Mayo Clinic, Jacksonville, FL

Paper medical records have not been circulated since 1996 and are currently not even on-site. Whether using extremely conservative data or results that are more realistic but more difficult to capture precisely, the estimated savings after expenses are $2.8-7.1 million annually.

Situation

Paper-based practice of medicine decreases the productivity of doctors while increasing both patient waiting time and the opportunity for medical errors. However, the shift to an electronic healthcare era is well behind the times. The business world has transformed, or is in the process of transforming, to electronic procedures and records. It is time for the healthcare industry to follow suit.

Solution

The Automation of the Clinical Practice (ACP) at Mayo Clinic in Jacksonville, Florida is a project undertaken in 1993 to encompass the computer-based patient record with the addition of the mechanisms for automated charging and order creation by physicians. This vision was crystallized and communicated as the "paperless" practice of medicine that would increase patient safety and improve physician effectiveness while at the same time driving down expenses. The last paper-based record was circulated in January 1996 and the integrated outpatient practice continues to the present day, with 445,000 patient visits conducted during 2002 with the computer-based patient record.

The Mayo Clinic uses a team approach to provide medical diagnosis, treatment, and surgery. This integrated system makes it possible for patients to get evaluations, tests, and treatments in one place and in a coordinated way. Physicians and allied-health staff provide quality, compassionate care. Their goal is to meet the needs of every patient every day. Because Mayo Clinic is a tertiary care center, most physicians are specialists with in-depth knowledge of specific diseases and new treatment and research breakthroughs. Their easy access to colleagues and Mayo's emphasis on teamwork allow medical problems to be evaluated and treated thoroughly. All Mayo physicians are salaried. Their compensation is not based on the number of tests ordered or procedures done. Mayo's patient-care activities are strengthened by programs in medical education and research. Patients who need hospitalization are admitted to nearby St. Luke's Hospital, a Mayo Clinic hospital with 289 private rooms.

Better Health & Lower Costs

The Automated Clinical Practice rollout involves all clinical users and not only certain groups. Paper medical records have not been circulated since 1996 and are currently not even available on-site. The areas that are automated now include most aspects of the practice.

Some examples are:

• An electronic medical record including all clinical documents, orders, scheduling, and laboratory.
• A fully electronic filmless radiology department with speech recognition for radiologist documentation.
• An automated Intensive Care Unit with Electronic Medical Record integration and bedside medical device interfaces directly to the EMR.
• Inpatient and outpatient surgery areas consisting of surgical scheduling, material management, and nursing documentation.
• And many others….

From this level of automation patient safety initiatives have been possible. For example:

• Orders automatically generating task lists for nursing, respiratory, etc. in the hospital.
• Automated fall risk assessment and Braden skin scale assessment in the hospital.
• A medical data warehouse that allows free text searching against the entire repository of millions and millions of documents in the electronic medical record for patient care and research.
• An infectious disease application that allows bioterrorism surveil lance and automated infection control monitoring.

Dictating notes shifted work from the physician and improved both legibility and medical record turnaround time. The system allowed for real time availability of clinical information (notes, Lab, X-ray, and other results), automatic checking for duplicate redundant orders, simultaneous access to the same patient chart, improved ability to answer ad hoc questions for patient calls, more timely response from physicians when they have questions, and improved flow of information to the physician enabling him or her to have a more "complete" picture of what is known about the patient's condition at the time of the appointment. The estimated expenditure to date is $21 million on the automated practice at Mayo Clinic Jacksonville. Whether using extremely conservative data or results that are more realistic but more difficult to capture precisely, the estimated savings after expenses are $2.8 to $7.1 million annually. Thus the system paid for itself by the fourth year in financial savings alone, without counting improvements in patient health, saving doctors' time, and minimizing errors.