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Painful but true: EMR not the end-all, be-all to patient information

The electronic medical record is often discussed as if it is the end-all, be-all to store information tied to a patient, but those who work in healthcare know that is not the case. Methodist Hospitals share their recent challenges and solutions with finding a holistic approach.

Depending on a hospital or healthcare system’s EMR, there are often chart completion functions, medical directives, some diagnostic results and other information that have to be managed from other sources. Much of that can be managed with a full-featured content management system.

But those working in healthcare also know that providers, once accustomed to the EMR, do not like to be directed to other systems to get or do what is needed for their patients. And so as the EMR process matures for many hospitals, they are looking for ways to make all of that information available from within the EMR.

That was the challenge facing Methodist Hospitals, a three-campus institution in northwest Indiana.

"We were in the process of upgrading our Epic installation when we realized that our old document imaging system would never be able to do what we wanted. And we were already behind schedule," says Dawn Smith, director of medical records at Methodist Hospitals. "Our goal was to make sure all the information, including any paper documents, would be available to users directly from the Epic screen where they’re doing their work."

Meghan DeMarse, healthcare solutions manager at Perceptive Software, echoes the importance of providing clinicians with all of a patient’s information, structured and unstructured, from one system.

"In an ideal world, 100 percent of clinically relevant data would be housed within the EMR. However, we know this is not the case and organizations struggle to manage unstructured information such as scanned documents, digital photos and wave forms. The key is making this non-discrete data relevant by giving clinicians seamless access to it as they work within the Epic record. Clinicians should not be required to break the context of their Epic view in order to find outside information. At Methodist, the ECM system has provided this link between unstructured and structured content through its seamless integration with Epic," said DeMarse.

The deployment of the new enterprise content management software took place in stages, to minimize training issues and make sure clinicians wouldn’t be dealing with a hybrid chart. Scanning went live in July 2010, with input of Epic electronic clinical documentation for ancillary staff — nurses, physical therapists, respiratory therapists, etc. — beginning in August. But doctors stayed on paper for the time being … with one key exception.

"Physicians started doing co-signatures for verbal orders electronically in July, but we didn’t go live with the computerized physician order entry until the following April," explains Smith.

Methodist turned again to its ECM system to fill the gap.

"I wanted them to be able to log into Epic, go into their inbox and see the co-signatures right there." Smith said. The scanned paper verbal orders were pushed from the ECM repository to Epic. When doctors logged in to Epic and accessed their inboxes, the signature deficiencies were highlighted for them to complete.

"By the time we went live with CPOE for physicians, they were already used to going into their Epic inboxes, looking at their orders and signing off on them. That made the transition very smooth."

Then when Methodist upgraded to Epic 2010 software in November, it utilized the ECM system to help during down time. The Epic system would be down for six to seven hours to install and test the upgrade, which meant there would be a gap in the EMR documentation. All paper documents created during the downtime would be scanned in to the ECM system, labeled as downtime documentation and made available from within Epic to complete patient records.

Smith said all of the downtime docs were put under a separate hyperlink. "So when a user logged into Epic and saw a gap in a patient’s vital signs, for example, he’d know immediately to go to the hyperlink to get that information."

A recent request for a change to the ECM involved emergency room patients that come in with paper documents — for example, the ambulance run sheet and information from the nursing home.

"It’s all vital for patient care and we were lumping it all together in one category. The nurse reviewers asked me to create a category just for ER documentation," Smith recalls.

But Smith takes the fine-tuning in stride.

"I don’t see paper going away in my lifetime, so the system will never be static. But our ECM solution is flexible, and we have people on staff trained to implement the changes."

The attitude toward the new imaging and document management system has been overwhelmingly positive. Doctors can log into Epic from anywhere and see complete information on their patients. For patients’ follow-up office visits, providers can see test results, consent forms and other key documentation without calling the hospital and waiting for information to be faxed to the office.

"Our physicians and their office staffs just love it. I would say we’ve decreased our paper by 35 percent, but we still work in a paper world to a great extent."