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EHR Pioneers Try to Stay Out Front
May 2007
Like the pioneers who headed West, blazing trails for millions of others to follow, a handful of hospitals and clinics in the final decades of the 20th century were electronic health records pioneers. They took the risk of automating clinical information at a time when many organizations were just taking the first steps toward automating financial records.
Many of these same trailblazers are leading the way toward a new generation of clinical automation decades after they began their original quests. And their efforts continue to yield many important lessons for others following in their paths.
The new goal of these trailblazers: James Holly, M.D., sums it up as electronic patient management.
"Electronic patient records are not the goal," says Holly, CEO at Southeast Texas Medical Associates, a 28-physician practice in Beaumont. Rather, the goal is to use clinical data to improve communication with patients while achieving better treatment results.
For example, Holly, who has been using an electronic records system from NextGen Healthcare Information Systems Inc., Horsham, Pa., for almost a decade in his clinic, now is using the technology to create daily progress notes at one hospital where he treats patients. These notes, organized in a disease management format, provide an "at a glance" look at all the key factors in the patient's treatment, enabling others on the medical team to more easily identify appropriate next steps.
"Very often in medicine the real benefit is paying attention to the simple things," Holly observes.
Rather than wait for the hospital to take the initiative, the 63-year-old internist designed the progress note with the help of his technological staff, creating a summary of hospital activity in what had been just an outpatient record. Because the hospital is not yet ready to incorporate the automated information, Holly and two other physicians are creating electronic progress notes and then printing them out, placing them in paper hospital records, providing a guide for others.
21st century innovation
Across the country, EHR pioneers are working on a broad range of 21st century clinical automation projects. Among the most common are:
* Embedding decision support capabilities, including appropriate alerts, into EHRs.
* Using clinical data to support research aimed at improving the quality of care and preparing for pay-for-performance.
* Looking for ways to increase connectivity so that hospitals and clinics can readily share life-saving clinical information.
* Supporting the growth of EHRs at clinics by coordinating these projects through hospitals.
* Phasing in personal health records that include data entered by patients.
* Adding new components to EHRs designed to make the data more complete. These include a broad range of test results, from diagnostic images to electrocardiogram strips. The military is even taking the step of adding dental records to its EHR (see related story, page 28).
* Providing easier access to EHRs at the point of care through wireless networks.
But all of these efforts are destined to fail unless physicians and nurses -those who actually use the data-are leading the way, executives at pioneering organizations stress. "My role is to evangelize about this," says James Morrow, M.D., vice president and CIO at North Fulton Family Medicine in suburban Atlanta. "My job on this earth is to help people to see that this is not the impossible task they hear it is." (See related story, page 30.)
Many EHR pioneers now are adding medication management or computerized physician order entry systems that include decision support mechanisms. Some are also building alerts into their EHRs to remind physicians, for example, that a patient is due for a test.
At Johns Hopkins Medicine in Baltimore, which started down the path toward EHRs back in the 1980s, CPOE is still being phased in as part of an effort to reduce medical errors. In addition, the organization, which is adding CPOE technology from Boca Raton, Fla.-based Eclipsys Corp. to complement its homegrown EHR, is creating alerts that tell a physician when new lab test results have been posted to the electronic chart, says Stephanie Reel, vice president for information services.
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