MERIDEN - A little more than a year ago, MidState Medical Center took a major step toward a paper-free hospital by introducing computerized physician order entry, which replaced handwritten doctor's orders with entry into a network.

The hospital recently took the next major step, by replacing the charts nurses keep by the bedside with a software program that maintains detailed patient information.

That information is about as comprehensive as it gets, ranging from the personal - as in whether the patient wants to be called Jim or James - to past medical history, condition and procedures.

"This is probably the biggest clinical application we have done," said Claudette Genova, MidState's director of clinical informatics. "It's basically setting the plan of care for the patient, and all the actions we take day-to-day in treating the patient."

It also takes care of a frequent complaint among patients, which is that they're constantly being asked the same questions. Now even a return visit to the hospital will require an update, not a re-introduction.

The overall goal is reducing medical error, and hospitals are increasingly seeking high-tech solutions. "We're closing the gap of risk," Genova said.

Use of a computer network instead of pen and paper can more effectively check for allergies, prior conditions and medication conflicts, for example.

"This is where we're supposed to be in 2008," said Abbi Bruce, the hospital's director of cancer care.

Since May, the system has been in place for all inpatient services except maternity. MidState trained about 450 nurses and therapists, said Genova.

High-tech solutions rarely come without a learning curve, and some of MidState's more experienced nurses found it a challenge, said Cynthia Decker, a registered nurse and education specialist.

"I certainly did not grow up with computers," she said. "So we had to start from square one."

It's a dramatic change, she said, "especially for people who have been charting on paper for 35 years. Now that piece of paper is no longer there."

The hospital provided extra training for a team of super users, to provide help for each shift during the transition.

Among the super users is Kay Yamartino, a registered nurse on Pavilion B. Yamartino has been a nurse for 24 years.

"I'm not computer savvy at all," she said. "I'm kind of computer pathetic."

Many nurses "had a hard time with it because it's such a big change," she said. "But now it's so much quicker and easier, and the documentation is so thorough, I jumped on board right away."

"Like everything there's a learning curve," said Tracy Luedke, a nurse and super user who works in Pavilion A. "I think the staff has adjusted very well."

MidState is using the Sunrise Knowledge Based Charting system devised by Eclipsys, an Atlanta-based company that specializes in hospital information technology. MidState affiliates Hartford Hospital and the Connecticut Children's Medical Center are also implementing the system, said Genova.

The approach gives anyone involved in taking care of a patient quick access to all relevant information, which along with conditions and treatment includes holistic considerations, like religion and emotional state.

The technology is a considerable time saver, said Keith LaChance, manager of rehabilitation services.

"The system allows us to be much more efficient in getting the notes completed and obviously legibility is key," he said.

"You can be as efficient as you want and as comprehensive as you need to be," he said.

Instead of charts, nurses now use workstations on wheels. So when Yamartino arrives for work she can check the latest updates on the patients assigned to her. The data entry can also be converted into a text document highlighting the most relevant information.

"I can get the full picture of the patient," she said. "Everything's here."

The system makes it easier to provide information to insurance companies, said Decker.

Patient confidentiality is enhanced "because you don't have pieces of paper lying around," said Luedke.

The system offers medical guidelines from the Clinical Practice Model Resource Center, out of Grand Rapids, Mich. The guidelines help nurses assess the condition of the patient, said Jeff Kayser, a registered nurse and clinical information systems analyst.

"It tells them to look for specific things," he said.

At the very least, the system "helps you from having to ask the patient the same thing over and over again," said Decker. "The patients may think we're a little bit smarter."

jkurz@record-journal.com
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