Electronic Medical Records Part II
I would like to thank everyone for the feedback sent on the August 2006 article addressing Electronic Medical Records (EMR). Your feedback addressed all sides of the issue. I had the pleasure of corresponding with several physician users, some of which work or consult with EMR vendors. I must say that this topic is quite dicey at the moment and both proponents and opponents seem to be strong in their views and opinions. Feedback ranged from total disagreement with my article to total agreement with some in the middle that agreed with portions of the opinions I expressed. Based on your feedback and the fact that this article will be published around the time of the ACEP Scientific Assembly where many EMR vendors and E.D. physicians will be gathering, I felt compelled to dig into this topic a little deeper with this article.
First, I want to make it clear that I am not opposed to EMR's. My goal with this series of articles is to present some of the challenges that will be faced so that they can be addressed prior to implementation. It is clear to me that EMR's are not a fad and thus represent the present mechanism for documenting medical records for some ED physicians and the future for most other E.D, physicians. The difference between the present and future for many physicians is the commitment and financial resources of your hospital business partner to the implementation of a paperless documentation system. Notice that I used the phrase “business partner”. This was not accidental as I often run into situations where one or both sides have forgotten that they are both there to support and contribute to the success of one another by providing good patient care that will eventually create long-term financial viability of both the hospital and physician group.
ED physician documentation has evolved from handwritten charts, to dictation, to templates, and now to EMR's for many physicians. As part of this evolution, a large number of physician groups were forced to discontinue dictation due to cost years ago and thus many adopted template systems. Template systems proved to be very user friendly for rapid documentation. Furthermore, many of the template systems were designed to remind the physician what needed to be documented. Although you had the positives of cost and ease to use, many non-ED physician users expressed their dislike for templates as they were harder for them to utilize than dictation. Thus, the templates were seldom referred to by all as the perfect documentation system.
Now that many recognize that EMR's are coming to a large number of hospitals, the real key is how to implement in a manner that won't increase documentation time to the point patient flow suffers. What I found as fairly universally accepted among the ED physicians I have spoke with is that the perfect ED EMR does not exist today. While some of the ED EMR users that are proponents of the EMR were very happy, many had some implementation difficulties and agreed with me in my assessment that they did not receive ample training regarding how to use the EMR with maximum efficiency. Yes, all of the physicians did receive training on how to use the EMR; however, I firmly believe there is a big difference between knowing how to use the EMR and how to use the EMR efficiently.
In our business, time is money. Additionally, patient turnaround time is integral to patient satisfaction and low LWBS rates. To survive with the EMR, we must be efficient. Efficient use of EMR's occurs in several areas. First, most EMR's I have seen allow you to utilize macro features that create documentation shortcuts. Most of the demos you see will utilize these shortcuts and thus they document faster initially than you will unless you have the macros. I would ask the EMR representatives if they could create the macros for you or refer you to clients that have already invested the time to create the macros. Reinventing the wheel at every turn doesn't always make practical sense.
Second, make sure the EMR is available to document in the patient room. Third, make sure the EMR integrates easily with lab and radiology so that you know how to retrieve your results without a goose chase. Fourth, ask that addendums be put in the usual EMR format rather than free-text format. This will save you time as initially I would suspect that you will have a large number of addendums. Lastly, make sure you have several hours of proper training before implementation. I would practice by entering dummy charts so that you know your way through the system before your first shift. The absence of knowing how to use the EMR efficiently is the single greatest problem with many of the physicians I have spoken to regarding their EMR
Remember that you and the hospital are partners. Keep a positive attitude about this change. Planning and training are the keys to successful implementation. EMR's will usually create some efficiencies with orders, lab/x-ray retrieval, discharge instructions, etc. Good luck and good charting.