As one of Houston's largest and oldest non-profit health systems, The Methodist Hospital System has a long history of providing innovative patient care. Extending the world-renowned clinical and service excellence of its founding entity, The Methodist Hospital, the health system ranks among the country's top hospitals for neurology and neurosurgery; urology; ear, nose and throat; psychiatry; ophthalmology; and gynecology in U.S. News & World Report's 2006 annual guide to "America's Best Hospitals."

In 2004, the health system was looking to establish a single electronic medical record (EMR) through its network of community-based hospitals. Doing so would provide Methodist's clinicians easy access to the latest and most complete patient information, regardless of their point of decision-making.

Additionally, the health system was looking to streamline its IT efforts by reducing the number of interfaces required between systems and simplifying system maintenance.

After an extensive analysis, a multidisciplinary team of physicians, nurses and senior management chose Sunrise Clinical Manager from Eclipsys for the solution's ability to support the health system's strategic goals to improve patient safety and advance thedeliveryof high-quality health care. Also important was the ability to integrate systems, rather than interfacethem.

A new 'MethOD'

Methodist established clinical technology goals to replace the existing clinical documentation system withadvanced tech-nologythat includedresults review, computerized physician order entry (CPOE) andinterdisciplinaryclinical documentation, amongother tools.

With a threefold project management strategy focusing on workflow, clinical adoption and change management, the health system proceeded with an aggressive implementation strategy to encourage everyone to work together to turn on the system quickly and according to plan.

In November 2004, a marketing campaign helped to kick off the project. A contest held for staff members to name the project proved fruitful: Methodist Online Documentation, or MethOD, became our moniker and proactive communication efforts kept the project at the forefront for employees.

The health system's board of directors and CEO led the project and a steering committee provided clinical and IT guidance while supporting the nursing informatics group, the physician advisory group and the project management team. Because we viewed the initiative as a patient care project, we selected a nurse executive and a physician executive as official project sponsors.

We simplified the project structure to encourage efficiency, and the project team met weekly (occasionally three times a week) to move the project forward.

Twice a month we gathered with our vendor to check progress and keep open communication lines. We made project decisions with consensus from a nursing informatics group, a physician advisory group and a clinical steering committee that spanned all four hospitals.

Go-lives span the system

The hard worked paid off. In March 2006, Methodist Sugar Land Hospital became the first hospital in the organization to activate the new system, with a two-phased implementation plan that included CPOE, results, vital signs, a pharmacy interface and the electronic medication record (eMAR). The hospital brought online clinical documentation approximately eight weeks later, a model that we successfully replicated in subsequent implementations across the system.

The Methodist Hospital followed in May 2006. Using a big-bang approach, the hospital activated CPOE, results, vital signs, patient intake and output flowsheets, and the eMAR. It also incorporated more than 29 interfaces in addition to worklists to support our clinical specialty departments.

Methodist Willowbrook Hospital went online in August 2006, with CPOE, results, vital signs, and patient intake and output flowsheets, and added clinical documentation and device interfaces in October 2006. A fourth hospital, San Jacinto Methodist Hospital, is slated to go live in August 2007.

MOD Squad provides support

An important contributing factor to our success is a strong super-user support system. As part of that effort, we established a command center to manage the go-live and support for Methodist's 3,000 end users. A team of 400 super-users, which was nicknamed the MOD Squad, provided go-live support.

We trained all 170 IT employees on MethOD, and split the Methodist Help Desk so that we could provide first-level support for MethOD and continue to provide operational support.

Adoption exceeds expectations

With the system in place, medical staff can complete administrative work more quickly, enabling them to spend more time caring for patients, thus improving the quality of care. The CPOE system communicates orders immediately to nursing flowsheets, eliminating delays that slow the care process and making it easier for The Methodist Hospital team to work together more efficiently. Physicians are already placing orders at rates beyond our initial expectations (and interestingly, without extra encouragement on our part). In fact, within the first two weeks after go-live, physicians entered more than 50,000 orders, and system adoption continues to grow.

We also plan to integrate best-practice clinical practice guidelines into the clinical system at all four hospitals to enhance critical thinking across the interdisciplinary team. Project management that kept us on time and on budget has guided us toward the clinical transformation we were seeking.

Mr. Vuchak is vice president of information technology at The Methodist Hospital System, in Houston (www.methodisthealth.com). He can be reached at JVuchak@tmh.tmc.edu.