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EHR Face-Off: What’s Easy, Hard
October 1, 2008
Four years after work began, Kaiser Permanente announced in May the completion of a national rollout of electronic health records systems across ambulatory facilities.
The milestone is part of Kaiser’s initiative to adopt a wide range of information technology applications across its provider network. Its Kensington (Md.) Center of more than 40 physicians was one of the earlier sites, going live about three years ago.
Solid support from Oakland, Calif.-based Kaiser and EHR vendor Epic Systems Corp., Madison, Wis., helped ease the go-live at Kensington, says Neelam Shah, an internal medicine specialist and physician champion at the practice.
For the first two weeks, “Blue Shirt” support personnel — easily visible by the shirts they wore — were available to clinicians and staff. “It really made a difference,” Shah says.
Physicians also had their schedules cut in half during the first week and had a two-thirds workload the second week. During that period, physicians also created customized lists of their most common prescriptions, lab test panels, referrals and other preferences as they charted treatment at the point of care.
Facing up to Reality
Creating the preference lists could have been done before go-live, but physicians get better lists by creating them in a real-world environment, Shah says. “It’s easier to create lists within the context of treating a patient,” she explains. “Once you go live, you see how things work with the system, such as setting up categories, so you can see what ways work best for you.”
Also, building the lists was a simple two-step process done while documenting care. The first time Shah made a particular routine order using the new EHR, for instance, she would right-click on the order and select “add to preferences.”
Kensington Center physicians had previous experience with a less robust EHR before implementing Epic. Consequently, some parts of the new system—such as viewing charts and results—could be mastered almost immediately, Shah says.
But mastering the physician message in-basket was a different matter. To start, many physicians needed Blue Shirt help just to find the messages. “It took time to efficiently use the basket and to route messages to appropriate people,” Shah recalls. “There are several different ways to send a message.” The practice held several team meetings to determine how to delegate the handling of messages and document resolution of the messages.
The new system also supported secure messaging between patients and physicians. “Many physicians were very apprehensive of secure e-mails with patients,” Shah says. “It’s actually turned out to be one of my favorite things and I speak for many doctors who love this thing.”
E-mail with patients makes taking care of them easier, Shah contends. “There’s no phone tag. Forty percent of my patients have signed up and I’m actively recruiting the others.”
Shah contends that the e-mails have not added to her workload, but have increased the quality and satisfaction of care. The messages are triaged and simple e-mails that a nurse or staff member can handle never reach the physician.
Messages that the physician should see are resolved quicker and easier by the physicians than when nurses and staff were the middlemen. The bottom line, Shah adds, is that e-mail actually is a time-saver for the doctor and results in a more educated patient. “I don’t have to spend 20 minutes on the phone answering questions.”
If a patient needs detailed information, Shah types it out in an e-mail. The patient can read and digest the information and most times won’t have follow-up questions. And because the patient is better educated, the follow-ups don’t take long to handle.
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