Skip to contents
In This Issue:
As part of BWH’s BluePrint celebration, BWH Bulletin features this special section to explore the past, present and future of the institution. Throughout 2013, you’ll find a new fun fact, story, photo or tradition in each issue of Bulletin.
During her residency at BWH from 2002 to 2005, cardiologist Amy Leigh Miller, MD, PhD, had the unique experience of helping to design the Brigham’s award-winning electronic medication administration record (eMAR).
“For most of my residency, the medication administration record was entirely on paper, but by the first year of my fellowship, eMAR was implemented in all inpatient areas except Oncology,” said Miller, now a physician champion for BWHC’s Partners eCare team.
During his 38 years at BWH, Chief of Pharmacy Services Bill Churchill, MS, RPH, has worked on the design, development and implementation of more than 12 clinical systems, including the original Brigham Integrated Computing System (BICS) order-entry system, the pharmacy-eMAR systems, Infusion Order Entry and Chemo eMAR.
“Since the early 1990s, BWH’s clinical systems have come a long way,” said Churchill. “They have become more sophisticated, user-friendly and compatible, while incorporating the very best in patient safety technology.”
Such rich partnerships between clinicians using the systems and IS staff developing them are unique to the Brigham and part of its very fabric. This collaborative culture allows clinicians to share their information technology needs with IS staff, IS staff to create new systems to meet these needs, and clinicians to test and provide feedback about the new systems.
“With a longstanding tradition of reducing errors and enhancing patient care, many of BWH’s home-grown systems have earned national recognition in the areas of patient safety, technological innovation, efficiency and cost savings,” said Catherine McGoldrick Schroeder, corporate manager of Partners Information Systems. “We are very proud of the teams that developed these systems. They have changed and improved how we deliver clinical care at BWH.”
During the next five years, Partners eCare—the enterprise-wide, integrated health information system with the goal of “one patient, one record, one team, one statement”—will integrate all clinical and administrative information systems across Partners HealthCare. Hundreds of BWHCers are working alongside their counterparts at other Partners entities, as well as with Epic’s software designers on the innovative new system.
With the implementation of Partners eCare on the horizon, BWH Bulletin takes a look back at a few of many signature IS achievements and how they have changed the way care is delivered at BWH.
Developed and launched in 1993, BICS was BWH’s original clinical information system. It has been regarded as one of the most functional systems in the health care industry. The system, which combines clinical, administrative and financial computing services at BWH, includes a vast range of hospital data and applications, including computerized provider order-entry, longitudinal medical records, operating room scheduling and automated inpatient summaries. BICS has achieved great success in helping to reduce adverse medical events, improve patient safety and increase cost savings.
In 2004, while other hospitals were just beginning to convert from paper to electronic medication systems, BWH brought the electronic medication record online with eMAR, a comprehensive system that links physicians writing prescriptions, pharmacists reviewing orders and nurses administering medications together electronically to reduce medical errors and improve patient safety.
“With eMAR, I can access the electronic record from anywhere, sort by medication name so that I can see all orders and administrations, pull up a history of all administrations for a given medication, access reference material on any of the prescribed medications with a single click and see exactly why a dose was or wasn’t given,” said Miller.
Bar code technology
As part of the eMAR system, IS developed bar codes to be placed on medications, which have enabled the BWH Pharmacy to store more information about each drug. That, in turn, helps to reduce dosage and dispensing errors when clinicians are ordering medications. As another safeguard, nurses scan the bar codes on both a patient’s wristband and the medication before administering it.
“Bar code scanning and eMAR completely transformed how our nurses administer medication,” said Anne Bane, MSN, RN, BWH nurse director of Clinical Systems Innovations. “It vastly improved the management and tracking of patient information, and it ensured we were giving the right medication at the right dosage to the right patient at the right time.”
A 2010 New England Journal of Medicine article by former BWH Corporate Manager for Clinical Systems and Director of Clinical Informatics Eric Poon, MD, MPH, concluded that bar code scanning and eMAR reduced errors by about 41 percent, potential adverse drug events by about 51 percent and timing errors in medication administration by 27 percent. Transcription errors were completely eliminated.
Originally developed for Radiology, the Picture Archive Communication System (PACS) allows images, such as ultrasounds and CT and MRI scans, to be viewed electronically by multiple clinicians in different locations throughout the enterprise. Prior to PACS, film X-rays could only be viewed in one location at one time, and would require physical travel from department to department, depending on the care delivery setting.
“One of the things unique to us at the Brigham is that PACS is multidisciplinary; it’s not limited to Radiology images,” said Maria Damiano, assistant director of Medical Imaging IT. In addition to Radiology, images from Noninvasive Cardiology, the Cath Lab, High-Risk OB and other departments are archived in a central PACS system and available across the enterprise. “If a patient is seen at a BWH clinic, is referred for surgery and then has treatment at DFCI, images can be viewed at each of these care delivery locations whenever needed.”
A more recent development is the Alert Notification of Critical Results (ANCR) system, created under the leadership of Ramin Khorasani, MD, vice chairman of Radiology. The nationally recognized ANCR system ensures that physicians quickly and reliably receive critical results about their patients through an automated notification and tracking system. ANCR has reduced critical results acknowledgment time from roughly 12 hours to under two hours. After seeing success at BWH, the system has expanded to BWFH and DFCI, with plans to expand to other departments as well.
“Our systems improve the quality of service being provided in terms of patient safety and also enhance workflow for our physicians,” Damiano said.
Added McGoldrick Schroeder: “We look forward to keeping the spirit of innovation moving forward as we advance to Partners eCare.”
Stay tuned for a Q&A about Partners eCare in next week’s issue of BWH Bulletin.
Some BWH Information Systems Awards and Distinctions: