The handwriting was on the wall | Behavioral Healthcare Executive Skip to content Skip to navigation

The handwriting was on the wall

February 1, 2008
by Greg Merkle, John Boronow, MD, and David Bush, RN
| Reprints
To increase efficiency, Sheppard Pratt moved to an electronic system

Like many inpatient behavioral healthcare organizations, Sheppard Pratt Hospital in Towson, Maryland, was inundated with reams of illegible handwritten paperwork, resulting in a functionally unusable chart which, in turn, led to increased potential for medical errors. We also were grappling with how to meet regulations required by external third parties, including The Joint Commission and other agencies. So in 2004 we began to look for a clinical information system that would help us streamline our processes, deliver an electronic patient chart, and improve our ability to meet regulatory guidelines.

A systematic evaluation of both major clinical information technology vendors and behavioral healthcare-specific technology vendors helped us narrow our possible choices. A site visit to see our preferred system actively in use in a similar setting helped the selection committee (comprised of clinical and technology leaders) to confirm our decision, and in June 2005 we selected a product (Eclipsys Corporation's Sunrise Clinical Manager).

We established high-level goals of providing open simultaneous access to the chart across the facility and from physicians’ offices and homes, increasing the amount of time nurses are able to spend on the unit with patients, and reducing medication-related errors. To move forward, we formed a project steering committee that included the vice-president, chief administration officer, chief financial officer, chief information officer, chief nursing officer, and a project manager from the vendor. This committee met monthly throughout the project to check on progress and resolve high-level issues. We established a systematic planning process, beginning 14 months before the first go-live date.

Like many behavioral healthcare organizations, we are heavily reliant upon physician and nursing documentation, and our physicians communicated that these capabilities were mission-critical as we rolled out the system across our organization. Additionally, one of our ongoing challenges was finding adequate resources to dedicate to the clinical-transformation project. To maximize our resources, we focused our efforts on capabilities that held the largest potential for enlisting physician buy-in.

For that reason, initial priorities included activating clinical documentation functionality and implementing medication administration record (MAR) capabilities. Having these tools available at go-live would help ensure we successfully activated the system on time and on budget and provided the best opportunity for wide-scale system adoption and long-term success in achieving our vision of more-connected care.

Physicians and nurses met in parallel workgroups comprised of representatives of each of our clinical specialties. These groups met regularly for eight months to analyze the entire paper chart, documentation forms, and work flow and create structured clinical notes, order forms, systems rules, and work flows. We began with 44 paper work flows, paring them down to 15 electronic documents to activate at go-live (table).

Table. Fifteen electronic documents activated at go-live

  • Admission Intake

  • Psychiatric Admission Note

  • Medical History & Physical

  • Suicide Assessment

  • Medication Reconciliation

  • Alcohol & Drug History

  • Skin Assessment

  • Psychosocial Evaluation

  • Nutritional Assessment

  • Admission Nursing Assessment

  • Nurses Admission Note

  • Nursing Daily Progress Note

  • Psychiatric Daily Progress Note

  • Master Treatment Plan

  • Rehab Functional Assessment and Screen

While the workgroups were busy prepping the system for rollout, a communications effort was launched to keep everyone in the organization in the loop. Along the way, we made available on our intranet presentations that described system features and functions, screen shots of the new system, and comparisons of how processes work in the paper world versus the electronic world. Promotional key chains and other trinkets also helped to keep users aware of our progress and promote buy-in. This active effort to convey how the system could help to improve patient care and change the lives of clinicians excited users about the clinical transformation on the horizon.

Maximizing Minimal Training Resources

The resources needed to train more than 1,000 users during six months were hard to come by and hence sorely stretched. To help maximize our training resources, vendor product training, manuals, and presentations were tailored to our unique environment. Additionally, five clinical instructors taught one another how to use the system and in the process determined the best way to instruct users based on their roles. Although it took considerable time to develop, physician-to-physician training for order entry and work-flow configuration was highly effective.

We use a significant number of per diem staff. For this reason, we determined that a “super-user” model didn't suit our environment (Under this model, super-users would be available to help make the transition shift to shift, unit to unit). Instead, we found several clinical specialists particularly adept at using the system and designated them as the “go-to” people on each unit as the system went live.