EMR enhancements to reduce caregiver risk
November 13, 2014 in Medical Technology
I recently visited my primary care doctor at a major northeast medical center for my annual checkup. While he was busily entering information into his EMR, I took the time to ask about the family, talk a little shop. Not surprisingly, he expressed to me concern for his and his staff’s personal safety given the recent events in Dallas. This was not the first time since the Ebola patient showed up in the Dallas ER that I heard a clinician express concern for his or her own personal safety.
While tragic and downright frightening, the circumstances around the Ebola cases have done much to raise awareness of our vulnerabilities, and to point out a number of “opportunities” for improvements both with clinical protocols and within the EMR. As a physician who has used and worked on the development team of a number of EMRs and technologies, I am reminded of how powerful, or dangerous, information technology can be both in terms of caring for the patient as well as safeguarding the caregiver.
Ultimately, your EMR should enhance patient care and reduce clinical risk across the enterprise. Does your EMR do that?
With awareness of the need for improvements high and caregiver’s concerned for their safety, there is no better time than the present to make improvements to your EMR. The reality is that sick and contagious people continue to walk into our ERs and medical practices everyday and most do not have the luxury of hitting a pause button to address flaws in their system or upgrade their EMR. What you can do, and I would argue must do now, is to clearly identify the flaws in your system and put a plan in place for improvements to reduce caregiver and, ultimately, clinical risks and enhance patient care.
Here are five important steps and EMR enhancements to reduce caregiver risk now:
1. Get honest about your EMR. If you, or your development team, have not already done so, now is the time to take a critical look at your EMR and also how it is perceived and utilized. Are users expecting the EMR to alert them to important CDC information? If so, is the information delivered at the point of care, in a usable format, when the caregiver needs to know critical, potentially life- saving information? Or do busy physicians have to click out of screens and go to the CDC site every time they see a new patient? Developers and users must be in reality and on the same page relative to what their EMR can do today versus how it should or “is going to” operate. At a minimum, any EMR system should present to a provider a complete view of the patient’s condition/s. It should NOT separate nursing functions from physician functions. The nurse, ancillary staffand the physician are a team. Patient data should not be segmented based on some arbitrary assumption that a member of the care team is not interested or will not find that bit of data useful. Incomplete data in a patient care setting is a dangerous thing and can lead to mistakes in care.
2. Usability across the enterprise. The only thing worse or more dangerous than not having patient information is having incomplete information. Or worse yet, having incomplete information and not knowing it! Do you know if everyone in your organization is using, and entering in complete, accurate information into the EMR? Is that information available and readily accessible at the point of care? Bottom line: EMRs are either used and accepted by all users across the enterprise, or they are not. If they are not, then information contained within is not reliable, and caregivers cannot and should not trust their EMR. To achieve usability across the enterprise, it is important to define what is real usability and what exactly caregivers need and want from their EMR. So many developers and decision-makers realize after they have made a huge investment in the very best EMR available that users “hate their EMR”. In fact, Healthcare IT News reported that a recent Black Book poll revealed that 98% of RNs hate their EMRs.
The good news is, there are a number of changes through either programming or the addition of tools that can be added to your EMR to enhance usability.
3. Give clinicians what they need when they need it. Every physician and nurse who has had to search through a patients records, click out of one program and open another to find information to try and get to the information that is relevant to the patient encounter can relate to this. Probably nothing is more important to a caregiver than to be able to see what is relevant for this patient, for this specific clinical presentation, at this particular point in time. What is needed for this specific patient, and what do I need to know now to ensure my safety and those around me? Systems need to be intelligent and integrated. EMR’s, population management systems, and clinical decision support need to be seamless and intelligent giving the provider critical information at the point of care that is actionable.
4. Real time information for missions critical. Does your EMR have the capability to send “real” alerts in real time to all users at the point of care? Is information meaningful, easy to access and does it give the user exactly what they need, when they need it? I recently learned of one enterprise that includes several links to the CDC site on the startup screen of the EMR so that all users can “conveniently link to and read” current information from the CDC. Have you seen any of these notices? Do you think anyone is going to refer to this in a busy ER five hours into the night? Remember, we are talking about safety to our frontline workers, so real time becomes real important.
5. Intelligent documentation that backs up what was done. Documentation takes on a new meaning given this “brave new world” of emerging threats. Sure we care about ICD-10 and MU and, of course, the care of the patient. We also may need to know on a minute-by-minute basis what a patient’s temperature and vitals are so that action can be taken as needed. And, need to be able to look back and have peace of mind knowing that the team followed the right protocols to ensure safety, not only for us but also for the health of the enterprise. To this end, documentation must happen at the point of care and not interfere with the clinical thought process. The last thing a physician or nurse needs to be doing when faced with a critically ill or infectious patient is to be focused on “clicking” and documenting versus making critical decisions about care.