Writing a Computer Script Helps Health Systems Realize Efficiencies

It’s often said that computers and their accompanying software are only as smart as they’re programmed to be. But, when programmed appropriately, they can enhance operations and streamline costs for virtually any enterprise—and healthcare is no exception.

(http://www.bostonworkstation.com

Riverside Health System (www.riversideonline.com), a Newport News, Virginia-based healthcare provider, found out as much when it began applying Boston WorkStation ) scripting technology in innovative ways to accomplish a variety of critical workflow and automation tasks. For example, the system, which functions as an electronic employee, has enabled Riverside to reduce the time spent logging patients out of its emergency department from 8 hours to less than 1.

“The script (think prescription for a computer) took us only three hours to write,” explains Jim Foss, director of Information Systems for Riverside. “The result is not only a more efficient registration process in the emergency department, but also a full-time employee to use in a more substantial capacity.”

Addressing a need

Riverside’s “working” relationship with Boston WorkStation began with the need to address the problem the healthcare system had by having one electronic medical record in its ambulatory practices, but a different application for its emergency room physicians.

“We’re a best of breed organization,” explains Charles Frazier, MD, vice president of clinical innovation for Riverside and a practicing physician. “As pieces of technology came available, particularly along the lines of emergency medical records, we implemented them. The problem, of course, is that the [two EMRs] don’t talk to each other.”

As a result, if a patient went to the emergency room one night and was told to see their doctor the next day, they would call for, schedule, and come in that day for an appointment. However, the doctor’s office wouldn’t have the notes from the emergency room visit. A staff member had to call over to the ER and have the information faxed in. “Physicians were kept waiting, patients were kept waiting—everyone was waiting,” says Frazier.

The temporary fix? If a patient phoned and said they needed an appointment for an emergency room follow up, that information would be flagged in the emergency room EMR, a system called Ibex, and a staff member would be alerted to go into Ibex, find the patient’s information, copy the notes and paste them into the EMR. Very time and labor intensive.

Enter the electronic employee

All of that changed just over a year ago when Riverside began using the Boston WorkStation. Now, every 12 hours, the system queries the Ibex database and asks to see all the patients who have been discharged from the emergency department in the last 12 hours. It then matches the patient’s name, date of birth and Social Security number against records in Centricity, which is the healthcare system’s electronic medical record on the ambulatory side. Then, for each of those patients, the WorkStation opens a file and cuts and pastes the information into the EMR.

“What it really does is create a little summary of the [emergency department] visit,” says Frazier. “Why the patient came in, date and time, who saw them, final diagnosis, and when they left. [Boston WorkStation] then puts a note on the desktop of the patient’s physician. When the physician opens it, there’s a little summary in there, and if they click on the link they can see the entire note. From a service standpoint, it’s much better for the patient. And it’s much more efficient for the receiving office because they don’t have to get on the telephone or wait by the fax machine.”

In addition to linking its emergency room and ambulatory electronic medical records, Riverside uses the WorkStation to automate a quality initiative with the State of Virginia. The healthcare system matches its entire patient population with the state’s death registry, and uses the WorkStation against the Centricity EMR to remove all of the patients that match the state registry. The two initiatives have saved the hospital in excess of $25,000 and more than 2,400 staff hours per year.

Only as smart as…

Frazier points out that learning and using Boston WorkStation was fairly easy. The key, however, is in writing an appropriate script, because the system is only going to be as smart as it’s taught to be.

“If we don’t anticipate all the eventualities of what could happen, then it becomes lost,” says Frazier. “It’s like, if I gave you a prescription for a medication and said to take one pill four times a day for 10 days, but the pharmacist only put 7 days’ worth in, you’d get to the end of the 7 days and stop because you can’t do anything else. That’s the way Boston WorkStation is—it follows the prescription.”

And, adds Frazier, “You’re not going to anticipate all the different things that could happen the first time through, so it’s a continual refinement of the process. But, you can bring it up so quickly and so relatively easy for problem solving that it is a very powerful tool to have at your disposal.”

Ed Rabinowitz is a veteran healthcare writer and reporter. He welcomes comments at edwardr@frontiernet.net.