Sunday, September 13, 2009

Helping launch an EMR go-live

I spent most of last week as part of the physician support team at our flagship hospital. It was more of a learning than a teaching experience for me. Here are a few observations:

The hospitalist group, 30 members strong, seem well organized and happy. The nurses and ancillary staff love them.

Although I was there primarily to support the hospitalists it was the non-hospitalist docs, generally an older bunch, who needed the most help. Many of the hospitalists had trained on CPOE. It was nothing new to them. Push back form the non-hospitalist docs, it seemed to me, was not against technology but against the unintended consequences of the new culture that inevitably results from implementation of an EMR. Their concerns are well founded. Although there are advantages of the EMR there are disadvantages too, and it has yet to be demonstrated that the advantages outweigh the disadvantages in a way that translates into meaningful improvements in patient safety. Some of the docs were angry but their basic attitude was one of healthy skepticism. There was no Luddite mentality that I observed.

Members of the support staff were dedicated and eager to help but some of them, the non-physician ones anyway, seemed unaware of unintended consequences and how the new EMR, initially, will adversely affect physicians' work flows. These are the folks who really push some doctors' buttons. I encountered a number of angry docs---docs who had already spent 30 minutes on something that should have taken 5. The best approach, I found, was to validate their concerns (because their concerns really are valid), get them unstuck so they could go on with their work, and try and encourage them that things will get better. Almost invariably their tone softened and they thanked me.

As an aside, while there I had the opportunity to visit the EICU which monitors all our system hospitals and gained a new appreciation for how those folks can be a real enhancement to patient care.


Evan Earl Dussia, II, MD said...

I'm just interested in what the perceived advantages of an EMR might be when a 5 minute activity takes 30 minutes.
This EMR is obviously not a clinical tool. And because it is not, why are the clinicians involved?

Frank Scavo said...

I've had my own suspicions that many are focused on the benefits of EMR, without understanding the "unintended consequences" for physician workflow, as you indicate. At least with how current EMR systems are structured.

It would be really helpful, though, if you could itemize or give a couple of examples of these unintended consequences.

Allscripts said...

These records are more easily retrievable than manual systems, and can make a patient’s navigation through the health care system much safer and more efficient.