Hospitals and healthcare providers may run into a flurry of problems and challenges after implementing electronic medical records in their practices or institutions — including successfully merging physicians' workflows with EMRs — and Ohio State University Medical Center is no exception. CIO Phyllis Teater discusses the specific challenges the medical center is facing after implementing EMRs and what is being done to overcome them.
Q: How, specifically, are Ohio State University Medical Center physicians struggling to use EMRs?
Ms. Phyllis Teater: One of the biggest struggles is making the system fit the work flow of physicians and enhance their ability to do their job. What they and leaders throughout the healthcare industry struggle with is that EMRs are sometimes intrusive to their workflow.
They're still providing quality care, but where they used to have people do things for them they now have to do for themselves and sometimes in a different way than originally taught. It's intrusive in every way they practice medicine. That's true for nursing and clinical disciplines, but it's true even more so for physicians. Traditionally, the physician would go to the nursing desk, go to the tab that says patient name and scribble orders into the order book. In the electronic world, they need to find an open PC, sign on, go through lots of security because of privacy issues, look up the patient, wait for the file to load, fill in orders, review it, sign it and sign off. Physicians understand the tremendous benefits of EMRs, but those benefits accrue to administration, payors and obviously patients but never to the physician.
Also, physicians may have to start an electronic chart for a patient by looking through physical paper charts, such as medical history and prescription history, and enter it electronically all over again. That affects their ability to return to full productivity. It used to be that the paper chart was always there in the binder, but now you have to transform that into an electronic chart. So fitting a system to individual physician's workflow is very difficult.
This also affects the way physicians are able to maintain patient volume. For example, before EMRs, surgeons could see 35-50 patients a day on surgical visit days as pre-op or post-op check in usually took about 15 min. The surgeon now has to go to the room, sign in and cycle through an EMR in a 15-minute visit, which is very difficult. If you're not in-tune with physicians' workflows, you'll blow them out of the water because you'll have these long drawn-out beautiful assessments that will now take half an hour for surgeons to do, when they used to spend 15 minutes doing it before. There are so many variables with the patient population and within the workflow, and physicians are right in the middle of it to try to make it work for them.
Q: So what is being done to help physicians better fit their workflow with EMRs?
PT: We have had really good leadership support and commitment. We'll also involve physician leaders and champions who can help their physician colleagues and consult with them on how to best make systems perform for them to fit their work flow.
Our medical director for our free-standing Ross Heart Hospital is one of our champions. He has worked with his staff to develop a good process for referral letters. A referring primary care physician may have a patient who needs specialized heart care to treat conditions like congestive heart failure, so those patients are referred to Ross Heart Hospital cardiologists to get evaluated and receive a special course of treatment and long-term guidelines. That heart specialist has to communicate back to the primary care physician in a referral letter what was found or what the course of treatment is because the physician is going to manage the long-term care of that patient. Physicians previously used to dictate letters through typing, but now they produce their letters through our EMR system. He has helped some of his colleagues work through better ways to ensure we still have that strong link with community patients to refer patients to the medical center for cardiology cases.
Learn more about Ohio State University Medical Center.
Q: How, specifically, are Ohio State University Medical Center physicians struggling to use EMRs?
Ms. Phyllis Teater: One of the biggest struggles is making the system fit the work flow of physicians and enhance their ability to do their job. What they and leaders throughout the healthcare industry struggle with is that EMRs are sometimes intrusive to their workflow.
They're still providing quality care, but where they used to have people do things for them they now have to do for themselves and sometimes in a different way than originally taught. It's intrusive in every way they practice medicine. That's true for nursing and clinical disciplines, but it's true even more so for physicians. Traditionally, the physician would go to the nursing desk, go to the tab that says patient name and scribble orders into the order book. In the electronic world, they need to find an open PC, sign on, go through lots of security because of privacy issues, look up the patient, wait for the file to load, fill in orders, review it, sign it and sign off. Physicians understand the tremendous benefits of EMRs, but those benefits accrue to administration, payors and obviously patients but never to the physician.
Also, physicians may have to start an electronic chart for a patient by looking through physical paper charts, such as medical history and prescription history, and enter it electronically all over again. That affects their ability to return to full productivity. It used to be that the paper chart was always there in the binder, but now you have to transform that into an electronic chart. So fitting a system to individual physician's workflow is very difficult.
This also affects the way physicians are able to maintain patient volume. For example, before EMRs, surgeons could see 35-50 patients a day on surgical visit days as pre-op or post-op check in usually took about 15 min. The surgeon now has to go to the room, sign in and cycle through an EMR in a 15-minute visit, which is very difficult. If you're not in-tune with physicians' workflows, you'll blow them out of the water because you'll have these long drawn-out beautiful assessments that will now take half an hour for surgeons to do, when they used to spend 15 minutes doing it before. There are so many variables with the patient population and within the workflow, and physicians are right in the middle of it to try to make it work for them.
Q: So what is being done to help physicians better fit their workflow with EMRs?
PT: We have had really good leadership support and commitment. We'll also involve physician leaders and champions who can help their physician colleagues and consult with them on how to best make systems perform for them to fit their work flow.
Our medical director for our free-standing Ross Heart Hospital is one of our champions. He has worked with his staff to develop a good process for referral letters. A referring primary care physician may have a patient who needs specialized heart care to treat conditions like congestive heart failure, so those patients are referred to Ross Heart Hospital cardiologists to get evaluated and receive a special course of treatment and long-term guidelines. That heart specialist has to communicate back to the primary care physician in a referral letter what was found or what the course of treatment is because the physician is going to manage the long-term care of that patient. Physicians previously used to dictate letters through typing, but now they produce their letters through our EMR system. He has helped some of his colleagues work through better ways to ensure we still have that strong link with community patients to refer patients to the medical center for cardiology cases.
Learn more about Ohio State University Medical Center.