Using HIT to Improve ED Patient Flow, Performance: Q&A with Dr. Michael Westcott, CMIO of Alegent Health

The role of the chief medical information/informatics officer is a relatively new one in the history of healthcare, but it is growing in importance. The position is generally held by a physician who is versed and passionate about both clinical medicine and informatics and how the two can work together. The CMIO bridges the clinical and health information technology silos that can exist within hospitals and health systems and plays a major role in HIT strategy, implementation and clinician engagement with technology. Michael Westcott, an emergency medicine physician, who has served as CMIO of Alegent Health in Omaha, Neb., for the last eight years, has played an instrumental role in implementing electronic medical records across the system's 10 hospitals, among other achievements. Here he discusses some of the things he's learned in his role and how Alegent uses technology to improve throughput in its hospitals' main point of entry — the emergency department.

Question: The CMIO is a relatively new, but important, position for hospitals and health systems. What skills do you think are most important for a CMIO to possess?

Dr. Westcott:
The number one skill is relationships. You have to know how to handle physicians [and other clinicians]; if someone is really stressed [by HIT issues], you know how to handle it. The CMIO is the closest administrator to physicians as far as IT goes. Physicians especially appreciate a buffer between specialized IT folks. The CMIO also plays a lead role when [a health system] is thinking about new projects or new software. CMIOs lead the team in how to modify it to meet physician needs. Having a physician who understands medical issues test any systems or technology before they're put into place is really important. 

Q: Alegent Health has qualified for Stage 1 of meaningful use and is working toward Stage 2 attestation. What is the biggest challenge you expect to face in relation to this and other goals you have for HIT implementation?

MW:
I think getting everybody up to speed on new government regulations will be the first challenge. We'll have to be fast and furious to make sure everyone understands the new meaningful use requirements as some will require a change in workflow and a change in philosophy. For example, one meaningful use requirement is the creation of problem lists [for 80 percent of patients in Stage 1]. The problem list started about 40 years ago in the outpatient world, usually appearing on the front page of a chart. It kind of jogs the memory when you open the chart for the first time. It works really well in the outpatient setting but hasn’t been used much on the inpatient side. Now, the list is created for inpatients, which involves a change in our daily workflow.

Q: Describe to me one recent technology or efficiency project you've worked on that really impacted Alegent Health for the better?

MW:
That would be our efforts to use technology to better track patients and improve patient flow in our emergency department. About 10 years or so ago, when I was working in the ED, census in the department became harder and harder to keep track of. We had been using an old grease board, which was never fully updated and got harder and harder to read the more patients we had. There were also some privacy issues there. We looked at bringing on a tracking system — a precursor to the system we use now. Using this system was a whole new way of doing things for us. The very first day we implemented the electronic tracking board system, a truck hit a school bus and we had 20 kids all in the ED at the same time. We didn't lose track of any patients; we didn't confuse one patient for another, so staff bought into the system quickly. We used it for several years, but there was a lot of documentation involved on paper and transcription was expensive. Plus, physicians didn't always get transcription done right away, which caused a delay in communicating to the attending physicians.

We began to look for a way to automate the workflow so we could get the notes done more quickly so everybody could know what happened to the patient. We selected and eventually implemented OptumInsight's Picis ED PulseCheck™, an electronic medical record designed for EDs.  Every staff member knows where each patient is, and it facilitates communication with ancillary departments. If a patient needs a lab drawn or an x-ray, we can keep track of that. It also facilitates computerized physician order entry and near real-time documentation. Physicians can do their documentation and order entry right in the room with the patient. It's a huge physician satisfier because physicians don't stay after their shifts to dictate, and they provide better patient safety and quality since they’re not writing notes somewhere and reentering or dictating them later. In addition to the PulseCheck system, we’ve also implemented desktop virtualization in the department; this further enhances the workflow for all staff.

Q: It sounds like the transition to an automated ED information system has benefited your organization overall. What do you think made it a success?

MW:
If you move from manual to automated, it's a huge paradigm shift. As I mentioned, we used paper charts and a tracking board previously, but users just demanded we have electronic solutions. It just makes the ED an easier place to work and improves our entire workflow.

The ED's throughput — the time from when patients arrive until they go home — has improved by about 15 percent since we've automated. We've also had a pretty significant improvement in our patient satisfaction surveys. We've seen a huge difference there.

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