Just before eHealth Week 2016 started, I had the chance to visit the Radboud university medical center, the first hospital in the Netherlands and one of only three in Europe to be awarded with the prestigious HIMSS EMRAM Stage 7 Award.
I was not expecting to find one of Europe’s most digitally mature hospitals in Nijmegen, the oldest town in the Netherlands! But three years after its big bang implementation of its Epic electronic health record (EHR) system it is operating in a virtually paperless environment.
Getting used to the new EHR
We started the visit with an introduction of the new EHR in a hospital with more than 4,000 professionals using it and over 30,000 admissions every year. Even if it is undoubtedly an immense operation, any troubles experienced during the go-live at Radboudumc appear to be a distant memory for the staff. Cees Buren, Chief Finance Officer at Radboudumc, told me “We’re very proud of our achievements but are really only at the half way point. EMRAM Stage 7 is where the journey really begins.”
From the outset of the tour it is clear that Radboudumc has big plans and as the third largest hospital in Holland, if it manages to accomplish them it will be a hard act to follow. The team say that care, education, research and business are identified as the key pillars of a successful health economy, all of which must be underpinned by sophisticated IT, as well as people who understand its value.
How does a paperless hospital look like?
As we take to the corridors, the ceilings are high, the walk-ways are bright and airy and it’s apparent that with a new building came a completely new infrastructure, including high speed Wi-Fi to support the sharing of patient data to improve care processes.
Digital information screens span the building, some direct visitors to the relevant area - a feature which in many other hospitals has raised concerns over patient privacy - others provide healthcare professionals with dashboards that identify staff movements, as well as key information about their patients such as pain and comfort scores.
As we make our way to the intensive care unit (ICU), attention is drawn to a medication management solution – functionality that the EMRAM Stage 7 inspectors said excelled beyond any other hospital in Europe when the award the hospital last year. Here, we are introduced to Marcel Houwer (ICU nurse) and Tim Frenzel (Intensivist) who have been responsible for the systems deployment in the ICU.
On this busy 40 bed ward all vital signs, monitoring, IV pumps, dialysis machines, barcode scanning, and alarm management are integrated into EPIC. Here, the team is focusing on capturing all patient data in one system and using the digital data for safe, quality and person-centered care.
In the ICU there is a small pharmacy on each ward. We are walked through the prescription process by going into the medical record, scanning the medication and going to the patient’s room where the patient is scanned.
Frenzel then reviews the medical record and shows us how the system pulls in patient data every minute and then presents it every two hours for validation and permanent saving. Meanwhile raw data is saved for three days.
“It’s amazing to see what your intervention is doing all on one screen - a complete overview with continuity of data.” Houwer adds: “Some wards have found that this can be information overload, so we tailor it depending on need.”
The ICU is unsurprisingly one of the most digitally mature parts of the hospital. The vast array of machines and data that clinicians rely on means that technology is generally embraced.
And Houwer concluded with: “Today, most staff simply cannot imagine working in a hospital without the system.”
After HIMSS EMRAM Stage 7 comes the Stage 8…
As the tour wraps up, Buren returns to the future and vision of Radboudumc. “We like to think we are inventing EMRAM Stage 8 here - demonstrably distinctive quality, person-centered care, efficiency and sustainable networks collecting the highest level of data and contributing to further improving the quality and safety of care and research for our patients.”