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CORDis EHR description and implementation at
Barwon Health
CORDis EHR is an
electronic Transcription System based on the FileMaker Pro (©
FileMaker Inc.) database platform. This system has been
developed by Dynamic Solutions with the assistance of Barwon
Health.
The initial CORDis EHR vision began as an electronic discharge
summary system providing clear, searchable discharge summaries
that could be faxed to the GP at the click of a button. It also
provides the
necessary
information for clinical audits and quality monitoring.
Once this was successfully implemented the clinicians wanted
more information to be stored, so CORDis EHR was expanded to
collect and record clinical information from other systems, to
provide the clinician with a single system providing a patient’s
history of care. CORDis EHR was then further expanded to enable
the creation and transmission of Operation Notes, Out Patient
Letters and PBS Prescribing.
The electronic health record now contains information required
for medical record coding and provides the practitioner and
manager with knowledge basis to assist in allocation of
appropriate DRG and WEISS.
CORDis EHR was
implemented at Barwon Health in late 2000 and is now used across
all acute and sub-acute departments. It is a patient reference
tool for many practitioners, providing information relating to
the patients admission, diagnosis, management, investigations
and medication profile. The system also contains the plan for
post hospital follow-up.
CORDis EHR stands for
Correspondence, Operating Records, Reports and Discharge Summary
information system. The cost of the system is a small fraction
of many other Clinical Information Systems. It’s user
friendliness makes it more immediately useable by clinicians,
Health Information Managers and administrators throughout the
hospital.
Comprehensive
listings of messages sent, and acknowledgments received are one
of the features of the quality monitoring of CORDis EHR.
Reports are produced continuously and monitored daily to ensure
information such as discharge summaries, operation notes and out
patient letters have been successfully sent to the intended
recipients.
The CORDis
EHR transcription system links legacy databases within the
Barwon Health Network, enabling many details relevant to patient
care to be automatically populated into the CORDis EHR record.
There is the potential to link many, if not all, computerised
databases through a single front end, accessible via the patient
file. The application’s ability to quickly interrogate data has
created improved efficiency for clinicians and health
information managers. Further, database linking eliminates the
duplication of data entry. This reduces the time and effort
involved in recording and producing correspondence from the
Acute Health setting, to the community health services,
including General Practitioners, Community Pharmacists and
Domiciliary Services (outside the Barwon Health Network).
CORDis EHR has
also been linked to modern hospital systems that communicate via
the Health Level 7 (HL7) standard. CORDis EHR is compliant to
Version 2.3.1 of the standard and has been implemented to
receive Admission/Discharge notifications and radiology results
via this interface. CORDis EHR also transmits discharge
medication information in HL7 format. The installation of a
separate HL7 gateway server is required before HL7 messages can
be transmitted or received.
The
transmissions from the application include discharge letters,
operation notes, outpatient letters, and notification to
community services (of client’s acute admission and discharge).
Transmissions can be faxed or printed and some can be emailed in
an encrypted format for increased security.
The introduction
of CORDis EHR at Barwon Health has had two major benefits,
improved clinical care and substantial cost savings.
Clinical care
has improved for patients because clinicians can access clinical
data related to a patient’s current and prior admissions
“instantly” compared to the slow process of requesting a paper
based medical record. Timeliness of such information can be
critical when assessing a patient presenting to emergency that
may be in an uncommunicative state.
The hospital to
GP communication has improved markedly. Barwon research showed
prior to implementing CORDis EHR the average time to completion
was 2 to 10 weeks post discharge of the patient. Also the
accuracy and legibility of the discharge summary was poor. The
long delay of completion often meant that patients were visiting
their GP’s post discharge before the GP had any information
about their episode of care. It was felt that this did not
offer the best continuity of care.
The median time
of completion post discharge was 5 hours in 2003 using CORDis
EHR. The General Practitioners are generally receiving the
discharge summary by fax on the day the patient is discharged
from hospital and more importantly prior to the patient visiting
the GP.
Major cost
savings have also been achieved by faxing documents
electronically. Faxing a document within CORDis EHR occurs at
the click of a button and takes negligible time for the user,
the cost of a local call fax is around 17 cents. Compare this
to the cost of pre-printed duplicate Discharge Summary forms (15
cents each), envelopes (5 cents each) postage (40 cents each)
and the labour cost for someone to fold the document, place it
in the envelope and address it (50 cents) then a saving of
around 88 cents per document can be achieved. At Barwon Health
over 33,000 documents were faxed via CORDis EHR in 2003 which
equates to a saving of $29,000. The cost savings will be
greater in 2004 as many of these documents are now being sent
via encrypted email.
Timely
completion of discharge summaries and the ability for medical
record coders to interrogate CORDis EHR greatly reduces the time
taken for coding of the discharge summary. This ultimately
results in improved cash flow to the hospital.
CORDis EHR
automatically copies the patient’s previous co-morbidities,
current procedures and investigations into the discharge
summary. This results in time saving for doctors and also means
these items are not missed when coding resulting in the maximum
claim for services provided to the patient.
Further cost
savings are also made because forms and envelopes do not need to
be ordered and stored by purchasing departments and staff
downtime when forms run out is eliminated. Filing costs are
also reduced as Clinicians may not request a copy of the paper
based medical record if they can access the information they
require electronically.
A cost saving,
that is difficult to quantify, is the cost saving resulting from
saving clinician’s time. Clinicians are often required to
perform analyses and audits. With paper based records these
analyses can be very time consuming and are subject to human
error as the clinician can often be wading through hundreds of
documents when performing an audit. CORDis EHR can produce many
of these reports at the click of a button not only saving time
but also providing a greater depth of detail. The ease of
access to information about a patient’s prior and current
admission at or near to the point of care saves a great deal of
time that previously required the retrieval of the patient’s
paper based medical record.
The clinicians
also save a considerable amount of time that they used to spend
talking to GPs. When the patient presented to the GP, and the
GP had not yet received the discharge summary, the GP would
often call the clinician to get a verbal summary of the
patient’s episode of care taking up both clinicians valuable
time.
Time saving for
clinicians and ease of information sharing with other hospital
staff are the main benefits of CORDis EHR.
There are over
100 users of CORDis EHR within Barwon Health.. |
