The following article appeared in our 2014 Annual Report.
Dr. Martin Johns
One evening when I was on duty, a 911-call patient was brought into the emergency room. The patient was unresponsive and unable to communicate.
I pulled up the electronic medical record and was able to see that he had been given a new medication when seen at a Gifford clinic earlier that day.
Clearly he was having a delayed allergic reaction, and because I could see exactly what medication he was given, I could immediately give him the appropriate antidote. If I had not had access to the information in EMR, I would have had to guess and start trying different medicines to counteract the reaction.
When another patient was confused about what medications they were taking, I pulled up their most immediate office note on EMR and made adjustments based on what had been done within the previous 24-hour period.
An important aspect of the new EMR system is that it allows medical information to follow the patient through transitions of care across all Gifford platforms: inpatient care, outpatient care in community clinics, radiology, and emergency room visits.
In the past, important information could be unavailable or even lost during these transitions—a clinic might be closed for the day, or important information not yet added to a patient’s record. Now, anyone caring for a patient can view important information and also update the record (adding a newly developed allergy or immunization) or note changes in clinical status.
This article was published in Gifford’s Fall 2014 Update Community Newsletter.
In his 50-year career, Sharon Health Center podiatrist Dr. Rob Rinaldi was always pretty certain that his gait analysis skills were spot on.
In his early years in private practice in Connecticut, he analyzed an athlete’s gait through observation. Next came a high-speed Nikon camera. Dr. Rinaldi would take pictures, develop the images, and study them for what the industry calls foot strike and toe off.
A video camera followed, and then most recently the Sharon Health Center had a treadmill, video camera, and monitor set-up. “I really thought we were cutting-edge,” says Dr. Rinaldi.
That is, until the clinic purchased a Noraxon MyoPressure Lab – a state-of-the-art gait and movement performance system – as part of its recent renovations and expansion.
Now providers at the Sharon clinic are using the new technology to diagnose problems, come up with treatment plans, and improve patient outcomes.
The new system includes a treadmill with a force plate that can analyze pressure, show that on a monitor, and immediately print out those results, showing where someone is putting pressure on his or her feet both walking and running, and with and without shoes.
It has two video cameras that can show live images on a computer monitor or be recorded. The health center is also using its original camera, meaning three video cameras are really at work monitoring gaits. And it has a surface EMG to measure muscle activation patterns throughout the body.
Gifford is the only hospital in Vermont with the technology. In fact, one would have to drive to Boston’s Children’s Hospital in Waltham, Mass., or to White Plains, N.Y., to find the closest other such systems.
Dr. Rinaldi is using the new technology for every sports analysis and for individuals at risk of falling. The health center’s other providers – including podiatrists, chiropractors, and sports medicine physicians – are using it as well to look at muscles, joint angles, alignment, and to train athletes.
The results of the Noraxon analysis lead to treatment plans, including sharing information with in-house physical therapists.
“We’ve always felt our success was based on a team approach. Now we’re able to quantify and graphically share information (among the team),” Dr. Rinaldi says.
“What I have found is my outcomes seem to be better,” he says. In some instances, he’s also offering more conservative treatments to surgery.
The Sharon Health Center is a renowned, multi-discipline sports medicine practice located off Route 14 in Sharon. Call the center at 763-8000.
Materials clerk Tina Brady uses a new handheld scanning device to quickly inventory supplies on one of many carts located throughout the medical center. The device is a gift from the Gifford Medical Center Auxiliary and greatly improves the department’s efficiency.
The Gifford Medical Center Auxiliary is turning Thrift Shop earnings into major support for the community’s local hospital.
The Auxiliary has funded more than $19,000 worth of “wish list” equipment requests spanning multiple departments at the hospital and greatly benefiting patient care.
Lending library books for the Cardiac Rehabilitation Program
Multiple pieces of equipment, from IV poles to portable oxygen saturation monitors to cardiac chairs for the inpatient hospital units
A handheld scanning device for the medical center’s Materials Management Department
Pulse oximeters for primary care offices
Play equipment and furniture for The Robin’s Nest Child Enrichment Center
Lead shield aprons for the Sharon Health Center
A changing table and digital scale for the Twin River Health Center
The Auxiliary historically has awarded “wish list” items to the hospital, meaning departments put their wishes in the form of funding requests to the Auxiliary. Auxiliary board members review the list and award what they can. This round the board fully funded the “wish list.”
Materials Management was granted a “wish list” item for the first time in memory. The scanning device is used to inventory supplies around the medical center, explained department supervisor James Shodunke Jr. It replaces a 15-year-old unit that didn’t meet the department’s needs, so staff had been taking notes with pen and paper.
As a staff member counts supplies around the medical center with the new device, which the department had been trialing, prints a report back in the materials holding area showing supply needs, meaning other staff members can immediately begin filling that supply order. The change in the busy department means a task that previously could have taken an hour and 15 minutes now takes less than 30 minutes.
“It greatly improves our efficiency and expedites the restocking process, which reduces interruptions in patient care,” Shodunke said.
Gifford’s inpatient unit received the bulk – $11,500 – of this round’s funding.
“The staff and nursing leadership of Howell Pavilion (Gifford’s inpatient unit) are very thankful for the extremely generous grants given by the Auxiliary. Many patients will benefit from the numerous requests, such as sturdier chairs for patient rooms, electronic vital sign monitoring system and alternative treatments for pain. The gifts will be a big help for both patients and staff. We would like to thank the Auxiliary for all of their hard work and support by granting our many requests,” said Alison White, vice president of patient care services.
Auxiliary board members Ruth Lutz, treasurer, and Nancy Gray, historian, walked around the medical center on Wednesday making in-person announcements to department staff that they had been funded.
Lutz was excited by the response from the departments. “They were so pleased,” she said.
Gray found the experience rewarding because of the inside look she got at the medical center and its many, diverse services.
But Lutz and Gray were quick to point out that it wasn’t they who were making the gift to the medical center, but rather the full Auxiliary and all who shop at the Thrift Shop. “We’re so fortunate to be able to do this because of what the Thrift Shop brings in,” Gray said.
The following is an excerpt from our 2011 Annual Report.
Information Systems Director Sean Patrick sits amid the old way of keeping patient records – paper files – and the new way to come – electronic medical records updated by providers via new laptops or even iPads.
As lawmakers embark on an ambitious schedule to create a health care exchange required under the federal Patient Protection and Affordable Care Act by 2014 and a Vermont single-payer system by 2017, Gifford is mindful of its role as a community care provider.
The laws seek to bend the health care cost curve, in part through information technology, advanced primary care and payment reform.
Through the implementation of Vermont Blueprint for Health initiatives, Gifford is embarking on reform initiatives including care coordination for the chronically ill and recognition of Gifford’s five primary care practices as Patient-Centered Medical Homes.
The medical center has chosen an electronic medical record (EMR) vendor and is progressing toward both the installation of an EMR system and meeting federal requirements for “meaningful use” of electronic health records (EHRs). EMRs are internal electronic medical records. EHRs can be viewed by appropriate outside entities, including specialists and providers from other hospitals.
Gifford’s modest budget requests and responsible spending also align with reform, notes Trustee Paul Kendall, who actively follows reform legislation.
But the non-profit community medical center is by choice not at the forefront of reform efforts.
Gifford Administrator Joe Woodin likens health care reform to a passing ship. Where others might be quick to jump on – appropriately, the region’s larger health care providers – Gifford is waiting to ensure the medical center commits to the best choice for
Gifford’s size, patients and rural area.
“Gifford is more inclined to stay on the dock and wait for the boat to come around on health care reform,” Joe says. “It takes a lot of fortitude to humbly wait for the boat to make a reiteration.”
“We continue to be watchful of what’s going on and gradually position ourselves to do
what is right and appropriate,” agrees Paul, noting some initiatives like information
technology upgrades can require huge investments of time and financial resources.
Gifford also strives to be a voice in discussions leading up to reform legislation. Leadership is suggesting cost-saving ideas the state could pursue now. They continue to set a standard
for financial stability and maintaining strong relationships with other hospitals, state and federal lawmakers, and health care organizations, like Bi-State Primary Care and the Vermont Association (VAHHS).
VAHHS represents the state’s nonprofit hospitals before lawmakers and the Green Mountain Care Board, which was created by the Legislature in 2011 to oversee the creation of a single payer Vermont system. Bea Grause, VAHHS president and chief executive officer, sees small hospitals’ role in health care reform as one of preserving local access to high-quality care.
“Hospitals are seeking to create reform opportunities by working with the Green Mountain Care Board and federal lawmakers that will balance the need to contain costs with the need to ensure sufficient revenue that will help hospitals meet their local missions,” she says. “Issues such as recruitment and retention of physicians and other health professionals, improving quality, ensuring access and long-term financial sustainability are just a few of the challenges small hospitals will face as Vermont and the entire industry prepare for a decade of continued change on all levels.”
Gifford’s work with Bi-State Primary Care in part addresses the recruitment piece.
Bi-State Primary Care is a nonprofit membership organization of Vermont and New Hampshire rural health care providers working to support primary care practices in medically under-served areas. Its members represent more than 175,000 Vermonters. This equates to one in four residents, or 46 percent of Medicaid enrollees and 52 percent of the state’s uninsured.
The organization is working on Gifford and small, rural primary care practices’ behalf to improve access by recruiting providers to underserved areas. They are also working on health information exchanges and quality improvement initiatives.
The ultimate challenge the state – and likely hospitals by default – will face for successful health care reform, however, will be answering the question: “What can we afford?”
“There are a lot of uncomfortable issues with health care reform that we don’t talk about. The most common issue is ‘what can we afford,’” Joe says, hoping lawmakers will address that question. If they don’t, it will fall on hospitals, which will be given limited funds to provide care. They will have to make tough choices on what care they can afford to