In 2005, while reviewing its ongoing efforts to utilize technology to improve care, Minneapolis-based Fairview Health Services accelerated a plan to implement an interdisciplinary clinical documentation solution across its three metro hospitals.

One of the largest not-for-profit health systems in Minnesota, Fairview Health Services had achieved numerous patient care quality improvements in using clinical information technology at four of its seven hospitals since 2001 and was looking to further its use of automated tools to support care delivery. The health system planned to deploy Knowledge-Based Charting from Eclipsys, which includes clinical practice guidelines that support the full scope of practice for nursing and allied health professionals such as physical therapy, respiratory care and pastoral care.

Adding a clinical documentation system would aid the health system's effortstoprovideevidence-based practice and interdisciplinary care. It also would support the health system in reaching its goals of providing individualized care plans for every patient while enhancing its ability to meet Joint Commission standards for provision of care.

Sharing project control

Fairview Health System's unique approach to project management was to capitalize on the strengths of each discipline. IT had strong skills in optimizing how the clinical tool functioned within the existing technology environment and how it integrated with other clinical systems already in place. But clinical leaders really owned the practice and the workflow and were best positioned to spearhead the communication effort among disciplines. Where IT understood table management and data flow, clinical leaders understood the day-to-day workflow requirements of caring for patients.

With IT and Practice aligned, the health system moved forward with a plan to implement the clinical tool one hospital at a time, with the first activation planned for the 419-bed Fairview Southdale Hospital in Edina, Minn. In November 2005, with an unannounced Joint Commission visit pending at the community hospital, the clinical project leaders worked in tandem with Eclipsys to begin assessing and improving workflow, culture and care practices. Their ambitious goal: to go live with the solution in nine months.

As Fairview Southdale's chief nursing officer and vice president of patient care, my role was to serve as executive sponsor of the project. Additionally, the hospital's president was heavily involved in the project, providing administrative support and helping clear the way so the project team could dedicate itself to the effort. Representatives from a wide variety of disciplines worked together to develop a new mode of interdisciplinary communication and workflow. Interestingly, the effort helped us to redefine the way that clinicians interact with each other and with each patient.

As we moved forward to clarify scope-of-practice recommendations and customize clinical content, Fairview Southdale's clinical leaders worked closely with their counterparts at Fairview Ridges Hospital and University of Minnesota Medical Center, both scheduled for subsequent implementation of the clinical documentation system.

Over 740 nurses and allied health providers learned to work with the solution's automatically generated, problem-linked interventions and expected outcomes. The clinicians came to appreciate the value of customizing the guidelines to establish the foundation of an individualized plan of care for each patient.

As the hospital approached go-live, training efforts focused on a two-phased classroom experience. Groups of 12 to 15 clinicians first walked through the new practice regimens and then proceeded through case study scenarios in the "point-and-click" environment to become comfortable with the software. Once the system went live, more than 100 super-users dispersed to provide staff support for all shifts. To augment training, we placed "playstations" in each unit so clinicians could continue their training independently.

Succeeding with go-live

Fairview Southdale went live with a big-bang activation of clinical documentation in July 2006. Five weeks later, The Joint Commission arrived for an unannounced visit. The hospital achieved compliance on each of the eight standards for provision of care, including 19 measures ranging from pain assessment to interdisciplinary documentation. Surveyors noted the accessibility of the guidelines and the high degree of plan-of-care individualization. There were no requests for improvement.

With the system in place, the percentage of patients with individualized care plans jumped from 13 to 100 percent, and interdisciplinary team involvement in patient education rose by 17 percent.

Additional implementations followed: Fairview Ridges Hospital activated the clinical documentation solution in September 2006 and University of Minnesota Medical Center is set for a go-live later this year.

Beginning a transformation

At Fairview Southdale, the implementation was just the beginning of an ongoing practice-transformation journey. By eliminating silos of information, the hospital is increasing its ability to provide truly interdisciplinary care. For example, the hospital has up to four allied health professionals charting on each education flowsheet (as opposed to just one nurse in our previous environment). Today, we have less care-practice duplication and clinicians build off of each others' efforts.

Additionally, the use of evidence-based guidelines has proven to be much more effective than previous methods of care. Nurses now update entry-point patient assessments directly into computers when making rounds, a practice that enhances patient satisfaction and caregiver insight. And with knowledge support and patient-specific information easily available at clinicians' fingertips, an improved level of communication during patient handoffs helps clinicians manage shift change more efficiently while improving patient safety. Now all caregivers work with the same patient plan and documentation, a process made easier with clinical summary screens tailored to various disciplines and patient populations.HIE

Ms. Pechacek is vice president of patient care and chief nursing officer of Fairview Southdale Hospital in Minnesota. She can be contacted at JPECHAC1@Fairview.org.