SUCCESS STORY: Akron General Medical Center

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Enhancing Patient Safety Reduces Costs

Akron General Medical Center is a 537-bed, adult, tertiary-care, not-for-profit teaching hospital that serves a population of more than 1.2 million people throughout five counties in Northeast Ohio. It’s ranked among U.S. News and World Report’s “America’s Best Hospitals,” Solucient’s “Top 100 Hospitals” in the nation, and was named a Consumer Choice Award winner for 2005-2006 by the National Research Corporation.
Technology is increasingly tied to healthcare today; and has become an important part of Akron General’s daily efforts to improve patient care. For example, the medical center’s physicians now have wireless access to patient charts and test results —in real time— inside the hospital and from their offices. The hospital also employs advanced workflow-based applications through MedPlus ChartMaxx for Patient Accounts.


The software program combines a patient’s financial and clinical data into one complete system, an approach that streamlines processes from registration to final billing and makes them more customer-friendly. And technology came to the forefront again, when the medical center’s leaders turned their attention to enhancing systems for patient safety and identification.


“In the past, we used blue cards, imprinters and embossers,” says Roger Edgington, Senior Project Leader for Akron General Medical Center’s Health Information Management department.


“But we found that the identifiers on many of our chart forms were illegible. We needed documents that were identifiable during the patient stay, and after discharge, when the forms became part of our electronic imaging system.” Akron General Medical Center utilizes McKesson Plus 2000 as its HIS system and MedPlus ChartMaxx for document storage and retrieval. They needed a software program that could interface with both systems. Xerox Global Services, a vendor to Akron General, recommended that hospital leaders consider FormFast. After conversations with several vendors and site visits to facilities using forms on demand software, the hospital signed a contract to add FormFast to its facility. Edgington and his team quickly discovered that FormFast not only helped them increase patient safety and security, it also offered many unexpected benefits along the way. It’s a success story born of software design and excellent project management on the part of Akron General’s staff.


Once the hospital signed its contract with FormFast, Edgington and his team were charged with making the implementation a reality. The team decided to start the process in Admitting and the Psychiatric inpatient units. They developed the necessary registration forms and added bar code symbology (for use with medication administration and identification verification).


They assigned electronic numbers to each form and then developed packets so that forms that were generally used together could be ordered as a group, which streamlined the process even further.“This is the beauty of FormFast,” adds Edgington. “Before, our packets were assembled by volunteers. Now, the unit clerk orders forms directly through the computer. They’re generated in the correct order, and already labeled.” This convenience extends to commonly used forms as well as forms that might be needed only occasionally.


The implementation team worked diligently with unit clerks and area directors on those first implementations to ensure their satisfaction with the new system. Once they had buy-in from these key groups, the initial users became champions of the system throughout the hospital. The system went live in the Admitting and Psychiatric departments in December 2004 and quickly gained momentum. Ten months later, the medical center has 523 forms in production, has printed more than three million pages, and has realized tens of thousands of dollars in cost savings on pre-printed forms. As an added benefit, the medical center put all of its forms under close scrutiny: the medical center’s Forms Committee reviewed every form for JCAHO-compliance and duplication. “The conversion process really gave us a great opportunity to get our forms cleaned up,” Edgington adds.


The addition of FormFast has also made regulatory and protocol changes to forms easier and more efficient. Where changes previously took months to work through the system—with no guarantee that all old versions of a form had been eliminated—changes can now be processed and made available within days. “We really look at this system as a “cost avoidance” prospect,” explains Edgington. “Under our old system, if we discovered that a form used abbreviations that were not approved by Joint Commission, we’d have to correct the problem and destroy all the old forms. A single change might cost $5,000-$10,000 in wasted materials. We don’t have to do that with FormFast. If we have a change, we make it once, and then all forms from that point forward are printed with that correction. With FormFast, our materials management will realize a huge drop in costs over time.”


The addition of FormFast has also streamlined the process of scanning forms for medical records. “Scanning gets arduous if you don’t know what to call a document,” says Edgington. “Under our old system, we used forms created by an outside vendor. Now we can create forms & affix bar codes in-house, so that when a chart arrives for scanning into the electronic record, it can be handled with very little preparation.”


Another frequently encountered problem encountered with mutli-part forms was remembering the correct order of distribution to other departments. “Now, the name of each department recipient is written at the bottom of each page. And every copy—whether it’s the first or the fifth—is legible.”


The same system that the medical center has followed for converting existing forms is also applied to the creation of new forms. “With our new system, we create a form, add a bar code and roll it out to our production side. We update our HIS system and the form is immediately available system-wide.”


A unique feature—and secret to the success— of the forms conversion process at Akron General has been the internal procedures put in place to monitor the forms. “Our audit trail on forms is unique,” says Edgington. “It’s a simple procedure, but it’s also very effective.”

Here's how it works:
The implementation team created a spreadsheet that lists the estimated 1,200 forms in use at the medical center. Information on each form includes: the originator of the form, the name of the form, its assigned electronic number, and its placement in the electronic medical record. Forms are also assigned a “short name” (the name commonly used by hospital staff). The spreadsheet tracks each form at every stage in its life at the medical center—whether it’s a PDF or other format and the dates of revisions. In the conversion from paper to electronic formats, each form goes through a verification process to confirm that the form is the correct version and has been approved by the Forms Committee. Once approved, the form is placed in the system for use. . “It’s a team effort,” says Edgington.
Akron General Medical Center has experienced tremendous success with FormFast and ChartMaxx; but Edgington admits that the process has taken a lot of work. “The biggest part of this process is the learning curve,” he says. Communication is also essential. Edgington also advises other hospitals to be prepared to address “surprises” along the way. “For example, we converted a pre-printed, multi-part form that we wanted to look exactly as the user expected. To do this, we had to set up multiple printer drawers, and we had to lock down the printers so that the settings were consistent. FormFast helped us with the design, and our printer vendor, HP, helped us secure the printers. Once this was in place, we rolled it out on the nursing units, one after another.”


The multitude of benefits that Akron General Medical Center achieved thorough its forms conversion program have received high marks from caregivers and support staff throughout the hospital. Satisfied users continue to seek out Edgington and his team with their feedback, “I had one doctor who told me he thought the system was ‘great’. He said he was on a division and needed new orders. That’s something that would have involved the unit clerk searching for forms and stamping them, all while the doctor waited. Now, it’s a matter of waiting four or five seconds for the orders to come through the printer.” And remember the issue of legibility that started this process? Edgington reports that when the process began, only 55% of all stamped records were legible. That number is now at 95%. But true to form, he’s not satisfied, “We’re shooting for 100%,” he adds. At Akron General, that’s business as usual.