We can't wait to replace our dinosaur of a DOS-based records system. Our hospital's surgical services department is cutting edge — we have a navigation system, the latest vitrectomy machines, we do spine surgery — but our data is stuck in the '80s. Our system is only slightly better than a manual typewriter: It's not mouse-driven, it populates text fields in all caps and it relies on function keys. The data's not to be trusted, either. Every month, 20 or so of our patients mysteriously vanish into the ionosphere. We have a record of them being admitted for surgery, but not of them making it out of PACU. All kidding aside, I don't have the tools to manage my department.

In 10 (short?) months, all that should change when we go live with our new electronic records management system. Before we could join the digital revolution, however, we had to make our case to the hospital's higher-ups — both that our current system had to go and that the new system would be worth the time, money and effort. This was a long, arduous process. I've already spent 300 hours on the project and sat in on 60 to 70 meetings.

Our deficient DOS-based system
Last month, after 2 years of intense research, our hospital CEO green-lighted the project and we signed off with our EMR vendor. When you include man-hours, software and training, we will sink about $1 million into the new EMR system. We almost didn't reach this point.

Our hospital's IT department wanted to add modules to our health information system, but would need 3 years to complete the work. Not only did we not want to wait that long, but we weren't convinced that was the best solution. We wanted a best-of-breed product that wouldn't force us to compromise. This led to some animosity and a few heated arguments between surgical services and IT, but we now have total support from IT.

Believe me when I tell you that our DOS-based system is deficient. "Workarounds" have become the norm. We have to scan handwritten forms into another system. Reports are limited. Data does not flow efficiently. Data mining is cumbersome. Documentation is redundant and time-consuming. True story: We document allergies 15 times from pre-admission teaching through discharge, meaning every clinician re-enters the same data. Scheduling is tedious — rather than clicking and dragging, we must re-enter each surgery to rearrange the schedule. There's more, but you get the idea.

The real payoffs
Yes, electronic health record "meaningful use" incentive payments from the government played some part in our decision, but they're not what triggered our 4-OR, 2-procedure-room hospital to move forward. For us, the real payoff lies in improved efficiency.

Right now, we have tons of data, but it means nothing and we're unsure of its integrity. Soon we'll have data that's actionable and reliable for strategic planning. We'll be able to improve our clinical quality with the data we collect, monitor core measures, generate physician performance reports, track tissue and stay prepared for accreditation.

On the nursing side, our new EMR will get nurses back to the patients. Now, nurses spend an inordinate amount of time documenting. The computer should be a tool, not a task. Our new system will make charting easier because it comes pre-built, its documentation wizard populating the fields that are the same for most procedures. This is known as "charting by exception." Every time we do a total knee, for example, we'll simply click a button and 90% of the charting will be completed. Our nurses will spend more time looking at our patients and less time looking at the computer screen.

Improved reimbursement is another key benefit. Right now, we leave a lot of charges on the table because of gaps in our automated supply chain. Our new process will be barcoded so that the allograft that comes into our system will be scanned when it comes in and scanned when it goes out, at which point it will be reordered and submitted for reimbursement.

Our case was airtight. Who could be against having the power to transform perioperative data into actionable intelligence? Now we had to find a vendor that could deliver what we promised.

Our must-have features
Our EMR had to have several must-have features. Among them: Windows format and functionality, comprehensive nursing documentation, data flow throughout the surgical experience and integrated supply chain management.

We came away from several visits to hospitals using the system we purchased convinced that we've found the best practice tool available to us. Now the real fun — and the real work — begins: designing the IT infrastructure. Will we survive OR computerization? Check back in March to see how we're doing.