Technology being used in Rouge Valley Health System’s chemotherapy clinic is helping to improve efficiency, accuracy and patient care. One simple solution is a computer on a wheeled cart that has allowed one oncologist to use electronic documentation and voice recognition software to help create more accurate, easily accessible patient records.
“It’s instantaneous and facilitates optimal patient care,” explains Dr. James Chiarotto, medical director of the Rouge Valley Health System (RVHS) oncology program, and main user of the computer cart. “In the cancer world, everything has to be done as quickly and as accurately as possible. So this does a great job in making that possible.”
The project, which has been in place since spring 2012, was designed specifically for the Rouge Valley oncology clinic by the hospital’s clinical informatics and information technology teams. The innovation is as a result of a Cancer Care Ontario (CCO)-directed project to allow data collection and reporting to take place right at point-of-care.
How it works
The system features a cart with a computer, dual screens, a keyboard, mouse and power supply with a cord so that it can be charged when it’s not in use. It can be moved into any examination room throughout the clinic. The cart computer provides access to three applications: Dragon, a voice recognition program; Meditech, where the patient’s chart is contained, and where Dr. Chiarotto can dictate his notes directly into the patient’s chart; and the Oncology Patient Information System (OPIS), a computerized physician order entry (CPOE) application developed by CCO.
The mobile cart allows Dr. Chiarotto to go into any patient room, order medication, access the most recent patient results and do his documentation right in front of the patient. During a consultation or assessment, he can examine the patient, order chemotherapy, find out how they’re responding to medication, and electronically generate a prescription. After speaking with the patient, he then puts on a headset outfitted with a microphone and begins to dictate his findings and notes into Meditech, using the voice recognition software. As he speaks, the words appear on one screen, while Meditech shows the patient’s electronic chart on the other.
While the carts are now working well in the chemotherapy clinic, it wasn’t always this easy. A year ago, each examination room in the chemotherapy clinic had its own PC equipped with voice recognition software so that Dr. Chiarotto could do his dictations. However, this system wasn’t seamless, and he would need to log into each computer every time he entered the patient room.
“By the time I went into a patient room, all of the programs had timed out. So you can imagine how frustrating it was to have to go in and re-initialize the programs each time,” he explains.
When he brought the issue to Lynn Tkac, project manager of clinical informatics at Rouge Valley, she pointed out that carts equipped with laptops were being used in the hospital’s general medicine inpatient unit. The carts featured Meditech and a wireless connection, and allowed physicians to access patient information right at the patient’s bedside. A similar solution could be created for the chemo clinic. Working with the hospital’s information technology and clinical informatics team, a mobile cart specific to the chemo clinic’s needs was designed. A wireless network was soon installed in the clinic, and not too long after, OPIS was introduced, and was installed on the chemo clinic cart computer.
“Our goal of this project was to have documentation available right at the point-of-care. To do that, we needed mobile devices,” explains Tkac. “From a continuity of care perspective, it’s important that a physician receive this information in real time.”
“Without voice recognition, there is always a lag when notes are added to the patient’s chart. But through this process, notes are added right away,” explains Thodoros Topaloglou, RVHS chief information officer. “By putting both the expediency of voice recognition in electronic documentation together, and the safety of computerized physician order entry, we’re using the highest level of patient care. This makes for a much better patient experience.”
The OPIS system allows orders that are created with fewer errors – something that is especially critical to patients undergoing chemotherapy treatment. Notes from the visit can also be sent to other specialists, their family doctor, or to another healthcare facility through Meditech. These notes can also be printed instantly, and the patient can keep a copy for their own records. The dictation is also done in front of the patient, adding even more value, Dr. Chiarotto explains.
“The patient can hear what I’m saying, and if there’s any issue with accuracy, it can be corrected immediately. From my perspective, that’s most important,” says Dr. Chiarotto. “The patient also hears the same information that’s being shared with their family physician. They should have the clearest possible understanding of their health status.”
Impact on physicians and staff
Seven similar, scaled-down versions of the carts are also being used in other areas of the clinic. Nurses use them to electronically document medication administration in OPIS when patients are receiving chemotherapy. The chemotherapy clinic pharmacist uses another cart with OPIS to receive physician orders, which can be done with fewer errors and better accuracy, improving patient safety. Traditional paper charts are still being used in the chemo clinic, however electronically documenting medication administration has helped to improve the quality of care dramatically.
“It’s great that the carts are mobile. We’re also able to better read doctors’ orders than if they were hand-written, so legibility has improved dramatically,” explains Sandy Shovlin, a registered nurse in the clinic.
This process improvement, which combines technology with Lean methodology – widely used in all areas across Rouge Valley – has helped to save Dr. Chiarotto much of the time he used to take doing dictations.
“Knowing that this can all be done together is such a feeling of satisfaction. For example, if I’m assessing a patient for chemotherapy, I can do my documentation, order the chemotherapy, and everything is done,” Dr. Chiarotto explains.
The innovation also improves patient safety by keeping all of the patient’s information together in one location. If the patient arrives at one of the hospital’s two emergency departments (whether at Rouge Valley Centenary or Rouge Valley Ajax and Pickering), the emergency physician treating the patient is able to see their most recent health information, including the oncologist’s orders, in Meditech. Administratively, it’s also making a difference.
“It’s almost instant, which is very helpful for me. Using this format means that I receive the entire report as well as the dictation together, and within minutes,” explains Liz Naunheimer, unit clerk in the RVC chemo clinic. Traditional dictation, Naunheimer adds, can take up to 24 hours to receive.