Digital Dilemma

The Hospitalist. 2009 September;2009(09):

September 1, 2009 | The Hospitalist

Efficiency: HM Cornerstone

David Yu, MD, FHM, works at a hospital with paperless capability and sees on a daily basis how streamlined health records have a practical effect on a hospitalist’s workload and efficiency. Dr. Yu, medical director of hospitalist services at 372-bed Decatur Memorial Hospital in Decatur, Ill., and clinical assistant professor of family and community medicine at Southern Illinois University School of Medicine in Carbondale, is one of EHR’s most passionate advocates.

Decatur Memorial uses GE Healthcare’s Centricity system, which allows hospitalists to “download automatically into our physical history with the click of a button,” says Dr. Yu, a member of Team Hospitalist. “As you’re downloading, you’re accessing the information. It’s literally the same as you driving to the patient’s primary-care physician’s office, pulling the chart, and looking at it.”

Dr. Yu and those who support EHR say it streamlines intakes, discharges, and handoffs, which in turn reduce throughput and length of stay—statistics often cited to prove HM’s value to the hospital administration. The rush for implementation takes on added urgency considering that less than half of 0.5% of hospitals are fully paperless, meaning they have interdepartmental systems that can communicate with each other, according to HIMMS Analytics.

Obama and other healthcare reform advocates envision a day not far in the future when all of America’s hospitals will be connected through a national health records system. Databases in hospitals and physician offices and other healthcare providers will communicate with each other. It will make such health records as X-rays and lab test results a portable commodity, which, in theory, will provide faster and more accurate information for both patients and their providers.

One of the economic stimulus plan’s most important features is its “clarity of purpose,” Dr. Blumenthal wrote in the New England Journal of Medicine earlier this year. “Congress apparently sees [health IT]—computers, software, Internet connection, telemedicine—not as an end in itself, but as a means of improving the quality of healthcare, the health of populations, and the efficiency of healthcare systems.”2

Don’t Get Left Behind

It’s often said that hospitalists are on the front line of the hospital. So when it comes to designing and implementing EHR systems, HM leaders are in a unique position to influence how these systems take root at their institutions. Here are a few tips from industry representatives:

Attend meetings. Bureaucratic sessions might seem technical and mundane, but they afford attendees a chance to network with the hospital leaders and IT staff who will be the main players in choosing, buying, and installing the new system. “The conversion is 80% politics and management, and 20% IT,” says Dr. Stanley, chief medical informatics officer at Cooley Dickinson in Northampton, Mass.
Speak up. Hospitalists must voice their concerns; you can be sure the other specialists will speak up with theirs. If you fail to speak when given the chance, administrators likely will tune out after-the-fact complaints.
Participate in design forums, testing, and feedback sessions. Often hospitalists say they don’t have enough time to carve out for these interactive opportunities. “But HM group leaders should look at this as their investment in the future of their practice,” says Ehab Hanna, MD, MBBch, FHM, assistant chief medical information officer at Eastern Maine Medical Center in Bangor.
Plan ahead. EHR implementation will come with a steep learning curve. Consider staffing a service to reduce patient encounters ahead of time, to allow physicians a chance to learn the systems with less stress and time pressure. “If you have busy hospitalists seeing 15 to 18 patients every day, and you throw in this new CPOE, it’s not going to work,” says Dr. Yu of Decatur Memorial Hospital.—RQ