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North York General Hospital Awarded Prestigious IT Award for EHR Success with eCare

Rationale / Objectives

North York General Hospital (NYGH) paired with the healthcare technology company Cerner in 2007 to integrate an effective EHR system into their healthcare delivery model. This project aimed to optimize NYGH’s core value which is to prioritize patients first by preventing errors and saving lives, while also increasing efficiency and avoiding unnecessary costs. 

Project/Program Description & Major Achievements

eCare is an integrated medical information system that improves the quality and safety of care delivered by clinicians. Using their multi-step advanced integrated information system eCare, NYGH found success in administering medications to patients, entering orders into a patient’s electronic health record (EHR), making evidence supported decisions with patients in real-time, and seamlessly transferring data from patient monitors to the EHR.2

Major achievements by integrating eCare into practice included:

  • Saved approximately $31 million by eliminating errors through proper medication reconciliation over a six year period;
  • Dramatic decrease in patient deaths and medical incidents such as Venous Thromboembolism (VTE) that can cause heart attacks, strokes, and death;
  • High rate of implementation and use of electronic medical orders by both physicians and patients, which lead to direct error-avoidance; and
  • Recognized with the prestigious 2016 HIMSS Davies Enterprise Award.

 

Lessons Learned

NYGH recognized flaws in the existing paper-based patient medical history process. The hospital was successful in implementing an integrated advanced technology to improve patient experience. With an advanced IT system that allows real-time support, clear communication of medical information, alerts to assist physicians, etc. NYGH provides safer health care to patients and avoid unnecessary costs to achieve efficiency. The eCare project implements evidence-based order sets with CPOE, clinical documentation, and CLMA with its barcode scanning functionality and clinical decision support tools. These electronic tools provide clinicians with the right resources to make it easier for them to accomplish high quality and safe care for patients. 

Further Description

North York General Hospital transformed the inconvenient paper healthcare delivery system into an integrated electronic eCare system. Medical errors such as improper assignment of medication or inconsistent tracking of patients’ home / new medications threatened patient safety and decreased quality of care. Poor handwriting, transcription of medical information and ineffective / slow transfer of patient data resulted in financial loss and threatened patient safety. Paper processes that were widely used by hospital systems were unreliable, inconvenient, inconsistent, and difficult to use. This was reflected in the low compliance rate of both patients and physicians with responding to and following up with medical orders as required. A low rate of complete use of medical orders by both patients and physicians leads to medical errors and a disconnect between the healthcare provider and receiver. However, with eCare, NYGH avoided spending tens of millions of dollars by simply eliminating preventable medical errors and incidents as much as possible. Different aspects of eCare achieve different objectives. The Computerized Provider Order Entry (CPEO) allows clinicians to enter treatment orders electronically which eliminates flaws like misinterpretation and the inability to mobilize data efficiently amongst healthcare providers. CPEO also provides clinicians with the latest evidence and best proven practices from medical literature, keeping them informed with up-to-date resources to develop a patient’s treatment plan. Another function called Closed-loop Barcode Medication Reconciliation (CLMR) assists clinicians when they administer medications to patients electronically by alerting healthcare providers about potential errors and uniquely identifying each patient’s medications. NYGH is the first hospital in Canada to implement barcode scanning of medications. The CLMR aims to create the most accurate list of patients’ medications by recording drug name, dosage, frequency, administration route, etc. and compares it to other forms to ensure consistency and correctness. These electronic tools make it easier for clinicians to “do the right things” to provide high quality, safe healthcare to patients.

Major Achievements

Problems When Using Paper Processes

Improvements With eCare

The paper-based medical process can cause medical incidents and errors that lead to the loss of tens of millions of dollars.

  • Saved approximately $31 million by eliminating errors through proper medication reconciliation over six years
  • $1 million saved by reducing VTE incidents and increasing VTE prophylaxis rates from 50% on paper to 97% with eCare
  • Retained more than $5.7 million by avoiding over 11,000 potential medications using CLMA

 

Paper processes lead to medical errors that threaten patient safety. These errors prevented NYGH from providing the highest possible quality of care.

 

  • Decrease in the probability of inpatient death from pneumonia and COPD by 56% over five years, saving an estimated 120 lives from these conditions
  • Decreased VTE incidences by 39.2%, which is approximately 40 different types of cases of VTE avoided

The paper-based inefficient system discouraged both patients and physicians alike from effectively filling out necessary forms. Patients often did not provide follow up information to their physicians and EHRs were often found to be inconsistent across different healthcare providers for the same patient.

  • Increase in percentage of patients that receive medical orders at admission from only 36% with paper to 97% with eCare
  • Increased number of patients that reconcile their medications at admission from 7% (with paper) to 45% (with eCare) and at discharge from 9% to 70%, allowing physicians to track a patient’s home/new medications
  • 92% of physician orders now entered via CPOE, leading to approximately 1,300 potential medication/patient mismatch errors averted, since eCare’s second phase launch
  • Estimated 7,700 unintentional adverse drug events and 11,000 potential medication errors prevented over the past 10 years (2007 – 2017)

The nationally leading Community Academic Hospital attained many goals allowing them to be recognized with the 2016 HIMSS Davies Enterprise Award. This award is presented to only 50 hospitals globally – NYGH is the first hospital in Canada to be awarded this IT honour. The Davies Enterprise Award recognizes outstanding achievement of organizations who have utilized health information technology to substantially improve patient outcomes and value.1