Maimonides Medical Center, Brooklyn, New York
Technological improvements have enabled 32,168 additional in-patients to be served by the medical center.
Situation
It may seem surprising that the site of the nation’s first human heart transplant was dependent on keypunch-based processes as late as 1995. While Maimonides Medical Center – Brooklyn’s leading tertiary care institution and the nation’s third largest teaching hospital – was renowned for the quality of its medical care, its information environment remained in the dark ages.
As an institution with deep roots in the community, this condition had continued for decades. However, the advent of deregulation and managed competition created the need for a new business model requiring prompt access to accurate patient data and financial information. In addition, a renewed focus on patient care and improved outcomes demanded a transition to a computer-based patient record (CPR) with knowledge-based decision support.
Solution
In 1996, Maimonides executive management made a commitment – and allocated the resources – for a strong information environment that would improve the quality of care, increase patient satisfaction, reduce costs, and position the hospital for future growth and initiatives. The result is Maimonides Access Clinical System (MACS), a CPR system that has transformed the delivery of health care at Maimonides and serves as a model for other large hospitals nationwide.
Today MACS is used by all of Maimonides attending physicians and residents, as well as more than 120 voluntary/community physicians, for entering orders and reviewing results. This puts the medical center in an elite group of health care organizations, as it is estimated that only 4% of hospitals in the U.S. currently have physicians entering orders and obtaining results/reports for patient care electronically.
Implementation of a CPR system is a major achievement for any health care organization. MACS is the only known health care information system to incorporate four distinct electronic medical records systems from different vendors:
- Eclipsys 7000 Inpatient CPR
- NextGen Ambulatory Care CPR
- E&C IPRob Perinatal CPR
- A4 Health Systems Emergency Department CPR
Today, Maimonides’ integrated CPR solution is used by all employed and community physicians and residents, who enter orders online, review drug interactions, ancillary results, and digital images as well as fully document and chart clinical information. This is true for every inpatient unit, including all critical care areas and psychiatry. Utilizing concurrent decision support and embedded capabilities, intelligent rules engines provide clinical staff with treatment recommendations, diagnostic guidelines, and suggested medical dosages. Ancillary departments access MACS to view the status of tests, while nurses use the system to document clinical information, dispense medication, and select charge information. All users can retrieve appropriate clinical data and results, including users in remote hospital locations and community physician offices.
Better Health & Lower Costs
Benefits have been remarkable. The medical center has seen a 68% decrease in medication processing time, a 55% decrease in medication discrepancies, and a 58% reduction in problem medication orders. Duplication of ancillary orders has decreased by 20% overall, including a 48% reduction in duplicate laboratory/chemistry tests. Over a seven-year period, accessibility of clinical data has improved time of diagnosis and treatment, contributing to a 2.21 day (30.4%) reduction in average length of patient stay. These improvements have enabled 32,168 additional in-patients to be served by the medical center, representing over $50 million in increased revenue, one-quarter of which is attributable to the CPR.
Many elements have contributed significantly to the success of the project and, if omitted or poorly executed, could have derailed it. Foremost among these was establishing programs and methodologies aimed at physician participation, buy-in and ownership. Other key factors included building a clinically-focused MIS staff, selecting appropriate vendor partners, conducting training to meet the needs of all user constituencies, and winning the support of key leaders and advocates. The result is an information system environment that has brought dramatic improvements in the delivery of patient care while positioning Maimonides to continue to fulfill its mission as a world-class medical institution in the years ahead.
