July 28, 2006

New info management system aims to boost accuracy, patient care quality

Featured Image

Nursing student Monique Jeanbaptiste uses the HED system to chart her patients on 4 East.
Photo by Dana Johnson

New info management system aims to boost accuracy, patient care quality

Vanderbilt University Medical Center has completed the roll out of the Horizon Expert Documentation (HED) system – a computerized information management system designed to reduce paperwork, increase accuracy and enhance the quality of patient care.

One of the key initiatives outlined at this year's State of Nursing address, HED had an expedited rollout due to positive pilot tests.

Within six months, the system was complete on 822 beds in Vanderbilt University Hospital, the Monroe Carrell Jr. Children's Hospital at Vanderbilt and within the Clinical Research Center.

"It helps facilitate clinical standardization, which enhances quality and patient safety. Technology is also a key factor in creating a professional practice environment that promotes retention of nurses," said Marilyn Dubree, M.S.N., R.N., VUMC's chief nursing officer.

From the moment a patient is admitted, his or her information is entered into the new system. Notations written on paper charts, such as medication, condition, treatment and progress, are instead entered into the computer system.

Patient information collected at the bedside and documented by nurses in HED appears in StarPanel, a Vanderbilt electronic medical record system.

“For the patient care team, the immediate benefit is the ability to view bedside data from any Internet connection,” said Neal Patel, M.D., co-medical director of Pediatric Critical Care and Medical Informatics officer for the Monroe Carell Jr. Children's Hospital at Vanderbilt.

Patel envisions future upgrades in which HED information of interest to physicians would be used to generate special reports or trigger alerts in other clinical applications.

Already, through a multi-purpose VUMC administrative Web site, Nutrition Services queries the HED data base each morning for any patients who've arrived at the hospital with nutrition problems, and the Center for Clinical Improvement runs queries for HED information about patient falls and any use of patient restraints.

The patient's HED chart is always up to date, which allows for better monitoring and decision making. It also allows nursing staff to be more aware of a patient's allergies or other conditions.

Additionally, nurses can see the relevant clinical protocols to help make the best possible patient care decisions.

While it can take a few more keystrokes to enter the information, there are also timesavers such as the system automatically recording the patient's vital signs from a cardiac monitor directly into the system.

“The system has so many advantages over the paper method,” said Brent Lemonds, Emergency Services and Inpatient Medicine administrator. “Now we have a new level of accuracy to better report activities, look for trends and seek improvements. Manual chart audits will hopefully become a thing of the past.”

Training has been a crucial part of getting the system up and running. The rollout started Jan. 30 and one or two units were implemented each week.

VUMC support services provided more than 800 hours of training for approximately 2,600 nurses and 250 care partners.

“This is by far the most ambitious system we've done in the nearly 15 years I've been doing system implementation support,” said Karen Hughart, director of System Support Services. “The organizational commitment required to set and achieve this kind of goal is phenomenal.”

It's also important to note that VUMC's HED system has been tailored by more than 600 comments sent to the project's Web site. Users have been encouraged to make suggestions and improvements. Most have been small tweaks to the system and have already been made.

— Paul Govern contributed to this story