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New Culture Club

Electronic medical records have become a buzzword of healthcare reform, billed as a way to improve healthcare services while cutting costs.

Less attention has been paid to another aspect of EMR, which is shaping up to be a keystone to a new culture at hospitals. The switch-over from paper files means that doctors, nurses and other personnel must adapt their medical training and instincts to new technology ranging from tablet computers to smart phones.

A prime example can be found at UCI Medical Center in Orange, which is about halfway through a shift to electronic medical records that’s expected to cost about $80 million, with the federal government expected to chip in about a third of the cost.

UCI Medical Center had $705.3 million in net patient revenue for the 12 months ended last September, according to the Business Journal’s annual hospital list. The facility historically ranks in the top three local hospitals by net patient revenue.

Chancellor Trained

The change in culture being driven by EMR has extended to the highest levels at UCI Medical Center. That includes University of California, Irvine, Chancellor Michael Drake, as well as Ralph Clayman, the dean of UC Irvine’s School of Medicine. Both are doctors who practice at the teaching hospital—and both have undergone training on EMR.

The high-level converts send a message.

“If you see patients, you’ve got to do it,” said John Heydt, a doctor himself, and chief executive of University Physicians and Surgeons, a medical group associated with UCI Medical Center. “You’ve got the institution as a whole and all leadership in every aspect to agree that this is something we’re going to do.”

The hospital began planning for the change-over to EMR in 2005 and began in earnest three years later, working with software provider Allscripts Inc. in Chicago. The system is being phased in, and plans call for an all-encompassing system to be up and running at the end of 2013.

The most obvious change EMR will bring is the ability for doctors to get information on patients’ medical histories from any location.

“You really do this to create better quality care, to help manage populations and hopefully, to make care safer and less costly,” Heydt said. “It really is a much different way of delivering care.”

A doctor using EMR can quickly learn if a patient recently had a certain laboratory test or other procedure somewhere else and decide that another is unnecessary. The lag time with paper records might lead doctors to take a better-safe-than-sorry approach and order another costly test.

Sounds simple, but the shift represents a significant change from a centuries-old standard. Electronic medical records lead to “changing the workflow that is all driven by paper,” said Jim Murry, who has overseen the project at UCI Medical Center as chief information officer.

“It’s kind of the elimination of the paper chart,” Murry said. “At the end of the day, what we want is that paper chart to go away.”

That’s easier said than done, with some medical professionals more resistant to new technology than others.

“At the Elbow”

UCI Medical Center has put extensive training programs against the challenge of establishing an EMR culture.

That has “made it desirable for physicians to figure this out,” Heydt said.

A big part of that has been training “at the elbow,” according to Murry.

Clinical personnel have been selected and trained as tutors as the program has proceeded. They work with doctors, nurses and others to guide them through the changes. They’ve even gotten special lab coats to identify them as helpers.

The effort has produced “an army of redcoats that deploys at every implementation so that people feel confident that they’re using the system,” Heydt said.

There are some financial incentives for doctors.

Federal laws created a “meaningful use” standard, where doctors who reach certain levels of aptitude get some payments for going electronic.

There’s also a stick—the government plans to lower reimbursements from Medicare for institutions that aren’t using EMR. That’s on top of what’s expected to be a general trend of lower reimbursements from government and commercial insurers in coming years.

A key area expected to lead to reductions is readmission rates. Hospitals that readmit patients with the same ailments in a short period of time are likely to lose reimbursement for the second visit.

“We know that we’re not going to be getting paid extra in the future,” Heydt said. “What’s going to happen is you’ll see payment reductions based on quality, readmission rates and things like that.”

Research Aid

Both Heydt and Murry said that electronic medical records can also assist UCI Medical Center in its mission as a research and teaching facility.

The system improves the ability of researchers to gain, sort and share data. UCI Medical Center will be connected with UCI’s School of Medicine and the four others at University of California campuses.

It’s already speeding up research, according to Murry, who said some projects have gone from years to months.

UCI Medical Center is not the only hospital that has implemented electronic medical records. MemorialCare Health System in Fountain Valley and Orange-based St. Joseph Health have also been placing such records in their facilities.

Credit to Kaiser

Murry credited Kaiser Permanente, which has hospitals in Anaheim and Irvine, with being a pacesetter in terms of mining patient data to use it for managing their patients with chronic disease.

“Kaiser has kind of led the charge of this with their EMR implementation,” Murry said.

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