Iowa Hospitals Get in the Loop
Nation’s First Rural E.H.R. Network Combines Bar-Code Meds with CPOE
to Create a Paperless Medical Loop
The hospitals that launched America’s first rural integrated electronic health record (EHR) system last summer are making the federal government’s vision of health care for 2012 a reality.
Ellsworth Municipal Hospital in Iowa Falls, Franklin General Hospital in Hampton, Hancock County Memorial Hospital in Britt, Kossuth Regional Health Center in Algona and Mitchell County Regional Health Center in Osage, implemented technology that ensures a paperless medication “loop:” a goal set by the government for all U.S. hospitals.
These less-than-25-bed critical access facilities, members of Mercy Health Network – North Iowa, activated “CareMobile,” a bar code medication administration tool from Cerner that works within the Genesis clinical system. But unlike stand-alone bar coding, using CareMobile with Genesis combines the safety of computerized physician order entry (CPOE) at the time a medication is ordered with the safety of bar code medication administration.
“The highest levels of accuracy and safety are provided from the time an order is placed, to the time of medication administration; i.e., from order to the bloodstream,” said J. Michael Kramer, MD, Trinity Health’s Chief Medical Information Officer.
How it works
Using a hand-held device, a nurse scans a patient’s wristband and medication, both bar-coded, to verify what is known as the “Five Rights” of medication administration: right patient, right medication, right dose, right route and right time. Once confirmed, the medication is dispensed, and the information transfers to the EHR.
“We used to manually validate Five Rights,“ said Dar Elbert, Director of Nursing at Kossuth Regional Health Center. “CareMobile changes our practice because we must use the scanner on every single vial, tablet or bottle.”
Despite the significant reduction of errors, adoption of bar code medication administration is low. Results of the most recent national survey by the American Society of Health-System Pharmacists – conducted in 2005 – indicate it is only used by 9.4 percent of U.S. hospitals. No hospital in the study with fewer than 50 beds report using this technology. Additionally, only 3 percent of hospitals with fewer than 50 beds have fully implemented EHR systems, which includes CPOE.
“These tools are rare in rural America and this is a remarkable application of advanced patient safety technology,” said Paul Conlon, Trinity Heath’s Senior Vice President, Clinical Quality and Patient Safety. “By providing a closed medication loop where technological resources are scarce, we extend the highest level of medication safety to some of our least resourced facilities. We are serious about extending superior clinical quality across the entire Unified Enterprise Ministry®.”
“Near-misses” indicate close calls
“Overall, it’s really going well,“ said Nancy Abbas, Director of Pharmacy at Hancock County Memorial Hospital and CareMobile coordination pharmacy lead for the sites. “It’s exciting. Several ‘near-misses’ have been caught before a medication error reached the patient.”
"This adds an extra layer of safety that many small hospitals don't provide,” said Jean Loes, Clinical Information Analyst at Mercy Medical Center-North Iowa and CareMobile nurse coordinator for the initiative. “Many people think that because a hospital is very small, it doesn't need those bells and whistles. They usually have fewer resources, however, and those bells and whistles are needed even more.”
RHIO reality
Two remaining Mercy Health Network sites, Mercy Medical Center in New Hampton and Palo Alto County Health System in Emmetsburg, will activate CareMobile this April. The network will then function with the same Genesis technology as fellow critical access hospital, Mercy Medical Center-Dyersville, and their larger counterparts, Mercy-North Iowa and Mercy Medical Center-Dubuque. All three have been “live” with Genesis between 3-4 years, and activated CareMobile in early 2008.
“These northeastern Iowa hospitals create a true Regional Health Information Organization (RHIO) — a necessary component for the National Health Information Network,” said Kramer. “By providing bar code medication administration, a comprehensive EHR system, and the level of standardization and consistency of practice, they model the government’s vision of integrated health care for 2012 — and the vision for every Trinity Health hospital.”
About Trinity Health
Trinity Health is the fourth-largest Catholic health care system in the country. Based in Novi, Mich., Trinity Health operates 45 acute-care hospitals, 379 outpatient facilities, 26 long-term care facilities, and numerous home health offices and hospice programs in seven core states. Employing 45,400 full-time staff, Trinity Health reported $6.3 billion in unrestricted revenue and $376 million in community benefits in fiscal year 2008. For more information about Trinity Health, visit www.trinity-health.org.