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Because of a new electronic patient record system, Paul Grover, RN, family educator in the child psychiatric unit at Stony Brook (N.Y.) University Medical Center, is well prepared to answer questions about test results, medications, and plans for care with the click of a mouse. After entering his password, Grover can access the patient’s records.

The new system, a roaming interactive computer called the Stony Brook Totally Automated Record System (STARS), is mobile and can be wheeled to the nurses’ station, the hallway outside a patient’s room, or a bedside.

“In the past, I had to walk back and forth to the nursing station to find the pertinent records as questions arose,” Grover says. “Now, however, I am able to provide a quicker response and can give broader information, including easily graphing trends if desired. While this is much more convenient and time-saving for me, I believe an even greater value is that it strengthens confidence for the patient and family, leading to greater treatment compliance and better outcomes.”

Stony Brook is among only 2.5% of hospitals nationwide to use an electronic patient record with its recent additional functionality of computerized physician/provider order entry. Two nurses from Stony Brook University Medical Center — Lee Anne Xippolitos, RN, PhD, NP, CNS, CNAA, BC, chief nurse officer, and Katharine A. Holzmacher, RN-BC, MS, NP, director of clinical informatics — researched, planned, and implemented the system. In January, the center went live with computerized physician/provider order entry.

On Long Island, Winthrop University Hospital in Mineola, N.Y., and North Shore University Hospital in Manhasset, N.Y., also are developing state-of-the-art systems, and Schneider Children’s Hospital in New Hyde Park, N.Y., may follow soon.

Benefits of using the systems include saving time and money while improving patient safety, enhancing communication and care-team coordination, and reducing medication errors and adverse drug events. The computers cut steps from order entry and eliminate time-intensive, duplicate processes. Physicians, nurses, pharmacists, and other caregivers can communicate, receive, and take note of patient care decisions more efficiently and effectively. Although paper records can be lost, unorganized, or difficult to read, standardized record keeping systems improve patient safety as well as operational and workflow efficiencies.

“Medical informatics is well behind many computer applications,” Grover says. “Ironically, I can put my credit card in a machine in China and in seconds it will know if I’m qualified for a purchase, yet if I get into an accident and my medical records are urgently needed, they may not be attainable.” Since many hospitals are complex, it is more difficult to retrofit facilities with this technology, Holzmacher says.

Roaming interactive computers at the bedside have improved nurse-to-patient communication and patient chart comprehension. “Before we implemented [computerized physician/provider order entry], in order to look up any history on my patients, I had to order his (or her) chart, wait a day, and then search through reams of paper or attempt to comprehend a difficult computer interface,” Grover says. “Now, however, there is a wealth of significant and valuable information at the nurse’s fingertips.”

Patient safety also has improved because identification information is always at hand. “Safety will take yet another step forward when we move to the next level of implementation — barcode scanning of medication, the patient’s wristband, and the nurse ID badge,” Holzmacher says.

To enhance acceptance of the change, Stony Brook implemented several strategies, such as seeking input from end-user staff and going live with test units first so the team could evaluate the results. “Initially, responses to the initiation of CPOE changes ranged from the naysayers at one end of the spectrum to the enthusiastic who were excited by the prospect of vastly improved information accessibility,” Grover says.

Holzmacher notes it may be more difficult, though not impossible, to protect patient privacy in larger institutions such as academic medical centers. “Because medical centers are so complex, we have different issues to contend with,” Holzmacher says. “For instance in the case of ongoing research projects, we must review applications for access to assure that the person seeking information has the right to know, as well as having credentials based on their role in the project.”

The STARS system has been set up to give right-to-know access to people who meet the criteria. As a result, privacy has been improved from the paper process because of the application review and password requirement.

Holzmacher says to avoid system crashes several servers back it up. “Our information technology department has done a wonderful job in managing the load on the system in addition to installing new equipment as needed.” Holzmacher says. “With more than 5,000 end-users, IT monitors daily the maximum number of users that would be on the system at peak times to determine whether our system can handle the load.”

Although Stony Brook sought advice from consultants at the beginning of the process, a unique aspect of the STARS system is the nursing informatics teams developed their own in-house consultants. “Rather than needing to call in outside consultants for help with the system, we preferred to build our own inner knowledge,” Holzmacher says. “Who better to design new processes than our own nurses and doctors?”

The Nursing Informatics Training team began a Champion program for STARS. The champions are volunteers who develop an advanced expertise in STARS to assist patients and answer questions.

The team’s expertise makes the system more responsive to the needs of the end users, Grover says. “Many of us have been involved from the first design session,” he says. “Stony Brook’s administration brought nurses into the process from the beginning and has exerted considerable effort to ensure the end product would support nursing process.”

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Maryanne E. Bezyack, RN, MSN, CPNP, is a contributing writer. To comment, e-mail editorNY@nursingspectrum.com.