HRS: EMR use critical for documenting workflows
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“Going live” does not equal adoption, he clarified. “When you have the system available, it takes a while to truly adopt and help patient care."
Kusumoto spoke on implementing and customizing an EMR in cardiology practices. However, he reported that with such a large market offering about 580 Office of the National Coordinator for Health IT (ONC) Authorized Testing and Certified Body (ATCB) products, it is “difficult to get into the weeds since no one has market share.”
He shared data from the ONC on vendors receiving money for EHRs, finding Epic contains the largest market share in the eligible provider arena; however, the vendor category of “others” is also significant. “This is just who received monies…When you look at not money spent but installed systems, you see that 'others' is even higher and Epic is actually a small percentage compared to what has been installed in the last year.”
What is important, he stated, is the EMR is not a paper chart. It’s taking complex data, location, timing and more and cataloguing that information into a single repository. “We need to think of new ways to use the tool,” he said, “because it’s going to be here” due to the government's large investment of time and money in the technology.
One of the big questions he acknowledged is whether an EMR assists with patient care. In electrophysiology, physicians are dealing with numerous workflows within different environments, including the hospital (where procedures are done) and the office (where patients traditionally come in to discuss procedures).
The EMR can assist communications with the use of an e-message where physicians can review documentation. “A trail of documentation is what the EMR provides,” Kusumoto noted. In the hospital setting, the EMR can be used not only for receiving data but also scheduling and ordering.
Subsystems have to communicate, which means the workflow of integration is complex, and an EMR can help facilitate communication between systems. However, as Kusumoto noted, seamless integration doesn’t happen overnight. In fact, he noted his organization began as a guinea pig for its EMR vendor in 1996 and will have one database for the organization in 2013 that uses structured data for clinical information.
He noted that the usual evolution of implementation involves a scanning phase of written records with the idea of shifting toward structured data; this is critical for meaningful use in the future. “It’s important to develop a feasible timeline.”
While he noted most hospitals use a single vendor (60 to 70 percent), many are moving toward a best-of-suite approach. “It’s hard for a single vendor to be good at everything,” he said. It’s important to pick a software package that emphasizes communication and interoperability, according to Kusumoto.
Going forward with implementation, he said it is important to think about what applications will talk to other applications in the future as well as the infrastructure required. Kusumoto said in the cardiac world, often a Cardiology Picture Archiving and Communication System (CPACS) is used for study image management and study documentation while an EMR looks at patient management and study management. Oftentimes, a cardiovascular information system (CVIS) bridges the gap between the two but there is speculation that CVIS will be eliminated in the future.
As migration continues, all stakeholders, including administrators and IT staff, need to be involved. The system also needs to be usable and minimize scrolling. “Flexibility will be lost over time,” he stated. “As you are starting to adopt, the most flexible times are in the first few years.”
The carrots are out now to adopt EMR technology; yet sticks will be coming fast, Kusumoto said.
Looking forward, he concluded that EMR security will be huge in the future. From September 2009 to Dec. 31, 2011, more than 30,000 healthcare data breaches occurred, affecting 7.8 million people, he said.