"Variation is harmful to patients at a net population level," Walker says. "We have to agree to do it one way, because while we're doing the thought work, the care is often rendered through the hands of other folks—nurses, physical therapists, whoever that is. We've got a graduate nurse in the middle of the night who's inexperienced and doesn't have a lot of supervision, and she's having to reinterpret two completely different sets of orders. Wouldn't it be better if we had an expected approach?"
Yet the responsibility for making EHRs effective continues to rest on the care team as well as the technology, Walker says. "We have not put enough structure around the information that doctors enter and whether or not that can be discretely tapped, and I'm as guilty of that as anybody."
Mercy's solution: an aggressive deployment of what it calls care paths, which build upon the notion of order sets to capture all the care, intervention, and evaluation required for a patient's entire length of stay, Walker says. Without incorporating these care paths into EHRs, hospitals haven't done much more than install very expensive electronic typewriters, he says.
Early proof that care paths are working: their use allows Mercy to intervene earlier in sepsis episodes. "We have cut mortality by 50%, average cost per case by over $3,000, length in the intensive care unit from 81/2 days to about 3 or 4 days, and the patients are healthier and happier and going home sooner," Walker says.
A key to overcoming physician resistance is being realistic about the hit productivity takes during the transition from paper records. At Mercy, that usually takes three to six months, says Jim Best, vice president of clinical business solutions.
Without pre-live training, physicians could take up to a year before they attain the same productivity levels they had prior to the EHR transition, he says.