As the nation moves toward standards for EHR and the Nationwide Health Information Network, the future of electronic health records has arrived.
Sometimes people ask why all of this is important, but there is really a simple answer. EHRs share healthcare data throughout the nation, and this data exchange can make a difference in saving lives, energy and pain. The Military Health System proves that concept every day by making faster and more comprehensive treatment decisions to its more than 9.6 million beneficiaries.
Even so, as of March 2009, as the New England Journal of Medicine has noted, less than 1.5 percent of U.S. hospitals have adopted a comprehensive electronic health records system.
For decades, the military and Department of Veterans Affairs have been using EHRs in some form. As a physician, I know first-hand the impact an EHR can make in treatment decisions and in patients' healthcare outcomes. The current military EHR is a system of systems through which physicians are capturing vast amounts of data every day. This computable data is captured from the battlefield to the home front and is usable in austere environments around the world. Over time, NHIN will be a common thread in EHRs.
This is where our EHR stands out now. But we treat patients as they move through facilities dotted around the world, whereas many people in private industry may only see a handful of providers throughout their lives.
As a pioneer, we didn't have the benefit of learning from others, so I would like to share some of the lessons we learned to help others move forward into the realm of EHRs.
An EHR has to blend easily into a practice's workflow, including everything from registration to nursing notes, clinical encounters and laboratory results. A system that meets your current workflow also needs to ensure computable data gets into patients' medical records. This easily manipulated data will help healthcare providers access the information they need, when they need it, in order to provide the best possible care.
System testing is also a critical component of a successful EHR roll-out. In MHS, testing environments that mimic the real world are key to ensuring our system meets the needs and workflow of those providing care around the world.
Regardless of the software chosen, the hardware used to run it is just as important. Not only should you test software repeatedly, but anyone who will use the software should also test the ergonomics of the hardware it will run on. Nurses may want a laptop on a cart to be able to move from room to room while physicians may want a wireless tablet to emulate paper charting.
The bottom line is that an EHR should be simple to use, so acquiring an intuitive system will promote quick adoption and deliver immediate benefits. The goal of any EHR adoption is to leverage modern technologies for greater clinical efficiency, higher quality and safer delivery of care.
Yet all the right software and hardware will do nothing if you don't train your team properly. In the Military Health System, we've learned that maximum success and rapid adoption is achievable with a hybrid mix of classroom, one-on-one, 'over-the-shoulder' and computer-based training.
Like with any change, nothing is more effective than involving your staff from the beginning so you can achieve "buy-in" and a desire for change. When the users have a voice in what is acquired and how it is deployed, they are more likely to support the plan for change.
The focus always has to been centered on what will ultimately benefit both patients and clinicians in achieving the best quality healthcare and outcomes.
And really that's all that matters.
-- Navy Capt. Michael Weiner is deputy program manager and chief medical officer of the Defense Health Information Management System (DHIMS).
