IDX announces winners of 2005 Carecast Customer Innovation Awards

Burlington 10 August 2005IDX Systems Corporation has announced the winners of its annual IDX Carecast Customer Innovation Awards (CIAs), recognizing four health care provider organisations that are Advancing Fail-Safe Care through the use of electronic medical records and sophisticated clinical information technology (IT) such as computerized physician order entry (CPOE) and wireless medication barcode charting. Judges included representatives of KLAS Enterprises and the Center for Health Transformation; clinician leaders and IT executives from IDX customer organisations; and IDX clinicians, technologists and executives. Winners were recognized during the IDX Users' Conference, Carecast User Exchange annual meeting, held August 7-10 in Boston.


Using IDX enterprise technology, CIA winners demonstrate remarkable achievements in standardizing care, preventing medical errors, creating more efficient clinical and business practices, and reducing costs.

The 2005 CIA winners are:

  • Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, for Advancing Patient Safety by decreasing pharmacist interventions in inpatient paediatric medication orders by 97,6 percent, thanks to use of CPOE combined with expert rules.
  • Park Nicollet Health Services in St. Louis Park, Minnesota, for Creating Evidence-Based Practices. For the second consecutive year, Park Nicollet Health Services' entry also won the Innovator of the Year award. Building on its use of IDX electronic health records, the organisation introduced an electronic tool for managing its 14.000 weekly phone inquiries, reducing patient wait times by 63 percent and prescription refill cycle times by 79 percent, among other significant results.
  • ProHealth Care Inc. in Waukesha, Wisconsin, for Improving Clinician Efficiency by reducing care co-ordinators' documentation time related to community care services and capturing this important clinical information within the lifetime electronic health record.
  • Oakwood Healthcare System in Dearborn, Michigan, for Improving Financial Performance by improving electronic charge capture of clinical events, resulting in a time savings of 2920 staff hours per year previously spent on paperwork.

"As health care consumers, providers and national leaders look for ways to improve health care delivery across the country, these innovative organisations are finding new ways to extend the reach of health care IT to increase patient safety, streamline clinician work flow, and provide better patient outcomes at a lower cost", stated Mike Raymer, Senior Vice President and General Manager, IDX Carecast Operating Unit. "They are the gold standard for health care delivery organisations in the United States."

For the competition, health care providers using the Carecast or IDX LastWord systems submitted entries outlining innovative clinical IT projects in one of four categories described above. Carecast, the next-generation IDX enterprise clinical system, and its predecessor system, LastWord, are fully integrated clinical, financial and administrative systems used to automate work flow, create comprehensive electronic patient records and support patient safety in complex health care organisations. Winners and finalists achieved measurable successes by collaborating across disciplines, implementing best practices and deploying IDX technology.

"With a health care industry in transformation, it's essential that we recognize providers who have creatively deployed clinical and technology solutions to improve patient safety, institute more efficient practices and reduce health care costs", stated Adam Gale, Vice President of Operations, KLAS Enterprises. "The Carecast CIA awards play an important role in the discovery process, highlighting examples of success that offer valuable lessons - and leadership - for the industry as a whole."

Winners' specific achievements include the following. Thomas Jefferson University Hospital physicians enter nearly all of the organisation's inpatient orders using CPOE, with orders for chemotherapy and parenteral nutrition orders being the only exceptions. This achievement places the organization in an elite group of healthcare IT leaders. According to health care technology researchers KLAS Enterprises, only 1,3 percent of the nation's hospitals are actively using CPOE, defined as physicians electronically entering at least 50 percent of orders. The Institute of Medicine cites CPOE as a critical tool for preventing medication errors, since it eliminates the risks inherent in handwritten orders.

Jefferson University Hospital's winning entry focused on the benefits of CPOE in the organisation's inpatient paediatric areas, including its neonatal intensive care unit. Medication ordering for hospitalized infants and children requires precise calculations to ensure that medication dosages are appropriate for the child's weight. In the majority of hospitals, physicians complete these calculations with a calculator or through mental arithmetic. Using IDX enterprise clinical software and integrated expert rules capabilities, Jefferson University Hospital's clinical IT team developed a sophisticated set of expert rules for its inpatient paediatric areas, which automatically calculate the appropriate dose of medication during the order entry process. In addition, the expert rules ensure that physician orders comply with national patient safety goals set by the Joint Commission on the Accreditation of Healthcare Organizations to standardize concentrations of medications administered by intravenous infusion, which can carry a high risk.

Jefferson University Hospital measured the number of pharmacist interventions - calls from pharmacists to physicians to double-check the details of medication orders. These interventions serve as indicators of averted potential medication errors. Following CPOE implementation on its paediatric units, the organisation reduced pharmacist interventions related to medication orders by 97,6 percent, because of the improved quality and clarity of the original medication orders. In addition, Jefferson University Hospital decreased interventions for intravenous infusions by 92,5 percent. Using CPOE, 99,6 percent of infusions were ordered according to established standard concentrations.

"Collaboration between physicians and pharmacists has always served as an essential medication safety check. With CPOE, we've taken error prevention to the next level by placing rigorous safeguards at the point of care - critical improvements for all patients, especially for the infants and children we care for in our paediatric units", stated Dr. Jonathan Gottlieb, Chief Medical Officer and Senior Vice President for Clinical Affairs for Jefferson University Hospital. "In addition to strengthening patient safety, we're also enabling our physicians and pharmacists to save time previously spent on clarifying orders, and to focus more on direct patient care." Dr. Gottlieb credited the collaboration and hard work of TJUH pharmacists, clinicians and IT professionals as essential to the success of CPOE in the organisation's paediatric units.

Park Nicollet Health Services, which includes Methodist Hospital and 24 clinics in and around the Twin Cities, receives 14.000 phone calls a week, including numerous patient inquiries and prescription-related requests from pharmacies, both of which directly impact patient satisfaction and quality of care. Using process improvement methodologies, the organisation standardized how clinicians manage requests for prescription refills and nurses respond to patient phone calls. Building on its IDX electronic medical record, which spans inpatient and ambulatory care settings, Park Nicollet replaced paper-driven processes with automated tools - developed in collaboration with IDX - that allow clinicians to easily manage and appropriately prioritize calls.

Since implementing the system, Park Nicollet has seen extraordinary results, both in enabling nurses to better respond to patient inquiries and in improving the prescription refill process. Successes include:

  • Reducing patient wait times by 63,3 percent.
  • Increasing the number of phone calls answered within 30 seconds by 560 percent.
  • Improving nurse productivity by 20 percent because of reduced paperwork.
  • Decreasing the amount of paper phone messages filed in the paper medical record by 100 percent, as messages automatically become part of the patient's lifetime electronic medical record.
  • Reducing by 79 percent the cycle time between when a request is made to the organisation's designated phone line for prescription refills, to when the pharmacy receives authorization.
  • Eliminating the number of prescription refills re-sent through the system more than once.

"Managing phone inquiries is a significant portion of the work flow of a large integrated delivery network", stated Dr. David Abelson, Vice President of Strategic Improvement, Park Nicollet Health Service. "Through a standardized, paperless approach supported by our electronic health record, we've turned clinician-patient phone communication into a real tool to support positive patient experiences and quality care - all while increasing productivity for our clinicians and staff."

Care received before and after hospitalization including such services as physical and occupational therapy, respiratory therapy, counseling, rehabilitation, and use of medical equipment, is crucial to patients' health and well-being.

ProHealth Care Inc. has established an initiative to actively document and evaluate community services and medical equipment used by patients before and after their hospitalization at Waukesha Memorial Hospital. Waukesha's care co-ordinators are RNs and social workers who manage interdisciplinary care encompassing these multiple services. Patient interviews regarding care and services used are an essential part of the care co-ordinators' work. Originally, this documentation occurred in two separate IT systems, requiring 30-60 minutes of time per patient chart.

As part of the implementation of the Carecast system in 2004, ProHealth created a Care Coordinator Pathway that allows care co-ordinators and other clinicians to document directly into the patient's lifetime electronic record, using flowsheets to help standardize data captured. All clinicians now can document patient data from any computer in the facility and information is immediately available to every member of the care team. When patients are discharged from the hospital, clinicians print out specialized reports from the Carecast system so that community agencies have the information they need to provide ongoing care.

The Carecast system also has enabled ProHealth to standardize the information captured, and ensure documentation is consistent between hospital units - important for Waukesha's patient billing, strategic planning and regulatory reporting requirements.

One of the most significant financial challenges for health care organisations is ensuring that all clinical charges are captured, and that the billing office has appropriate documentation to submit insurance claims and send out accurate patient bills. When documentation necessary to support charges for clinical care is lost, illegible or incomplete, clinicians, administrative and financial staff members must devote time to reconciling charges and locating information.

To address these challenges, the IDX enterprise clinical system supports a clinically automated revenue cycle, generating charges directly from the care process. Using its IDX system, Oakwood Healthcare System created custom electronic reports, files showing total clinical charges, credits and transactions for each of its 392 departments across three acute care facilities. The organisation also developed a database to automatically import the IDX files and compare data with charge information processed by its accounts receivable system, automatically notifying business office staff of any discrepancies.

As a result of its customized IDX reports and database, Oakwood has eliminated:

  • 2920 staff hours per year collecting paper reports and documenting charge information. This time savings has freed clinicians to focus on patient care, and allows information technology and billing staff to work on customer requests, system enhancements and other projects.
  • The need to print and manually compare 286.160 pages of charge reports.
  • 40 staff hours per year spent researching and correcting discrepancies.
  • The need to re-submit bills based on delays in capturing information about clinical charges.

The 2005 award finalists included the following organisations:

  • Evidence-Based Practice Finalists:
    • With a consult registry for chronic diseases, PeaceHealth in Bellevue, Washington, enables clinicians to actively collaborate in the care for patients seen at any of its six hospitals and other facilities across Alaska, Washington and Oregon. This ensures treatment adheres to clinical best practices, whether patients are seeing caregivers across town or in a neighbouring state.
    • Memorial Healthcare System, the public, non-profit health care provider serving South Broward County in Florida, integrated a combination of Infrared and active RFID from Versus Technology Inc. with the Carecast system to clearly and accurately locate and update patient status throughout the organisation's emergency departments. Implementation of this technology has streamlined ED patient flow; increased ED bed capacity, allowing for treatment of additional patients; increased the time nurses can spend at the bedside with their patients; promoted patient safety; and increased patient satisfaction.
  • Patient Safety Finalists:
    • Lehigh Valley Hospital and Health Network in Allentown, Pennsylvania, integrated its IDX electronic health record, including CPOE and barcode medication administration technology, with an intensive care unit (ICU) information system that fully supports a new remote ICU monitoring facility.
    • OSF St. Joseph Medical Center in Bloomington, Illinois, a member of OSF Healthcare System in Peoria, Illinois, has developed reports based on Carecast data to identify hospitalized patients with potentially high-risk conditions and to produce a twice-daily score indicating each patient's risk level. This score allows early recognition by clinicians of patients at risk and enables care needs to be met before an event occurs, through proactive measures that include deploying a Rapid Response Team of clinicians.
    • Parkview Health in Fort Wayne, Indiana, has reduced the risk of medication errors by standardizing orders, implementing expert rules created with the Carecast rules engine, powered by Fair Isaac Blaze Advisor, and deploying Carecast wireless barcode medication administration. Parkview decreased non-standard orders by 52 percent, and improved compliance with standard medication administration time by 80 percent.
  • Clinician Efficiency Finalists:
    • By giving anaesthesiologists access to on-line nursing documentation within the electronic health record, PeaceHealth reduced by 50 percent the time necessary for anaesthesiologists to conduct pre-surgery interviews with patients. This streamlines care, reduces redundant questions and prevents unnecessary delays by ensuring patients are prepared for procedures.
    • The Nebraska Medical Center in Omaha, Nebraska, created an expert rule that alerts primary care physicians if any of their patients have been seen in the Emergency Department in the past 24 hours. Invoked with log-on into Carecast, the alert displays key information including encounter diagnosis and disposition, supporting effective and efficient patient care follow up.
  • Financial Performance Finalist:
    • St. Vincent's Medical Center in Bridgeport, Connecticut, developed an electronic scoring tool within the IDX integrated clinical and financial system to analyse the status, volume and accuracy of all patient billing claims. The provider decreased A/R days from 43 to 32 days and lowered outstanding receivables by $6,7 million; increased clean claims by 10 percent and reduced denied claims by 2 percent; and improved revenue by $32 million.

All CIA entries were ranked by the judging panel based on benchmarks and metrics used to assess the improvements, the degree of process change required in order to achieve results, and exemplary, cutting-edge use of the Carecast or LastWord systems. Identifying information was removed from all entries to support impartial judging.

Judges included Laura Linn, RN, MN, the Center for Health Transformation; Adam Gale, Vice President of Operations, KLAS Enterprises; Wayne Kaniewski, MD, Park Nicollet Health Services; Willa Fields, PhD, RN, Vice President, Patient Care, Sharp HealthCare; Russ Cucina, MD, Assistant Professor of Internal Medicine, UCSF Medical Center; Cindy Perry, Associate CIO, University of Virginia Hospital and President, IDX Carecast User Exchange (2004-2005); and IDX clinician leaders, technologists and executives.

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 healthcare executives - Carecast builds on 25 years of innovation with the IDX LastWord enterprise system. Customers include 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, Local Service Provider 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 company news can be found in the VMW July 2005 article UCLH NHS Foundation Trust Hospital goes live on IDX Carecast Electronic Patient Records system.

Leslie Versweyveld

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