DULY NOTED Customizable interfaces improve the efficiency and accuracy of charting cases on a variety of screens.

Three years ago, when the St. John Macomb-Oakland Hospital in Warren, Mich., went live with its new EMR system, the nurses nearly revolted. "We all protested," says Pamela Borello-Barnett, BS, RN, CNOR, CSSM, LNC, CNM, the hospital's clinical nurse manager of perioperative services and sterile processing. "We thought, How can this possibly be easier than paper?"

Their concerns were understandable. EMR technology has been plagued by complaints about less-than-intuitive interfaces and too-rigid design configurations. In some cases, the technology has developed a rap for interfering with — rather than enabling — quality care. But design configurations have gotten less rigid and user interfaces have become more intuitive. In fact, many recent EMR users say going paperless has improved their workflow, documentation efficiencies and patient safety. Count the initially resistant staff at St. John Macomb-Oakland among the converted. "Even the most die-hard holdouts among us agree that we never want to go back to paper," says Ms. Borello-Barnett.

Designed with users in mind
Improved interfaces mean EMR systems are allowing for computer-guided workflow. Think chronological views of a patient's record, swipe-through options that limit the need for scrolling and drag-and-drop options that limit the need for clicking. In other words, interfaces are increasingly built to feel like a commercial app. And they're increasingly built to work on familiar screens, like a tablet or smartphone. Some are cloud-based, meaning your data is safe in the event of a server breakdown.

This increased usability allows for greater customization. For example, the latest platforms provide more flexibility when creating a user dictionary, which determines how information is categorized and stored. Additionally, when looking at data in a spreadsheet, users are increasingly able to adjust column heights and widths to their preference.

During documentation, exam fields are automatically filled, using info gathered during patient registration. Some stats (like vital signs) don't need to be gathered at all; they can be downloaded automatically from patient monitors that interface wirelessly with newer EMR systems. Systems are even programmed to remember a clinician's exact and preferred wording for things like dosing and treatment instructions.

Some newer EMRs also make it possible to customize checks and balances. For instance, you might program a chart so that it won't advance without the surgical team first documenting that the pre-op time out took place or won't close out unless they've checked off the final steps of a procedure, including the logging of start and end times. Previously, if this information was missed, the charge entry person might have to spend time tracking down a nurse, consulting an anesthesia record and pulling papers from a file drawer, all of which can delay the billing process. "Our system makes forgetting a field nearly impossible," says LoAnn Vande Leest, RN, MBA-H, CNOR, CASC, the CEO at Northwest Michigan Surgery Center in Traverse City, Mich. "There's a lot of potential with this technology to work smarter, not harder."

FUTURE FORECAST
Efforts Underway to Solve The Interoperability Issue

ONLINE CHAT The ability to share patient data among different EMR platforms would bring the technology to the next level.

While some physicians applaud improvements to digital record keeping programs, others say recent changes are mostly cosmetic. "To some degree it's like lipstick on a pig," says David Hanauer, MD, assistant director for clinical informatics at the University of Michigan's Comprehensive Cancer Center's Informatics Core in Ann Arbor.

One of the most frequent complaints about EMR technology is the lack of interoperability, meaning different systems can't communicate with one another. The good news: Innovative solutions may be on the horizon. A large project called Fast Healthcare Interoperability Resources (FHIR), engineered by a coalition of worldwide developers, seeks to create an open standard for exchanging healthcare information electronically.

"Some vendors cannot keep up with the changes clinicians want," says Dr. Hanauer. "But if they opened up their products more, we could innovate around them. For example, if I wanted to view patient data in a new type of chart, I could wait for a vendor to develop one or, if the vendor permitted, industry could build a charting app that taps into the EMR's data. I think we'll see more of this openness and more of these applications in health care over the next 5 years."

—Diane Stopyra

Blowing past the paper trail
With the latest EMR systems, multiple users can access patients' charts immediately and simultaneously at any time of day or night, and on a variety of devices. Some platforms expedite the admit process by letting patients enter registration information through secure online portals from the comfort of home. Improvements to benchmarking applications let facilities easily track how many cases started on time, how many started late and the reasons behind any holdups. (Was the patient delayed? Was a piece of equipment missing?) A nurse simply enters a code linked to the reason for delay, and that information is logged into the system, so that trends can be readily identified. Likewise, turnover times are easily catalogued.

"We're able to see how long it takes a particular surgeon to perform, say, a knee arthroscopy, so we can schedule with more accuracy," says Joshua Sheridan, RN, the OR manager at Henry Mayo Newhall Hospital in Valencia, Calif. "While you can end up with information overload, this function is helpful if you want to put a laser focus on a specific issue."

Additionally, the option for billing system integration is a time-saving measure. Info on everything that's used for a procedure is automatically transferred to a patient's charge, a process that decreases the potential for human error and increases billing accuracy. This automatic documentation also makes life easier for the materials management team, who can easily pull this information to see how much of a certain supply is being used.

"The biggest benefit of an EMR is that it lets you make intelligent business decisions," says Ms. Vande Leest. "This type of data gathering can help determine whether it's feasible to bring in new or more types of cases."

Built-in safeguards
A digital system increases safety by letting you enter red-flag alerts that pop up if, for example, a physician tries to order a medication for a patient who's allergic to the drug. These systems are also conducive to launching quality initiatives. Because EMR technology makes it quicker to trend, say, surgical site infections, conducting root cause analyses to stamp out any problems becomes easier.

Adding to peace of mind are the ways a digital system decreases HIPAA risk. On the backside of the system, access can be limited depending on role, making sure only the right people view charts, and only the right people alter them. The bottom line, says Mr. Sheridan: "EMRs have vastly improved access to patient records and the ability to track and trend information that can improve patient care." OSM