated with just a few clicks or transferred from previous hospital stays, and daily work lists can be generated automatically. Moreover, a structured nursing process documentation ensures safe documentation through transparency and completeness in terms of patient care. It also supports the interdisciplinary work of physicians and nurses.

More time spent with the patient thanks to rapid availability of information and greater safety in treatment, care and decision support during the demanding everyday life at the hospital ‒ these significant aspects drive the digitalization revolving around the wellbeing of patients at Klinikum Esslingen.

The goal: HIMSS EMRAM Stage 6

“The state of digitalization at Klinikum Esslingen approximately corresponds to the national average. According to the HIMSS EMRAM score ‒ a model that measures the level of digitalization in hospitals ‒ we operate between Stages 2 and 3. There is currently no hospital in Germany at the highest level of 7. Project Patient Record will help us reach the standard of Stage 6 by the end of 2022. Thanks to this, the clinic is already prepared for future requirements as they are already dictated by the German Hospital Future Act.” Managing director Matthias Ziegler and his colleague, commercial director Michael Hedtrich, know that their goals are highly ambitious ‒ and they are pretty relaxed about it.

The mission statement of Project Patient Record: “We have a plan, we have a strong and experienced partner in Cerner, and we have employees that support our project because they can visualize the tremendous improvement of their working conditions. These are all essential prerequisites to successfully manage a project of this size.” At Klinikum Esslingen, the fully digitalized hospital project will take shape in the years to come.

Photos: ©Klinikum Esslingen