May 28, 2004

Pilot group designs paperless hospital

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Martin P. Sandler, M.D.

Pilot group designs paperless hospital

Just as Vanderbilt Medical Group has done in outpatient areas, Vanderbilt University Hospital is going to phase out paper-based processes in favor of computer-based processes. They’re calling the project E5, hoping by 2005 to at least demonstrate the feasibility of a paperless, electronic way of working.

“We’re trying to do on the inpatient side what we’ve done on the outpatient side, where new tools for communication and disease management are supporting significant gains in quality and efficiency,” said C. Wright Pinson, M.D., VUMC chief medical officer and associate vice chancellor for clinical affairs.

Vanderbilt has won distinction for development of computer applications for use in clinical settings. For physicians and nurses at Vanderbilt University Hospital, the writing of orders and the viewing of test results has long been a computerized process. However, other elements of the inpatient record — nursing documentation, for example — remain paper based, and the paper chart that sits with the patient is still a means for organizing the work of the inpatient team.

This month, the E5 steering committee will review initial findings from a pilot project that got underway on the trauma unit in February and on general medicine units in April. The pilot units began by adapting tools originally developed for the clinic.

People leading the project say it’s too early to predict how E5 will change work in the hospital.

“We’re not implementing anything, we are piloting,” said Nancy Lorenzi, Ph.D., assistant vice chancellor for Health Affairs and a member of the E5 Coordinating Council.

Here is some of what has been happening on the pilot units: roughly 20 percent of the nursing staff are testing electronic tools for processes formerly completed with paper; various types of computers are in testing in the two pilot areas; the pilot sites have developed a new method of computerized nursing documentation; trauma is developing a computerized surgical progress note and electronic forms for restraint ordering and other processes; a new tool called StarDeck provides a view of patient data for use in rounding; inpatient screens let users page the patient’s resident and attending physicians.

When E5 is implemented, “It’s going to make everything easier and quicker,” said trauma Staff Nurse Tisha C. Barzyk.

Lead clinicians for the pilot are John A. Morris, M.D., professor of Surgery and director of the division of Trauma, and Allen B. Kaiser, M.D., professor of Medicine, VUH chief of staff, and associate chief medical officer.

In a recent weekly biomedical informatics seminar, Morris presented his vision of where E5 might eventually lead. He put forward a Vanderbilt virtual bedside that would interact with a clinical enterprise data warehouse, that would in turn be connected to various national specialty databanks.

This combination would support the redesign of care at VUH on the disease management model, with more intensive outcomes measurement, prediction of adverse events, more decision support, nurses more able to focus on information analysis, and medical directors in a better position to uphold practice standards.

“I am absolutely convinced that we are on the cusp of one of the most dramatic eras of medical change,” Morris said.

Dario A. Giuse, Ph.D., associate professor of Biomedical Informatics, is the systems architect for both E3 and E5.