Hospital Improves Staff Efficiency by Automating Patient Order Form Distribution

Microsoft Office System Customer Solution Case Study

Overview “We didn’t spend a lot of money on a third-party Country or Region: United States automated physician order entry system; we used a Industry: Healthcare solution based on the Microsoft Office System. It Customer Profile met our needs and integrated into our workflow.” In Richmond, Indiana, Reid Hospital & Health Care Services is a not-for-profit Jason Buckner, Information Services Manager, Reid Hospital & Health Care Services 233-bed regional referral medical center, employing approximately 1,600 people Reid Hospital & Health Care Services is guided by a mission of who use about 1,000 personal computers. treating patients in body, mind, and spirit. Reid’s 169 physicians and medical specialists manually filled out patient order sets— Business Situation Reid wanted to eliminate delays in paper forms that describe care instructions. Nurses and clerical patient care caused by illegible patient staff, who entered orders into Reid’s medical system for other order sets. It needed to replace its paper forms with user-friendly, electronic care providers to access, often had difficulty reading the versions. handwriting. Confirming orders with doctors wasted time and

Solution delayed patient care. In response, Reid deployed a clinical form

Reid deployed a cost-effective, intuitive, automation solution, based on the Microsoft® Office System, automated solution for clinical forms based on Microsoft® Office System which has solved 100 percent of patient order legibility issues, technologies. improved medical and nursing staff efficiency, and reduced

Benefits delays in patient care. At a fraction of the cost of third-party  Eliminates by 100 percent the solutions for physician order entry, the hospital is building its incidence of illegible patient order sets, and therefore the potential for error in own solution with familiar desktop tools that require no patient care due to illegible order sets specialized training.  Improves staff productivity  Helps reduce delays in patient care  Improves Reid’s ability to conform to national standards of care “For Reid, the Situation William M. Ducey, Chief of Surgery at Reid Reid Hospital & Health Care Services is a Hospital & Health Care Services. business value of not-for-profit 233-bed regional referral “Everyone recognizes that handwriting is making use of an medical center serving east central Indiana inefficient, and it’s prone to errors in and west central Ohio. In 2005, Reid had interpretation. Doctors can spend up to a existing flexible and 12,576 inpatient admissions and more than half-hour completing a single patient order integrated Microsoft 50,000 emergency room visits. set, which can contain several orders. If any of the information is illegible, nurses infrastructure—as Reid is accredited by the Healthcare have to confirm the orders with the doctor. opposed to buying a Facilities Accreditation Program (HFAP). This wastes everybody’s time and delays The accreditation process ensures that patient care.” third-party solution and health facilities meet national standards of trying to incorporate care and suggests areas of improvement in Doctors complete the appropriate order set hospital policies and procedures. During by drawing a line through the orders they that into its systems Reid’s last HFAP accreditation, the audit don’t want and initialing the required items. and workflow—was highlighted a common problem in Often, they write extra orders and healthcare facilities: the illegibility of patient instructions on the bottom of the form. very clear.” order sets filled out on paper by attending Completed forms are then faxed or hand- Greg Aaron, Director, National Healthcare medical staff. delivered to the ward clerk on the patient’s Practice, Quilogy ward, who confirms the order with a nurse Patient order sets form the basis of all and a head nurse. Once the order is patient-centered care in a hospital. Every confirmed, the clerk enters it into the facet of a patient’s treatment—admission hospital’s Siemens medical order system. If orders; medication; lab tests and imaging the order was meant for the nurse on the studies; medical equipment orders; and patient’s ward, he or she can go ahead and dietary, respiratory, physical therapy, and carry it out. Otherwise, care providers in nursing orders—originate from an order different departments—for example, form completed by the attending or radiology—can access the instructions consulting physician. At Reid, there are 250 from Siemens and execute the doctor’s different patient order sets. Instructions on orders. a patient’s order forms are communicated to the various medical and clinical staff “Often, it is difficult to read the handwritten members throughout the hospital, who orders, so the clerk, nurse, and sometimes carry out the instructions to make sure even the pharmacist all look at the order each patient receives appropriate and and still cannot figure out what was written timely care. Reid’s goal is to ensure the on the order sheet,” says Debbie Eckhoff, seamless and efficient flow of the correct Director of Nursing Practice at Reid patient orders to the appropriate staff Hospital & Health Care Services. “We then members, thereby enabling the highest- have to track down the doctor to confirm quality care. the order. This could mean chasing the doctor down the hall, or calling him or her Struggling with Inefficient, Paper- back at the office. After hours, all we can Based Orders do is talk to the on-call doctor, who didn’t “We had a problem achieving efficient write the order in the first place. During this communications between the medical staff time, none of us is being productive and and other care providers because the care could be delayed for the patient.” process was paper-based,” explains Dr. According to Pharmacist Mary Alexander, Reid Hospital & Health Care Services. “We all the prescription orders are faxed to the liked what we saw; however, as we pharmacy, where pharmacists pick out the became pressed for time, we approached medication orders to enter into the Medical Microsoft to recommend a technology Administration Record (MAR) system. “If I partner that had expertise in InfoPath 2003 can’t read the order, I have to phone the and the healthcare industry.” doctor. If I don’t reach him or her right away, there’s a delay in filling the Solution prescription.” After seeing a collaborative healthcare demonstration from Microsoft® Gold Evaluating Physician Order Entry Options Certified Partner Quilogy, Reid was excited “We’ve wanted to improve physician order to begin helping doctors, clerks, nurses, entry for a long time,” says Jason Buckner, and other medical staff to collaborate more Information Services Manager at Reid efficiently by automating the entry and Hospital & Health Care Services. “Because implementation of patient orders. the doctor can complete and sign a patient order anywhere in the hospital, we wanted “Quilogy proposed a Microsoft Office to create an audit trail of when the orders System–based solution, which made so were completed by the physician and much more sense to us,” relates Buckner. when they were entered by the clerical “Instead of buying a very expensive staff. That way, we could also measure our solution that had more functionality than we compliance in reducing the delays we had need right now, we saw the benefits of been experiencing.” using lower-cost Microsoft technology that we are familiar with to achieve immediate Reid investigated commercially available results.” solutions for automated physician order entry but found that they were expensive Taking Advantage of Technology and the graphical user interfaces were Investments confusing. It took more time to complete Reid standardized its 1,100 desktop the digital forms than it did to write the computers on Microsoft Office Professional forms manually. “We were never going to Enterprise Edition 2003. The hospital had get the physicians to accept a system that already supplied all physicians with Tablet they had to learn and that didn’t PCs running the Windows® XP Tablet PC immediately save time,” says Ducey. “We Edition operating system and had installed saw the benefits of a computerized solution a wireless network throughout the campus, that would integrate with our back-end as well as hard-wiring the doctors’ offices. systems, but we had to find one that we The Tablet PC offers the physicians all the could tailor to our needs and that the capabilities of a desktop computer, plus the doctors would find more intuitive.” convenience of choosing pen-based computing or the use of a traditional Reid’s IT department began investigating keyboard. Because the Tablet PC has built- ways to build a solution using readily avail- in wireless access, doctors can access the able, user-friendly technology that would hospital’s information resources, including ensure adoption by the medical staff. “We patient information, from anywhere in the went to the Microsoft® Web site and read hospital or from their offices. case studies about Office InfoPath®,” recalls Jon Wesmore, a Systems Analyst at The hospital had also deployed the He or she can select a patient from a list of Microsoft Windows Server™ 2003 current cases, and the solution presents a operating system, which is part of Microsoft hierarchy of forms from which to choose. Windows Server System™ integrated Once a form is selected, the solution opens server software, and migrated to the Active an InfoPath-based form, and the doctor can Directory® service. As the authentication use the Tablet PC pen to complete it, tool, Active Directory aligns each doctor’s adding extra comments if necessary. For access to network resources with that those doctors not using the Tablet PC pen doctor’s assigned role in the hospital’s for their signatures, Quilogy built a function organizational structure. that enables physicians to enter their user name and password, which are “Reid had already made significant steps authenticated against the Active Directory toward laying the foundation for a Microsoft service when the Submit button is clicked. collaborative healthcare solution,” says When the form is completed, doctors can Greg Aaron, Director of Quilogy’s National remotely print the order form at the nursing “Instead of buying a Healthcare Practice. “For Reid, the station closest to their patient. Nurses are very expensive solution business value of making use of an existing immediately notified by pager when a new flexible and integrated Microsoft patient order set has arrived and told where that had more func- infrastructure—as opposed to buying a it was printed. With no further delays or tionality than we need third-party solution and trying to incorporate guesswork, nurses retrieve and read the that into its systems and workflow—was order. They can execute any nursing right now, we saw the very clear.” orders right away, and the clerk can benefits of using lower- immediately enter the order set into the Building a Solution More Efficiently medical system. cost Microsoft Quilogy and Reid’s Information Services technology that we are (IS) department worked to translate the first “The Quilogy consultants worked hard to patient order set into the Microsoft Office achieve the remote printer function,” recalls familiar with to achieve InfoPath 2003 information-gathering Wesmore. “Working with a responsive immediate results.” program so they could show the doctors partner and a technology that we could the proposed automated forms solution, tailor to our needs was very satisfying.” Jason Buckner, Information Services dubbed Physician Order Entry–Lite (POE- Manager, Reid Hospital & Health Care Lite), and ask for their feedback. Quilogy Ducey concurs: “As a small user group Services then worked to translate six other order partnering with Quilogy to build a solution sets into their InfoPath equivalents. The with user-friendly tools and technology, InfoPath templates are stored in the we got action right away based on our hospital’s file system, and the completed feedback. Instead of using another forms are all stored in a database in company’s static product, we are building Microsoft SQL Server™ 2000, which is also our own solution, using our own order sets, part of Windows Server System. and committing them to electronic format in the order we want.” A pilot group of six doctors tested the new InfoPath-based order sets, including the In just nine months, Reid has gone from no electronic equivalent of Newborn Nursery automated forms to 9 order sets in produc- Orders, Adult Diabetic Protocol, and Acute tion and 10 more in development. There is Myocardial Infarction Administration orders. also a generic form that doctors can Using POE-Lite, a doctor logs on to the customize to meet their individual needs. hospital’s intranet to access the solution. Once the 10 forms in development are finished, the hospital expects to roll out the traditionally conservative medical solution to the entire medical staff. Ongoing profession. “Because everyone can read a enhancements to the InfoPath-based forms digital document, our InfoPath 2003 are under way, as suggestions come in solution reduces by 100 percent the from the pilot group. incidence of illegible patient order sets, thereby reducing by 100 percent the “We will continue to convert patient order potential for errors in patient care due to sets in digital format throughout the next misinterpretation of the order set,” says year,” estimates Wesmore. “And because Buckner. “Because there is no longer any InfoPath 2003 is XML enabled, we have delay associated with determining what a the capability to move on to the next step in patient order says, we are also reducing building a collaboration solution: communi- delays in patient care. That was our first cating directly with our back-end systems priority. However, now we see the benefits so that clerks no longer have to enter the as much more far reaching.” information into Siemens. With Microsoft collaborative technologies, we are not tied For Reid, these benefits are ongoing. to some proprietary system that we can’t Today, the hospital has a solution that it scale to meet future needs.” can use to improve its compliance with national healthcare standards. Medical and clinical staffs are saving time; they are Benefits more productive; and they can provide Reid Hospital & Health Care Services has more responsive, higher-quality patient Figure 1. Statistics from the POE-Lite pilot test indicate the benefits addressed a common issue in healthcare care. What’s more, working with Quilogy gained even at a 0.75 percent usage facilities through a result-oriented, hands- and listening to feedback from its medical among all medical staff. on approach that takes advantage of the staff, Reid has taken control of a hospital’s technology investment. Based on collaborative solution that it can fine-tune to familiar Microsoft Office interfaces, the meet ongoing communication and collaboration needs across the facility for years to come. POE-Lite Pilot Test (0.75% of all hospital medication orders Meeting Standards of Care The POE-Lite solution is helping Reid Number of medication orders annually 390,000 conform to national healthcare standards, Number of medication orders produced annually by six thus improving patient care. This is doctors in the pilot test 2,940 because Reid and Quilogy are taking Illegibility rate 0.38% advantage of the flexibility inherent in Number of illegible orders annually if handwritten 11 InfoPath 2003 to build intelligence into the Number of illegible orders annually using POE-Lite 0 InfoPath-based forms, using drop-down menus that progress logically and that Pharmacist hours saved annually 0.9 follow best practices based on the doctors’ Delay of care hours eliminated annually 5.6 feedback. Because its solution is highly adaptive, Reid has greater control over modifications to its order sets—without paying a third-party vendor to make solution requires virtually no training, which modifications. Today, the hospital is taking encourages adoption by users in the advantage of this flexibility and is building health standards compliance into its For three months, Reid tracked the POE- Estimated POE-Lite Benefits Lite usage for medication orders of the six (20% of all hospital medication orders) doctors in the pilot group. This group currently enters 0.75 percent of the Number of medication orders annually 390,000 390,000 medication orders submitted by all Number of medication orders produced by doctors using doctors at Reid during the year. Reid is POE-Lite annually increased to 20% 78,000 excited by the initial findings of the pilot Illegibility rate 0.38% test. Number of illegible orders annually (if handwritten) 296 Number of illegible orders annually using POE-Lite 0 “Even at 390,000 orders per year, medica- Pharmacist hours saved annually 24.7 tion orders are only one one-hundredth of all patient orders written in the hospital,” Delay of care hours eliminated annually 148.2 explains Buckner. “If we extrapolate the savings from the pilot group to a complete electronic forms solution in use by the Figure 2. As usage of POE-Lite increases, entire medical staff for all orders, we expect the number of hours saved is to see many thousands of hours saved expected to increase significantly. InfoPath-based clinical forms solution. For overall. We didn’t spend a lot of money on example, for pneumonia there are standard a third-party automated physician order administrations of antibiotics that doctors entry system; we used a solution based on are required to follow, so Reid has built that the Microsoft Office System. It met our select group of antibiotics into that needs and integrated into our workflow.” particular order set with suggested dosages. Buckner bases his expectations of the solution’s success on the results of the pilot “Health facilities are graded on the percen- test. Figure 1 shows these results: 0.75 tage of times they hit the mark for each percent of 390,000 medication orders is quality indicator in a specific treatment equivalent to 2,940 medication orders protocol,” explains Ducey. “We expect to hit submitted to the pharmacy in a year. If the the quality indicators more as we build doctors had filled out the forms manually, InfoPath 2003–based patient order sets Reid estimates that 0.38 percent of the that ensure we follow the right protocols.” forms would be illegible, adding up to 11 per year. Using POE-Lite, that number “Commercially available clinical physician would be reduced to zero. Because the order entry systems are on most hospitals’ hospital estimates that each illegible order five-year technology plans. However, hos- wastes 5 minutes of the pharmacist’s time, pitals keep delaying deployment because 11 illegible orders would waste a total of it’s a huge investment and time 0.9 hours of the pharmacists’ time. The commitment,” says Aaron. “Reid’s success hospital also estimated that each illegible proves that there is great value in Microsoft order form caused 30 minutes of delay in Office technology because it makes it patient care. Eleven illegible orders would possible for the hospital to do something therefore incur 5.6 hours in delay in patient today.” care annually. The pilot group using POE- Lite for medication orders saved a total of Expected Benefits from the Pilot Test 6.5 hours (0.9 + 5.6) annually. Judging by the pilot test, Reid expects to

see significant benefits from this solution. Figure 2 shows the amount of time saved if 20 percent of those medication orders were completed using POE-Lite, instead of manually. If the same rate of illegibility (0.38 percent) is applied to all 390,000 medication orders written in a year, the result is 1,482 illegible orders. Applying the 5 minutes of pharmacist time wasted per order, 1,482 orders would cause 24.7 hours of wasted time annually. Similarly, at 30 minutes of delay in patient care per order, 1,482 orders would add up to a total of 148.2 hours of delay in patient care annually. These two figures add up to 741 hours of delay that would be eliminated by using the POE-Lite solution.

Saving Time, Improving Patient Care Dr. Patrick Anderson, one of the physicians in the pilot project, estimates that he saves about a half-hour every day. “I don’t have to track nurses down to communicate my patient order sets, and I don’t have to return their calls, either,” he says. “I love how the Tablet PC and the InfoPath 2003 solution work together so I can work anywhere. I can do virtual rounds in the cafeteria in the morning and submit my patient orders to print out exactly where I want them. I’m more efficient, the nurses get my orders more quickly, and the patients are treated faster.”

“With InfoPath 2003, our doctors are embracing a better way of doing things,” concludes Buckner. “We are working out issues regarding people, policies, and workflow, and we are providing higher- quality patient care. For patients in the hospital right now, today is when it counts the most.” For More Information Microsoft Office System For more information about Microsoft The Microsoft Office System is the products and services, call the Microsoft business world’s chosen environment for Sales Information Center at (800) 426- information work, providing the programs, 9400. In Canada, call the Microsoft servers, and services that help you Canada Information Centre at (877) 568- succeed by transforming information into 2495. Customers who are deaf or hard- impact. of-hearing can reach Microsoft text telephone (TTY/TDD) services at (800) For more information about the Microsoft 892-5234 in the United States or (905) Office System, go to: 568-9641 in Canada. Outside the 50 www.microsoft.com/office United States and Canada, please contact your local Microsoft subsidiary. To access information using the World Wide Web, go to: www.microsoft.com

For more information about Quilogy products and services, call (866) 784- 5649 or visit the Web site at: www.quilogy.com/healthcare

For more information about Reid Hospital & Health Care Services products and services, call (765) 983-3000 or visit the Web site at: www.reidhosp.com

Software and Services Hardware  Microsoft Office System  Web Server − Microsoft Office Professional − Dell PowerEdge 1855, Intel Xeon 2.8- Enterprise Edition 2003 gigahertz CPU, 2 gigabytes of RAM − Microsoft Office InfoPath 2003  Database Server  Microsoft Windows Server System − White Box Server, 4 Intel Zeon 1.5- − Microsoft Windows Server 2003 gigahertz CPU, 2 gigabytes of RAM Enterprise Edition − Microsoft SQL Server 2000 Partner  Windows XP Tablet PC Edition − Quilogy © 2006 Microsoft Corporation. All rights reserved. This case study is for informational purposes only.  Technologies MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY. − Active Directory Microsoft, Active Directory, InfoPath, the Office logo, Windows, Windows Server, and Windows Server System are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries. All other trademarks are property of their respective owners.

Document published April 2006