BEYOND THE BASICS Many surgical facilities that invest in paperless systems don't use their EMRs to their full capacities.

Ever wish your EMR could do more than schedule, chart and code cases? It might be able to do a whole lot more — you've just yet to click through every tab, read the manual from cover to cover or ask your vendor to give you a screen-by-screen tour of your system to discover all its hidden horsepower.

"I didn't know all the things our system could do when we started," says Natalie Coubrough, RN, CASC, the director of the West Lakes Surgery Center in Clive, Iowa. That was before Ms. Coubrough and her staff discovered the full capabilities of their EMR. Now, she says that while "the change to electronic charting was painful, it was totally worth it for us. We would never go back to paper."

She describes her system as "extremely user-friendly, in that it is configured like a paper chart with tabs." The EMR is set up on tablets that can be deployed anywhere in the center. Among the many pleasant surprises, she most likes the "charting by exception" feature. Instead of typing out all of the narrative charting for every case, a click of the mouse populates the chart with the norms and staff add the items that are outside the norm. Similarly, she likes the fact that certain information will populate throughout the chart after being entered only once.

There's more. All physician standing orders and discharge instructions are at the nurses' fingertips. They have immediate access to old forms and records, and the ability to cut and paste information from the old record to the new. They can use a webcam to identify patients. They can scan documents into the record in any location. They can generate customized reports for implants or antibiotic timing for infection control purposes and reporting. "A huge plus for us — rather surprisingly so — is the great customer service we get from the company," she says.

Yes, you can customize your EMR
Annette Saylor, RN, CNOR, CRNFA, the director of surgical services at the Community Hospital in Grand Junction, Colo., loves that she customized her software to suit her needs, even though the software came pre-built. Before she went live with her EMR, she spent considerable time building documentation templates (known as wizards) to match her workflow. In the initial software design, the wizard for prepping came before the wizard for positioning. One of Ms. Saylor's nurses pointed out that they position patients before they prep them, so Ms. Saylor flipped the order of the wizards. "This small fix saves our caregivers considerable time," she says.

Ms. Coubrough also modified her templates. "Our record is set up and customized as we want it to be," she says. "It's not a cookie-cutter program that we had to adjust to." She added to her EMR a deep vein thrombosis evaluation so that it would notify surgeons if a patient was at risk for DVT. She also added a few questions about a patient's fall risk. And every time her facility adds a new surgeon, she can add that doctor's discharge orders into the EMR.

A good way to discover what your EMR can do is to challenge the system to track or report something, like whether patients received their antibiotics 60 minutes before incision and whether patients with implants developed infections, says Ms. Coubrough. "When we decide there is something we would like to track or something we need to report, we discover new capabilities," she says.

When Jennifer Teeter, COA, administrator of the Fry Eye Surgery Center in Garden City, Kan., went live with her EMR last summer, she had already completely customized the software's templates. "We custom-designed all EMR templates in-house for ease of use," she says. "It was very similar to the paperwork process. Staff trained very easily."

WISH LIST
What Capability Do You Wish Your EMR System Had?

SCRATCHING THE SURFACE Your EMR might have a lot more functionality than you're aware of.

Here's a sampling of what surgical facility leaders wish their software could have or do, according to our recent survey:

• Integrate with pre-admission software.
• Let doctors' offices review and schedule surgical procedures.
• Retrieve lab values from doctors' offices.
• Interact with the surgical software.
• Capture assistant hours on reports for credentialing of physician assistants.
• Voice activation.
• Integrated inventory system.

— Dan O'Connor

Digital to-do lists
The most pleasant surprise for Ms. Teeter was the software's "tasking" system, which sends automatic tasks — digital to-do lists — to the appropriate staff member based on the information that's been filled out. So, for example, staff know which patients need a follow-up phone call. If a corneal implant was used, the billing staff receives an alert to code and bill the case. If an IOL is needed at a higher power than they have on consignment, the materials manager receives an alert. Based on which staff member is assigned a particular job duty, the software sends a line item to that person's workflow, similar to an e-mail inbox. "It tells the patient's name and what's being requested of them and the due date," says Ms. Teeter. The task alert turns red if the item's not done by the due date. As the manager, Ms. Teeter can see who has accepted or declined tasks, and which have been reassigned.

"I knew it was there, but I didn't visualize using it in the manner in which we're using it today," she says. "It's a pretty slick workflow."

Ms. Teeter attended a week-long template editing course sponsored by her EMR software company, learning the ins and outs of the EMR system and what it's capable of. "It was extremely beneficial," she says.

Can your EMR automatically download patient vitals from monitors directly into the system? "It only takes one time to show how efficient it is to automatically download a full set of patient vitals from a monitor, as opposed to manually entering the data, to show why this is one of the most rapid ROIs in a well-designed EMR," says an industry insider. "Unfortunately, many of the EMRs on the market today do not offer this functionality."

What about computerized physician order entry (CPOE)? Once a physician approves his orders, the EMR will automatically check all planned medication use against patient allergies and current patient medications for any contraindications. The use of CPOE will provide an efficient way for nurses to receive those instructions, confirm compliance of those instructions and document all actions to fulfill those orders, says the industry insider.

Then there are op notes. Your docs will prefer to stay with their normal process of producing op notes, as they did when your facility maintained paper records. A well-designed EMR will let your docs produce an op report electronically without incurring transcription and dictation costs.

Finally, there's outcomes analysis. Can your EMR perform patient recovery studies based on data from the medical history, PACU and the anesthesia record?