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