1 ADVANCE for Executive Insight

CIO Perspective
Extensive planning in the selection and implementation
of IT projects can result in measurable benefits,
but organizations must stay focused on true
drivers for technology implementation in order to
avoid ‘paper benefits.’
sion assessment. At the onset of a new clinical
system implementation, the nursing staff identified
issues with the time required to document
an admission assessment. Time studies
conducted to validate anecdotal observations
showed that the average admission assessment
took 45 minutes. Nursing leadership felt that
improved technology should reduce this timeframe
and established that objective as a project
success metric.
After working with IT staff and the vendor,
the nursing team felt that the documentation
time could be reduced by 15 minutes using
the new system. A multidisciplinary team including
IT, nursing, ancillary clinical areas and
others met to review the assessment process.
Problem lists were consolidated and streamlined.
Documentation tools were revised and
mobile carts were introduced to permit bedside
documentation.
The result of this work was a reduction in the
average time to document an admission assessment
from 45 minutes to 27 minutes. Certainly,
the outcome was positive and the goal was attained,
but did the hospital see value from this
increased efficiency? The math shows us that
if the hospital admits 100 patients per day on
average, the annual time savings amounts to almost
11,000 hours or nearly 5 full time equivalent
positions.
Unfortunately, this is ‘marketing math’ and
often does not translate to the ability to reduce
staffing levels since small time savings may be
difficult to aggregate effectively. The lesson
learned was to ensure that the true intended
value of any measureable benefit is understood
and that metrics are set appropriately.
To be sure, the time savings had benefits in improved
documentation and enhanced nursing
satisfaction, but those are difficult to translate
to hard value.
Barcoded med administration implemented
to improve patient safety and reduce
documentation time. The introduction of barcoding
to the medication administration process
has clear benefits in terms of the reduction
in avoidable medication errors. Additionally,
vendors also made claims that their systems
would improve nursing workflow and enhance
medication charge capture.
While the rationale for implementing this
technology is grounded firmly in patient safety,
the organization conducted audits of medication
charges and found that nurses were often
double documenting medications. Rather than
doing all documentation online, some RNs were
documenting on paper in real-time and going
back later in the shift to document electronically.
The audits found that the nurses documented
100 percent on paper, but failed to complete
the electronic documentation 3.7 percent of the
time. Since the medication charges flow from the
electronic documentation, the resulting gap was
an obvious improvement opportunity.
A new process was streamlined in that documentation
would take place in real-time at the
bedside. Mobile carts with computers and lockable
medication drawers were introduced to
enable nurses to bring the medication and documentation
system to the bedside. Documentation
at the bedside was a significant disruption to
nursing workflow and initially slowed down the
nursing staff. However, by working closely with
nursing leadership, the use of barcoding was
standardized and the result was better charge
capture without loss of nursing productivity.
Evaluating Workflows
Incentives are an excellent inducement to implement
or upgrade clinical systems. However,
clinical system implementations are complex
and rushing through them can ultimately result
in negative impacts. Carefully consider what
efficiencies your organization is attempting to
achieve by implementing new technology. Ensure
that the measures are clear and translate directly
to the desired benefits as in the case of time
savings and FTE reductions. Evaluate workflows
and processes carefully to make changes that are
aligned with the flow of the new system. Proper
planning will provide strong and lasting benefits
to the organization.
30 ADVANCE for Executive Insight