In 1993, I was a practicing gastroenterologist with Guthrie's Robert Packer Hospital, a 238-bed teaching hospital that is part of the Guthrie Healthcare System, a community-based, not-for-profit healthcare organization in Sayre, Pa. At that time, my colleagues and I had never heard of Epic. Or computerized physician order entry. Or even the term EMR. But that's not to say our practice, our hospital, and our patients didn't benefit from information technology.
That year, Guthrie's Robert Packer rolled out its own homegrown version of an electronic medical record (EMR), called the “clinical repository.” And it was just that: a view-only database of test results, diagnoses, medications, and patient history. Provider reception of the repository was, to put it politely, a bit chilly. As with most change-particularly that which is technology-driven-many insisted that the work could be completed just as quickly and just as thoroughly by hand.
Over the next nine years, a gradual affinity for the availability of clinical information developed. Perceptions started to change as the last hurdles to adoption fell, and we all began to fully understand the convenience-and the benefit to patient care-that our IT infrastructure could provide.
Fast-forward to 2001. Guthrie's Robert Packer won its first national Top 100 award from Thomson Reuters for its cardiovascular services-an accolade it would earn five more times. In 2007, the hospital won the first of four Top 100 Hospital awards. It was also named a Top 100 Performance Improvement Leader four times, and, in 2008 and 2009, it received the prestigious Thomson Reuters Everest Award-an exclusive recognition given to 23 of the Top 100 hospitals. Today, Guthrie's Robert Packer is among the cream of the crop, and I believe the early adoption of EMR played a huge role in getting us-and keeping us-there.
By the time these national recognitions began to pick up steam, the hospital's clinical repository had given way to an important inpatient computerized physician order entry (CPOE) system supplied by Epic Systems Corp., Verona, Wis. When we made the conversion to CPOE in 2002, our culture of change and our existing IT infrastructure had already given us a head start.
The catalyst for adopting CPOE was a directive from the hospital's board of directors that urged us to focus in new ways on patient safety and outcomes. We soon found CPOE to be an indispensible tool, because it helped us to organize order sets so nothing is missed-and it helped us to ensure that we are able to deliver to the patient the necessary medications, procedures, diagnostics, and care at precisely the right time.
The classic concern with EMR-and particularly with CPOE-is that it forces “cookbook medicine” on physicians. But the reality is that you don't neglect the details. The process of providing care is critically important to the outcomes. It's giving medication at the right point in time, and it also has implications for the cost side of the equation. EMR helps physicians keep tabs on the frequency and necessity of what they're ordering. It also yields another critical perspective: a look at the patient's cumulative history. This longitudinal view helps each physician involved in patient care see the “big picture” for that patient. And, it is a tremendously effective tool in facilitating the communication process between and among all the disciplines that interact with that particular patient. Providing patient records in one place makes it easy for pertinent information to be available for the next consultant or to the next surgeon. This naturally saves time and money, and improves quality.
Ensuring that the process of care is as reliable as our skill at providing it has been key to attaining better patient outcomes. Being in the national spotlight through Top 100 awards has been a little bit like putting the perfect icing on a delicious cake made from a longtime family recipe. Talk about cookbook medicine. If you look at the criteria for Top 100 status, it's a combination of quality outcomes, cost, length of stay, and patient safety and satisfaction. Having an EMR directly contributes to higher performance and higher quality. It supports better care by providing pertinent information that sets the stage for safe, effective, and efficient care. In addition, an EMR also enables a rigorous focus on measurements and outcomes. When we reflect on the care we provide, outcomes data mined from EMR open a window of understanding about what we're doing well and what challenges remain for us.