Hartz also puts the system's growing clinical data warehouse to work, building evidence-based, clinical decision support tools into its order entry system. Called the "Lighthouse" project, Eastern Maine worked with Cerner to identify best clinical practices at Mayo Clinic, which is using the same software at its Florida hospital.
Eastern Maine analyzed its workflows around hip and knee replacements, developing an electronic "care pathway" to guide physician decisions. Since July 2007, orthopedic physicians have been using the tool, which suggests which antibiotics to use and when to ambulate patients after surgery. The system's capacity to put forth real-time data has been a key to driving physician change, Hartz says. "Before the EMR, we would do patient reviews a month after the fact," he says. "Now we get data the next day. If the patient has not been ambulated, we can tell. Real time data drives change."
The potential to improve quality has compelled Eastern Maine to participate in another IT venture that will put shared governance to the test. Having invested $250,000 over two years, the health system is a participant in a statewide data sharing project called HealthInfoNet. The venture will attempt to exchange patient data across hospitals and clinics statewide, and will include three other large hospital systems plus hundreds of physicians. Bruno is bullish on the data exchange's success, despite the fact that some thorny issues around patient identification need to be resolved. "The culture in Maine is not as competitive as in some other states," she says. "There are limited resources, so we cooperate as much as we can."
Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at firstname.lastname@example.org.
Eastern Maine Healthcare Systems' Cathy Bruno and C. Eric Hartz each have major projects under way. Here is a glimpse at a few of them.
CATHY BRUNO, CIO
Project 1: IS directors group
Managing IT projects across multiple, widely dispersed hospitals is a challenge. So Bruno is hammering out business processes with her IS Directors Group. The group includes project managers and a key IS staff member from Eastern Maine's seven affiliates, plus staff from her corporate headquarters. About 150 of her 200 IS staff work at the central location. As the number of applications has grown, so has the need to clarify responsibilities, Bruno says. Much of the work is nitty-gritty. "We have to determine who does what, what is the time frame, and how we set standards for such purchases as new phone switches."
Project 2: IS strategic plan
Eastern Maine's current long-term strategic plan—a three-year vision that was crafted nearly two years ago—needs updating. Thus, Bruno will take to the road in the year ahead to gather information from affiliate hospital leaders about what applications and services they need next.
Project 3: HealthInfoNet
Bruno is Eastern Maine's representative to the state's newly formed data-sharing venture, HealthInfoNet. Bruno wants the data exchange to work, but she also needs to make sure its technology can fit well with her hospital's. By outsourcing the data exchange to a newly formed nonprofit corporation, Eastern Maine and the other hospital members are hoping to depoliticize key decisions. HealthInfoNet is taking on the thorny problem of creating a statewide master patient index, a component that Bruno says is critical to its success.
C. ERIC HARTZ, CMIO
Project 1: Barcode medication administration
Eastern Maine Medical Center is in the early stages of the deployment of a "closed loop" medication administration system. Although orders are placed electronically, nurses still use pull-down menus to document when and what they have administered. With the barcode system, nurses will scan the med, the patient and themselves to record all the pertinent data. The system also includes alerts that may caution against administering a certain drug. "An intervening lab result may show up," Hartz explains.
Project 2: Expand CPOE
Eventually, Eastern Maine Healthcare Systems will deploy electronic orders at each of its hospitals; Hartz is currently helping the CEOs at affiliate hospitals with preparations. A standard formulary is part of the equation, but Hartz is sensitive to the fact that the local affiliates want to have a say in how they practice medicine. A clinical system steering committee, chaired by the EMHS' chief medical officer, will weigh in on these issues.
Project 3: Cardiac clinical pathway
Buoyed by the success of orthopedic practice guidelines, Hartz is turning to the hospital's electronic medical record to help manage cardiac patients. "We want pathways to standardize treatment and remove the variability in the care of heart attack, heart failure, or bypass patients," he says. Another goal is to eliminate unnecessary blood transfusions among cardiac patients, Hartz says. For many patients, there may be alternatives, such as hormone injections that can correct anemia, rather than supplying the patient with new blood. "It is a risky patient safety issue."