Spotlight on EHRs

Chuck Christian explains the challenges and opportunities facing electronic health record implementation across the nation.

We have to develop and implement standards now; that’s the bottom line in health-care IT. Electronic health records—EHRs—are changing everything, but the technology is the easy part. Getting the process correct so we can use tools without making errors is the hard part.

Chuck Christian, St. Francis Hospital

It’s not about installing widgets; it’s about making widgets work together so the information flows. Systems have to talk to each other. The data isn’t going to just magically move itself around. If you ask clinicians now, the info they have might not always be the info they need to improve care for patients. But it’s a start, and it’s going to get better.

It’s a mad dash. Everyone is scrambling to meet Stage 2 meaningful-use criteria, but right now, the Centers for Medicare & Medicaid Services say only four hospitals in the country are compliant. Stage 1 was all about putting the technology in place, and Stage 2 is moving up to actually use the software and tools that we put in place.

We have a national initiative to move medical records to the electronic space. We can actually use some of that data to investigate what’s best in standard practices of care and find out what treatments work the best. That’s great, but it requires a significant amount of data analysis. This has to be done in a secure way to prevent the potential of a security breach. We can’t just rush forward as an industry. I don’t think anyone is being malicious, but we have to take our time to do this the right way.

There is a lot of potential, but as CIOs, we need to be more process and less technology focused. How do we use the tools we have to provide great care? How do we design processes so the technology doesn’t get in the way of the people? These are the questions we need to be asking. We don’t want the process of admitting patients, for example, to be disjointed and frustrating.

“We can’t just rush forward as an industry. I don’t think anyone is being malicious, but we have to take our time to do this the right way.”

We also need to pause often to ask these important questions and to figure out what we don’t know. That’s what these early stages are for: we’re just now learning what questions we need to ask. In my hospital, we’re looking at readmission rates and outcomes. We just now have good data we can use. We’re getting more efficient in workflows and getting more info and results out of the data analysis. That’s the blocking and tackling of health-data management. We can present this info back to clinicians and make suggestions. Maybe we can use the system to give them options. If a physician is prescribing an antibiotic, for example, the software could prompt them to consider other treatments, leaving the decision up to that physician. Maybe it could provide a link to brand new clinical studies and other relevant resources.

These are exciting yet challenging times in the industry. I think the
issues that arise are usually around process. This stuff is really hard. We’re trying to change procedures designed around paper records. Paper records make certain things like chronology easy because that’s how we write. Everything is in one spot with visual cues like flags and highlights that remind staffers to re-up antibiotics or schedule appointments. In an electronic system, we have to design steps to create similar trigger events so nothing falls through the cracks.

Simply put, this work is not for sissies. There are a lot of moving parts and all departments work differently because each one focuses on a specific part of the process. If you’re a hospital-based CIO, you can’t just be focused on what happens in the four walls of your facility. I spend a lot of time talking to doctors about what’s happening in our clinics and our partners’ practices. We have to work and partner with physicians to help them meet new reporting standards. We’re all in this together; it’s no longer isolated between hospital and physician practice. We have to coordinate much, much better.

“We’re just now starting to learn what questions we need to ask.”

Compatibility can become an issue. We’re working to create interfaces between orders and results in systems that were never designed to be connected together. Things are often coded differently in a clinic and a hospital. One system may use the term “patient ID” while another uses “medical record number.” We have to create the normalization of orderable items.

We also want to make sure that we don’t lose the personal side of health care. For me, I see a paper chart and an electronic device in the same way—they’re both just tools that a physician uses to help his or her medical decision making. The key here is communication. Some patients don’t like being asked the same questions again and again, but if you explain why you’re doing what you’re doing, they become much more comfortable and understanding of the processes.

We’ve already done a lot, but there is more work to do. I think we’ll keep progressing. We need to integrate more, and we need to educate the patient population. We want them to be more involved in their own care. They need to know how to ask the right questions, and how to use the info we’re working to put in front of them.