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Winnipeg Clinic Medical Corporation
Electronic Medical Record & Practice Management System
Setting a 'Chartless' Course into the Future
Challenge
Everything at the Winnipeg Clinic seemed to depend upon the traditional patient chart -- but that wasn't a healthy state of operations.
The Winnipeg Clinic, the first of its kind in Manitoba, was founded in 1938 to provide excellence in medical advice, treatment and therapies. It now has 55 physicians representing more than 20 speciality areas who see more than 1,000 patients every day. Lab, x-ray and other diagnostic services are also available on site at the clinic, which, in addition to its main downtown Winnipeg office tower location, includes two suburban walk-in clinics.
Paper patient charts were the source of many of the clinic's challenges. One entire floor of its 12-storey head office was dedicated to storage of nearly 600,000 patient charts, and 10 members of the clerical staff were dedicated to filing and retrieving those charts.
Receptionists on each floor would often become involved in the hunt for charts, time that would have been better spent greeting patients; and transcriptionists wasted valuable time printing chart notes on to paper and then cutting them out to paste into patient charts.
In spite of all the focus on patient charts, approximately 20 per cent of patient encounters had to be conducted without them because they had been misplaced, misfiled or lost. This often resulted in duplication of information collection and forced physicians to make decisions without the full benefit of patient history.
If a patient needed to be treated at another location for some reason, such as a medical emergency, diagnosis and treatment delays might be encountered while charts were found and faxed or couriered. Physicians and staff were becoming increasingly frustrated and stressed by the clinic's antiquated and inefficient paper medical records system.
Solution
The Winnipeg Clinic replaced its paper charts with an electronic medical record (EMR) system and implemented a practice-management application to automate and streamline patient scheduling and billing.
To create an environment that could properly support the new level of complexity and performance requirements associated with the EMR system and the clinic's other applications, a complete new IT infrastructure, including new servers, user desktop devices and network, was also installed.
With the new EMR system, all authorized staff can now access patient information quickly and easily online. With Internet access, patient information can be also accessed easily and securely from other locations, including other clinics, hospital emergency rooms and physicians' homes.
Results
The move to a paperless environment has transformed the way the Winnipeg Clinic operates, producing significant business, clinical and personal benefits for the organization and its staff.
As patient information from existing paper charts is added into the new EMR system and the physical charts are sent to offsite archives, the area previously used for storing charts is being reallocated for additional physicians' offices and exam rooms. This is expected to produce an additional $1 million in fees for the clinic annually.
The 10 people previously dedicated to filing and retrieving charts are being reassigned to higher-value tasks or eliminated through attrition, saving the clinic $150,000 annually in salary-related costs. In addition, receptionists can spend more time dealing with patients, and transcriptionists spend less time generating chart notes, since it's all done online now.
The EMR system has also contributed to increased physician efficiency, reducing the average amount of time required to see each patient. The new system is also producing important clinical and care-delivery benefits.
Since up-to-date patient data is always at physicians' fingertips - no more lost or misfiled paper charts - and it's always legible, patient exams and diagnoses now benefit from having medical history information available, complete with physicians' notes and lab results. Patient records are now available to authorized staff from any location where there is Internet access, so patients can receive informed and timely care no matter where they present themselves or where their physician may be.
Innovative Use of Technology
A server-based computing model is used for delivering the EMR and other applications to clinic staff. Instead of the traditional method of running applications on user PCs at the desktop, applications are run on back-end servers, and users interact with those applications through a "presentation layer" consisting only of screen images, keystrokes and mouse clicks.
Users can therefore use thin-client devices, which are much smaller and less expensive than traditional PCs. This reduced capital costs as well as maintenance and support costs. In addition, any new applications that need to be installed or any upgrades, patches or other maintenance work on applications need only be done once - to the applications residing on the servers - rather than having to install them on every desktop.
Unlike many organizations its size, the clinic took a close look at what it would cost if their computer systems went down for even one day. Based on that analysis, the clinic has removed as many single points of failure as possible. Fully redundant network switches and cabling were installed, for example, and clustering and load-balancing technology was used to ensure high availability of the back-end application servers - so systems stay up and running smoothly 99.999 per cent of the time.
A 2007 CIPA Winner!
For exceptional application of information technology to transform processes and bring benefits to its stakeholders, the Winnipeg Clinic Medical Corporation has been awarded a CIPA Gold Award of Excellence in the Organizational Transformation, For Profit category.
Technology partners
BridgeComm Corporation
Oxygen Technical Services
Citrix Systems Inc.
Cisco Systems Inc.
Wyse Technology Inc.
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