Mount Sinai Family Medicine

Nightingale's EMR produces safer, team-based care for large clinic

Overview

Mount Sinai Hospital is a preeminent academic health center affiliated with the University of Toronto. Its family medicine teaching unit – the Granovsky Gluskin Family Medicine Center - is involved in outpatient care, research and education and has 30,000 patient visits a year. With 10 staff doctors and 25 residents and allied health professionals, it is the first Mount Sinai clinic to make the transition to the Nightingale On Demand electronic medical records (EMR) solution.

Challenges: Accessible files for everyone

As part of a large urban hospital the family medicine center at Mount Sinai faced a particular challenge when it came to working within a large institution. As one of over 100 clinics at the teaching hospital, this center works differently from other specialized practices. Their data collection needs set them apart. While other clinics may be singularly focussed – arthritis, cardiology or fertility for example – a family practice needs to collect data that covers the big picture. They must track preventive care practices, illness and disease rates and patients’ risk factors in addition to the clinical educational experiences of its trainees and the clinical activities of the inter-professional family health team members that form the recently established Mount Sinai Academic Family Health Team.

Those differences were heightened further when it came to transitioning to a paperless environment. Any electronic medical record system would have to support the multidisciplinary needs of the clinic.. Mount Sinai Hospital had already begun to transition to electronic records for its inpatient care in 1999. Several years ago the hospital and outpatient clinics’ practitioners made a joint decision to select a system specifically designed for their unique needs. The selection process involved family practice clinicians from the beginning, including the request for proposal (RFP) stage for companies bidding on the business. “

Not only did they need to make sure doctors could continue to look after patients, but they also wanted all clinicians to take advantage of the data stored in any new system – allowing everyone to access a chart whether they were within the practice or at another clinic. “You can imagine a paper chart passing around from person to person and see the inefficiencies. Now everyone involved with a patient’s care can have instant access to an accurate and up-to-date chart,” says Dr. Tannenbaum who firmly believes hard-to-read paper files are not conducive to team-based care.

Results: Improving team communication

Nightingale’s intrinsic knowledge of how family physicians work and interact allowed Mount Sinai to customize Nightingale On Demand (Electronic Medical Records) to meet the clinic’s needs.

The introduction of Nightingale On Demand (Electronic Medical Records) in the clinic has proven to be innovative for how an ambulatory practice and a large hospital can work together.

Improved team-based communications allow doctors and other practitioners such as social workers and dietitians to share important patient information. And having online access to medical records has its payoffs, especially for residents who can face geographic challenges. “They’re learning in various locations throughout their two years of training. They could be across the road or participating in training in a small town in Ontario,” says Dr. Tannenbaum.

This approach also allows clinic patients who go to the Mount Sinai lab or to one of three public labs in Toronto to have their lab results applied directly to their electronic record at the clinic. This is also true for diagnostic imaging tests done at Mount Sinai - the results are automatically applied to the patient’s electronic record.

The system has also benefited nurses who job share. When a new nurse begins their shift he or she can instantly find out what is left to follow up on if the previous nurse was unable to finish updating a file. The continuity this provides is reassuring.

Increased patient safety

Also reassuring -- doctors have become more disciplined in recording data. “Nightingale On Demand solution has improved how we treat our patients at various points of care - from the waiting room to the pharmacy. The quality of data is better than what appears on paper because the templates force us to be more disciplined in how we record and provide information. And since some doctors have handwriting that is difficult to read, the pharmacists, who now receive printed prescriptions, notice a difference right away,” says Dr. Tannenbaum.

“From a patient safety standpoint, I’m impressed by the data flow into our  electronic medical records (EMR). Outside labs used to take up to a week to post results, now it’s less than a day, sometimes even hours. I saw a patient at 5:30 and examined their chart at 6:30 - the lab results from the Mount Sinai Laboratory were already there,” says Dr. Tannenbaum. He has also been impressed with how Nightingale On Demand has improved the management of patients taking anticoagulation medicine. They need to have their international normalized ratios (INR) monitored regularly to make sure their medication is on track – mismanagement can lead to a stroke or other complications. Thanks to electronic records our pharmacist is able to quickly access results and coordinate this important component of care. Under the old system, in many cases it would have taken two days or more to receive and follow up on results.

Nightingale On Demand also allows drug interactions to be neatly identified. When a clinician adds a medication to a patient’s file the system will automatically flag it if it conflicts with a prescribed medication or allergy.

Any fears of being seen by patients as officious record keepers with a laptop instead of a friendly doctor with a stethoscope would be unwarranted. “Patients are very impressed with Nightingale On Demand. They take comfort in knowing their information is accurate and easily accessible.It’s a means to achieve better outcomes,” says Dr. Tannenbaum who makes a point of putting the keyboard away when engaging patients in counseling.

Future Plans

“We are focusing on more complete notes, keeping better records and improving communication among the health-care team,” says Dr. Tannenbaum.“This should provide improvements in patient care and allow us to study our clinical practices more effectively in the future.”