Psychiatric center reaps EHR benefits

By Bernie Monegain, Editor Healthcare IT News 02/26/07

HOUSTON – The University of Texas-Harris County Psychiatric Center, is reaping the benefits – and savings – of automating its medical records.

The gains are coming after three years of implementation and tweaking to get it to work just right. Psychiatric facilities present a unique set of challenges for turning paper-based records to digital ones, said Richard Montanye, director of medical information systems at the center

Now that that the electronic health record system is up and running, Montanye and his 14-member IT team are ready to tackle other work: Improving registration with photo capability; automating more forms on the Web and making it possible to capture patient electronic signatures on consent forms. They will also upgrade the electronic health record system – Eclipsys Sunrise – to include progress notes and more alerts for clinicians.

The center also is streamlining IT desktop support by centralizing all nursing unit computers in the server room using blade technology

Over the past three years, the psychiatric center partnered with the University of Texas-Health Science Center to introduce document imaging, share bandwidth for telehealth, helpdesk support and a common e-mail system. It also improved its infrastructure to support its electronic health record, wireless access, carts and telehealth with various organizations within and outside of Houston,

The center “is the only hospital along with the VA that has complete documentation for all disciplines,” Montayne said, including computerized physician order entry, medication administration record, initial physician exam and master treatment plan.

Montanye calls the center “small, but modern.”

The 250-bed public psychiatric hospital delivers psychiatric services to children, adolescents and adults with mental illness. It serves more than 6,000 inpatients and 3,000 outpatients annually. It has 25 on-staff physicians and more than 170 nurses.

The repeated visits, and the at times long, unstructured notes physicians enter at each visit don’t fit into an ordinary template, so some adjustments to the EHR system had to be made.

“While implementing an EHR system in a psychiatric setting presented a unique challenges, said Jay Deady, executive vice president, customer solutions, at Eclipsys, “the solution’s flexibility and the team at University of Texas-Harris County Psychiatric Center’s domain expertise made the project a success.

“The ultimate reward for all the hard work is the improved patient outcomes UTHCPC documented following the activation, in particular a reduction in both medication errors and adverse drug events.

In less than three months after implementing the electronic health record system, the pilot unit reported it had eliminated nursing transcription errors and had reduced medication errors by 89%, Montanye said.

Hospital-wide, the number of adverse drug errors reported decreased each quarter by as much as 51 percent after the implementation of CPOE.

Sheppard Pratt, a psychiatric hospital in Baltimore, is at the start of its implementation and customizing of its Eclipsys system. John Baronow, MD, said Eclipsys Sunrise is highly customizable. The down side, he said, is every installation is custom.

Psychiatric hospitals present a unique challenge for automating records, he said. “The kinds of clinical data are not things that med-surg software have been designed to define and capture.”

“All we really want is to record how often the patient is yelling, is he being reclusive? They can do it, but they don’t have a template for doing it.”

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