In Implementing Electronic Records, Don’t Forget the People

The most valuable thing about EHR is the data and the control it gives you. I can see all of my patients, filter for diabetics, filter for those who are uncontrolled and focus on getting them in for screenings. We have easy access to data that was unimaginable with paper but none of it matters if I can’t even get my password to work.

Dr. Nailah Thompson

Having completed residency training in a largely paper-based hospital, former CIR Executive Vice President Dr. Nailah Thompson reflected on transitioning to her new position in Internal and Preventative Medicine in the fully electronic Kaiser Permanente in Oakland, CA.

When we speak of EHR, we extol its virtues in creating a safer, more efficient patient care setting. Yet one of the greatest barriers to creating this more efficient system is the providers themselves. In addition to cost and technological hurdles, hospitals face the challenge of training physicians and healthcare workers to adopt and be proficient in an entirely different work flow. We asked Dr. Thompson to share her experiences working in a fully electronic health records system. Kaiser Permanente is an industry leader in health IT, recognized by the Healthcare Information and Management Systems Society for its implementation of EMR.

Vitals: Why did you choose to work at Kaiser?

NT: I wanted to work at Kaiser because the position I have now blends primary care and preventative medicine. Its focus on public health provided opportunities to do a lot of community work.

Vitals: Kaiser Permanente has a fully electronic medical records system. What does that look like on the ground?

NT: Kaiser’s EMR is very intergrated. I can have a patient come from any other Kaiser hospital in California and have their information. Everything from the patient’s chart to notes from specialists are all immediately available. The entire hospital — radiology to pharmacy to physical therapy — uses the same system.

Vitals: How does EHR improve your day-to-day work?

NT: During residency [in Internal Medicine at Alameda County Medical Center in Oakland, CA] and at a small community hospital I worked at in Northern California, we were still using paper charts. What really sets my work apart now is the access I have to data. I can look at all my patients, filter for diabetics and for how many of them are controlled. If only 20 percent are, I can focus on getting those patients in for check ups and screenings. That’s not possible with paper charts. Not only can you not get these kinds of measures, you often don’t even know how many patients you have. It also makes the doctor’s work much more streamlined. You can include prompts for all sorts of measures: blood pressure screenings, mammograms, colon screenings. And the physician doesn’t have to commit these to memory. In fact, other staff can be sure to prompt patients for preventive measures as well. You can have reminder messages automatically sent to patients and you can communicate with them through the health net [the hospital’s online patient communication system].

Vitals: How did you adjust to working with EMR?

NT: There was definitely a learning curve but what’s really helped me adapt quickly is learning from my colleagues. You can’t be afraid to ask questions. The hospital has implemented programs like a physician mentorship program and a year-long physician orientation program that create a supportive environment for continued learning.

Vitals: What factors do you think are most important in creating an efficient EHR system?

NT: Training. We received one full week of training on the system. It’s so important because learning on the job just doesn’t work. We ran through everything—logging in, checking patient charts, checking email—with the hospital’s IT staff. We were able to troubleshoot many of the inevitable problems, so you are not unable to access a patient’s medical history because you are sitting in front of your computer trying to get your password to work.

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