Treating a patient is a team effort, so key members of that team--from floor nurses and attending physicians to the surgeons, pharmacists and anesthesiologists--need timely access to test results and vital data contained in a patient's record. But this requires that the information be stored in a central and secure data repository like that found in a clinical information system (CIS).

Setting Goals

For Jodi Samsel, B.S., M.T. (ASCP), C.L.S., having a CIS means nurses have a "then and there" ability to document patient information and have it available in the system, while physicians can retrieve that information at any time and from anywhere. Samsel is the director of clinical applications support at Princeton HealthCare System in Princeton, N.J., a 450-bed medical center and a teaching affiliate of the University of Medicine and Dentistry of New Jersey--Robert Wood Johnson Medical School. She says the decision to purchase a CIS dates back to 1989, when the chief nursing officer received a grant to find a nursing documentation system that could handle point-of-care documentation.

But the hospital also set two more goals. Hospital administrators wanted physicians to be able to access patient information from anywhere in the hospital--and even from outside the hospital--and they also wanted to eventually implement an electronic medical record (EMR).

Having this kind of informational access also was a driving force behind the decision of the University of Michigan in Ann Arbor to purchase a perioperative CIS for its operating rooms, says Michael O'Reilly, M.D., a clinical associate professor in the department of anesthesiology.

O'Reilly says his department chairman Kevin Tremper, admits to being less than computer-savvy, but he knew as early as 1995 that he needed better access to patient data. "We wanted a perioperative data system," O'Reilly says. "We wanted a system that would close the gap and improve workflow."

As O'Reilly explains, many surgical patients were being seen for pre-surgical tests such as a stress test, but the results were recorded on paper charts that were often filed away in file cabinets. "There was no way for the anesthesiologist to know what tests were administered or what the results were. It was critical to have this information before surgery, because our role is to make sure all organ systems remain healthy during surgery. Usually, it was easier just to call the patient and ask him a lot of questions all over again," he says.

Likewise, determining if the patient was allergic to medications often resulted in duplication of efforts. O'Reilly says, "If five different people ask a patient, 'What drugs are you allergic to?' the patient says, 'Don't you guys talk to each other?'" Not having all this information when it's needed can delay moving a patient into the OR or result in the surgery being rescheduled. "ORs are expensive," says O'Reilly. "We don't want them empty."

Consent forms posed another problem. He says that patients would move through the system faster than paper, and often they would get to the OR before the paper did. With hundreds of surgeons performing 35,000 surgeries annually, collection and dissemination of data had to be done electronically.

Doing away with paper and giving the healthcare team greater access to patient data also prompted Fairfield Memorial Hospital in Fairfield, III., to invest in a series of electronic patient care modules.

Cindy Meagher, R.N., the hospital's assistant director of nursing, says a primary goal was "to get everything onto one plate" so various data could be entered into a patient's record and accessed from any computer. "There was no link," she says. "Everybody was doing his own thing."

But not anymore. "The CIS has helped make everyone into a multidisciplinary team as opposed to silos or separate departments. It has allowed us to function as a single unit. From the documentation perspective, automation helps, because now when a nurse inputs information into a patient's initial assessment, she can view the patient's record at the same time. If the patient has a patient hospitalization history with us, all that information is available to the nurse at assessment time," says Meagher.

Getting Started

With the search for a CIS beginning in earnest in 1989, Princeton HealthCare System signed a contract in 1991 with Health Data Sciences (HDS) for a product then known as UltiCare. Subsequently, HDS was acquired by Atlanta-based Per-Se Technologies Inc., and the product was renamed Patient1. [Editor's note: Per-Se Technologies announced in June that it sold Patient1 to Raleigh, N.C.-based Misys Healthcare Systems, which is planning to enhance and market the product under the names Misys CPR and Misys CPOE.]

For Samsel, installing the new system entailed an extensive overhaul of the hospital's information systems. "In March 1992, we converted nursing documentation, pharmacy, radiology, cardiopulmonology, nutrition---everything but the lab--to what became Patient1 from Per-Se," she says. The lab has been using Cerner's Classic laboratory information system since 1989 and, because it is moving to HL7, will soon convert to Cerner's Millennium product. Even so, Samsel says a custom interface was designed linking the lab's system to Patient1.