In this issue:

• Three Issues to Consider in Eliminating the Paper Chart
• WoundExpert® Paperless Charting Benefits: Efficiency, Efficacy & Economics
• Focus: Banner Good Samaritan Medical Center
• WoundExpert Client Conference Video Available
• Net Health News

An incredible amount of work, cooperation, and planning goes into a successful transition to an electronic medical record for wound care. When planning an EMR implementation, carefully consider the following three key issues:

• Interoperability
• Records retention: conversion, handling, legal issues, and privacy
• Change management

In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged.

Effective EMR programs can transfer data back and forth -- such as patient admissions into WoundExpert and patient records from WoundExpert to the hospital record system -- in order to avoid duplicating efforts and reduce transcription errors. Messaging between systems is standardized, so that different systems can talk to each other.

Assuming that the hospital can receive the information, the WoundExpert software can supply it. Without interoperability, medical records will need to stay as paper, with the records retained in charts or scanned manually into the hospital system. Scanning hundreds of pages of charts manually can decrease productivity and increase expenses for the hospital.

The second issue facing clients migrating to electronic documentation is records retention. A question frequently encountered during pre-implementation is, “What is to be done with charts that were written in the past?” These historical charts could be scanned into an electronic format and uploaded into WoundExpert in order to provide a seamless record for the patient. That may not be feasible in cases where the patient has been treated for years and the records are already archived, or it may be unnecessary where records were already scanned into the hospital system.

According to Denise Malinowski from Overlook Hospital's Wound Healing Program, “WoundExpert supports a legal medical record for all wound care patient encounters that eliminates paper, avoids dictation and transcription expense while saving space. The chart room was eliminated in our move to the new Medical Arts Center II building in early 2008.”

WoundExpert also is able to track when a form is altered, retaining the original version of the document and tracking what was altered, when, and by whom. Also, alterations to signed forms will necessitate forms being resigned by necessary parties.

There are elements inside of WoundExpert and outside to consider when securing patient data. For example, WoundExpert's secure, browser-based, 128-bit encryption scrambles transmissions, but it is the responsibility of the program director to authorize which users have access to the patient data and to what extent they can affect or visualize the information.

Paper charts can be mislaid or otherwise left unattended, leading to potential HIPAA violations. This is less of an issue with WoundExpert, where patient information is under electronic lock-and-key. Understanding these issues can lead to safer, confidential patient record handling.

Finally, the decision to transition to an electronic medical record will require administrative, clinical, operational and cultural change, necessitating a proactive change management approach. The ADKAR methodology is a model we have found particularly effective in working with facilities implementing electonic medical records:

• Awareness of why the change is needed,
• Desire to support and participate in the change,
• Knowledge of how to change,
• Ability to implement new skills and behaviors, and;
• Reinforcement to sustain the change.

There are many reasons why wound clinics turn to paperless charting through electronic medical records like WoundExpert. Getting to the ”go-live” phase should be the end of the journey; not the beginning.

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The benefits a wound clinic realizes in migrating to electronic charting with WoundExpert are three-fold: efficiency, efficacy and economics. Optimizing the patient workflow and improving the delivery of services yields an overall improvement in the quality of patient care.

In terms of efficiency, WoundExpert interoperability with hospital information systems allows hospital staff to securely view the history of patient's visits across the organization enabling staff to make decisions based on complete, current information. WoundExpert charting is real–time, so physicians, clinicians, and adminstrators are always viewing current information on the patient.

With respect to clinical efficacy, WoundExpert paperless charting facilitates adherence to Joint Commission National Patient Safety Goals, including:

• Improved accuracy of patient identification as WoundExpert provides accurate, real-time information standardizing multiple patient identity verification methods across the care center, including patient photographs. In addition, WoundExpert paperless charting yields improved security as paper charts have no audit trail, including who accessed the information, how long they looked at it, and when the information was changed.
• Improved effectiveness of communication amongst caregivers as WoundExpert paperless charting improves timeliness of reporting through measurable and assessable standards. Paper-based records have legibility issues - handwriting, multiple faxing, and abbreviations. With WoundExpert, "hand off" communications are automatically populated through standardized task designations, both user-directed and automatic, electronic “sticky note” reminders of critical tasks to be completed during patient discharge, referral, or transferal.
• Improved safety in using medications as WoundExpert assists clinics with their duties to record medications and other supplements which the patient takes. The traditional, paper-intensive process is tedious and prone to transcription and other human errors - prescribing look and sound alike medications – and are effectively eliminated with WoundExpert electronic assistance.

Lastly, WoundExpert paperless charting economics contribute to the financial bottom line and can deliver a handsome return on investment (ROI):

• Elimination of clerical chart pulls, complex care provider reviews and re-filing,
• Reduction in space needed for chart storage and preparation,
• Repetition is reduced, information is stored, and communications across the multidisciplinary team improves resulting in increased productivity and improved outcomes, and finally;
• WoundExpert paperless charting, reduced paper handling and records retention is a more environmentally friendly ‘green’ proposition as well.

In summary, WoundExpert paperless charting is a scalable solution offering adaptable to the policies and procedures of any wound program’s clinical and physican documentation needs.

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The Wound Care Program and Hyperbaric Medicine at Banner Good Samaritan Medical Center in Phoenix, Arizona, is a large physician based patient clinic performing nearly 1,000 clinical encounters each month.

In early 2005, recognizing the limitations of their in-house, manual approach, Mark W. Loudenslagel, Director, Wound Care Services and Hyperbaric Medicine and Patricia Gill, MSN, RN, CWCN, COCN, Clinical Director, led a requirements analysis initiative. Banner Good Samaritan reviewed several alternatives, focusing on solutions tailored to the specific needs of ambulatory outpatient wound clinics. For Banner Good Samaritan, the choice was simple, WoundExpert.

Given Banner Good Samaritan’s experience in migrating to paperless charting, a follow-up dialogue with Mark W. Loudenslagel, Director, Wound Care Services and Hyperbaric Medicine, was initiated to better understand how the program addressed several key considerations mentioned in our lead story.

Question: Chart retention - what happened to the old charts?

Answer: (Wound Care Services and Hyperbaric Medicine) follows the hospital’s retention policy. Since most of the patient chart is in WoundExpert, (it) acts as our medical records storage entity in accordance with HIPPA requirements and Joint Commission standards. A small portion of our patient’s electronic records (physician notes) are in Cerner and their retention is the responsibility of IT. At present, we only retain physican orders on paper, and they are sent to medical records on discharge of the patient for records retention.

Question: Patient chart handling. WoundExpert keeps charts in perpetuity and you can control who sees or edits charts; was that important in your decision?

Answer: Absolutely, as our delegated repository of patient medical information, we rest easy in the knowledge WoundExpert is handling our patient records in accordance with the same stringent HIPPA requirements and Joint Commission standards we all must follow.

Question: Patient chart privacy - any security challenges or concerns?

Answer: We have given access (read/print only) to people in billing, coding, and medical records. Since these organizations are outside of our domain, I periodically contact WoundExpert’s Client Services for a report on who currently has access in our facility outside of our department and then contact each of them to confirm they are still Banner employees and performing the same functions.

Today, Mark is confident Banner Good Samaritan has realized many benefits from implementing WoundExpert paperless charting. “Before we implemented WoundExpert, our medical record was completely on paper,“ notes Mark. ”It was impossible for us to cost effectively compile the information necessary for quality management and continuous process improvement initiatives.”

“The near instantaneous availability of outcome data has helped us improve our processes and approaches with patients,” continues Mark. “Now we are able to perform peer reviews with our entire clinical staff, helping to keep our team focused on the goal of healing our patients in the most cost effective, efficacious way possible.”

Mark concludes, “WoundExpert is used to justify our requests of reimbursement to fiscal intermediaries and managed care providers, aiding the all too thin bottom line of metropolitan ambulatory centers like Banner Good Samaritan.”

Learn more about Banner Good Samaritan Medical Center’s implementation of WoundExpert.

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Net Health Systems is pleased to announce the following new additions to our Client Services team. Amy K. Boyles provides first tier customer support for our client base via phone and email. She resolves software issues and triages support requests, as necessary and assists in trainings and higher level client support as required.

Prior to joining Net Health, Amy worked as a director of education for Sylvan Learning Systems, as well as teaching in public schools in Maryland and Virginia. Amy has a Bachelors of Science in Education from Slippery Rock University.