St. Luke's Regional Medical Center in Boise, Idaho was diligently attempting to maintain accurate charts. But their business processes, and lack of technology, made the task time consuming and frustrating - as well as nearly impossible.

The Problem
St. Luke's was using paper-only charts with an electronic billing system. Clinicians charted on paper before returning to the office to complete bubble sheets to scan for billing. If there was an error, the scan sheet would be rejected and the clinician would have to return to the office to complete again. Billing information was entered into the hospital system for the centralized billing office. However, the hospital billing office did not have the resources to follow up on rejected accounts. Clerical staff spent most of their time at the copier, attempting to maintain current charts that were generally out of date despite their diligence.

Leadership was frustrated that clinicians spent so much time in the office and that clerical staff wasn't able to perform more strategic activities, due to the constant need to make copies. Clinicians were frustrated that patient charts, particularly medication lists, were unreliable. Clerical staff felt like they were bearing the blame of inaccurate charts in what was an impossible situation. The constant copying was such a mundane task that clerical staff felt underutilized, unappreciated and bored. In fact, one position experienced turn-over so frequently that temporaries were brought in to perform the job.

It was the picture of inefficiency, not to mention unsafe for the patients. Not surprisingly, the department was unprofitable.

The leadership team knew something dramatic had to be done. While they weren't sure they could quantify how much the inefficiency was costing, they knew the board was committed to patient safety. In fact, the Chief Nursing Officer believed this was the most unsafe department in the hospital system. With a primary goal of increased patient safety, St. Luke's began to review electronic medical record systems that were designed specifically for home care. Leadership wanted to provide accurate information on every patient, to every clinician on every visit. Secondary goals included automating or eliminating the redundant, mundane clerical tasks, thereby enabling office staff to engage in the "higher end" of their job description. This would also eliminate the need for clerical temporaries as well.

The Solution
St. Luke's selected NDoc, homecare and hospice management software developed by Thornberry Ltd. A recently acquired agency was already using NDoc and was very pleased with the product and its results. As the complete home care system was implemented, leadership worked with staff to stress the importance of using laptops in the home and other key behaviors to ensure the greatest return on investment possible.

The results have not only met the goals, but so much more. As the redundant paperwork was removed for clinicians and clerical staff, all team members were better able to focus on more important tasks. This revealed a significant chasm that had developed between the clinicians and clerical staff. As mentioned earlier, clerical staff felt blamed for inaccurate charts and really couldn't see how making copies impacted patient care. But with NDoc in place, this on-going source of frustration was removed. The efficiency of clerical staff improved to the point where they could be sent on an occasional patient visit - in order to better understand the impact of their work. One office staff member noted that being able to assist on a patient visit was the most meaningful work-related experience of her life. Clerical staff began to connect their work with the difference home care makes in the lives of patients. Clinicians experienced accurate charts as well as additional field time each day. Billing began to be completed by home care staff, instead of being run through the hospital's centralized billing office. As a result, the agency went from being unprofitable, to break-even and today is making a profit!

"Moving from paper to electronic has had a significant impact on our financial picture. Since we've launched NDoc we've seen about a 37% increase in our profits," said Mary Lou Long, Executive Director of Community Services for St. Luke's Health System.

Coincidentally, the agency experienced dramatic growth at the same time. Home care census grew by 40 percent and the hospice census doubled in just five months. Due to the increased productivity, the staff managed all of this growth without the need to add personnel until recently. St. Luke's just hired a 0.6 FTE.

Moving from paper charts to an electronic medical record made a dramatic difference at St. Luke's in terms of patient safety, staff morale, productivity and efficiency.