EMR Pre-Population Strategies

SMMC's documentation environment has consisted of dictated notes that were edited and electronically signed through a vendor website and then transferred to our HIS. These dictations could then easily be accessed digitally by all providers within our system, along with laboratory and radiology results.

A pre-loading strategy was initiated several months before go-live. All primary care providers were instructed to do at least one dictation with a new document type labeled "AEMR Data Extraction" which included, at the very minimum, the problem list, the patient's current medications and allergies. These key data elements had been decided by the Clinical Standards Committee (CSC), a group of providers that has met monthly for over a year to decide on issues in regards to EMR implementation, content and display. Interns at the high school or beginning college level were hired as temporary help and trained in the task of pre-populating the electronic charts with this data.

Of course, the cons to this approach include the time needed to train (for the most part) clinically naive personnel in medical data entry, the subsequent mistakes they made reflecting their inexperience with such data and an unsustainable model for chart pre-loading. The advantages were less expensive labor, protecting clinical personnel so that they could continue to care for patients and a significant number of charts pre-populated.

Nevertheless, go-live has revealed charts of extremely complex patients with long problem lists and medications numbering in the teens that have not been touched by the interns. I have frequently heard frustration from clinicians during the go-live that the data of these patients are taking inordinate amounts of time to be entered fully within the AEMR. To try and help relieve their burden, I have suggested that they enter only 30%-50% of the crucial data (which would include those items relevant and important to their current visit and immediate future care) and leave the rest for the patient's next clinic visit.

Scanning existing documents for pre-load was left to the discretion of each clinic (we have 11 total) and although each chart was allowed a limit of 5 pre-loaded documents (per CSC decision), all clinics elected not to do any scanning prior to go-live. Most clinics gave the reason for this decision as inadequate time or resources were available beyond those dedicated to patient care.

Challenges in a hybrid environment of paper and no paper include enhanced user confusion in regards to policies and workflow for remnant paper, disrupted workflow and reeducation once paper is eliminated. Luckily for SMMC, our immediate trend will be for decreasing paper documents, and hopefully this will lead to further workflow efficiencies.