The new Progress Note upgrade to the PowerChart electronic medical record software is a significant step forward in digital medicine, helping providers to write and share notes faster and more efficiently.
Christiana Care’s rollout of the new system was fast and efficient, too. It was achieved on a super-accelerated timeline of less than five months.
“The goal is to spend less time gathering information and copying it to paper and more time managing the patient.”
The system went live at 5 a.m. on May 18, with system-wide electronic Progress Notes and Computerized Provider Order Entry (CPOE) in Pediatrics, with the exception of the Neonatal Intensive Care Unit.
By 3 p.m. that day, there were more than 1,000 electronic notes created by credentialed providers, with 162 unique note signers. Dragon voice recognition software allow users to dictate notes.
“In first two weeks, more than 700 users created more than 15,000 notes,” said Greta Ehrhart, project manager, Information Technology.
Initial concerns from some physicians that electronic progress notes would take longer to enter than a handwritten note quickly eased as providers realized some of the efficiencies gained and the improved quality of the notes, said Timothy Shiuh, M.D., who functioned as a bridge between the technical and clinical teams.
“There’s no running around trying to find charts and information,” said Dr. Shiuh, an Emergency Medicine physician. “All the information a doctor needs to take care of the patient is in one, streamlined view.”
Progress Notes is another milestone on a continuum. Advances in 2014 include electronic medication reconciliation for Labor and Delivery, Antenatal and Postpartum, electronic nursing documentation across Emergency Medicine and a portal for inpatients.
“This was a monumental undertaking because Progress Notes touches everybody,” said Terri Steinberg, M.D., MBA, chief medical information officer. “An important component of our success was the leadership of department chairs and the Medical/Dental Staff, who helped to build confidence in the process.”
Doctors had significant input into the Progress Notes initiative. Dr. Shiuh gathered ideas from colleagues throughout Christiana Care and translated their insights into system requirements.
“We reached out to all the various specialties to learn their needs for progress notes and develop efficiencies that would support their workflow,” he said.
Residents who trained as super users also donned green vests and joined the IT staff in helping doctors and other providers as the system was launched.
Jamie Gellock, M.D., a Family Medicine resident, worked the overnight shift the first week after the system went live.
“I worked with some surgical residents, and it was nice for them to see a colleague and friend,” she recalled. “The next day I saw them they were already savvy.”
In surgical critical care, information gathering that would normally take a half an hour per patient was reduced to a few clicks, thanks to a dynamic document template that populates information automatically to make the work flow more efficient.
“The goal is to spend less time gathering information and copying it to paper and more time managing the patient,” Dr. Shiuh said.
The initiative to fast track the rollout was spearheaded by Janice Nevin, M.D., MPH, chief medical officer.
With the new electronic format, Christiana Care gains consistent date, time and signature stamps, in compliance with government regulations.
Providers also can expect a robust support model after the command center closes.
“The goal is to create a process in which the physicians get help very quickly,” Dr. Shiuh said.
The system will continue to evolve over time to meet the needs of users. For example, additional templates for exams and bedside procedures are being developed. Users also can develop their own Dragon commands.
“This is a work in progress and we will continue to meet with clinicians to make the product better and more efficient,” Dr. Shiuh said.