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Of Physician Documentation--And Disaster Recovery

July 13, 2013
by Mark Hagland
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Brian Yeaman, M.D., CMIO of Norman Regional Health System, shares important thoughts about physician documentation issues—and disaster-recovery lessons learned

In early June, HCI Editor-in-Chief Mark Hagland interviewed Brian Yeaman, M.D., of the Norman Regional Health System in Norman, Oklahoma. Yeaman has been with the health system since 2008, and has been CMIO there since 2009 (while he continues to practice part-time as a family physician and as a hospitalist). The planned subject of the interview was the challenges and opportunities inherent in physician documentation these days, including the role of speech recognition technologies in optimization the physician documentation process (the Norman Regional Health System has been using the suite of speech recognition solutions from the Burlington, Mass.-based Nuance Communications).

But, given the devastation wreaked upon the local area by the May 20, Moore tornado—which destroyed the Norman Regional Health System’s Moore facility—Yeaman and Hagland naturally spoke first of the tornado experience, its aftermath, and lessons learned from that disaster. Below are excerpts from their interview.

Moore Medical Center, before and after the May 20 tornado

Before we converse about physician documentation issues, how are you and your colleagues doing, following the tornado of May 20?

Moore Medical Center was our hospital; we had three facilities, including the Moore facility, which was completely destroyed. I happened to be the hospitalist on call that night. All the electronics and communications went out. I was in our clinic in Norman, and I automatically went to the main campus.

So the Moore facility is a complete and total loss. But the way our team came together was amazing.  Our director of radiology there was shooting films at the time of the tornado. And as CMIO, I was watching everyone zoom around with COWs [computers on wheels]. We saw 134 patients in three hours that day. And we had just launched Nuance in the ER about two weeks before. The doctors were using the EHR and using Nuance. So what happened was that we had 98 employees who fully or partially lost their homes, and about 50 who lost their cars.

And actually, the ONC [the federal Office of the National Coordinator for Health Information Technology] sent out a documentary film crew the week after and followed us around, and I walked them through some of the storm damage at Moore Medical Center, which was a total loss. And we had a lady who was a “9” in labor [9 centimeters dilated] at Moore; but we transferred the patients to Norman, and never missed a beat on them.

Brian Yeaman, M.D.

What happened to that lady?

It’s incredible. L&D [Labor and Delivery] at Moore Medical center—they moved them all down to the first floor and the inner corridor. The woman who was a 9, they moved into a c-section room on the second floor. They had the woman on a gurney, and the nurses were holding onto her—her labor arrested, we got her into an ambulance, and got her down to our neighboring hospital in Norman, and she delivered in Norman.

Were there any lessons learned from the terrible experience of the Moore tornado?

I mean this very generally, and this was my point to Farzad [Mostashari, M.D., national coordinator for health information technology] when I talked to him about it afterwards, because they called us to check in on us—we were an early adopter for meaningful use, and we moved to VMWare [the core cloud computing solution from the Palo Alto, Calif.-based VMware, Inc.] ,and did a lot of zero-client; and because of a lot of redundancy with our servers, we didn’t miss a bit. And we have a very robust health information exchange. Our arrangement was that we had three campuses running off one central database, with one redundant location. But there’s also some serious, tangible value to what we’re doing with meaningful use stages 1 and 2, and in terms of health information exchange. And because of that infrastructure, we were able to shine through. And I think that’s why Farzad sent a camera crew down; I imagine that the camera crew was as much for the President and Congress as anyone else.

Do you have anyone reporting to you as CMIO?

There are a lot of dotted lines, but no one who reports to me formally. We have 26 people in our IT department and eight clinician analysts; and in the Norman Physician Organization, there are another three analysts there. I lead strategy for that. The analysts are full-time, most are RNs.

How would you characterize the state of physician documentation right now?

Right now, here, we live in this world that remains a mix of electronic and paper notes. And on average, you can’t read half of the paper note. And the part you really need to evaluate from the consulting or attending physician, you can’t read; so that part speaks for itself. We have gone live with physician documentation, but there’s still a fragment who are documenting partly on paper; in September, we end all that. At least half of our notes on the inpatient side are being done electronically, and half aren’t; we’re getting ready to do a big bang—we’re “partially pregnant” for CPOE [computerized physician order entry] and physician documentation, and when we flip the switch, we’re going to go full-out.