Sovera® Health Information Management St. Michael’s Hospital (SMH)

CGI Sovera Health Information Management solution provides big enabler for Electronic Patient Record adoption and clinical practice transformation

St. Michael’s Hospital (SMH), located in Toronto, is a world-renowned academic health sciences center. Every year, 4,800 staff and 600 physicians teach 1,800 students, perform 25,000 day surgeries, treat 600,000 patients in clinics, see 54,000 patients in the emergency department and provide round-the-clock care to 24,000 inpatients. SMH leads the way in clinical care, education and research in heart disease, trauma and critical care, neurosurgery, arthritis and osteoporosis, keyhole surgery, diabetes, cancer care and care of the homeless and vulnerable populations in the inner city. It is the designated adult trauma center for downtown Toronto and a major referral center for the province of Ontario.

The Challenge
In 2003, St. Michael’s Hospital launched Gemini, a large, multi-year initiative to transform how care is delivered to patients, including transitioning the hospital from using paper-based patient charts to an Electronic Patient Record (EPR). To achieve this goal, SMH began implementing and integrating clinical applications based on online patient information, such as a Laboratory Information System, Picture Archiving & Communications System, Radiology Information System and Pharmacy Information System. Other systems being implemented included an application for scheduling patient visits to outpatient clinics and an application used in inpatient units for placing non-medication orders, such as for lab tests and diagnostic imaging studies. The platform for many of these applications is the Siemens Soarian Clinical Information System, an innovative, new workflow technology that gives physicians and other caregivers access to real-time, online patient information. The implementation of additional Soarian capabilities such as Clinical Documentation and CPOE (Computerized Practitioner Order Entry) is part of St. Michael’s EPR plan.

However, recognizing that moving to an EPR is not an instantaneous transition and that paper records will still play a role in patient information management for several years to come, SMH needed to find a document management system that could bridge the paper and electronic worlds. The system would need to be integrated with Soarian so that paper records scanned into the system could be viewed by physicians working in Soarian without them having to log into a separate application.

The hospital also needed to address a critical space problem in the Health Records Department, where 500,000 patient records were being stored between two areas, while an additional 700,000 charts were kept offsite in a third-party storage facility. An additional 55,000 records every year and a daily 44-inch-high pile of ‘loose notes’ added continually to the space problem. Compounding the problem, the records were stored offsite, making retrieval more difficult and time-consuming.

The paper records also posed an accessibility challenge – a record that was signed out by one clinic or service was not available to any other service needing to access the same record, resulting in undesirable delays and the tendency to create photocopies of records, which could easily get out of sync.

A new, more-streamlined approach to paper records management was needed that would solve the records department storage problem and make accurate, up-to-date patient health records quickly and easily accessible by all authorized SMH staff.

The Strategy
After spending six months conducting extensive research and a market scan of available document management solutions, a selection committee consisting of the CIO and representatives from physician groups, IT and the Health Records Department chose CGI Group Inc.’s Sovera for Health Information Management, an electronic health records management system.

Sovera would provide online storage and retrieval of patient health records to complement real-time patient records in the Soarian system. Clinicians would build and access records in Soarian during a patient’s visit or stay at the hospital; and then, upon discharge, patient information would be electronically fed from Soarian and other hospital systems into Sovera, and any paper charts or forms would be scanned into Sovera. It was also decided that the paper records from the previous year would be scanned into Sovera to give clinicians quick and easy online access to recent records.

“CGI architected and implemented all this for us, including working with our hardware system vendor to ensure that the necessary redundancy and high-availability infrastructure was in place to support the system and provide automatic failover in the event of a hardware failure,” says Michael Stewart, SMH’s Director of Decision Support, Health Records & Patient Registration.

Perhaps the most important, yet challenging phase of the project was integrating Sovera with Soarian so that physicians and other users could easily access and view a Sovera record from within Soarian, without having to switch applications. This not only involved integration at the document and patient levels, but also required controls to ensure that a user could not have different patient records open at the same time, thus reducing the chance for an error based on confusing one patient’s information with that of another.

“We knew that having this integration was an absolute must if we hoped to get physician buy-in to use this system; and without that, the project would likely fail,” explains Dr. Dan Cass, Director of Medical Informatics at St. Michael’s Hospital and one of the physician champions for this project. “CGI was a fully engaged partner in defining the requirements around this and jumped in with both feet to make it work. We were successful because of the great partnership that formed between St. Mike’s, Siemens and CGI.”

The subsequent go-live of the new Sovera system went very smoothly because of the extensive stakeholder groundwork and change management work that was done beforehand.

“This was one of the quietest go-lives I’ve ever seen,” enthuses Dr. Cass. “It was very gratifying that all the technical and change management work that had been done by the joint St. Mike’s and CGI team resulted in such an easy go-live.”

The Results

• CGI Sovera® HIM (Health Information Management)
• Siemens Soarian® Clinical Information System
• CGI Sovera® Content Connector
• IBM Enterprise Content Management
• Oracle® Database
• IBM pSeries/xSeries Server Infrastructure
• IBM DS Series Storage Array

The Results
As soon as the new Sovera document management system went live, SMH began seeing substantial clinical and administrative benefits. On the administrative side, Sovera eliminated any further need for the Health Records Department (HRD) to retain paper copies of new patient records. This, along with scanning 42,000 historical patient records into Sovera representing about three million pages, allowed the department to solve its space problem. HRD was also able to redeploy 50 percent of its 35 staff members to other areas of the hospital, resulting in considerable reduction in ongoing costs.

“With Sovera and online patient records, we were also able to increase our operational efficiency by creating automated workflows for handling patient records, including the identification of chart deficiencies and notifications to physicians,” says Norma Forbes, Manager of Health Records at SMH.

The system also allowed SMH to solve the problem of fragmented patient information. While the bulk of a patient’s record resided in the records department, some information was being held in different clinics; but now, all of this is being consolidated into a single, online record that can be quickly and easily accessed by any authorized clinician. This not only eliminates the need for any duplicate information or the copying of paper charts, but also makes it easier to manage the confidentiality and security of patient records.

“Patient documents in electronic form are much less likely to get lost and it’s harder to walk out the door with them and inadvertently leave them somewhere where they could be found,” claims Michael Stewart.

This is just one aspect of the positive feedback that has been received from the risk management personnel at SMH whose job it is to prevent any adverse patient events from happening in the hospital. They also benefit from being able to access a patient’s records easily, without having to wait for a request to be processed and paper charts to be retrieved by the records department as in the past. While records can now be accessed from outside the hospital, such as by physicians in their offices are at home, access occurs over secure network connections. Patient data never resides in the user’s PC, so it cannot be inadvertently lost or stolen. Sovera is also helping SMH reduce any legal risk associated with patient records – a paper record scanned into Sovera cannot be changed, guaranteeing the integrity of patient information.

On the clinical side, the project team has received positive feedback from physicians indicating that the new records management system is intuitive and easy to use; and with only one patient record, which is quickly and easily accessible to the physician online, there is no waiting and no more competition with other services trying to retrieve the same charts.

One group that has been particularly supportive is the Emergency Department (ED) physicians. Previously, it took as long as 45 minutes to retrieve a record from HRD for someone arriving in the ED. Now, patient records are available immediately online to ED physicians. If the person has not been a patient at the hospital previously and thus has no record there, this too is known immediately, and appropriate intake assessment and information gathering can be started.

“The ED docs can’t say enough about how important it is to them to have timely patient information available when a patient shows up at their clinic,” says Dr. Cass.

Once the dust settles on this first, clinical phase of the project, SMH will begin looking at using Sovera to introduce the same records management capabilities in non-clinical areas, such as in HR and Accounts Payable. With that longer-range goal in mind from the beginning, it had always been part of SMH’s product selection criteria to buy an enterprise content management system, rather than just a health records system, which is another reason why they chose Sovera. As a content management platform for addressing this broader need, Sovera supports the storage of other types of content, such as voice and video, along with documents.

According to Dr. Cass, this has been a hugely successful project to date. There was an identified need that physicians would acknowledge and there was a potential to make things better through this project.

“We went out and did our due diligence, found the right product and the right vendor, and had a great relationship with CGI from start to finish,” says Cass. “As these things go, there are always little challenges and hurdles, but this went as flawlessly as a project of this scale could possibly go and it was done in a very reasonable length of time. This is a huge success story for St. Mike’s and CGI.”