St. Paul’s Hospital Improves Follow-Up Care with ObjectsPlus/XA™

For almost a decade, Sunrise Clinical Manager™ has been helping streamline operations at St. Paul’s Hospital in Vancouver, BC. With its powerful workflow engine, embedded evidence-based content, and advanced order entry and clinical documentation, the system has helped reduce average patient stays at St. Paul’s busy Emergency Department by 30 minutes. Time to MD assessment has dropped by five minutes and time to first lab order has been reduced by 15 minutes. Even better, wait times are now the lowest in the region.

Although proud of its record within the ED, St. Paul’s management knew it needed to improve its ED discharge process. Some patients were treated and released without the knowledge of their PCPs, and many patients who did not have a PCP left without a referral. Most of the patients’ PCPs practice outside the Providence Health Care parent organization, and many lack technology such as integrated email and Web access.

“We needed to give our patients better instructions and provide PCPs with better information about their patients who visited us,” says Eric Grafstein, MD, associate research director of Emergency Informatics at St. Paul’s.

“Whether or not a patient had a PCP often didn’t get communicated,” adds Kevin Lonergan, clinical application analyst at Providence Health Care. “Our ED physicians often didn’t know what services were available.” These problems are not unique to St. Paul’s, he said. In fact, pending government regulations require better instructions and physician referrals for discharged patients throughout the region.

The Solution
To improve follow-up care, Grafstein and his team set out to create a computer-generated discharge summary. Fortunately, the project coincided with Eclipsys’ release of ObjectsPlus/XA technology. This open objects development platform makes the underlying code of Sunrise™ clinical software available for seamless linking to other applications, opening up new opportunities for customization and integration. This capability is accessible to any organization that licenses the software.

Using ObjectsPlus/XA together with Microsoft .NET technology, Grafstein went to work with his team, including Lonergan, product sponsor Grant Innes and project manager Christine Jennings. The discharge application they created prints follow-up instructions for discharged patients and automatically generates and faxes a summary to PCPs. The tab integrates data from a legacy ADT (admission, discharge, transfer) system and other sources, but it’s based primarily on Sunrise Clinical Manager’s Health Data Repository and computerized physician order entry (CPOE), lab and imaging data.

Using an intuitive graphical user interface, ED physicians can now select from a list of approximately 850 ED discharge diagnoses displayed in a convenient tree structure.

“ObjectsPlus allowed us to create links between the diagnosis categories and specific procedures, prescriptions and follow-ups,” Grafstein says. “It makes it easy for physicians to quickly find what they are looking for.”

A newly created End-of-Visit button sends the discharge summary to the treating physician, generates a printout for the patient, and prints a prescription list. If the patient has no PCP, an alert pops up along with care options, enabling the physician to make an immediate referral.

The Benefits
The ED discharge application has been on-line since July 2005. “ObjectsPlus worked brilliantly,” Grafstein reports. “The Discharge Summary tab has the look and feel of Sunrise Clinical Manager. It looks like it’s part of the program.”

By November, 2005, all 25 full-time ED physicians were regularly using the discharge summary, with a completion rate of 95 percent. Mount St. Joseph’s Hospital, another Providence Health Care facility, is going live with the discharge summary early in 2006.

“The feedback has been very positive,” Grafstein notes. “Our physicians like the prescription writing functionality and the fact that they only have to click a single button.”

Most of all, ObjectsPlus/XA helped St. Paul’s achieve its goal of a seamless connection with the area’s PCPs. “It’s been very gratifying to hear from the primary care physicians how pleased they are to get information about their patients,” Grafstein said.

Community physicians are now better prepared for follow-up visits, and they no longer need to track down ED clinicians. The result is better patient care — without creating extra work for St. Paul’s clinicians.