Background

Calvary Health Care Bethlehem is a Victorian hospital that has served the community for over 85 years, and specialises in patients with complex palliative care needs and provides care, on a statewide basis for patients with progressive neurological diseases. Bethlehem is part of a the Calvary Health Care wider group of 15 Public and Private Hospitals, 15 Retirement and Aged Care facilities and 22 Community Care centres which operate nationally in Australia. Calvary is a charitable not-for-profit organisation with more than 12,000 staff and volunteers.

Within six months of speaking to Calvary Health Care in Australia they had signed a contract to start using Vitro, the clinician centric EMR at Bethlehem Hospital. Like many hospitals, Bethlehem Hospital wanted to;

• Capture all clinical data electronically
• Achieve even better quality of care and patient outcomes
• Spend less time on administration and more time with their patients
• Realise efficiencies and cost savings
• Improve the quality of patient information and collaboration, and
• Have a solution that the users engaged with and didn’t take away from their work.

The Calvary Health Care group planned a parallel project which took a core suite of their forms to be used as a National electronic End of Bed Chart, for use across the group’s private hospitals. The suite required all aspects of clinical workflows for Orthopaedic and General Medical, Surgical and Oncology.

Challenges

The challenges that Bethlehem Hospital experienced were similar to that of many hospitals without an electronic medical record or those using a not fit for purpose solution. The particular challenges that Bethlehem wanted to address were;

• Patients with progressive disease and complex needs require a multi-disciplinary team with many clinicians simultaneously looking after each patient. The availability of the single paper chart to simultaneous care givers caused challenges in being able to provide the best care to their patients.
• The high quantity of records and costs associated with paper records, relating to storage, management, retrieval.
• Identifying a solution that could be implemented in both large and small hospitals efficiently and that would be scalable.
• Identifying a solution that could be used both in the hospital and in the community and that staff would quickly adapt to and not hinder their everyday work.
   

Solution

Vitro was implemented within six months end-to-end providing Bethlehem Hospital with a completely paperless environment where all clinical data was being capturing electronically. The project team which included staff from both the Vitro team and Bethlehem team worked together to identify and review the existing paper forms of which there were 197 in total. During the review process it became evident that streamlining and efficiencies could be created, the opportunity was taken to assess the requirements of the hospital which resulted in the reduction to 67 forms which would be converted into Vitro Apps.  This streamlining was achieved though Bethlehem’s own review process combined with Vitro’s functionality which enabled workflows between Apps and, automatic data population between Apps.

The configuration of the Vitro platform, App development, integration and the implementation processes began. The Apps included all aspects of clinical work flow from progress notes and care plans to interdisciplinary discharge summaries, while integrating with the Medchart and iIPM, applications that were already in place in Bethlehem.  As avoiding disruption to the ongoing function of the hospital was paramount to both Bethlehem and the Vitro team; review, testing and the management of the work in progress records were carefully managed. Go-live went as planned and the Vitro team were only required on-site for three days post go-live.

Results

Bethlehem Hospital saw immediate benefits in terms of user adoption, the increased quantity and quality of data captured, the simultaneous accessibility of records by multiple clinicians and the economic benefits seen from the start of paper elimination. Additionally;

• There was more than 90% decrease in the time taken to audit medical records.
• There has been a 95% improvement in the completion of clinical documentation.
• There has been a 75% saving in the costs associated with becoming paperless and these costs are continually decreasing.
• The collation of information for freedom of information requests has been reduced by over 80%.

 
"From an adoption point of view, quite a few nursing staff have been surprised at how easy it has been to use. Since the implementation of Vitro, patients have commented on the presence of staff closer to the patient’s bedside they’re not having to be at the central nurse’s station because they have got access to various workstations around the ward.” Belinda McRae – Nurse Unit Manager

"Given the time if you talk about 6 months from ‘woe’ to ‘go’ in terms of getting to the point of implementation it was amazing and I’m not aware of any other site or service that has introduced any form of electronic record that have been able to achieve that. I’m very proud of the work that we’ve done but also very proud of the work that we’ve done collaboratively with Sláinte Healthcare." Shannon Thompson - Director of Clinical Services

"Yes we are saving a lot of time by not looking for histories. Clinicians are also able to write their notes and complete their stats on the day that they see the patient and we were never really able to do that before." Maryanne McPhee – Manager Statewide Progressive Neurological Disease Service

"The added extras that we put into Vitro for our application were our safety features that we were able to put into our clinical charts that allow us to ensure things are correctly filled in, that we don’t miss important information or even just that numbers aren’t added up correctly… so for us they were incredibly important features to enhance safety in our clinical notes. The thing we liked about Vitro technology was that it was intuitive so what we were doing there was looking at the charts as they were in paper and digitalising them so to a nurse on the unit they just look at a piece of paper and it will look the same." Brenda Ainsworth – National Director Public Hospitals

"I only use a computer for work purposes I don’t use them in my leisure time, I found it really easy. To tell you the truth I have shown people in my department certain things that are available because it is so easy to use and scroll through." Joanne Patira – Allied Health Assistant Physiotherapy

Phase Two

Throughout the six month implementation work progressed for the National End of Bed Chart project which has now been implemented throughout the Calvary Health Care group. This has enabled Calvary to standardise the provision of care across the group, the electronic end of bed chart contains all aspects of clinical work flows for Orthopaedic and General Medical, Surgical and Oncology

www.calvarycare.org.au  

What the Video

Watch the video about how Vitro delivered an EMR for Calvary Health Care Bethlehem, Australia, enabling the hospital to go completely paperless.