TGH puts patients' records on computer

Tampa General Hospital has implemented a $120-million electronic medical records system designed to make the hospital more efficient and make a patient's stay briefer and safer.

TGH implemented the system Oct. 1, becoming the first fully integrated paperless records hospital in the Tampa Bay area.

"It's a huge culture change and very costly, and it takes a lot of bandwidth to do this," said Beth Lindsay-Wood, the hospital's chief information officer. "But this has to be the standard of care for health care, and this is just the beginning. It's just the starting point."

Patient records used to be on paper, which left a margin for human error and slowed the process.

With paper records, files potentially could get misplaced; staffers in the operating room might transcribe incorrectly; handwriting might be illegible. Trends inside and outside TGH — things like emerging diseases or even people getting sick in one particular area of the hospital — might not get noticed immediately.

Changing to electronic records is hugely important and beneficial, Lindsay-Wood said.

Doctors and nurses more easily will see a patient's family and medical history as well as a patient's allergies. If they want, doctors may sign on from home to view files and work on them, from writing prescriptions to deciding which patients need to be seen first based on health concerns. And the system provides more security of patient information than paper files.

"It allows a seamless integration of real-time patient status into the medical record," said Rich Paula, the program's medical director.

The federal government motivates hospitals to move toward electronic records, helping pay in part for the systems and in the future, penalizing those hospitals that don't make the shift by reimbursing less per patient, Lindsay-Wood said.

But TGH has moved at a faster rate than other area hospitals to implement, Paula said.

Ninety percent of the system's cost comes from TGH's capital reserves and operating expenses. The other $12 million, TGH hopes, will come from federal and state funding.

TGH's project was a massive undertaking. The hospital has 1,018 beds and about 7,000 employees, including roughly 2,000 physicians. It has about 84,000 patients come through its emergency and trauma centers each year, and nearly 29,000 surgeries a year.

Two years ago, the hospital chose Epic, a company based in Madison, Wis., to implement the system. Implementation began last year.

Hardware and software cost about $40 million. The remainder of the project's cost came from staff and training — each nurse and doctor trained roughly 12 to 30 hours on how to use the system.

TGH's nurses have had a learning curve because their workflow has changed; but now everybody can see the same information in one concise area, said Donna Borst, a nurse manager at the hospital.

Borst said it's too early to tell how effective the new system has been, "but our goal obviously is to have more efficient patient care and decrease our length of stay."

The process for prescriptions is streamlined under the system. Doctors now enter prescription information directly into computers, speeding up the timetable for patients to get the drugs they need, Lindsay-Wood said.

TGH already has medical records in the system from as far back as 1½ years ago. Other records have been scanned in from five to seven years back.

All TGH doctors and nurses — including those at TGH's community clinics — have access to the information. Also, many community physicians could opt to put Epic into their own practice — through TGH — at a discounted price. So far about 15 practices are signed up.

Major hospitals in the area ultimately want to exchange data and share as well with the University of South Florida and Florida Orthopaedic Institute, Lindsay-Wood said. That way, hospitals would have an easier, centralized way of knowing key patient information.

"It will save lives, and it's transformational for healthcare," Lindsay-Wood said.