1. Paperless Hospital Amy Stayer

2. Objectives Describe Paperless Hospital Describe hardware/software Assess nursing implications Examine related legal/ethical issues Advantages/Disadvantages from nursing perspective

3. Paperless Hospitals Key Concepts Minimize the amount of paper Convert all forms of documentation to digital form The integration of all disciplines to one system Patient images & information are readily available Secured network

4. Introduction 5% of hospitals are computerized Electronic prescriptions to be mandated by 2010 Cutting the paper load Electronic health records within 10 years as mandated by President Bush in 2004 (McGonigle and Mastrian, 2009)

5. Computer based records may include: EHR {Electronic Health Record} Prescriptions Test order & result retrieval Physician orders & progress notes Messaging & reporting Documentation & vital sign recording Billing & coding

6. Lab Radiology Nursing Physicians Medical Records Coding Billing Order Entry

7. Paperless Model Being Used at the Altoona Regional Health System Picis ED Pulse Check Part of the CareSuite® family of high-acuity solutions The most comprehensive & well integrated ED information system {EDIS} in the industry. Combines triage, patient tracking, physician and nursing documentation. Combines risk management, charge management, prescription writing and other unique features. (Picis, nd)

8. Hardware used in the ARHS Emergency Department Flat Screen Monitors {10} Mouse Two printers {located in the nurses station} Keyboards

9. Software used in the ARHS Emergency Department Company name: Picis EDIS-Emergency Department information system Product name: ED PulseCheck ED PulseCheck is Web browser- based software Designed by clinicians (Picis, nd)

10. ED PulseCheck combines the following: Patient tracking Complete online ED record Real-time documentation for physicians and nursing staff Precise prescription writing Comprehensive charge capture Interoperability with hospital information systems (Picis, nd)

11. Benefits of Picis ED PulseCheck Quick and easy charting {check boxes & drop down menus} Proven 3 to 6 month payback with charge management Improved patient satisfaction {faster door to doctor times} Increased revenue & reduced costs Promotes patient safety Increased efficiency (Picis, nd)

12. Physician Order Entry

13. Nursing Documentation

14. Reported success with Picis ED PulseCheck at ARHS Initial return in investment in 6 months $175,000 savings in coding and dictation costs a year Doubled captured of charges monthly from $800,000 to $1.6 million Helps reduce denials for reimbursement Allows the ED to bill faster ( Picis, nd)

15. Usability Minimal Training Updates periodically Ease of use User friendly displays and tracking board Staff and patient satisfaction Increased efficiency

16. Advantages of Paperless Hospitals 24 hour access Reduces medical errors Prevents deaths by mistakes Alerts nurses and doctors to allergies Eliminates hard to read handwriting Eliminates transcriptions errors

17. Advantages of Paperless Hospitals Instant visit history accessibility Time efficient {decreased turn around time for test results} Assists with accurate billing Improves patient satisfaction Avoids duplicate ordering Can be used in inventory replacement

18. Disadvantages of Paperless Hospitals Costly to initiate with ongoing costs Continuous need for upgrades System failures Difficult transition as well as resistance to change Still generates paper HIPPA violations

19. Siemens Information System Synonymous with technological innovation and global business. They have a wide array of products and services. Their products help their customers in industry, energy and healthcare. They strive to help businesses meet their challenges and stay competitive. (Siemens, n.d.)

20. Siemens Healthcare Siemens medical solutions Siemens medical solutions health services Siemens diagnostics Siemens hearing instruments (Siemens, n.d.)

21. Siemens at Altoona Regional Health System Invision Patient Care Solutions: Online capture of assessments Invision patient care solutions help to streamline clinical workflow and enhance overall productivity. Enable improved interdisciplinary and interdepartmental communications. Support consistent communication of patient information. (Siemens, n.d.)

22. Siemens Invision Financials: A cost effective billing and receivables management solution. Access to patient accounting information through a web enabled browser. Helps streamline your patient accounting processes. Invision financials is complemented by and integrated with other Siemens Patient Financial Service Solution. (Siemens, n.d.)

23. Siemens Invision Clinicals: Supports the flow of patient information and resources throughout the healthcare continuum. Invision facilitates the support of an Electronic Health Record. Standardizes collection and structure of clinical information. (Siemens, n.d.)

24. Ethical/Legal Issues Computer hackers Potential for HIPPA violations- onscreen patient tracking board Access only to employees & departments with need System sign on- fingerprint or password sign on

25. Functions & Responsibilities of the Professional Nurse Minimize onscreen patient tracking board to protect patient privacy HIPPA rights and responsibilities- maintain patient confidentiality Keep passwords safe and to self Log off when walking away from computer

26. Competency Requirements of the Professional Nurse On the job training Attend updates and training seminars CEU’s

27. Summary A paperless system improves patient and employee satisfaction while reducing errors and preventing deaths. The Picis system used at the ARHS emergency department has proven to save money and monthly captured charges have doubled.

28. Summary The PICIS system at the ARHS is user friendly and requires only minimal training. It has an easy to read patient tracking board and the staff has 24 hour access.

29. References McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Boston: Jones & Bartlett Publishers. Picis (n.d.) ED Pulse Check. Retrieved November 4, 2008, from http://www.picis.com/products/emergency- department/ED-pulsecheck/default.cfm

30. References Picis (n.d.) Success Stories. Retrieved November 4, 2008, from http://www.picis.com/success/- stories/default.cfm Picis (n.d.) Take the crisis out of emergency management. Retrieved November 4, 2008, from http://www.picis.com/solutions/hospital- executives/ED/default.cfm

31. References Siemens (n.d.) Invision clinicals. Retrieved December 11, 2008, from http://www.medical.siemens.com/web app/wcs/stores/servlet/ProductDisplay ?storeId=100