OUTSIDE ASSISTANCE Patients can play a role in their care by providing accurate information through your EMR system.

During a recent laparoscopic colon resection, I couldn't confidently visualize the polyp that needed to be removed and questioned whether it was where we thought it was. I broke scrub and pulled up the patient's electronic medical record. In a minute, I'd confirmed that we were in exactly the right place.

The rise of EMR technology has, to many critics, been accompanied by a sense of obligation. But, as my mid-procedure check shows, it's easy to see the practical benefits that EMRs bring and why they'll continue to be an essential technology for surgical facilities.

START TO FINISH EMRs can track a patient's entire experience, offering insights into your quality of care.

1 Advantage of accessibility
The easy accessibility of data — and potentially a patient's entire medical history — through EMRs is definitely an asset. Physicians can make better judgments and stop second-guessing themselves.

During the case I described above, I didn't have to call the physician who performed the colonoscopy to verify the targeted site. I didn't have to hope I'd be able to catch him while he was available, and I didn't have to wait for him to get back to me while he consulted his own records on the case. The need for outside information arises frequently in surgery. With EMRs, chasing paper is in the past.

But an even bigger benefit to surgeons is having instantaneous access to radiology studies. As a resident, I had to carry 50-pound racks of X-rays to the OR, then shuffle through them, hoping I'd brought the right one. Now it takes surgeons a couple of seconds to access electronic records and refresh their understanding of where they're going.

EMRs' benefits don't stop at the OR door, though. Their availability through secure, web-based portals makes charts, test results and other patient information portable and retrievable for physicians anywhere, at any time, without making a single phone call.

2 Expanding reach
While the accessibility and portability of patient data has been EMR systems' main selling point, their expanding interconnectivity over the past 10 to 15 years — their ability to communicate seamlessly with other systems — is the advance that has made them better and better.

In the early years of EMRs, information was spread across several different platforms: charts were available through one system, the lab's test results through another, radiology studies on a third. To see all of them, you'd have to log out of one and sign into another, and any efforts at consolidation required getting your hands on paper copies and scanning them in. This was a huge limitation, and extremely time-consuming.

Now, though, an EMR system's ability to communicate with non-related systems means direct links to that information. Health records, lab tests, pathology findings, X-rays — they're all automatically there and just a click away.

In the high-tech, centrally controlled, integrated OR, interconnectivity also lets physicians easily archive the images, videos and other documentation they've generated during surgical procedures into patients' electronic records. The more components that EMRs connect to, the more users they draw and the more useful the technology becomes.

3 Improved patient management
While EMR systems may be increasingly indispensable, their accessibility, portability and interconnectivity do not essentially change the way you perform surgery or lead you to adopt radically different clinical practices. They're also generally not as visible a technology shift as other advances that you now rely on, such as minimally invasive surgical techniques and various methods of intraoperative imaging.

They can, however, have a huge impact on several aspects of patient management, enabling more efficient and more reliable delivery of care. From your perspective as a surgical leader, this could in fact be EMRs' most valuable use.

In medicine, documentation is everything. If you didn't document it, you didn't do it. With EMRs, there's no such thing as a lost chart or lost notes. Plus, their clarity brings improved communication and patient safety. Physicians are known for their questionable handwriting. But if you're reading the orders or prescriptions they've input into EMRs, you're not going to miss a word. Additionally, from the standpoint of the business office, tying EMRs into the billing system ensures that all case charges are captured.

EMRs can also serve as your ally in monitoring your facility's quality of care and conducting peer reviews. They effectively track a patient's experience, from the time they walk in the door through to discharge, noting what type of care interventions they received and which physicians and staff delivered them. The existence of such records can go a long way toward resolving many recurring patient satisfaction concerns.

Optimal patient care depends on accurate patient information. You can improve the accuracy of the information you have — ?as well as the efficiency of your pre-admission process — by inviting patients to supply it themselves. Some EMRs let them sign in to access online forms from their computers at home, where they can easily refer to their own records and medications, and enter a wealth of information before they even arrive on the day of surgery, saving your staff much time and effort.

Healthcare providers have a strong interest in patients being involved in their own care. At this stage, the capability of EMRs to make their medical records transparent and available is an often overlooked and underutilized benefit. More patient education is needed to encourage them to contribute to their own medical histories, review their own test results and see their own radiology images. EMRs' web-based portal systems offer a much more user-friendly option for making that happen.

LESSON LEARNED
EMR Access Essential to Public Health Response

When contaminated steroid injections sparked a multi-state fungal meningitis outbreak in 2012, killing 64 patients and infecting 751, investigation and response efforts were reportedly hindered by the difficulties that public health authorities met in obtaining patient health information from healthcare facilities' electronic medical records systems.

As a result, CDC researchers are leading a study to evaluate the challenges that public health officials faced in accessing EMRs during the outbreak, with the aim of improving the information sharing process to better handle future healthcare-associated infection incidents (tinyurl.com/mjcrgtp).

The CDC researchers, along with staff from the Association of State and Territorial Health Officials and the Keystone Center, a Colorado-based non-profit policy research organization, are currently interviewing health department officials from 15 states, with plans to interview representatives of healthcare facilities in those 15 states, including infection preventionists and information technology staff.

CONNECTION FAILED A 2012 fungal meningitis outbreak highlighted the importance of improved information sharing.

The participating states are Florida, Indiana, Kansas, Maryland, Michigan, Minnesota, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oregon, Tennessee, Texas, and Virginia.

— David Bernard

AVAILABLE ANYTIME The immediate accessibility of a patient's medical history makes EMRs useful in the surgical setting.

4 Keeping current
Government requirements and Medicare incentives brought paperless charts into the mainstream, while vendors' sales pitches practically guarantee your facility will be left behind without them. Do you really think EMRs are going away? Now is the time to invest in the technology and become accustomed to its use.

As with any computer system, EMRs carry the risk that the technology you invest in today will, at some point down the road, fall out of date. There are, however, a few considerations to factor into your purchasing decision to help ensure a good fit and a long usable life.

First, choose an established vendor with demonstrated experience in the field. Keep in mind, however, that their reputation for training and service matters as much as their name does. Ask your professional peers for references and real-life implementation and use stories.

Many EMR systems are known to be facility- and specialty-specific. Go with one that is geared to your needs. For our general and bariatric surgery department, for instance, we didn't choose the system that flourishes in internal medicine practices. If you're at a freestanding surgery center, find out which EMRs are in use at other centers like yours, not just what the majority of local hospitals have found success with.

Lastly, seek out a company that is building for the future. By this I mean one offering EMRs that can be upgraded over time. As with any computer, a system that can build on itself and that has room to grow lets you discover its possibilities and add to them as your information technology needs change.