Breathing New Life Into Hospital's EMR System


Background

With a patient base of approximately 280,000 spanning 11 counties, Jefferson Regional Medical Center (JRMC) is the fourth largest medical center in Arkansas. The center’s staff of 150 physicians represent all major specialties, and JRMC offers teaching programs for medical students, residents and students in allied health fields. As a community-owned, not-for-profit health care provider, JRMC is dedicated to providing excellence in health care services in a cost effective way to fulfill the needs of its patients, physicians, employers, employees and the community.

JRMC’s Information Systems (IS) department maintains all the equipment and software within its facility, according to Chief Information Officer, Patrick Neece. "Mainly, we operate a Wintel environment, and our main HIS system runs on an IBM iSeries box," adds Neece.

Challenge

The center uses multiple applications including Eclipsys’ Sunrise Clinical Manager™, a computerized physician order entry (CPOE) solution for clinical documentation within all the areas of the hospital, and Cerner’s Dynamic Vision, an electronic medical record system (EMR). Internally dubbed DOC VIEW, the EMR also serves as the main documentation entry point, according to Neece. The records management system has a back end that used the IBM Medical RecordsPlus/400 (now a program that runs on the IBM iSeries®, AS/400® platform) stored in MO:DCA, an old IBM format, and housed on a pair of IBM 3995 optical jukeboxes that IBM sunset about two years ago. We’ve been running without support on the EMR product for approximately three years so there are limited options for enhancing the product to meet our ever changing needs. This component plays a critical role in providing our clinical staff with electronic access to patient charts and other important data."

When a patient is admitted to the hospital, their basic information such as insurance, is entered into the HIS system during registration. That information is then passed on to DOC VIEW by an ADT interface. The EMR makes it easy for hospital staff to access details on any previous visits, including scanned and imported images. "It’s critical to have the ability to search and view available patient information quickly," says Neece.

But without support, the existing system had limitations. "We managed the entire system internally, both the Dynamic Vision front end and the backend IBM components that handled all the scanning and indexing," notes Neece.

Although the system didn’t require a lot of support, Neece and his team couldn’t do anything more with it. There were no more new releases, updates, or functionality coming that would enable them to provide enhancements for their clinical and administrative users.

Solution

"I began researching image viewers for the ability to open MO:DCA-formatted documents, specifically our MO:DCA images," continues Neece. "Although everyone who still runs the iSeries box that uses this old format definitely needs MO:DCA viewing capability, this is not a file format you find supported by many image viewers."

Neece evaluated several image viewers. "When I found Snowbound Software I knew I had come to the right place. I chose their RasterMaster™ Imaging SDK for .NET, which is specifically designed for Visual Basic .NET. This solution gave me all of the image tools I needed to pull up, view, split, and modify images in a multitude of formats, including MO:DCA."

Initially, Neece had planned to rewrite the front end of Dynamic Vision to create a custom front-end viewer from the ground up. But the Snowbound RasterMaster SDK provided JRMC with robust image-viewing functions, making that step unnecessary. "Snowbound’s SDK kept me from having to write all the bits and pieces to that viewer. It provides the ability to zoom in and out on an image, annotate, and create various formats, if users want to scan in images," stated Neece.

The TWAIN interface proved to be an additional benefit for JRMC. Neece adds, "All scanning used to be done in the Medical Records Department after the patient was discharged, but with Snowbound’s TWAIN interface, we were able to move components of scanning to Admissions and other clinical areas. One of the real benefits is that it has redistributed some of the scanning workload from Medical Records into other areas of hospital so I’m not relying on one central place to do all my scanning. So instead of having the information transferred to Medical Records for scanning, the information can be scanned at the point of admission and immediately available throughout the system.

And best of all, when our clinicians and other staff members access files for viewing within our program, the embedded viewer (built with RasterMaster) seamlessly displays images for them on demand." With a small staff and tight budget, Neece didn’t have a lot of resources or time to spend on systems development. He reports, "Snowbound worked with us to provide components that we incorporated into our code, which really helped us rapidly develop and deploy the new solution. This enhanced application, which utilized the snowbound components enabled us to extend the life of our EMR and enabled us to provide a higher level of support to our clinicians and others using the system."

With assistance from the Clinical Documentation/ CPOE system, Neece developed 60-percent of the hospital’s Dynamic Vision system internally. "Viewing is a key piece of this process. Snowbound’s RasterMaster SDK for .NET gave me the image viewing capability so I could rewrite the code. Snowbound wasn’t the only vender in town, but I liked the tools – they were really easy to work. I didn’t have to spend a lot of time up front learning their codes. Snowbound provided working examples that got me up to speed quickly, without needing classes or training."

"Snowbound’s RasterMaster SDK was one of the components that allowed us to extend the life of a sunset product, instead of purchasing a new EMR, which would cost us over a million dollars plus the expense and challenge of implementation and training.​" — Patrick Neece, CIO, Jefferson Regional 

Solution

  • Saved an estimated $1 million by extending the life of the EMR system
  • Simplified the process and expanded the options to access patient charts
  • Saved implementation/development time estimated at 6 months
  • Saved an estimated 4 FTE’s for 9 months for implementation and development
  • Extended the life of the EMR by an estimated 3 years

Before adding Snowbound’s viewing component to view an in-house patient chart, a clinician using JRMC’s Eclipsys CPOE system would have to go through 4-5 steps to access the external EMR to view patient history account. "Now with our updated system, the clinician can reach a patient account with a single click. It’s a seamless process to the end user now. They really don’t know they’re leaving one system and going to another."

The hospital provides staff with many different ways to access the patient charts. The wireless network supports mobile carts and some physicians now use tablet PCs instead of carrying charts around. "Our physicians love the simplicity of our DOC VIEW application, and so does everyone else," says Neece.

The Snowbound toolkit also enables us to add printing features to the new EMR frontend with limited development efforts "Printing made easy". This allows our users to print documents with a single click within the DOC VIEW EMR.

Neece notes, "Although Snowbound is a small component of our entire IT system, their RasterMaster SDK helped us simplify how our users access, view and utilize documents throughout the hospital. And when you consider the volume of images viewed daily, which can number in the hundred thousand range, this is a noteworthy contribution."

The viewer is very customizable, according to Neece. "Snowbound enables us to view, create and store any MO:DCA-formatted document, whether it’s a picture from a camera, a scanned image, an electronic file, or anything that’s not a diagnostic test. The whole AS 400 component is still there in the background, but we don’t have to change or modify any code to view these MO:DCA documents. I just use our DOC VIEW to create the image, then create trigger files that allow the existing programs to pick up each image, and know what it is, and where it’s stored within our system."

By creating DOC VIEW, Neece enabled the hospital to extend the life of its EMR system. "There was very limited implementation and DOC VIEW required very little user training, which we boiled down to a simple, one page document," notes Neece. "Snowbound’s RasterMaster SDK was one of the components that allowed us to extend the life of a sunset product, instead of purchasing a new EMR, which would cost us over a million dollars plus the expense and challenge of implementation and training. Ultimately, our efforts have made it so we don’t know when we’ll have to replace the system at this point."

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