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Electronic Health Records Raise New Concerns for Hospitalists


 

Implementing an electronic health record (EHR) remains a major concern for hospitals and their hospitalists, with even successful “go live” EHR rollouts accompanied by a host of difficulties, says Russ Cucina, MD, MS, hospitalist and medical director of information technology at the University of California at San Francisco (UCSF) Medical Center.

Speaking at the 17th annual Management of the Hospitalized Patient conference in downtown San Francisco on Nov. 1, sponsored by UCSF and co-sponsored by SHM, Dr. Cucina said training of physicians should be mandatory—along with a test of their competency—before they use EHR and computerized physician order entry. But even more important is the “elbow-side” support provided during the rollout, while post-implementation training will have more impact.

Dr. Cucina urged hospitalists to look at EHR implementation as a process, not an event, and to develop their own goals for EHR, expecting that their hospital’s goals will only partially overlap with what they need from the system.

“Take a minute and forget the computers,” he said to participants. “How would you like to change your day-to-day practice to be more efficient, safer, with less paperwork, fewer redundancies, and processes that actually support your work?” An EHR system can impose new and unwanted structural requirements on physicians’ workflow if they don’t speak up about how they want it to be structured.

Dr. Cucina told attendees that UCSF spent a lot of money on its EHR, but still thinks the investment was worth it. With federal “meaningful use” incentives and penalties looming in 2014 for hospitals’ participation in health information technology, EHR will continue to become more important. Some hospitals may find it worthwhile to subscribe to an existing computerized system at another hospital in their region. UCSF will be making its system available by subscription to nearby Children’s Hospital of Oakland, Dr. Cucina said.

Barriers can be enormous for a dissatisfied hospital that wants to exit an unsatisfactory implemented EHR system, Dr. Cucina noted.

“Ask yourself: Does the software really stink, or is your implementation not so good?” he said. He recommended that dissatisfied hospitals ask their EHR vendor to name several top performing hospitals that use its system. “Go visit them, with all of the questions you didn’t know you needed to ask before you purchased the system,” he added. TH

Larry Beresford is a freelance writer in San Francisco.

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