EMR Woes

I said in a previous post that I am part of a team working on a new EMR for our hospital system.  I haven’t yet put down my thoughts on the process except briefly.  Writing about situations and changes makes it easier to digest, it gives me time to mull over what I’m taking in and really process what’s at hand.  I haven’t done that so much, mostly because of the sheer volume of information we’re being exposed to.  Imagine learning a whole new charting system from scratch, in near-minute detail in a matter of hours.  Then imagine you have to make decisions for workflow and behaviors based on a brief overview.  It’s a bit overwhelming to say the least.

Right now I’m guardedly optimistic about it all.  There a great many things in this new EMR that will be incredible.  There’s a lot of things that we’re going to have to change in our current processes to work around the new system as well.  Additionally, there is going to be a radical paradigm shift required for our system to implement it.

One those biggest things is CPOE, or computerized physician order entry.  While this has one of the greastest benefits, it’s also going to require the biggest amount of buy in by stakeholders (yes, I’ve been studying corporate jargo-speak).  I can pinpoint the docs who will jump on it, feet first and be the leaders.  Then I can also target the docs who will have to have their hands held all the way through who will go kicking and screaming to it.  Then there are the middle ground who will grudgingly accept it as a measure of change.  It should reduce a lot of the transcription errors we currently encounter.  No more will we pass the chart around looking for someone fluent in “dr. X’s” scribble.  The responsibilty for the right orders will no longer be on the nurses and the unit secreatary, but rather the doc themselves.  Maybe that will reduce hissy fits as our come back can be, “You entered the order, not me.”

Another cool thing is being able to see what is being charted in the ED prior to the patinet coming up.  We can even see the triage nurse notes for clues to the actual beahvior of the patient.  No more hiding the fact of drug seeking behavior, or drunkeness, or other bad behavior.  We wold be able to see the record from triage on. No more trying to figure out is the patient got ASA in the ED or not. It’s in the electronic MAR.  The lines that are palced in the ED carry over to in-patient status allowing us floor nurses to really see where that IV is (left, right, what’s the diff).

But moreso is the abilty to (in theory) seamlessly see the records from the PCP, the meds, the treaments, all the imaging done in system, all of the intangibles that sometimes get duplicated because we just don’t know if a certain study was done or not.  We can see that they’ve been to the ED 3 times in a 24 hour period, even if it is at different hospitals, or that they followed up per dischrage instruction when they present back to us on the rebound.

No doubt it’s going to be painful.  In the begining I’m sure the amount of time we spend charting will go up.  It will be that way until we (nurses and others) find the right rhythm, where what we need to chart on is located adn how to do it effeciently.  There will be growing pains, for sure.  BUt as it stands, I think it will be a good thing.  The goal is to bring all the disparate systems curently in place, insular systems that rarely talk to each other and flush them away to be replaced by this overarching canopy of a system where it is all integrated and communicating with itself.  I know that it is something we have to do.  In order to keep abreast of the variety of rules and regs that are foisted on us by folks like the Joint Commision and CMS and to be able to provide discreet data to prove that we are as good as we say we are, will be a huge step in the right direction.

I just feel lucky that I’m able to get in at the ground level.  I figured since I was a harsh critic of our current system, I had better put my money where my mouth was and take part inthe process to hopefully prevent the smae mistakes and missteps from happening again.  Besides, it’s cool.


One Comment

  1. We went paperless (or nearly) 18 months ago. I loved it then I love it even more now; the only thing missing is CPOE. Keep us posted how the CPOE goes.

    One piece of advice: make sure TPTB budget upstaffing during the first ten days you go live. It made a huge difference in maintaining our high level of patient satisfaction and associate satisfaction.


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