Turning the all-digital vision into a reality
Saint Clair’s Hospital Ministry Health Care of Wisconsin and Minnesota built an all-digital hospital called the Marshfield Clinic that will be completely chartless by the end of the year. On Tuesday at the HIMSS conference in New Orleans, Steven R. Pelton, MBA, CIO of Ministry Health, and Jim Koehler, MBA, director of telecommunications at Ministry Health, detailed how the hospital developed an advanced information technology infrastructure capable of optimizing the flow of information across care by linking systems in hospitals, clinics, doctor’s offices, and at home.
The committee that organized the clinic’s construction, including volunteer physicians and nurses from other hospitals, coordinated with building designers and were involved in space planning with the architects. They also collaborated with electrical and mechanical engineers through department interviews, so that all who were involved could understand user requirements, discuss current and future technologies, and anticipate the needs of future users.

“One of our key goals is that we wanted to be completely chartless,” said Pelton. That meant there was no medical file record room built inside the new facility. The clinic is also filmless, so no film storage area was built, either. “It gave us the motivation that we couldn’t fail,” Pelton said. The facility doesn’t have vast storage rooms either. Instead, all medical records and x-rays are recorded and stored digitally. Ninety percent of all documentation is done in MARS/CMR, IDX and QS.

Even the doctors’ Tablet PCs allow handwritten notes to be translated digitally. The Tablet PCs allow doctors to remain connected anywhere, while recording documentation, managing signatures, and keeping progress notes chronological. “I realize this was a critical piece of the success of our strategy,” Pelton said. “Doctors weren’t going to type [notes].”
While Ministry Health Care was successful in implementing an all-digital environment, they faced many challenges. “We realized there was too much ‘new’ when we opened our doors,” Pelton said. The staff was completely new, the facility was new, and all of the technology in the facility was new, which meant there were no veteran employees to aid in training. “Everyone started on the same day with the same level of experience,” he said, adding that staff became overwhelmed by too much training all at once. “Ongoing training and education is needed to master the EMR sytems,” Pelton said.
They also realized that patient registration is vital. “Nothing happens until you register the patient,” Pelton said. He recommends hospitals invest in their registration clerks, and make sure clerks follow the same registration process every time for consistency. There were also a lot of conflicts in the wireless networks, and a business recovery plan was needed, if the system were to suddenly go down.

It took time to adjust to an all-digital environment, but Ministry Health Care is learning from the experience and teaching other hospitals how to avoid the mistakes they made for a smoother transition. “It was a unique opportunity to start fresh with a blank slate, a new staff, and new physicians you could train,” Pelton said. “We had IT involved right from the start.”