February 5, 2007
EeMR: technology meets bedside manner
by dedra cantrell, chief information officer, emory healthcare
What would it be like to work at a hospital that documented treatments in real time? Where doctors could make the best decisions based upon easily accessible patient information? Where paperwork decreased while patient care and patient safety improved dramatically? Emory Healthcare employees know. Emory Electronic Medical Record is changing the face of patient care at EHC, one unit at a time.
"It took three years to establish the infrastructure to get us where we are today," Jack Morford, EeMR project director at EHC, explained. "Initially, a group of Emory University Hospital nurses were involved in the pilot group for Clinical Documentation. It was rolled out to the rest of EUH in November 2006. Things went extremely well. This was one of the biggest go-lives in my 15-year history at Emory and one of the smoothest."
The Clinical Documentation system addresses six major processes for the inpatient hospital environment: admission processes, nursing documentation, results reporting, communications processes, medication processes, and order management. "Clin Doc" is ultimately designed to reduce dependence on the paper chart and provide support for real-time actions based on readily accessible clinical data.
"We can see real results in real time," said Cheryl Wheeler, nursing administration at Emory Crawford Long Hospital. "It's a huge win. Previously, nursing staff had to work from memory for most tasks. Clin Doc creates tasks and reminders for those tasks."
Before rolling out the EeMR pilot, the team had plenty of research to do. They visited all units to observe documentation processes that were then benchmarked with local hospitals. Next they chose the mobile unit. Two hundred nurses attended a device fair, where they evaluated workstations based on maneuverability, weight and screen size. The EeMR workstation chosen was determined to work best at the patient bedside. After all, electronically charting at the patients' bedside is the ultimate goal.
Known as WOWs (workstations on wheels), these computers were designed to improve the immediacy of information gathering and facilitate the process of EeMR clinical documentation. The WOWs have received a warm reception from everyone involved in the Clin Doc system.
When nurses sign on to one of the mobile EeMR workstations, they are greeted with a task list of items that need attention. Driven by physician orders, the list could include anything from checking on patients with wounds that need tending to providing medications.
"The EeMR task lists ensure our patients receive the care they need," said Bill Bornstein, EHC chief quality officer. "This is right in line with our organizational goals of patient safety."
Since EeMR is always current, if medications are changed or doses are altered, that information is immediately evident on the system.
"Right now, nurses typically have a paper Medication Administration Record that is static. They may handwrite changes or scratch things out," explained Morford. "If they don't communicate changes to the pharmacy, it will show up on the list each day. With EeMR, if a medication is discontinued, it must be acknowledged on the task list and the nurse then contacts the pharmacy."
"Having current information is crucial," agreed Bornstein. "With EeMR, the information is always current and correct. There is no comparison to previous methods of communicating changes in treatment."
What are the nurses saying?
"They don't want to go back to paper," said Kemi Ogunyemi, EUH nursing services. "Everybody says, 'I'm going to another unit next week, and I'm dreading it. I have to go back to paper for a month.'"
Nurses who have used EeMR no doubt share Ogunyemi's enthusiasm. Working virtually paper-free definitely has advantages. Not only does it simplify the day, but it frees up time for the number one priority -- our patients.
"The ultimate goal is to spend more time with the patients. EeMR will give us the time to do that," said Morford.