How Can Hospitals Make the Most of Their EMRs?

Laurie Saloman
APRIL 19, 2018

Patients Benefit

It’s no secret that many doctors and nurses have a love-hate relationship with EMRs. For all of their promise, these systems often are a source of frustration and wasted time. Nevertheless, some clinicians have realized that patients directly benefit from the use of this technology.

Because Jayant Jagannathan, MD, operates 4 clinics in central and northern Michigan, the interchangeability of an EMR helps him keep track of his patients, some of whom live in the farthest reaches of the state near the Canadian border. They occasionally come downstate for treatment but often can’t manage frequent travel. “I can be sitting in a hospital here and be looking at a chart for a patient 300 miles away,” Jagannathan said. The electronic system is also a great help when he confers with his partner, who may be in another location. “So we don’t miss a beat when it comes to patient care.” He also appreciates that he no longer has to sift through “huge and overwhelming” physical charts when looking for a particular piece of information.

Patient privacy is another selling point for Jagannathan. He pointed out that without EMRs, records must be printed by someone in the medical records department, physically mailed or faxed to another clinician, and then manually scanned into a new system. “There are 3 different areas there where protected information could be contaminated,” he said. Restricting use of passwords and PINs only to those who should have access keeps his patients’ data safe.

Becky Fox, RN, described a time when EMR technology made a difference for a young man who showed up at one of the system’s emergency departments. “If you eyeballed him, you’d think he was fairly healthy,” said Fox, assistant vice president and chief nursing informatics officer at Atrium Health. However, she noted that this patient’s lab results were flagged in the EMR system for possible sepsis. “We were able to intervene quickly and get the patient moved up to the critical care area,” she said. “It was a really ‘aha’ moment for the nursing staff.” Fox also recalled the time a friend’s mother arrived at the hospital and was flagged for Clostridium difficile testing by the EMR, which was fortuitous because she ended up testing positive for the infection.

The Years Ahead

Unfortunately, too many hospitals and physicians’ practices aren’t yet using EMRs at this advanced level. Experts agree, however, that the next frontier for EMR is moving from capturing raw data and making it easy to find and share to analyzing and making suggestions, as in the sepsis and C. difficile scenarios. “Predictive analytics, which have transformed the retail and finance sectors, will begin to impact medicine,” said David Levin, MD, chief medical officer at Minneapolis-based Sansoro Health. “Today, Amazon makes ‘people who bought this’ recommendations. Tomorrow, EMRs will make ‘patients like this have a high risk of’ or ‘patients like this respond best to drug X’ recommendations.” He likens current EMR systems to the first generation of cars more than a century ago. “[EMR systems today] are more like the Model T than a sleek, self-driven sports car.”

Winkelstein compared EMRs today with where Google and Apple were a few years ago. Back then, you could use map applications to help you figure out where you were, but not much else. Now, he said, the applications are smarter and can point you to the nearest craft cocktail bar. “We’re not there yet with EMRs,” he said. “Right now, most physicians see them as data entry devices.”

The good news, according to Winkelstein, is that EMR systems are becoming more responsive. “For the past few years, vendors [have been] concentrating on regulatory compliance,” he said. “Now they’re beginning to be able to focus on how to make [the systems] more user friendly.” While he’s heartened by EMRs’ abilities to flag patients for certain conditions, he wants systems to go further, such as alerting clinicians that patients need screening tests, such as mammograms or colonoscopies, based on their ages or medical histories.

All of these alerts, however, can lead to sensory overload. “Research by informaticians has shown that there are beneficial aspects to EMR implementations, including decreased transcription risk via electronic entry and decreased medication administration errors via barcoded medication administration,” said Randa Perkins, MD, chief medical information officer at Moffitt Cancer Center in Tampa. “However, we are aware that we traded old errors for new ones. For example, well-intended alerts have fed ‘alert fatigue’ and possibly contributed to provider and clinician burnout concerns.”

Will clinicians want to, or be able to, adapt as EMRs evolves? No one claimed adapting will be easy for clinicians who are used to doing things a certain way.

“I think everyone’s getting used to the fact that [things are] always going to change,” Fox said. “It’s important to have clinicians in executive roles at the table.” As with other industries, younger people working in healthcare are more likely to take to the new systems fairly easily. She noted that a substantial portion of the nurses who work at Atrium Health are millennials, which bodes well for their embrace of new electronic methods. “Millennials are willing to take risks,” she said.

Perkins is optimistic that clinicians eventually will wholeheartedly embrace EMRs. “Eventually we will see EMRs and their related functions as being as essential to healthcare as the stethoscope,” she said. “Once that happens, we’re more likely to get more of the relevant and accurate data that healthcare research needs to make discoveries faster and make personalized medicine a reality.”

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