Understanding the Purpose of the EMR
Do patients really benefit from the complex EMRs that are in use today?
We’d like to think so.
An EMR’s purpose is to enable easier ordering, facilitate documentation and progress notes, remind clinicians of activities to be performed, and protect the patient against potentially harmful drug interactions—just to name a few.
But, what happens if the nurses and doctors and lab techs and pharmacists aren’t using the system properly? What if no one conducts medication reconciliation or fails to fill in all the right fields when placing an order? What if they decide to chart at the end of the shift instead of in real-time?
“EMRs are tools used by clinicians to aid in the delivery of patient care. And just like any tool, if you don’t use it properly, the value is hard to find.”—Bill Arnold, President, Atlanticon
So this begs the question, who should be responsible for making sure the EMR is being used properly? The vendor who develops the basic software?
No, probably not.
What about the Consulting firms or implementation teams that drive the design and customization?
Probably not them either.
What about the hospitals, who ultimately conduct and approve the quality of training?
Yes, to a degree.
The hospital is responsible for seeing that the system is used properly and effectively. But we aren’t happy with that answer. More people should bear the responsibility and carry the weight.
As healthcare IT consulting firm, we’re responsible for helping hospitals implement systems every single day. We certainly carry responsibility for guiding the customer.
But guide them how???
Once the system is live, our job is typically considered “done.”
We’re usually gone within thirty days from the go-live. So what steps should a quality consulting firm follow when responsibly implementing a new system?
Here is part of Atlanticon’s checklist:
- -Ensure that workflows have been developed, validated, reviewed, and approved.
- -Insist on a Conference Room Pilot to instill the correct procedures on the superuser community through visual and hands-on examples.
- -Confirm the training team incorporates workflow into the training classes as well as the competency tests.
- -Initiate monthly internal user group sessions so all disciplines gather to discuss how the system is being used and make adjustments when improper use is identified.
- -Develop a series of reports and a routine audit schedule, validating that events are occurring in a timely and consistent manner, such as reviewing the timing of allergy entry, the completeness of orders, the quality and timing of patient education, the posting of results, or the consistency of medication reconciliation.
- -Implement routine shadowing sessions where peer to peer review of correct processes can be confirmed.
- -Engage the executive team to highlight the correct usage of the system.
- -Work with the Quality and Risk department to conduct audits of select patient records multiple times during the day while the patient is in house, enabling corrective action in a timely manner.
Patient care is a serious business—the lives of mothers and fathers and brothers and sisters and children and grandparents are at stake every single day.
Who keeps the clinicians from falling into bad habits or not following these accepted processes?
We all should carry the load.
Granted, the hospital bears the burden of execution, but vendors, consulting firms, and implementation teams should meet and strategize about it as part of the project lifecycle. It’s part of our normal process to follow and it should be one that is followed industry-wide.
Atlanticon recommends more weight to be placed on the process side of implementations. We design, build, and test these systems thoroughly. The hospital must own and embrace the thorough testing of the processes that are to be used with the new system.
As part of our implementations, we should be asking at every step,
“How will this help improve patient care?”
That should be a big part of the goal when implementing these systems. We talk about improving patient care, but we need to walk the talk. We can’t expect the system—the tool— to automatically improve care. It all falls back to how we use it. The patients should be the ultimate winners!