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Where's the Value?

Carrie Vaughan, for HealthLeaders Magazine, July 10, 2009
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For an EMR system to be worthwhile, experts say it should be accessible to the user, adequately funded, and used to create evidenced-based pathways.

Believe it or not, implementing an electronic medical record system is the easy part. Realizing the value that the technology can bring to the healthcare organization is the real challenge. And now hospitals are under even more pressure to ensure their organizations are getting "meaningful use" out of the systems they implement, if they hope to snag some of the $19 billion slated in the American Recovery and Reinvestment Act of 2009 for health information technology.

Robert Kiely, president and chief executive officer at 185-staffed-bed Middlesex Hospital in Middletown, CT, is concerned that organizations will rush to grab their share of the stimulus dollars without taking into account the budgeting and planning steps required for these systems to be successful long term. "The stimulus funds are a very attractive hazard," he says.

Here's a look at how four organizations managed the process so that their organizations can move past the implementation phase and start to see real results from the EMR.

Easy access to data
The steps an organization takes in choosing the technology, then training and implementing it are key pieces to how the system will end up being used, says Tom Smith, chief information officer at NorthShore University HealthSystem, which received the HIMSS Analytics Stage 7 Award this year and has been paperless since 2003. The four-hospital, Evanston, IL-based system decided to focus on building a database rather than just an error-reduction system. So it chose a system by Epic, a Verona, WI-based software company, that could be installed in both the physician offices and hospital settings, and it made the system available to physicians, nurses, and pharmacists everywhere—home, hospital, hotel room. "CPOE is important but the more important activity is the availability of data," says Smith. "Our assumption was if we made things available to people, the users would find ways to use it and use it well."

That assumption has proved true. NorthShore, which has a 600-physician employed medical group, now has 40% of its appointments scheduled as same-day appointments. That wasn't an outcome that Smith originally thought of when he implemented the system. Patients may not be able to see their regular physician for a same-day appointment, but the physician they do see will have access to their medical record. In addition, the patient's regular physician can access the patient encounter right away to see any medications prescribed or tests ordered. As a result, the heath system has improved its patient satisfaction and can compete with retail clinics. The patient no longer has to decide between seeing their regular physician in a couple of weeks or going to Walgreens, Smith says.

Continuous training
"The challenge to us in healthcare is very much generated out of IT," says Peg Reiter, RN, PhD, the chief nursing officer at St. Luke's The Woodlands (TX) Hospital , which has been paperless since 2003. Everyone has made a specialized product—for the ED, ICU, and OR—and there are interfaces between the systems that allow nurses to see ED notes or physicians to access data on the last visit, but you have to navigate between the programs, explains Reiter. "That is what caregivers don't want to do. They don't want to navigate a lot of programs. If the link is there, great. But if they have to navigate, no way."

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