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The secret to success for electronic health systems is not to do them halfway, says Tom Smith, CIO of Evanston Northwestern Healthcare. When ENH began its three-year, $30 million move to a fully integrated system, he says, the biggest resource was the support of the ENH board, which ensured that all health care workers participate in the systems’ development and implementation.

“This was not the No. 1 IT project, it was the No. 1 corporate project,” Smith says. The system effectively shifts “the focus from the institution to the patient. This allows the record to follow the patient—from the physician’s office to the laboratory to the hospital—rather than be scattered among various providers. It integrates computerized physician order entry [CPOE] with electronic patient records, so all charting of patients; ordering of tests, procedures and medications; registration; scheduling; and physician billing is done electronically through one system.”

ENH’s three hospitals are among 41 throughout the nation that fully comply with the CPOE standards set by the Leapfrog Group, a coalition of large employers that is setting standards for health care.

Installing the System

In August 2001, ENH signed a contract with Epic Systems Corp. of Madison, Wis., for software products and implementation support, and spent the rest of that year training the IS staff and determining appropriate hardware, which currently includes some 6,000 computers, including wireless mobile stations. By January 2002, the real work of integrating began. Teams representing various health care divisions, such as the pharmacy, inpatient and emergency care departments, began meeting to map out workflows, carefully tracking what paper form went where when orders were filled or tests requested.

The teams consisted of doctors, nurses and technicians, who met regularly with IS staff members, sometimes as often as three days a week. “This required a lot of extra work,” Smith acknowledges, “but management really insisted,” and since everyone knew using the system would be required, people were motivated to help set up a system that would work for them.

After about three months of mapping workflows, IS spent another five months going back to the teams to rethink and refine the workflow analysis. In the end, says Smith, “we had about 500 major workflows, each with two or three subsets, such as weekend versus weekday procedures.”

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