Bringing improved patient safety and the latest evidence to the bedside

Patient safety at North York General Hospital (NYGH) received a major boost with the launch of bold technology that is reducing medication errors and providing clinical staff with the latest evidence-based information to facilitate their decision making.

Dubbed “eCare”, the initiative leaves behind manual systems that are vulnerable to errors and summarizes mountains of medical literature for health care providers, all to benefit patients. The new system includes barcode scanning to uniquely identify each medication and each patient.  This reduces the risk of medication errors by alerting health care providers if they are about to make an error when administering a medication.

“A significant proportion of preventable errors involve medications prescribed and administered using traditional, manual systems,” says Dr. Jeremy Theal, Director of Medical Informatics and a gastroenterologist at North York General Hospital. “By integrating the latest medical literature and implementing barcode scanning with electronic orders, we are raising the bar on patient care and preventing errors to significantly improve patient safety. Ultimately, we have new tools that research shows will help people get better faster, and save lives.”

A key feature of eCare is computerized provider order entry (CPOE) which allows physicians to enter their orders electronically instead of on paper, reducing the possibility of misinterpretation and increasing information-sharing among health care providers. The CPOE solution, provided in partnership with Cerner Corporation, incorporates the latest medical knowledge into the clinicians’ workflow, including clinical decision support and a library of over 350 evidence-based electronic order sets. NYGH is the first hospital in Canada to implement an electronic order entry system that integrates regularly-updated evidence from the medical literature into a doctor’s decision-making process.

“This hospital-driven initiative is the result of outstanding teamwork involving informatics personnel, nurses, pharmacists, physicians, dietitians, physiotherapists and more,” says Dr. Tim Rutledge, President and CEO at North York General Hospital. “The tremendous efforts of all involved will ultimately benefit our patients. eCare is a significant step forward in patient safety, quality of care and achieving a paperless medical record.”

In order to better understand the benefits of this system, it is possible to extrapolate from two US-based studies that evaluated patient outcomes for two common life-threatening illnesses, pneumonia and sepsis. If the system were implemented across Ontario, approximately 1,350 lives and 700 lives could be saved from pneumonia and sepsis respectively in a single year by implementing this new standard of practice that North York General Hospital has achieved with eCare. These are just two examples of the many disease areas that will see benefit from eCare.

This past fall, NYGH was awarded the Innovation in the Adoption of Health Informatics award, and together with Cerner Corporation, the Project Team Innovation & Care Delivery award, at the 7th annual Canadian Health Informatics Awards Gala. The awards were presented to NYGH for the second phase of its eCare project that achieved several Canadian firsts, including: the first Canadian deployment of CPOE with regularly-updated evidence-based order set content integrated into the physician decision-making workflow, firstCanadian medium to large size hospital to implement closed-loop barcode medication administration, and first community teaching hospital in Canada to reach the Healthcare Information and Management Systems Society’s (HIMSS) Stage 6.

In 2010, Dr. Jeremy Theal won the Physician Leader/Innovator of the Year award from COACH: Canada’s Health Informatics Association at the 6th annual Canadian Health Informatics Awards Gala. The award was presented to Dr. Theal for his leadership and contributions to eCare.

Since the launch of the second phase of eCare (October 2010), physicians have entered 94 per cent of their orders via CPOE and over 1,300 potential medication errors have been averted.

Phase two of the eCare project resulted in NYGH achieving a Stage 6 designation from HIMSS Analytics, the research arm of the Healthcare Information and Management Systems Society (HIMSS). NYGH is one of only three hospitals in Canada to have a Stage 6 designation.

“Our Stage 6 designation means our electronic medical record system is able to provide intelligent, evidence-based reminders to our physicians as they enter electronic orders for patients. All medical imaging examinations like X-rays are captured and viewed on computers, improving the quality of treatment and patient outcomes,” says Dr. Tim Rutledge. “We are very proud to be leaders and early adopters of eHealth strategies that are transforming how we provide quality care and ensuring patient safety.”