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Dialogue: Daniel Nigrin and Eileen Sporing on CHAMPS

Chief Information Officer Daniel Nigrin, MD, MS, and Senior VP of Patient Care Operations Eileen Sporing, MSN, RN

What is the CHAMPS project?
CHAMPS—Children’s Hospital Applications Maximizing Patient Safety—is a multi-year, multi-phase project designed to replace many of the key computer-based systems that we use to care for patients. These systems—including Results Reporting, Electronic Clinical Documentation (ECD) and the Ambulatory Prescription Writer, among others—will be replaced with a comprehensive source of patient information that will be all available on everyone’s local computer.

What is the goal of the project?
This primary goal, is to enhance patient safety, which is an extremely important topic—in this institution and nationwide. One compelling patient safety issue is medication error. Based on published reports, medication errors leading to injury can occur at a rate of three per every 100 patient admissions. The majority of these errors happen because the appropriate information is not available to clinicians at the time medication decisions are made. Today’s research demonstrates that by implementing technology-based patient care systems, errors can be reduced at every step of the medication administration process.

How can a computer system improve the safety of care provided to patients?
Our new systems will have the most impact on medication safety—not just the ordering of medications, but really the whole medication administration process. In addition to ensuring that a safe and correct order is placed by physicians from the outset, these systems will enable us to address the “Five Rights” of medication administration by nurses—right patient, right drug, right dose, right route and right time.

In essence, the new systems will provide patient information—such as lab results, medication administration records and allergy information—to nurses and other clinicians, allowing them to benefit from real-time decision support at the point of care. The systems will allow every clinician to have immediate access to all information on a given patient, improving communication among the care team and reducing the risk of information falling between the cracks. The result will be systems that can streamline processes, improve patient care and reduce errors.

Why did Children’s select the Cerner Corporation for this project?
Cerner was chosen after a lengthy and comprehensive selection process. The bottom line is that Cerner has the most integrated set of systems. Whether it be surgical scheduling, the lab system, the pharmacy system, or the order entry system, Cerner consistently did better than all of the other vendors across the whole range of systems they can implement. They also had more of a focus on pediatrics than the other vendors—with a special subdivision entirely devoted to pediatric institutions and children’s hospitals—and they are interested in working with us to develop the products we need.

How long will it take to implement CHAMPS?
It will be rolled out in three phases over the next three years. The first phase, which began this April, involves the replacement of our lab, pharmacy and Results Reporting computer systems. New features will be added to the lab and pharmacy systems to improve department operations and to position the hospital to implement computerized provider order entry (CPOE). The first phase is expected to be completed by late summer 2005.

“The systems will allow every clinician to have immediate access to all information on a given patient, improving communication among the care team and reducing the risk of information falling between the cracks.”

During the second phase, CPOE will go live, and we will begin to roll out inpatient nursing documentation. This phase will have the biggest impact on physicians and nurses, as well as on patient safety itself. With these new systems, clinicians will be required to enter patient orders—which are currently written on paper—directly into the computer, with warnings of potential drug interactions presented directly to them through the computer at the time the order is entered. Additionally, nursing notes and medication administration records currently recorded on flow sheets and in paper patient charts will also be entered directly into the computer. Also in this phase, communication among clinicians will be improved through computer-generated rounds and shift reports. The second phase is expected to be completed by late spring/early summer 2006.

The third and final phase will incorporate additional clinical documentation capabilities in both the inpatient and outpatient settings. This will include physician documentation and structured clinical documentation based on templates. A case-tracking/
peri-procedure documentation system will also be incorporated during this phase, along with a scanning application for medical records. We expect to complete this phase by early summer 2007.

Will there be training for staff?
A variety of trainings will be offered as this project unfolds—in classroom settings, in one-on-one settings on the individual units and in computer settings that employees can complete on their own time. We fully recognize that training people before, during and after the implementation dates is one of the most important aspects of this project.

How can people learn more about the CHAMPS project?
Employees can go to the “Hot Projects” section on the internal Web site and click on “CHAMPS/Clinical System” to visit the CHAMPS web page. The site includes general project information as well as links to the Cerner Corporation, and will be updated as work on the project progresses.