Sharp Healthcare is the largest health care provider in San Diego County, with over 2,000 beds and 18,000 employees. Sharp employs a full suite of Cerner solutions for lab, ambulatory, oncology and more.
I have been a keen student of electronic systems ever since I used a mainframe computer during my undergraduate days to print the results of my genetics fruit fly experiment. I’ve moved on from bugs, but I’m still into systems – in particular, how they can empower a health care organization when the right ones are in place.
In 1984, I helped implement Sharp’s first electronic health record (EHR). Since then, I have come a connoisseur of electronic systems to support medical practice. I am chagrined to read and hear how experts – sometimes even my colleagues – blame the EHR for everything that is wrong in the world of medicine today, especially in relation to issues of physician burnout and increased dissatisfaction with the profession. I believe that much of the frustration and ill will felt by clinicians toward the EHR is more a product of what we are asking clinicians to do with EHR systems rather than some built-in malfeasance or fault baked into these systems that is aimed at users.
Advantages EHRs have brought to clinical practice
EHR systems have brought two major advances to clinical practice that are often forgotten during these discussions. First is the ability to access the chart at anytime from anywhere simultaneously with other users. This is a chart that is replete not only with documentation but also with lab data, imaging and sophisticated clinical decision support. Second is the fact that when we use these systems, we are connected to a network which is usually plugged into the Internet, the world’s greatest medical library. We take both of these advances for granted.
I have no intention of going back to the paper days of standing in line to get at a chart during the morning rush hour. I do not recall with fondness the innumerable times I left the intensive care unit (ICU) to find an X-ray in the radiology department, only to discover that it had been signed out to the operating room, then to find that the surgeon had left it in their office.
I’m an intensivist. I just turned 71, and in spite of my years, I still practice as a full member of my critical care group – although these days, I’m limited to 12-hour shifts on the weekends and 12-hour shifts at night. I practice at Sharp Memorial Hospital, a busy, high-acuity community hospital. We do heart transplants, kidney transplants and left ventricular assist devices. We are a trauma center. Our women’s center does almost 10,000 deliveries a year – more than any other hospital in California. And as a community hospital, we have no academic affiliations. There are no fellows, residents, interns or house staff. In the evening, when I get ready for work, my badge is clipped to my belt on the right, my pager on the left and my stethoscope strung around my neck. So girded to do battle with disease and trauma, I am secure in the knowledge that the most dependable partner, the one I can count on at any time to give me rock-solid advice is my friend the EHR. I could not and would not practice without this indispensable partner. The plain and simple truth is this: Our EHR system makes me smarter and my patients safer.
Opportunities for improvement today and the potential for the future
Do you know how many times I have forgotten to order deep vein thrombosis (DVT) prophylaxis for patients being admitted to one of our ICUs?
Not once since 2008.
I have never forgotten to order DVT prophylaxis because my friend the EHR (and the power plans that I help construct for it) not only reminds me to order it, but also helps me decide which type of prophylaxis or when prophylaxis is contraindicated. We often forget that some of the best clinical decision support comes from well-constructed power plans and care sets. They are the best aid de memoir. It’s not a recipe – it’s more of a checklist. And if that’s OK for every airline captain and first officer landing airliners all around the world, it’s OK for me admitting my patient to my hospital.
So why do so many providers complain about the EHR? Certainly, there are legitimate issues. Computer systems are, by their nature, frequently fickle – though much of that is due to our own doing with custom implementations and unnecessarily complex infrastructures. There are many reasons why an EHR system might go down or be unavailable, but there is one common denominator as far as every user is concerned.
The consternation clinicians frequently express toward the EHR system – any EHR system – is really the result of what we have been asking clinicians to do with the EHR, not with the EHR itself. The perfect storm for physician frustrations was created when trouble moved in as a series of low-pressure fronts to continue the meteorological metaphor: We had Meaningful Use, ICD 10, medication reconciliation, computerized provider order entry systems (CPOE) and, of course, the dreaded clinical documentation improvement (CDI) with its infinite queries. Who comes up with this stuff?
Much of the frustration for clinicians comes from the notion that these newly imposed EHR duties involve a lot of activity that is not necessarily at the top of one’s license. Asking anyone to do something new and different, perhaps requiring the acquisition of a new skill, is challenging enough – but for such an order to be mandated without sufficient explanation of why or of the benefit that will be accrued is even harder to stomach. Yet, that’s how clinicians often feel thanks to the implementation of mandatory use systems.
There is no question, however, that EHR systems can make clinicians more efficient. Here are a few ways health care leadership can make sure the hospital EHR is a partner on the job.
1. Pay attention to the infrastructure supporting the EHR
Make sure there are enough devices for clinical staff and take the time to experiment with and invest in modern technology like mobile devices and mobile-supporting software. Slow computers and missing, broken or faulty auxiliary devices denigrate the experience.
2. Be judicious with clinical decision support
Let’s put the “meaningful” back in Meaningful Use. At Sharp, we use the Lights On Network® for peer comparisons of implementation and results data. This means we can compare our baseline with local and national health care organizations and see what we may learn from the models our peers are using.
3. Don’t be afraid of the voice-to-data system
Many clinicians are already heavily invested in voice to data systems to create all the clinical notes required to document care. It’s time to start using voice for navigation in and around the EHR since most of us can talk faster than we can type.
Our EHR is just as real a partner in the team caring for our patients as any clinician. By improving our systems and making them more user-friendly, we increase the efficiency of our providers and, most importantly, we make our patients safer.
Cerner services and technology can help you advance your vision. Learn more here.
Hear more from Rick LeMoine during his session at the 2018 Cerner Health Conference, "Stop Blaming the EHR: A Graybeard Intensivist Describes His Love Affair with Cerner Millennium." (Session #1100) Make sure to visit the Empower a Connected Care Team zone on the Solutions Gallery Floor on Tuesday, October 9 at 11 a.m. CST. Register for CHC18 here.