The Computerworld Honors Program
Honoring those who use Information Technology to benefit society
LOCATION:
Miami, FL, United States

YEAR:
2008

STATUS:
Laureate

CATEGORY:
Healthcare

NOMINATING COMPANY:
EMC

ORGANIZATION:
University of Miami Clinical Enterprise Technologies

PROJECT NAME:
CaneCare: Bringing physicians together with critical patient information on the Web



Introductory Overview
Quick, easy access to current and complete information about the patient’s medical history is a critical requirement for delivering the highest quality patient care. While the majority of healthcare providers still reply primarily on paper records, a growing number are now putting significant resources behind the development of electronic medical record (EMR) systems. In fact, the US government has mandated that all hospitals transition to a shared EMR within the next ten years.

For all of its potential to improve the quality and efficiency of healthcare, the creation of an EMR as a completely integrated, easy-to-access source of comprehensive patient information has been elusive for most healthcare providers. EMR implementation has proven especially difficult for institutions as large and decentralized as the University of Miami Medical Group (UMMG), which has sites located throughout metropolitan Miami.

Today, UMMG includes more than 800 physicians across a dozen of South Florida hospitals. The medical school needed to improve their current EMR system and to create a unified platform that aggregated, managed and archived all paper and electronic patient information.

Even within the confines of its own hospital, UMMG faced considerable challenges in standardizing the medical records used across the organization. For example, the hospital had many different versions of a patient consent form, all of which included the same basic information.

UMMG had learned from previous experiences that an EMR implementation is a very difficult undertaking and one that is best done in small steps. That’s why the University of Miami Clinical Enterprise Technologies (UMCET) division chose to take an incremental approach toward a full-scale EMR. By implementing CaneCare—a hybrid medical record system, UMCET has provided UMMG physicians with an electronic patient chart that can be accessed from any location using a Web browser.

CaneCare enables UMCET to create a common patient record across the major health institutions in the State of Florida by sharing experience and tools with other sites. Patient data from the University of Miami Hospitals and Clinics’ paper charts are scanned, indexed and appended to the patient’s electronic chart within 24 hours of the visit. Physicians, nurses, office staff and other pertinent clinic and hospital staff now all have access to the most current electronic version of patient information. What’s more, multiple people can view the same electronic patient chart file at the same time—without anyone running from place to place to locate and pull a chart, or spending time tracking down a chart that was traveling from one facility to the next. A common patient record has also made compliance with stringent HIPAA regulations a more reliable and streamlined process.

The Importance of Technology
How did the technology you used contribute to this project and why was it important?
The CaneCare system is an example of an emerging trend in next-generation software, called composite applications, which combine off-the-shelf software with custom-built functionality.

At the heart of CaneCare are EMC Documentum ApplicationXtender and its companion product, EMC DiskXtender. Together, the products form an easy-to-use electronic solution for organizing, managing, and archiving all clinical documents, files, and other patient care information, with fast, security-controlled access to information through Microsoft Windows or Web-based clients.

UMCET built the CaneCare User Interface using the ApplicationXtender Web Services API (application programming interface) to provide Web-based access to the clinical repository and to manage the clinical documentation while EMC DiskXtender archives the scanned images. ApplicationXtender supports the receipt of patient data from a wide range of sources in a wide range of formats, including data from UMMG’s registration system, scanned paper forms and Microsoft Word documents such as progress notes from the hospital transcription system.

Use of Web technology helped ease the implementation and provide universal access to users across the UMMG enterprise. Since ApplicationXtender is a Web-based product built on Java technology and easily deployed with Java Web Start, UMCET was able to easily and rapidly develop CaneCare using in-house resources. New functionality as well as application updates can be rolled out much more quickly.

To ensure easy access to the electronic patient charts, the rollout of CaneCare also included placement of additional computer terminals in exam rooms and other key clinic and hospital locations. Because it is a Web-based application, the system can be readily accessed by not only computer terminals at multiple locations but also table systems and handheld PDA systems.

Benefits
Has your project helped those it was designed to help?   Yes

Has your project fundamentally changed how tasks are performed?   Yes

What new advantage or opportunity does your project provide to people?
When a patient visits a UMMG hospital or clinic, data from patients’ paper charts is scanned, indexed and appended to their electronic charts within 24 hours. At the same time, CaneCare archives patient data from other UMCET applications such as the transcription system and those supporting ancillary departments such as lab and radiology. UMMG clinicians and other staff have online access to this information on a secured, “need-to-know” basis to help protect patient privacy. The system employs sophisticated checks and balances to guarantee accuracy of the data and improve patient safety.

To address the inconsistencies in medical forms used by different clinics throughout the UMMG network, UMCET developed policies and procedures to standardize the process of creating and approving a form for CaneCare. Now, clinicians and administrators can access a single Web site to locate the standardized forms, print them or order them in bulk.


If possible, include an example of how the project has benefited a specific individual, enterprise or organization. Please include personal quotes from individuals who have directly benefited from your work.
Unlike traditional clinical software solutions that practitioners have resisted using because they have inevitably slowed critical processes, CaneCare has been very well-received due to its ease-of-use and customized functionality.

Elizabeth Rockowitz, former UMCET executive director who held this position during the CaneCare implementation, said: “By building the application ourselves, we were able to create a highly customized user experience. We strived to let our practitioners drive the design of the CaneCare application from very early on in the project. The result is a system that caters to the clinician’s specific needs and is intuitively easy for them to learn and use.”

With ApplicationXtender Web Services API, UMCET’s IT organization was able to implement a highly customized user interface that provided a range of functionality, including advanced sorting and filtering. This particular functionality allows doctors to quickly and easily gather data about their patients, such as treatments previously received and where they were given. Doctors can also set up custom filters, automatically saved as user preferences, to enable them to instantly find the documents that are most applicable to their specialty.

Rockowitz added: “The many advantages that CaneCare brings to the practice have resulted in a substantial increase in the number of physicians using the system compared to our previous solutions. This is a giant win for today’s medical industry, in which there has been a considerable resistance to change on the part of practitioners.”

Speaking from a technology perspective on the benefits of the CaneCare solution, Oscar Perez, UMCET’s IT director, said: “Since our first go-live, we’ve been able to release seven new updates of the CaneCare system. This means we’re able to fix patient safety issues quickly, which helps us satisfy our compliance office. An added benefit to the Web-based nature of the system is that our users can access CaneCare from their Windows or Apple computers at work or at home, without the need to install additional software.”


Originality
Is it the first, the only, the best or the most effective application of its kind?   Most effective

What are the exceptional aspects of your project?
At first glance, the CaneCare system seems similar to typical “cold feed” document imaging system, where multiple documents and forms are scanned into the system. What makes it unique and exceptional is that the front-end interface of the system was custom designed by the UMCET team to be not only be extremely patient-centric but also very easy and intuitive for physicians, nurses and other staff to use. CaneCare was also designed with the future in mind, laying the groundwork for the move to next-generation EMR that will allow for even more dynamic data entry and manipulation.

Difficulty
What were the most important obstacles that had to be overcome in order for your work to be successful? Technical problems? Resources? Expertise? Organizational problems?
UMMG’s previous attempts at implementing EMRs have not been completely successful, with user acceptance being one of the primary roadblocks. Practitioners would often not use a system if it slowed them down or made their jobs more difficult. And physicians simply do not have the time to focus on new technology or be trained to use a complicated new system.

However, when physicians and administrators saw how easy the CaneCare system was to use, resistance evaporated and the new solution was quickly accepted. Most UMMG clinicians and other staff were impressed with how the CaneCare quickly provided one integrated, holistic view of a patient’s medical history, ultimately saving valuable time their hectic schedules by eliminating the need to access multiple different computer systems or search for paper charts.

The traditional obstacle of clinicians finding time to be trained on the new system became a non-issue, because most users found the CaneCare system so simple and intuitive to use that training was not needed.

Often the most innovative projects encounter the greatest resistance when they are originally proposed. If you had to fight for approval or funding, please provide a summary of the objections you faced and how you overcame them.
As is the case with most any new technology project, the UMCET IT team found some initial skepticism from management regarding the cost and value of the proposed EMR project. To help justify the project and build initial support, the UMCET IT team first rolled out a CaneCare system pilot in one hospital department. The success of the pilot helped build acceptance for the project as a whole and laid the groundwork for the subsequent phased deployment. Across-the-board buy-in—from management on down—is essential to launching any new IT project successfully. To build early-on interest in and support for this project, the UMCET IT team sponsored a naming contest for the EMR system. The winning name—CaneCare—is a spirited tribute to the Miami Hurricanes, the name for the University of Miami football, basketball and baseball teams.

Success
Has your project achieved or exceeded its goals?   Achieved

Is it fully operational?   Yes

How do you see your project's innovation benefiting other applications, organizations, or global communities?
In the two years since CaneCare’s official release, UMCET has already implemented the system at five new clinics and two new hospitals. There are plans to extend the system to three satellite sites as well as other teaching hospitals in the state of Florida.

UMCET also won the 2006 Excellence in IT Leadership Award for the State of Florida for its creation of CaneCare. The group plans to expand the system to additional sites and teaching hospitals throughout the state of Florida.

An unanticipated benefit of the CaneCare system is that it has served as a catalyst for process improvements across the UMMG system. As a result, many forms and data categorization have now been standardized, which helps generate workflow efficiencies and boost productivity across UMMG.


How quickly has your targeted audience of users embraced your innovation? Or, how rapidly do you predict they will?
The acceptance curve for the CaneCare system was short. After overcoming the expected and initial reluctance to learn any new computer-based technology solution, the physicians, nurses and other staff at participating UMMG hospitals and clinics now readily and avidly use and support the CaneCare solution. Users have taken the time to provide feedback on additional features and enhancements that they would like to see added to the system, many of which have now been incorporated into subsequent system releases and updates.
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