Shasta's Approach to Pre-Populating the Electronic Chart

I didn't want Dean's thoughtful remarks to get buried under "comments", so I'm raising it to the level of it's own post. - SA

"This was a challenging issue for us during the planning stages right through to implementation and beyond. In preparation for EMR our EMR Committee gave notice to our clinical teams that they should be cleaning up their medication lists, chronic problem lists as a first step warning the teams that when the time comes to imputing the data this would make things a little easier. We also tried to make our transcription service follow a certain template format a year in advance so that we could import those dictated noted from the following 12 months right into the EMR. Well, it was a huge challenge to get the transcription service (and a dozen or more of their contractors) to do this so in the end we could not import old dictated notes (we could and did scan them). We also talked about using nurses to pre-infuse the EMR with medications, other specific data elements and shared with the medical staff that ultimately it was their responsibility to ensure that the entries were accurate. We also used some of our other clinical clerical support from our QI department to help input certain data elements such as the last dates of services for PAPS, Mammograms, etc. We found that process took considerable time, particularly with our most seasoned doctors who had among the largest patient panels. We had heard of private firms using RNs who do a lot of the pre-loading of the data at a price (too pricely for most CHCs). As we started our EMR implementation each practitioner and their nursing team started to enter data. To do so slowed the teams down so schedules were reduced and the clincians typically worked serveral hours over their normal daily hours to do this. We paid them for these hours and while expensive, the alternative was to cut access further during the day and/or to make them very unhappy. It was a tough 6- 8 months realizing that your most complex patients are typically the first ones you will see and that made it even more difficult. I will defer to Beth and Charles from my team for more specifics. We did use the weekly (sometimes daily) EMR committee to determine priorities as to what was to go in the chart and training and support issues. I think a weekly meeting of this Team that included several clinicians was critical to help us work through our challenges. The issues of what is scanned vs what needs to be inputed came up regularly and we made adjustments to those decisions as we went along. Folks moving down this road could learn a lot from the mistakes of those who went before. In all fairness, the software and hardware today is signficiantly better than what we looked at nearly 3 years ago. There are also more of us who can share some pratical experiences. Nevertheless, unless I missed something, moving from a paper based system that we had been using for nearly 20 years to EMR for our 40,000 active patients does not happen with just some computer programming or a few extra hands. In the end it is the clinicians who ensure that the EMR stands on its own."
April 8, 2009 3:42 PM