Providers Take Note: Huron Perth Embraces Electronic Documentation Tools and Processes
[This blog post is adapted from an interview with Dr. Robert Davis, lead physician, and Ms. Annette Stelmachuk, IT clinical analyst, Huron Perth Healthcare Alliance, conducted by Barry Gutwillig, PatientKeeper’s VP of Sales & Marketing.]
BACKGROUND: PatientKeeper is deployed at the Huron Perth Healthcare Alliance (HPHA) and the Alexandra Marine & General Hospital (AMGH). HPHA and AMGH serve a region encompassing two counties in southwestern Ontario with a population of approximately 135,000. HPHA comprises four hospitals in Clinton, St. Marys, Seaforth and Stratford; AMGH is in Goderich. The five hospitals have a combined total of 250 beds and 150 physicians, and share a common MEDITECH® information technology infrastructure.
[Annette Stelmachuk:] Physicians had a very difficult time finding information in MEDITECH, with all the arrows up and down. The feedback we were receiving from physicians was they wanted a system that was easier to view information in. We were looking for something that would be able to sit on top of MEDITECH, so that we didn’t have to change our whole system, but that would provide physicians a mobile option, and a more point-and-click user environment that was easier to maneuver around.
[Robert Davis:] I was first introduced to PatientKeeper several years ago as part of a team tasked with evaluating software for providers at our hospital network. Previously I had looked at software for our family practice clinic, so I had some experience doing this. To me it was quite obvious that PatientKeeper stood out as being very user-friendly from a physician user’s perspective.
One significant value-add of PatientKeeper is mobility. It’s a time saver. You can be anywhere and look up a patient’s information or make a note on a patient or put an order in for a patient. As a physician, you never know when you’re going to get a page or a call about a patient. Rather than run to a computer to look up that patient’s record, you can simply look on your mobile device and the patient’s information is right there. It’s much more efficient, and I think it adds to patient care. I know for a fact that physicians will log into PatientKeeper from home before they come to work, so they already have a head start when they get to the floor of the hospital.
[AS:] Before PatientKeeper, some providers were writing their daily notes on paper; for things like history, physicals, discharges, operative reports, consults, many would pick up the phone and dictate their notes into Nuance, and then a transcriptionist would type it for them.
What started the transition to NoteWriter from Nuance dictation was we were having issues finding transcriptionists. People were leaving the profession. There just aren’t many people who want to be typists anymore. If someone was sick or on maternity leave, we were having trouble filling those spots.
The second concern was the Nuance system that we were using at the time was way past end of life, so we had to decide do we upgrade and continue on the same road that we’ve been going down with transcriptionists, or do we move forward with technology and have our physicians write and edit their own notes electronically.
When we started with PatientKeeper NoteWriter, it quickly became clear to Bob and me that some physicians were not happy having to type their notes. Younger physicians were fine with it – they’re used to typing with two thumbs when they text – but the older providers were used to being able to pick up a phone and just speak and have someone type for them; typing their own notes was something they found very challenging and time consuming.
Our solution was to integrate front-end dictation within NoteWriter, so a physician could speak into a microphone. Now the notes still live within PatientKeeper, but providers have the flexibility to either type, if that’s what they prefer, or to enter their notes by voice.
Our physicians were never forced to review their notes even with a transcriptionist. Notes were always left in a draft status in MEDITECH, and if there were errors or blanks and no one had reviewed them, that’s how they stayed. It was not ideal at all. So looking back, before we switched to NoteWriter, an easier transition for the physicians would have been to start having them edit their notes that were being transcribed, and to sign those notes and send them back, to get used to that process. Because they never had to do that previously, one of the biggest complaints we heard from physicians was that they didn’t have time to review their notes and correct them. They found that very time consuming. It’s a change. Also, it’s taking time for the front-end speech-to-text system to learn and correct mistakes; if you don’t correct them, it also learns bad habits.
Throughout this process, we had a lot of support from higher ups, which was important. They took a stance and they put their foot down and said this is the way that we’re going. There were no other options, so providers had to put in the time and the work for this to be successful.
[RD:] Some of the metrics hospitals typically use to measure the success of a software deployment didn’t apply to us because using the system was mandatory. Providers didn’t have a choice, so we didn’t have to measure what percentage of physicians are using it versus what percentage of physicians are not. We relied on physician surveys to find out what areas needed more support versus what areas were doing well and we could reduce support resources.
One of the things we did compare was the speed with which reports were ready. In the past with the Nuance dictation and transcription workflow, it could take two or three days for a history to be on a patient’s chart, or for a discharge to be on the chart. We found that with front-end speech-to-text or typing using PatientKeeper NoteWriter, information was available much, much faster, pretty much in real time. This proved to be very beneficial and was noticed and appreciated by our physicians over time. It was definitely considered a benefit of using NoteWriter, because timely and accurate documentation on the chart can impact quality of care and patient safety.
[AS:] I think all our providers do appreciate the benefits of having notes readily available. Now when they do a note, it’s there automatically for viewing, and at the same time we send it out electronically. As soon as it’s signed, it’s sent out to family physicians and anyone else that they have copied it to. They like that the information is readily available whereas it wasn’t before.
[AS:] If you are deciding to move forward with something like this, it’s important to know that within PatientKeeper the notes are very flexible. This is about the physicians and their workflow, so another thing that Bob and I have done to make this easier and the transition smoother for the physicians is listening to what they want. So while we started with five generic templates, now we probably have 50 templates customized to various specialties and workflows. Some have tabs and boxes and sections, but we also have what we call speech-friendly ones, which are open text boxes for those who just want to speak into it. We’ve given multiple ways for physicians to do their notes so that they can decide what works best with their workflow.
[RD:] When I joined this wonderful technology team, I was told that the software would be adapted to the physician’s workflow, not the other way around, and that’s what we’ve done. Another key is support, support, support. As a physician, it’s nice to have somebody at my elbow to whom I can say, “I can’t get this to work,” and there’s someone there to help me. Support has been huge for making this successful.