The Journey to a Paperless Hospital: Why Medication Management is the Key

Even without IT solutions, the healthcare environment is a complex one. Although implementing healthcare solutions can have positive effects on patient outcomes and improve patient safety, it is important that these solutions do not further complicate things and become a distraction for medical teams. For healthcare IT solutions to truly have a positive impact, they must be simple to use, have exceptional UI/UX, and need to leverage all available modern IT technologies. Medical teams are very agile and constantly on the go, which means that anyone working with patients needs access to all of their key information – anytime and anywhere.

Seven years ago we started working with Slovenia’s largest children’s hospital. At that time they had extremely limited IT support which was focused entirely on administration and billing. All care processes were paper-based. They did, however, have the goal of transforming their hospital into a paperless one.

Their ambitions were high: to achieve a near instant transformation, practically overnight. We, on the other hand, with 25 years of experience in developing healthcare IT solutions for hospitals, registries, and national projects, knew that in order to reach their goal they would have to embark on a journey which would take some time. We did not simply want to deploy an IT system, but instead really hoped for the system to have a positive impact, help medical teams provide better care, and improve patient safety.

We also understood that no matter how hard we tried, or how many people we hired to help with the journey and development of new modules, we would never be able to fulfil all the medical teams’ requirements. However, based on decades of experience, we knew what the crucial first step to guarantee successful and sustainable transformation was: to set up a centralised, vendor-neutral, and structured clinical data repository to ensure that no matter which module the hospital deployed in the future, it would store the data in the same repository. As the first step in the process, we recommended that the hospital set up their infrastructure to enable the development of an ecosystem of solutions around their centralised clinical data repository, and then slowly build their overall clinical information system based on their needs and financial capacities.

Luckily, the hospital’s management quickly understood the benefits of the whole approach we were proposing, the overall challenges of such a transformation, and the importance of their involvement in the overall process. Under our guidance, they developed a short-term plan and re-defined their vision. We first set up a vendor-neutral clinical data repository, and then started rolling out individual clinical modules that covered their basic hospital processes, such as order comms and nursing, while at the same time never losing track of the hospital’s final vision: to become a truly paperless hospital.

This approach enabled the hospital to gradually reengineer and optimise their processes, from the ground up. They never had more than one transformation process at a time, which allowed them to really iron out any inefficiencies users experienced during the rollout phase. There was also another advantage to this approach – the hospital had enough time and oversight to truly ensure that each step of the process was done by the right person at the right time in the sequence. This meant that there was no fall-back to paper, or delegation of requests. Today all orders are completed by doctors electronically, and all activities that follow these initial orders are done by nurses, pharmacists, or other doctors.

When closely working with these medical teams I quickly realised another key component to fulfilling their vision of becoming truly paperless: we would also have to support medication management, which is tightly connected with the two other important areas – order comms and observations. Clinicians constantly monitor the latest lab results and observations to see whether the prescribed medications and performed procedures are having the desired effect. A subset of this information is also needed at the time medications are prescribed, such as blood sugar, INR, and more. So, it became clear that to successfully deploy a useful electronic flow chart the medical teams could effectively use for patient care, medication management would have to be completely supported by the IT system.

Implementing a comprehensive medication management system in any hospital significantly reduces prescribing errors and improves patient safety. **

By replacing more and more of their paper-based system, and after implementing a comprehensive medication management system which enabled medical teams to let go of paper medication charts and rely completely on the  IT system, even within the ICU, medical teams quickly recognised the benefits of using this clinical information system on a daily basis. They could quickly access all patient data, worklists, and outstanding tasks through a smart phone app, a bedside computer or desktop PC, and even remotely.

Since the hospital understood the importance of our “from the ground up” approach, they were able to carry out this transformation in a controlled way, and in turn gain the support of all their employees. Today the children’s hospital already has several wards which no longer use any paper charts, and rely solely on our IT system. But more importantly, they now have a system in place with all the patient data stored centrally and independently of the applications that created it. This means that patient data will remain available for the lifetime of the patient, regardless of the IT solutions that might be deployed in the future. By ensuring that patient data will not be lost, regardless of the future evolutions of their IT system, patients can be confident that the medical teams will always have all the key details necessary to make the right decisions regarding their care.

** Safety improvements of implementing an IT medication management system are explained in more detail here: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2125.2007.02995.x/full