Stanford Hospital and Clinics and PeaceHealth upgrade to next-generation IDX Carecast

Burlington 11 May 2005Stanford Hospital & Clinics and IDX Systems Corporation have signed an upgrade agreement for the next-generation IDX Carecast enterprise clinical system. Using IDX LastWord, Carecast's predecessor, Stanford has achieved close to 100 percent physician adoption rates for computerized physician order entry (CPOE) for inpatient care. With its upgrade to Carecast, signed in Q1 2005, Stanford plans to launch wireless medication barcode charting and continue its roll-out of CPOE and electronic, interdisciplinary clinical documentation across its hospital facility. In addition PeaceHealth, a long-time IDX LastWord customer, will upgrade to the next-generation IDX Carecast enterprise system from IDX Systems Corporation. Carecast will enable the organisation to further advance its electronic community health record (CHR), which supports the care of 1,4 million people across three states. Accessed by 16.000 employees and affiliated physicians, PeaceHealth's community health record (CHR) spans six acute care hospitals as well as multiple physician clinics in Oregon, Washington and Alaska. Using Carecast, the organisation plans to expand use of computerized physician order entry (CPOE), further advance on-line clinical documentation, and introduce a fully image-enabled electronic patient record in conjunction with IDX Imagecast technology. PeaceHealth's upgrade to Carecast was also signed in Q1 2005.


Stanford plans to roll out Carecast in Q4 2005 across the 613-bed Stanford Hospital, the internationally known primary teaching hospital for the Stanford University School of Medicine. Currently, 1850 Stanford clinicians and 580 residents and intern physicians use LastWord to support CPOE. CPOE adoption rates are approximately 100 percent for residents and 90 percent for attending physicians, according to Larry Shuer, MD, Chief of the Medical Staff at Stanford. CPOE is used in approximately 80 percent of Stanford's patient care units and the organisation anticipates reaching 95 percent CPOE within the next year.

"By enabling our physicians to electronically submit patient care orders, Stanford is fulfilling one of the most important initiatives outlined by the Institute of Medicine for the national improvement of patient safety", stated Carolyn Byerly, Stanford's Chief Information Officer. "We look forward to continuing our momentum with CPOE and to supporting our clinicians' collaborative work through Carecast's real-time, on-line patient care documentation."

IDX and Stanford worked closely together to tailor LastWord CPOE to support the organisation's clinical work flows and to incorporate direct feedback from physicians and other clinicians. In keeping with Stanford's collaborative approach to clinical systems implementation, an interdisciplinary committee of Stanford clinicians is pursuing an innovative strategy to promote electronic multi-disciplinary documentation (EMD) supported by Carecast.

When the EMD project is complete, all clinicians - from physicians to nurses to respiratory therapists - will be able to document and view comprehensive patient information on-line, using on-screen tools tailored to the needs of each discipline. Through EMD, members of the care team will be able to make more informed clinical decisions because they are viewing timely, comprehensive patient documentation.

"Collaboration has always been essential to patient care but communication is often complicated by paper processes and the pace of health care delivery", stated Dr. Shuer. "With EMD, the clinical team will log onto Carecast to immediately see the full picture of each patient's progress - complete with an interdisciplinary care plan, new test results, clinical notes, orders, medications and other essential information. EMD will be a major milestone in our progress toward lifetime electronic patient records."

Stanford intends to pilot its EMD functionality in Q1 2006, following the go-live of Carecast, and roll it out throughout the organisation in the subsequent months. The organisation also will launch wireless barcode medication administration charting in conjunction with the EMD pilot. Barcode charting provides safeguards against errors during medication administration, the last stage in the medication cycle and the second most likely place for errors to occur (JAMA, 1998).

The technology reinforces the "five rights" of medication administration - that the right dose of the right drug is being administered to the right patient via the right route at the right time - and alerts clinicians if there are any discrepancies. Both medications and patient ID bracelets will be tagged with barcodes. Stanford nurses will scan the barcode tags to verify patient identity and the "five rights" before medications are administered. Because barcode medication charting is built into Carecast, scanning the tags will automatically enter the drug, dose, time of administration and other relevant data in the patient's chart.

As part of its ongoing medication safety initiatives, Stanford also has made LastWord pharmacy applications accessible from anywhere in its inpatient facility, enabling pharmacists to work in patient care units instead of remaining only in a central pharmacy unit. This allows pharmacists to interact more with physicians and other prescribers, nurses and patients. The organisation plans to further enhance its clinical pharmacy programme with Carecast by automating more of the central dispensing functions, increasing efficiencies and expanding opportunities for pharmacists to serve even greater roles in direct patient care.

"The Stanford team managed their complex CPOE roll-out with persistence, partnership and commitment", stated Mike Raymer, Senior Vice President and General Manager, IDX Carecast Operating Unit. "We value our six-year relationship with Stanford, and look forward to working together on the adoption of electronic documentation that will serve as a touchstone for thousands of Stanford clinicians."

As a veteran user of LastWord, Stanford understands the importance of reliability of enterprise clinical systems in the mission-critical hospital environment. Carecast and LastWord run on the HP NonStop platform, which offers unsurpassed reliability, scalability and a guarantee of 99,9 percent uptime. "As we further expand our use of clinical IT, the NonStop platform brings a great deal of reliability and a great deal of comfort", commented Carolyn Byerly.

Stanford Hospital & Clinics is a university-owned, non-profit corporation known for advanced patient care. The 613-bed hospital in Northern California consistently ranks among the top in the nation in surveys by consumers and health professionals. Stanford Hospital & Clinics, in co-operation with the Stanford University Medical School, has pioneered medical advances that save lives and protect against disease.

Using IDX clinical information technology, PeaceHealth has attained new levels of quality care, provider satisfaction and operational efficiency. PeaceHealth's electronic patient record system is used across ambulatory and inpatient environments, and is accessed by the organisation's 330 employed physicians as well as independent group practices. Repeated physician surveys have indicated a high level of satisfaction with the CHR project. By accessing the organisation-wide electronic patient record system, clinicians can view a patient's medical history, regardless of what facility the patient visits. Physicians can also remotely review the progress of their hospitalized patients, which allows providers greater flexibility to discharge patients.

"A CHR programme of our size and scope demands the most fail-safe technology platform possible, comprehensive functionality, and a true partnership with our vendor", stated John Haughom, MD, Senior Vice President of Healthcare Improvement at PeaceHealth. "Our ten-year working relationship with IDX has been distinguished by all three of these important qualities. Strong clinician satisfaction with IDX technology's usability, reliability and consistent response time were key factors in our decision to upgrade from LastWord to Carecast. Now, our clinicians are looking forward to using Carecast's expanded array of capabilities for enterprise orders, clinical documentation and diagnostic image management."

Through IDX Patient Online PeaceHealth and IDX are rolling out a Web-based patient portal that provides patients with secure, convenient on-line access and self-service tools for scheduling appointments, paying bills, accessing clinical information direct from their EMR, communicating with their providers, and other capabilities. In addition, patients can take advantage of the new eVisit solution which supports reimbursement to providers who conduct clinical care on-line.

Building on its CHR, and supported by a "Pursuing Perfection" grant from the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement, PeaceHealth also has developed sophisticated disease management programmes for diabetes and congestive heart failure. LastWord enabled the creation of a clinical data repository that allows PeaceHealth to mine patient data in order to identify patients who would benefit most from these programmes. For example, using a few key strokes, PeaceHealth physicians can view such key health indicators as average cholesterol levels for their diabetic patients, allowing them a much clearer view of the progress of patients with chronic conditions. Since implementing the diabetes programme in 1998, adherence to guidelines for diabetic care has tripled among patients in two of PeaceHealth's facilities.

With Carecast, PeaceHealth will move forward with CPOE capabilities across its outpatient and inpatient environments, building on its success with medication safety initiatives. Research conducted by PeaceHealth has shown that documentation of patient allergies - a key measure in preventing adverse drug events - is near 100 percent in PeaceHealth hospitals. In addition, the organisation's widespread use of electronic prescribing in the ambulatory environment, approaching two million electronic prescriptions this year, supports medication error prevention. PeaceHealth's Barger Clinic in Eugene, Oregon documented an 83 percent drop in potential adverse drug events after going live on IDX electronic prescribing.

PeaceHealth is also notable for its leadership in the area of on-line clinical documentation. Nationwide, nurses spend an average of 30 percent of their time documenting patient care and many nurses still must document care on paper in handwritten patient charts. By using IDX on-line documentation capabilities, PeaceHealth has been able to reduce nursing documentation time to nearly half of the national average, providing nurses with more time for patient care. PeaceHealth clinicians use on-line documentation to electronically capture electronically capture assessment data, medication administration, clinical findings, care plans, interventions and other activities.

During the Carecast implementation, PeaceHealth will focus on developing care planning and documentation tools to support interdisciplinary care. With the system, nurses and all other caregivers will leverage expanded Carecast Patient Summary View capabilities, giving the entire care team the information they need to develop and monitor effective interdisciplinary care plans at the point of care. PeaceHealth's commitment to comprehensive electronic patient information is also supported by use of Imagecast, which provides electronic access to diagnostic images such as X-rays and mammograms, as well as accompanying physicians' notes.

PeaceHealth's technology investment has made a positive impact on the organisation's bottom line while enhancing the quality of its care. The organisation has realized more efficient administrative and billing processes by deploying LastWord's fully integrated patient accounting capabilities and by using IDX Flowcast in the group practice environment. Through its commitment to both automation and process improvement, PeaceHealth has reduced average hospital A/R days from 64 to 46 and documented savings of approximately $35 million, based on research the organisation conducted over a two-year period.

"Given the national interest in Regional Health Information Organisations (RHIOs), PeaceHealth's achievements demonstrate the power of electronic patient records to improve the cost and quality of patient care across entire regions", stated Mike Raymer, IDX Carecast. "From their CHR to their disease management initiatives, the PeaceHealth team is constantly pushing the bounds of using clinical IT to improve patient care, and we look forward to supporting them in these initiatives far into the future."

Carecast is a fully integrated clinical, financial and administrative system, combining core clinical processes for orders, results, pharmacy and clinical documentation with administrative and financial processes for scheduling, registration, admitting, charging and billing. Representing the next generation of electronic clinical information solutions, Carecast delivers unsurpassed response time and reliability to support fast-paced clinical environments. The system automates work flow throughout the health care enterprise and enables rapid access to patient records across the care continuum, from admission to discharge, including inpatient and ambulatory care. The result is a comprehensive lifetime patient record that enhances the quality of care and promotes operational efficiencies.

Developed by and for providers, in collaboration with leading hospitals, clinicians and health care executives, Carecast builds on 25 years of innovation with the IDX LastWord enterprise system. Customers include leading health care organisations in the United States, Canada and Europe.

Founded in 1969, IDX Systems Corporation provides information technology solutions to maximize value in the delivery of health care, improve the quality of patient service, enhance medical outcomes, and reduce the costs of care. IDX systems are deployed to serve approximately 150.000 physicians and are installed at over 3400 customer sites, including more than 850 group practices and approximately 370 integrated delivery networks servicing more than 500 hospitals.

IDX also provides its enterprise clinical software as a subcontractor to BT and Fujitsu Services, Local Service Providers for the United Kingdom National Health Service's National Programme for Information Technology, an initiative to establish electronic patient records for 50 million patients.

The IDX web strategy includes browser technology, e-commerce and Web-based tools, built using Internet architecture, that facilitates access for patients, physicians and care providers to vital health information and data managed by the IDX clinical, administrative, financial, and managed care products. IDX has approximately 2400 full-time employees. More information is available in the VMW April 2005 article Near-paperless Hospital of the Future now open in south Florida.

Leslie Versweyveld

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