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Discussion on Medical Records Improving Care – Both Technology and Software Evolution Can Complicate At Times

Posted Apr 12 2010 10:12pm

I found the discussion area in here a bit interesting.  Having written an EMR several years ago myself I think can comment a bit here.  One of the comments that was bothersome to me was the inability to check on a class of drug and that staff needed to go through all records to find a drug that was not officially classified as an image ace inhibitor.  All programs are not written the same, but even in the one I wrote I had an area to where a filtered search could be done instantly to search by drug name, so the comment of having to search each record was a bit astounding here as one or the other occurred, the programmer left this out or the users didn’t know where or how to use another type of search, or could be both.  

I am thinking though it might have been the users as I would have thought that this type of search was pretty standard, but can’t say for sure as I was not there.  Another choice would have been the ability to change the drug to an ace inhibitor category, then all records would have shown, that is if it was an option left open for users.  The article discusses Cedar Sinai and their mess which was a lot to do with a bad implementation at the time, plus it was older technology too without some of the conveniences we have today.  On the other hand though, some feel some of the newer systems are more complicated as like any other software we have a ton of preferences to configure first, and that is a maize of it’s own at times. 

Here’s an example of a good implementation, I interviewed Dr. James Leo of Long Beach Memorial Hospital and they had a good plan and worked it.  They got everyone involved and training was mandatory.  They collaborated and made it a group effort.   Long Beach Memorial uses the same system that is in place at Cedar Sinai, Epic, which is also in place at Kaiser Permanente.  I included a couple relative paragraphs below the link.

“Also, what added to our success was identifying what we called “Super Users,” physicians and employees (400 in total) who took on additional training to achieve an extra level of competency in the Epic System. During those first few critical weeks after go-live, when someone had questions or issues related to the software and procedures, they could immediately find someone on staff who was a “Super User” to get help or ask questions.

Having employee and physician Super Users around to help others at and after Go-Live was a huge success, as the hospital is a pretty large facility and there were only so many Clinical Training Specialists available. Additionally Epic as a vendor only allows certified Epic trainers to train clinicians. So early in the process we pulled clinical staff from all areas into the certification process. It was important to have these home-grown experts training our colleagues in the classroom.”

Slowly too, everyone is finally coming to the conclusion that greater patient involvement is needed, now to just convince more patients, and we’ll have it made in that area.  Healthcare technology also throws us another curve here too, because just as soon as you get one item down pat, here comes the new and improved version with updated software that goes with it, so we have a continuous churn on meshing all of this together and keep a good sense of morality at the same time as things get busier.  More has to be done with technology as far as data input is concerned and is with mobile devices so we have turned another corner here and next week there will be another one.  Anticipation and innovation are definitely needed on any agenda today.  BD  

They'll improve patient care, in part by eliminating many errors. They'll stem the soaring growth in costs. They'll make health care more efficient. image

Those are the promises, anyway. The question is, how can we make sure the technology actually delivers? How can we make sure the digitization of medical records does everything its advocates believe is possible?

Meanwhile, many doctors and nurses say they're frustrated with the technology. While some say electronic records have improved the way they practice medicine, many others say the systems are time-consuming distractions that take away from patient care.

Some doctors also complain about errors. Dr. Fernandopulle recently tried to use his electronic records system to check how many of his heart-failure patients are on a class of drugs called ace inhibitors. But several patients who he knew were taking an ace inhibitor didn't show up on the list generated by the system. It turned out that a popular pill that combines an ace inhibitor with another type of medicine wasn't recognized by the system as an ace inhibitor. So he and his staff had to go through each patient's chart to check medications.

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