Implementation of The T SystemEV improves revenues of Graham Hospital

For the past 100 years, Graham Hospital in east central Illinois has provided the city of Canton and its surrounding communities with outstanding healthcare. Today, Graham Hospital provides a full range of inpatient, outpatient, home care and long-term care services. Not unlike many communities across the country, the area Graham Hospital serves has been faced with economic challenges. Despite those challenges, the emergency department (ED) at Graham has actually seen an increase in revenue, even with a slight drop in patients, due to their relationship with T-System, the nation's leading provider of clinical documentation solutions for emergency departments.

"We're in a largely rural area that has really struggled in our recent economy," said Sherry Alton, RN, MBA, CEN, Emergency Department Director for Graham Hospital. "We've lost some major employers over the past several years, which has had an impact on our emergency department traffic." According to Alton, many of their emergency department patients face large co-pays, or are in a self-pay situation. "As a result of these increased out-of-pocket expenses, our patient counts have dropped. Over the winter, for example, our traffic was down three percent."

Because of efficiencies created by implementing new patient charting solutions, the ED at Graham Hospital has actually seen an increase not only in per patient revenue, but in overall revenue. These efficiencies were the culmination of a two-year initiative developed by Alton, her staff and the hospital's executive team.

"In discussing our future strategies for Graham with our CEO and medical director, we all agreed to pursue systems and technologies that would enable the hospital to work smarter and more effectively," said Alton. "In the ED, one of the first things we focused on was our charting."

Previously, the department had been using a homegrown charting system to capture each patient's chief complaint. "We were doing our best with the processes we had in place, but we felt that there was significant room for improvement and that there were more efficient data capture techniques available. We obtained some sample T-System paper charts from another hospital and were immediately impressed," said Alton. "We reviewed the system with our medical staff and hospital administrators. We felt confident that the system would help us achieve process improvement goals, and we immediately began implementing the T-Sheets(R) system in the ED."

According to Alton, the system was easy for the physicians and nurses to learn, resulting in the rapid realization of quantifiable results. "As with all hospitals, a concern from a revenue perspective is coding for reimbursement. With The T System, this is less of an issue, as the system encourages comprehensive coding to avoid missed charges for services provided," said Alton. "Our clinicians immediately felt comfortable with the system, and within months we saw our revenue per patient visit increase by 27 percent."

Administrators at Graham Hospital continued investigating methods to further improve workflow and processes in the ED, and they looked at migrating to an electronic system. Less than a year after adopting TSheets, the ED migrated to The T SystemEV, T-System's state-of-the-art emergency department information system (EDIS). "The migration for us made sense, as we already knew The T System and the value it provides," said Alton. "We were very pleased with our go-live experience in October 2008, as we had great support from T-System training staff during the switchover."

John Quinones, DO, ED Medical Director for Graham Hospital, noted the quality of service benefits of the new EDIS. "T SystemEV covers the entire ED process from triage to discharge, resulting in an efficient means of charting throughout the patient encounter," said Quinones. "The electronic templates enable real-time charting at the bedside, ensuring accurate capturing of clinical data while enabling our doctors and nurses to spend more focused time with their patients." ED physicians and nurses access the EDIS from PCs in the treatment suites, via two tablet PCs, or through the department's seven "WOWs," or Workstations On Wheels. "Because the chart is electronic, it's a living document that progresses right along with the patient's treatment," said Quinones. "If the patient is transferred to another department, the chart goes right along with them."

According to Quinones, the move to T SystemEV was consistent with the hospital's initiative to work smarter through technology. "The EDIS integrates directly with our hospital-wide health care information system, greatly improving our efficiencies and workflow. We also added the Computerized Physician Order Entry (CPOE) module, which allows physicians to complete their own order sets during treatment."

With the implementation of The T SystemEV, Graham Hospital saw further improvements in efficiencies and revenue, with the ED seeing an additional 12 percent increase to their revenue per patient visit. This additional increase meant that Graham hospital saw more than an overall 39 percent increase in revenue per patient visit as compared with their homegrown solution, which resulted in improvements to their overall revenue as well. According to Alton, despite the drop in patient counts in the November-to-January time period due to the slowdown in the economy, Graham Hospital's overall ED revenue actually increased by nearly eight percent during that time period.

Revenue, of course, was not the main motivator for Graham Hospital. "The benefits go far beyond increased revenue," said Robert Senneff, President & Chief Executive Officer for Graham Hospital. "Accuracy, safety and quality of care are a primary focus for us. The electronic charts are a powerful means to positively impact our clinical excellence by working to ensure the accuracy and legibility of our patient records. A quality medical record reflects the quality of care our patients find at Graham Hospital."

Used in nearly half of all emergency departments in the country, T-System provides the most-used clinical documentation systems for emergency departments in America.