An EMR Can't Wash Your Hands for You

Jay Moore, for HealthLeaders Media, February 12, 2009

I am not a technophobe. I surf the Internet and listen to my iPod and watch digital TV just like the next fellow. Nevertheless, I also believe that technology can sometimes create barriers even as it spawns possibilities, and generate a false sense of security even as it protects us from bad things.

And so as much as electronic medical records, bar coding, radio frequency identification, and a host of other innovations have done to advance the cause of providing better, safer healthcare to patients, I confess I'm not entirely disappointed to see a growing emphasis on the fundamental human aspects of quality improvement.

In our HealthLeaders Media Industry Survey 2009 released this week, chief quality officers, chief nursing officers, and other executives charged with leading the quality and patient safety efforts at their organizations offered some intriguing thoughts on the role of technology in improving quality:

The best way to combat the spread of infections? Not even close—72% said hand washing.

When asked how effective EMR systems have been in improving quality and patient safety at their organizations, only 12% said an EMR was vital.

Thirty-three percent said their organization doesn't even have an EMR.

When asked to rate the effectiveness of eight measures in improving physicians' quality of care on a scale ranging from strongly effective to not effective, respondents' top answer was strongly effective for three of them: improved communication among doctors and hospitals, spending more time with patients, and a stronger focus on prevention and education.

Some notably low-tech perspectives, to be sure. The expanding awareness of the importance of seemingly simplistic practices can be seen elsewhere, as well. I talked to a quality leader at a California hospital for a story in the February issue of HealthLeaders magazine, also out this week, who told me her hospital cut medication errors by 20% in 30 days by having nurses wear vests when dispensing medications. Twenty percent in 30 days—just by creating a simple signal that certain people are not to be bothered when they're performing a certain task. And in the Wall Street Journal, I read a piece last week about how the Centers for Disease Control and Prevention says unsafe injection practices like reusing syringes are a leading cause of infections in physician offices and outpatient facilities. Reusing syringes? Seriously?

I know plenty of you could cite a litany of concrete improvements that provider organizations have realized from implementing high-tech initiatives. I know plenty of you would say that technology holds great promise for improving quality on a broad scale while also boosting efficiency and eliminating waste. And you'd be right on all counts. Technology can do a lot. But it can't do everything. Even if you have the most advanced computerized process in the world in use at your organization, it can still be undermined when human beings forget to wash their hands or don't dispose of a syringe or talk in the ear of a nurse who's dispensing medications.

The good news is that more and more healthcare leaders seem to be realizing the importance of addressing both the technological and human elements of quality improvement. Striking the proper balance between the two is the real challenge.

Jay Moore is managing editor for HealthLeaders magazine. He can be reached at
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