PALESTINE -- For centuries, healthcare has made advances in diagnosing and treating the various injuries and maladies people are subjected to. But for all the advances in the technology that is used inside the hospital, the technology used to run hospitals often lags behind the cutting edge. But not at Palestine Regional Medical Center.
"In 2006 we converted to our first system to change all of our in-patient documentation to electronic. Meditech," Leah Vintila, Director of Clinical Informatics at PRMC explained. "Now, nine years down the line, we are fully electronic."
PRMC is ahead of the curve in electronic records, which are the latest push from the government to increase the quality of healthcare available to patients in the US.
"The HITECH Act was what (The Government) first started with in order to convert internationally all medical records," Lea said. "The smaller component of that is Meaningful Use, where hospitals not only make the data electronic, but also make it meaningful. I could theoretically be on vacation in Florida, and the physician there could access all of medical records."
According to Vintila, Meaningful Use is the underpinning for PRMC's Electronic Healthcare Record (EMR) system. PRMC's EMR system allows for physicians and nurses inside the hospital to access a patient's records, as well as for physicians outside the hospital to have access as well. A nearby clinic, for example, can be tied into the system directly to allow for full functionality, or simply access the system remotely, even via mobile devices.
"The first thing our physicians wanted when we converted to CPOE, (Computerized Physician Order Entry) they asked, "Can I access that from my iPhone, my iPad, any other mobile device?" The answer was yes, we did work on the technology for that," Vintila added. "And so a physician can, theoretically, be dining out a restaurant and have a patient come in with a heart condition, and view their EKG remotely. There's much faster ordering, accordingly."
And the access isn't just limited to clinics and physicians. According to Vintila, PRMC is currently working on expanding their EMR network to nearby nursing homes, pharmacies, and psychiatric facilities. And, the information on a patient's record is also made available to the patients, with unparalleled access to your own medical history now available.
"I'm not sure if other hospitals are yet to this phase in the government's plan for meaningful use, but any patient coming into our hospital has the option of receiving a Summary of Care," Vintila explained. "When they're asked on admission, 'Would you like to have access to your patient records via our patient portal?' if they say yes, then they're e-mailed a secure link to access their records."
This allows for someone to view their own lab reports, check what procedures the hospital implemented during their stay, and review their plan of care. This not only allows for greater oversight of hospital activities, but allows patients an unprecedented level of involvement with their own healthcare.
"We love being able to incorporate that level of partnership with our patients so they can see and engage with us," Vintila added. "It's huge!"
Of course, with any change, there are hurdles to overcome. One of the biggest issues which has slowed implementation of EMR systems nationwide is concern over patient privacy. Lisa Musick, Director of Health Information Management at PRMC, says that those concerns are valid, and something which the implementation of EMR has to be aware of.
Currently, PRMC's EMR system has strict access controls. Logging into the system requires two-step verification, and any information available once inside is limited to specific records.
"Nursing units are only able to access patients from their unit, lab only has access to information if they've ran a lab result. Physicians, in their office, can only access patient records if their name is associated with that patient record," Musick explained. "Nobody can just say, 'Hey, my neighbor was in the hospital, let's see what's going on.' Unless their name is associated with that patient as PCP or Consulting Physician, they will not have access to those records."
In addition, the outside systems which are allowed limited access, such as nursing homes, are restricted as well.
"Currently, with hospitals in the area, nursing homes, and even rehab and psyciatric facilities, we electronically send them copies of the medical record to a secure email address that only one person at the facility has access to," Vintila added.
In addition, the staff are vigilant in their efforts to maintain patient privacy. According to Musick, her department routinely runs privacy audits which review random patients, and inspect their files to verify that everyone who has accessed information needed to have access to those records.
For those that are allowed access, however, the information is extensive, and incredibly useful.
"Radiologists have access to the previous day, month, year's X-rays so they can see if a disease process has occurred," Musick said. "Physicians can see lab results from the day before, and make sure they're not duplicating work."
This has allowed for an increase in the standard of care, in hospital efficiency, and most of all in the safety of patients at PRMC. For decades, a common quip was that a doctor's signature is illegible. Now, doctors can sign off on procedures electronically, and ensure that the correct procedures are followed.
"The vast majority of physician's ordering is done via the computer system directly, which cuts out the middleman and the chance of errors," Vintila explained. "I'm also the hospital's risk manager, and I've noticed a sharp increase in patient safety."
Of course, not everyone takes to technology at the same rate.
"Some physicians do still struggle, if they're not as computer-literate, just because it seems time-consuming," Vintila said. "For example, if they're not typists, they hen-peck at the keys, so we've had that challenge with some of our older physicians."
"But they're all adapting well," she added.
"With anything, change is hard. It has taken a while, and we've got there," Musick explained. "Everybody has grasped the concept, now that they've seen how it works, and how much more quickly information can be distributed."