Square Pegs, Round Holes


Martin Johns, MD, joined Gifford Medical Center, a 25-bed full access hospital in rural Randolph, Vt., five years ago to launch its HM program. The landmark push toward implementing electronic health records (EHR) now has Dr. Johns and his colleagues scrambling.

Dr. Johns, whose program now has four hospitalists and four physician assistants, recently spoke with The Hospitalist eWire to talk about the technology challenges specifically faced by rural hospitalist programs.

Question: What role did EHR play in your HM group when you began the service?

Answer: Five years ago, I was definitely concerned about that. I came from Geisinger Medical Center (in Danville, Pa.). They had Epic embedded into every aspect of documentation. I was very used to the seamless integration of information in transitions of care. I was somewhat spoiled in that regard, but I also realized a small hospital was going to have different types of systems.

Q: How far has your digital record-keeping in the hospital come to date?

A: We currently have a data repository more than EHR. CPSI is the system we use. One of the difficulties in us making the decision to move to an EHR is a very interesting problem for all small hospitals. Because they require so much augmentation after installation, small hospitals can't afford to have your large Epic system, for example, to put in place. They can't have 10 IT people in house running the service. What ends up happening is that the hospital purchases an EHR based on outpatient clinic interest and said EHR usually doesn't really speak to your inpatient system.

Q: How can a smaller institution transition into a comprehensive system?

A: The biggest barrier is there's just not a really great all-level-of-care product that would take you through that in a small hospital. It's just too difficult and too expensive for someone to create that product, or at least it appears that way. An all-encompassing solution for a small hospital—the market is not just there.

Q: So where does that leave the rural hospitalist?

A: At a smaller place, it sets up all the variables for a communication breakdown. Mrs. Jones comes in for cataract surgery and she gets morphine and she has a reaction. That's on her hospital chart, but doesn't make its way onto her clinic chart. Those are the breakdowns that can happen and that's really challenging. … With this EHR push, if it's not done correctly, the patient can suffer more than they would with paper records.

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