Introduction

Hospitals, large physician group practices, and other enterprise-level medical organizations require specialized software and systems that can serve hundreds or even thousands of end users.

As of 2014, 76 percent of non-federal acute care hospitals have adopted at least a basic electronic health records (EHR) system, an increase of 27 percent from 2013, according to the latest data from the Office of the National Coordinator for Health Information Technology (ONC-HIT). In the same report, ONC-HIT revealed that 97 percent of all reported hospitals possessed an ONC-certified EHR. This mismatch is indicative of a lag between purchase and adoption at roughly one third of non-federal U.S. hospitals. While basic EHRs are a vast improvement over paper-based charting and clinical note-taking, the comprehensive functionality offered by modern enterprise medical software can increase clinical efficiency, improve care outcomes, and better serve patients and providers alike.

This guide to enterprise medical software will help you to better understand the capabilities of enterprise medical software systems, how it can benefit your hospital or physician group, and how to choose the best enterprise medical software solution.

Defining Enterprise Medical Software

Generally speaking, enterprise medical software can be defined as any medical software system designed to meet the needs of larger healthcare organizations such as acute care hospitals (ACHs), critical access hospitals (CAHs), psychiatric hospitals or rehabilitation centers, large multi-specialty physician groups, etc. Enterprise medical software has many names; it is sometimes called inpatient software, a hospital information system (HIS), hospital management system (HMS), or even a hospital enterprise resource planning (ERP) system. For the purposes of this guide, we’ll split the types of software into three main areas: administrative, clinical, and patient engagement.

Types of Enterprise Medical Software

At smaller healthcare organizations, software that manages administrative aspects of the clinic is usually referred to as practice management software. At hospitals and other large healthcare organizations, despite the difficulty in integrating systems, it isn’t uncommon for several separate systems to be used to satisfy the administrative needs of the organization, although more comprehensive solutions are available and are increasingly being adopted.2 Comprehensive solutions are usually preferable, as a single system can minimize duplicate data entry, offer a better long-term return on investment, and increase efficiency.

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Administrative

Administrative Medical Software, whether used at a hospital or large physician group, usually includes functions to manage:

1. Patient Registration – allows electronic capture and verification of patient demographics and health histories.
2. Patient Scheduling – allows electronic booking and management of patient appointments.
3. Provider Scheduling – allows electronic assignment of providers to various shifts, departments, patients, etc.
4. Inventory Management – supports electronic management of various medical supplies and/or equipment. Helps track the use of medical supplies and optimize ordering.
5. Human Resources – allows electronic management of HR functions, including time/attendance management, benefits administration, and payroll.
6. Claims/Billing – allows electronic submission of claims to insurance companies, Medicare, Medicaid, and facilitates invoice generation for collections from self-pay patients.
7. Analytics/Reporting – supports health informatics and the optimization of data acquisition, storage, retrieval, and reporting for various initiatives, such as the physician quality reporting system (PQRS) and population health management/modeling.

Clinical

Software that manages the clinical aspects of enterprise-level healthcare organizations typically includes far more functionality than comparable outpatient or ambulatory software systems. Features usually included in clinical systems include:

1. Physician Notes/Orders – Supports electronic input, editing, communication, and storage of progress or other clinical notes, and physician orders. Newer systems often support multiple input methods, including traditional mouse/keyboard, dictation, or tablet/smartphone touch.
2. Nursing Assessments/Orders – usually only seen in an inpatient setting, this software supports the electronic input, editing, and verification of nurses’ notes and orders.
3. Problem Lists – allows for the creation and management of patient complaints, and usually will allow the assignment of the corresponding ICD code.
4. Medications / E-prescribing – Supports the electronic tracking, managing, and dispensing of medications. Most solutions also include barcodes for verifying that the correct medication is dispensed.
5. Discharge Summaries – helps automate the creation and dissemination of patient discharge documentation.
6. Lab Reports – Allows for the creation, dissemination, and viewing of laboratory orders and results.
7. Radiology Tests – Allows creation of radiology orders and viewing of results. This system is sometimes referred to as a radiology information system (RIS) or picture archiving and communication system (PACS).
8. Consult Requests/Reports – the software allows providers to electronically request, receive, exchange secure messages, and track physician consults.
9. Clinical Decision Support – Includes electronic functions that establish clinical guidelines, generate automatic notifications, view drug allergies, view drug-drug interactions, view drug-lab interactions, and also drug dosing support.

Patient-Facing

Patient-facing aspects of enterprise medical software are quite similar to comparable systems for smaller organizations, though enterprises seem to be lagging behind smaller organizations in innovative features. Patient engagement software, sometimes interchangeably referred to as patient portal software, usually includes most or all of the following functions:

1. Online Patient Registration – though more common in smaller, agile systems, more enterprise medical software vendors are building in the capability for patients to complete registration and other forms online, before they arrive at a practice. This helps increase efficiency and reduce documentation errors.
2. Online Scheduling – allows patients to schedule or request an appointment online.
3. Appointment Reminders – helps automate the patient appointment reminder process, usually via email, SMS, or automatic dialer.
4. Online Bill Pay – Allows patients to view, manage, and/or pay their outstanding balances online.
5. Secure Messaging – a requirement under both stages 2 and 3 of the Meaningful Use Incentive program, the software allows secure communication between patient and provider concerning questions, lab/imaging results, etc.
6. Patient Education – Allows the creation and dissemination of educational materials, after-care plans, and other resources. This functionality is becoming increasing important in Meaningful Use Stage 3.

Creating Executive Buy-In

If you’re leading the effort to purchase a new enterprise medical software platform, you likely have an uphill battle, particularly if your organization is invested in another solution. To ensure successful adoption, help minimize sunk costs, and reduce cognitive dissonance, you’ll need to build a compelling argument that will win over stakeholders. Here are a few suggestions about how to begin.

CIO – Your CIO’s main concerns will be systems architecture and security. Ease their fears early on by making sure whatever systems you recommend integrate well with your existing technology stack, especially if you’re going to deploy an on-premise enterprise medical system.If your organization is attesting for Meaningful Use incentives, make sure that your vendor has already achieved 2014 Edition certification, has a roadmap for the upcoming ICD-10 rollout, and a plan for meeting the interoperability and API requirements from Meaningful Use Stage 3.

CEO/Hospital Administrator – Your CEO’s main concern, at least at a for-profit institution, is maximizing revenues and profitability so they can return value to shareholders. Even not-for-profit hospital administrators are concerned with the bottom line, so first and foremost you’ll need to explain why adopting a new system makes financial sense. Highlight how well-implemented hospital management systems can help reduce revenue leakage and readmission rates. If you’re looking for a supplement to an existing system rather than a full replacement, make sure you select a system that will integrate well with your current one and help shorten the path to ROI.

Chief Medical Officer – Your CMO’s main concern should always be patient care, but staff satisfaction plays an important role as well. When approaching your CMO with a proposition to adopt a new health IT system, you should emphasize the potential improvements to workflow efficiency — no physician will be happy with a poorly designed system that makes clinical documentation a chore, even if it reduces complications and otherwise improves patient care outcomes.

Chief Nursing Officer – if you think your CMO is concerned with documentation time and potential inefficiencies, just wait until you speak with your CNO. As of 2014, 92 percent of nurses were dissatisfied with their hospital’s EHR3, so you’ll have your work cut out for you. Focus on improvements the new system offers versus existing workflows. Every nurse may not love the system, but hopefully they’ll dislike it less than your existing system. It will be especially important to involve the CNO early on during the implementation process in order to increase the likelihood of the project’s success.

Case Study: Barts Health NHS Trust

Solution: Cerner Millennium

Streamlining the Emergency Department Workflow from Registration to Discharge

The Emergency Department at the Royal London hospital is paper-lite. Using the Cerner Millenium FirstNet module, the Emergency Department went paper-lite in pediatrics in January 2012 and in the Adult Department in September.

The process of ‘writing on paper’ may mean that we never find the notes. On a busy ward, there are times when a referral paper had been tucked into a consultants’ back pocket, and it needs to be wrestled off them.– Dr. Malik Ramadhan, Clinical Director for Emergency Medicine

Since adopting FirstNet, the Emergency Department at Barts Health now registers every patient electronically, so there is no need to look for paper notes. Everything is integrated into the Electronic Health Record (EHR). Using this system, they reduced registration time from five minutes per patient to just 60 seconds.

Patients are tracked via FirstNet, so that all staff can see who is waiting to be seen, waiting for tests, or waiting for an inpatient bed. Observations are also entered directly into the system, improving both collaboration and coordination across the entire care continuum.

In the past, valuable time was wasted trying to locate inpatient beds in the trauma area. Now, vacant beds pop up automatically on the computer screen, enabling a faster process and allowing for more time to be spent on patient care. One doctor explained, “I’m not great on computers and can’t type, but if I can go digital, anyone can.”

Key Benefits

1. Track patients within the Emergency Department
2. Streamline the Emergency Department workflow from registration to discharge
3. Provide access to information at the right time and place, including historical patient records, enhancing clinical decision-making
4. Effective and safe operational management of the Emergency Department through a fully integrated administration and clinical solution
5. Supports multidisciplinary decision-making
6. Provides major incident preparation functionality

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Other Market-Leading Solutions

Unlike the software market for smaller organizations, there aren’t a whole lot of options for enterprise-level healthcare organizations. Outside of specialty or department-specific solutions (like Cerner’s FirstNet), comprehensive medical software solutions for hospitals or large physician groups are relatively limited. The following solutions are the most highly-rated systems for organizations of this size:

Epic

athenaHealth

MEDITECH

ClinicTracker Connect

Allscripts

GE Centricity

MetaCare Enterprise

Healthland Centriq