| Nursing and computers have not always been a | | | | The issue of electronic system workflows in the |
| perfect mix. Typically, nurses try to get away | | | | healthcare setting adversely affecting patient care |
| from new computer systems as much as | | | | has also been a concern. However, the opposite is |
| possible. However, it is an inevitable workflow | | | | true. According to the Institute of Medicine (IOM) |
| evolution in today's hospitals. | | | | in a report called To Err Is Human: Building a Safer |
| "It was so easy before when all I had to do was | | | | Health System (2000), "98,000 Americans die in |
| give it (orders) to the clerk." | | | | hospitals each year as a result of medical errors. |
| "This new computer system is such a mess. Why | | | | Even when using the lower estimate, deaths in |
| can't we keep our old system?" | | | | hospitals due to preventable adverse events |
| "It takes time away from my patient care." | | | | exceed the number attributable to the 8th-leading |
| "This is never going to work." | | | | cause of death. Deaths due to preventable |
| As an RN working on the informatics side of | | | | adverse events exceed the deaths attributable to |
| healthcare, such comments are commonplace | | | | motor vehicle accidents (43,458), breast cancer |
| when I travel on site to different facilities. | | | | (42,297) or AIDS. |
| Why I wanted to do it | | | | In her report, Key Capabilities of an Electronic |
| With billions of dollars allotted to deploy this | | | | Health Record System July 31, 2003, Dr. Carolyn |
| project to multiple facilities nationwide, I wanted | | | | Clancy, Director, Agency for Healthcare Research |
| to be a part of it. "It's never been done before in | | | | and Quality stated, "There is a great deal of |
| this scale," stated Vicki Levario, the Director of | | | | interest within both the public and private sectors |
| System Solutions & Deployment at Kaiser | | | | in encouraging all health care providers to migrate |
| Permanente Southern California Region. When I | | | | from paper-based health records to a system |
| was offered this job, I didn't hesitate. Here was a | | | | that stores health information electronically and |
| marriage of two things I feel comfortable with - | | | | employs computer-aided decision support |
| clinical content and computers. | | | | systems. In part, this interest is due to a growing |
| The magnitude of this project can be appreciated | | | | recognition that a stronger information technology |
| when you take into consideration the 8 million | | | | (IT) infrastructure is integral to addressing such |
| Kaiser members it will affect. By 2007, all 12,000 | | | | national concerns as the need to improve the |
| physicians and 150,000 employees in the Kaiser | | | | safety and quality of health care." |
| organization are expected to be fully trained and | | | | National Mandate |
| use the software in their workflows. After a few | | | | Automation of records in healthcare is not only a |
| weeks of involvement in this project, I began to | | | | step in modernization, but a national mandate. The |
| see what a Herculean undertaking this will be. | | | | following is excerpted from the United States |
| Resistance | | | | Department of Health Services. |
| "Good luck with that job. They're just wasting | | | | Mission statement: |
| their money. It's never going to happen, " a | | | | "... to guide the nationwide implementation of |
| physician said to me one day. | | | | interoperable health information technology in both |
| Healthcare automation is an inevitable progression, | | | | the public and private health care sectors that will |
| but not met with resistance. There are those who | | | | reduce medical errors, improve quality, and |
| are so defiant to the change that they would | | | | produce greater value for health care |
| rather retire than work under these conditions. | | | | expenditures, and coordinates outreach and |
| This sentiment is not unique to this organization. | | | | consultation by the relevant executive branch |
| Cedars-Sinai Medical Center in Los Angeles met | | | | agencies with the public and private sectors." |
| with such resistance from physicians that the | | | | Vision: |
| implementation phase failed despite the system | | | | "...Clinicians will have a patient's complete medical |
| being two-thirds online. | | | | history, computerized ordering systems, and |
| I can understand where the overtone of paranoia | | | | electronic reminder." |
| comes from. Working on the units to support the | | | | The implementation of electronic health records |
| software, I observed some users who are | | | | (EHR) is integral to this national mandate and it's |
| obviously using the computer for the first time. I | | | | just a matter of time when all hospitals in the US |
| saw them having difficulty using the mouse and | | | | will be fully electronic in their workflow systems. |
| typing their user names and passwords with | | | | With this daunting task ahead, I'm reminded of |
| painfully slow pecking style. | | | | the words of the National Coordinator for Health |
| I try to encourage users by showing them the | | | | Information Technology National Coordinator, |
| positive side. With the nation's healthcare trend of | | | | David J. Brailer, MD, PhD when he addressed the |
| medical record automation, this will make health | | | | System Solutions and Deployment personnel. "All |
| care givers more marketable as electronic health | | | | eyes are on you." As an RN and healthcare |
| record (EHR) experienced professionals. And, in | | | | provider, it's breathtaking to see through the |
| time they will master the system, and their | | | | telescope to look beyond the horizon and be part |
| workflows will be more efficient. | | | | of the mission. |
| Safer Practice | | | | |