The shift by hospitals to electronic medical records has been one of the most talked-about aspects of the healthcare reform passed last year.
A number of Orange County hospitals started switching to EMR years before the passage of healthcare reform and well ahead of a 2009 economic stimulus plan that offered upward of $30 billion in federal incentives to entice hospitals and medical professionals to drop paper records and go digital.
Changing to electronic medical records won’t necessarily be voluntary—the government could start cutting Medicare payments to hospitals and doctors who don’t make the switch by 2015.
Vita Reed, the Business Journal’s healthcare reporter, asked several Orange County hospital executives how they’re progressing on electronic medical records, how they use them, whether they’ve had to deal with resistance from doctors, and the role government incentives have played in the process.
Here is an edited version of their answers.
Julie Miller-Phipps
Chief Executive
Kaiser Permanente Orange County
Irvine and Anaheim
We started by implementing the ambulatory portion of the electronic record. Over a period of six months, we made the transition one office at a time, until all 19 of our outpatient medical offices were up and running.
Subsequently, the inpatient portion of the electronic records was deployed at our two Orange County hospitals in Anaheim and Irvine. Our Irvine hospital had the unique distinction of opening live in 2008 without ever having a paper chart.
Now all sites are fully automated and integrated between inpatient and outpatient and home care, so we can optimize and coordinate patients’ health across the entire care continuum.
We built the system to provide a single chart for every patient that would be available to every involved provider anywhere within our system. It is all completely paperless.
The same information is available for any use, no matter where the patient is in the system. The immediate access to patient information helps to guide clinical decisions and also helps to reduce unnecessary, repeat testing.
Point of Care
Clinical-decision support is provided at the point of care to help with reminders to do screening tests, such as mammograms, and to provide safety alerts on drug interactions.
From the patient’s standpoint, they have a personal health record where their medical problems, lab tests, medications and summaries of doctor’s visits are available. Patients can also e-mail their physician, request appointments and request pharmacy refills online.
On training, we created all our own materials and curriculum and constantly upgraded and improved it, both as we learned how to train better, and as we received updated versions of the software from our vendors.
Throughout the deployment of KP HealthConnect, we continued to refine the training tools and curriculum, and developed a network of physician, nurse and staff “super-users” that helped plan, prepare for and support the transition. These super-users received special training to help their colleagues learn how to make the system work well for them.
We also have several programs to “circle back” and help those who are struggling to receive the support they need to further advance their skills.
When it comes to addressing resistance, we did extensive leadership training for our facility experts and super-users so that they could help their peers overcome the stress of learning how to use the system.
This project brought historic and revolutionary change for all of our physicians and staff, and there was plenty of pain and resistance.
Top-Level Support
Support of our senior leadership and the expectation that all users would use the system was an important component of our success.
In Orange County, we had a partial electronic health record prior to the implementation of KP HealthConnect, so our users saw the potential benefit that a fully integrated system would bring to our organization. This also helped with overcoming the resistance.
Despite some initial pain and resistance, at this point in time, you cannot find a single Kaiser physician who would be willing to go back to paper.
To the stimulus question, we have a significant effort under way to ensure that our vendors provide upgrades that support the meaningful use requirements. We are implementing everything that makes sense to enhance the quality of care for our members.
Clyde Wesp
Chief Medical Information Officer and Chief Medical Officer
Larry Stofko
Senior Vice President and Chief Information Officer
St. Joseph Health System
Orange
St. Joseph Health System and its three Orange County hospitals—Mission Hospital, St. Joseph Hospital and St. Jude Medical Center—have been upgrading technology since 2003 to support its mission of delivering healthcare to patients and the communities they serve.
St. Joseph Health System has been very aggressive in implementing inpatient electronic medical record technology. Mission Hospital and St. Jude Medical Center have been recognized by the Healthcare Information and Management Systems Society for their success in achieving high levels of electronic medical record adoption, with St. Jude being rated 6 out of 7, a level achieved by less than 2% of hospitals in the nation.
Open Dialogue
The success of changing work flows that relied on illegible paper records and charts to work flows that included electronic medical record technology and computer order entry can be attributed to open dialogue with clinicians—we engaged their participation in the actual design, build and implementation of the new systems and work flows.
In addition to implementing inpatient medical record technology, St. Joseph Health System has also established connectivity via secured Web portals for doctors and doctors’ offices to access the records of their respective patients. The health system also has future plans to allow its patients access to their own medical records through a secured Web portal.
We believe this will make it easier for parents to track and maintain health information for their children and will provide peace of mind to those caring for elderly parents by having a secure place to store medical information that they can access in the event of an emergency.
The economic stimulus legislation of 2009 offered incentives for hospitals to adapt electronic medical record technology. St. Joseph Health System adjusted its technology implementation schedule to meet the timelines and exacting standards set forth in the legislation.
Liz Johnson
Vice President, Applied Clinical Informatics
Tenet Healthcare Corp.
Dallas
Improving Patient Care through Technology is Tenet’s strategic initiative to implement electronic medical records throughout its hospitals across the country.
In fall 2010, six of Tenet’s 11 California hospitals put in the first phase of electronic functions that include electronic clinical documentation, bar-coded medication administration and bedside medical device interfaces. These hospitals are preparing for their next phase, in which physicians will be using computerized provider order entry and ensuring all patient medications from home, hospital and post-hospital are tracked and managed.
The records include the capturing and sharing of patient information to reduce paper charts and allow physician access to patient data from remote location. Bar-coded medication administration provides safety checks by scanning the patient’s wristband and the medication prior.
A bedside medical device interface provides direct input from devices such as patient monitors to the electronic patient chart to avoid human transcription errors and to provide instant access to this information by all clinicians serving the patient.
Hospital employees and physicians go through training that is tailored for their job function and employs the use of instructor-led training, self-paced online training modules and practice sessions. Plenty of onsite support is provided during “go-live” periods, including at-the-elbow support for physicians.
Understanding Need
As to resistance, most hospitals and physicians understand the need to use technology to improve patient care.
Tenet has involved hundreds of physicians and clinicians from across its hospitals to make decisions on clinical standards and how they will be used.
As for how our records are affected by the stimulus bill, our vendor was certified in October 2010 by the Certification Commission for Healthcare Information Technology.
Harris Stutman
Executive Director, Clinical Informatics
MemorialCare Health System
Fountain Valley
MemorialCare has implemented the Epic electronic health record on our major campuses. Saddleback Memorial Medical Center “went live” in 2006, followed by Long Beach Memorial, Miller Children’s Hospital and Orange Coast Memorial. Although back-end programming of clinical applications is complex, on the “front end,” it works like any standard computer application.
Complete electronic health records are created for each MemorialCare patient, giving the healthcare team immediate and secure access to all documents, including progress and procedure notes, physician orders, test results, vital signs, etc. Since clinicians can access this data from the patient’s bedside, physician’s office or even from the doctor’s home, key decisions don’t wait until everybody is assembled at the bedside.
New prescriptions, for example, are immediately sent to the pharmacy for verification and dispensing. Routine and “as soon as possible” orders are implemented six times faster by moving from paper/manual processes to digital ones. If an order is entered for a medication the patient is allergic to, a reminder alert appears on the screen.
While humans are better at interpreting information and making decisions, none of us are as good as computers at remembering everything. With systemwide availability, doctors and nurses have access to all patient medical information, regardless of the MemorialCare location. For doctors and hospitals not using Epic, we are developing other methods of data sharing to maximize communications.
Competency Tests
Everyone who cares for patients at MemorialCare receives hours of comprehensive electronic health record classroom and Web-based training tailored to their specific role, and must pass a competency test.
To the question of whether there’s been resistance, health professionals understand the practice of medicine must progress to ensure the higher levels of quality and safety that an electronic health record offers. While a change of this magnitude is significant, presentations on change resilience and rationale for digital record adoption helped to facilitate acceptance.
Nothing makes morning rounds go faster for physicians than knowing new overnight results or X-rays, having reviewed them before leaving their house. Enhanced data access and other benefits minimize discomfort with new technologies.
As more physicians implement electronic systems in their offices, comfort with our hospital systems should increase further.
On the stimulus question, almost all features required were criteria MemorialCare was already fulfilling. We expect to soon complete fine-tuning our data collection and reporting methods and become one of less than 25% of the nation’s hospitals to achieve meaningful use of electronic health records this year.
Mark Headland
Vice President, Chief Information Officer
Children’s Hospital of Orange County
Orange
CHOC Children’s has historically recognized and placed a strong emphasis on leveraging technology to improve safety and quality of care for the children we serve.
We became one of the first Orange County hospitals to implement electronic medical records, providing greater patient safety and efficiency, and ensuring vital patient information is instantly available in clinical situations.
Our journey of implementing electronic health records has been years in the making—since 2001—long before healthcare reform or before stimulus dollars were available. We implemented computerized physician’s order entry in January 2007.
Computerized physician order entry was embraced and adopted by the medical staff as a key strategy for preventing harmful errors.
Our team understood the importance of a system designed to reduce medication errors. Computerized physician order entry enables medical staff to clear new prescriptions and other orders through linked error-prevention software and all electronic information in the patient’s file.
The software checks for medication conflicts, dosage errors, and any changes in status from the patient’s latest lab tests.
To train and ease the transition into using the technology, training options to accommodate needs and computer skills of individuals were made available.
More in Store
As we look to the future, we are focused on technologies that elevate patient safety and quality care, including data warehouse with business intelligence capabilities for improved health outcomes, reduced costs and enhanced efficiencies.
We look to technology to reduce the burden patients and their families face as they navigate the health system—to streamline the referral process and enable patients and their families to make appointments online in addition to accessing results, health education and communication with their physician and hospital online.
Implementing a medical records system is one of the most challenging and transformative undertakings a hospital will ever engage in. CHOC will continue to serve as a model among hospitals nationally.
