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January 30, 2006
Using high tech to deliver high-touch health care

donna price is coordinator for communications and marketing services in Academic and Administrative information technology.

Shifting to electronic medical records from the days of keeping a separate paper chart for each patient at each hospital and ambulatory practice holds exciting potential for health care delivery in the United States. It also presents the dual challenge of building an information technology (IT) infrastructure and orienting health care providers to the associated changes in processes and structures.

All in all, a tall order—and one to which Emory Healthcare (EHC) committed in 2002 with its multiyear Emory Electronic Medical Record (EeMR) project. The incentives are great: greater safety and efficiencies, improved care, reduced costs, and the capability to put at the fingertips of physicians, nurses and authorized staff all the information that’s needed, at the time it’s needed, for each step in the patient-care workflow.

“As providers, we feel the advantage because when you open a paperless electronic folder, there’s so much information,” said Penny Castellano, chief medical officer for clinical operations at Emory Clinic and EeMR project executive. “It’s easier to provide excellent care for patients. The technology allows you to be more efficient and more foolproof. Even though this is a technology project, it allows you to concentrate more on the human side of the health care experience and on the patient-physician interaction.”

EHC had been using a computerized patient database since the early 1990s, so accessing information online was a familiar concept for staff, but the tool selected for the project is much more than a database.
“We worked with Cerner to develop more than 30 applications, making EeMR an integral part of clinical operations,” said Dee Cantrell, EHC Information Systems (EHC IS) chief information officer and EeMR project executive.

Led by EHC IS project directors Tanya Cossett, Jack Morford and Katie Smith, EeMR’s foundation was laid in 2003–04 with the conversion to the new architecture and migration of some 130 million clinical events, including laboratory and radiology results, into the system.

Beginning with the online rollout in January 2005, nearly 7,000 physicians, house staff and other EHC providers were trained to use the system, and some 4,000 more will be trained over the life of the project. Seven new Cerner applications went live in 2005 including FirstNet, which automates emergency-department patient triage and tracking processes, orders and documentation; and cardiology scheduling, which will be expanded this fiscal year to Surgery and eventually throughout EHC.

PowerChart, PowerChart Office and PrescriptionWriter added new desktop solutions for viewing, ordering and documenting, as well as a comprehensive EHC medications list.

“I think every organization’s underlying reason for thinking about an EeMR is that it includes safety tools that make medical practice better,” said Castellano.

For example, thousands of drugs in today’s market sound alike, look alike and even are spelled alike, and new drugs come to market every week. It’s virtually impossible for any individual to know every drug, its dosing guidelines and what can and can’t be mixed for a specific patient.

“When I am writing a prescription for a patient, I have their list of medications in our [new] system,” Castellano said. “When I write the 10th prescription drug for that patient, the system automatically checks for interactions with the nine others the patient is already taking, and also checks for cross-reactivity with allergies the patient may have.

“It’s [also] allowed all of us who get phone calls on the weekends, after hours, or when out of town to have the ability to continue to provide care in as excellent a fashion as if we were standing in our office with the patient in front of us,” she continued.

EHC’s implementation is unique in that the system was designed to include functionality for both inpatient and outpatient settings. This allows for a continuum of care; for example, if patients who have been seen both at Emory Clinic and Emory Hospital have an emergency visit at Emory, their care providers will have access to a comprehensive medical record, including radiological images, the most current allergy lists—all the basic information needed to make clinical decisions without having to locate a paper chart.

“It’s really a revolution, a wave that is sweeping the nation and the health care industry,” Castellano said. “In 2007 or 2008, we’re going to look back and say, ‘How did we ever do this without these tools?’”

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