James Holly, M.D., CEO and managing partner in the Southeast Texas Medical Associates (SETMA) group in Beaumont, Texas, knows exactly why his organization implemented an electronic medical record (EMR) system for the 24-physician, 260-staff-member medical group. It's all about optimizing patient care quality and empowering physicians — and not, he repeats, not about simply automating processes.
"What compelled us, and it was a compulsion, to move into an electronic record system, which very quickly morphed into what we call electronic patient management, was the ability to analyze patient care and provide decision support at the point of care," Holly says. "As we provide decision support at the point of care, then it's worth the cost, and it's worth the hassle" of EMR implementation.
"As we developed a multispecialty group," he adds, "we realized that to maintain quality and improve efficiency, it would take more than paper records. And once we decided to do it, we decided to do it well and excellently."
For SETMA's electronic patient management system, which helps support specializations in diabetes and hypertension care, the group was given the Nicholas E. Davies Award of Excellence for ambulatory care in 2005, from the Chicago-based Healthcare Information and Management Systems Society (HIMSS). SETMA's system is a customized version of the ambulatory EMR product from Horsham, Pa.-based NextGen Healthcare Information Systems.
It's for the same kinds of reasons that 24-hospital Trinity Health System has spent $315 million so far to create a comprehensive system-wide EMR, says Narendra Kini, M.D., senior vice president of clinical operations improvement at the Novi, Mich.-based system, which spans seven states.
Improved patient care and optimized workflow, along with increased physician and nurse efficiency, are all top of mind for Kini and his colleagues. By 2009, Kini says, all 24 hospitals will be live with computerized physician order entry (CPOE) — nine are live so far. When completed, Trinity Health System's EMR will be the largest of its kind in the nation outside the Veterans Administration and Kaiser Hospitals, Kini points out.
Some might be surprised that such a comprehensive and assertive implementation is taking place across a non-academic, multi-hospital environment; and, Kini confirms, it is more difficult to achieve full-fledged EMR with CPOE in a non-academic environment. But, he says, "The aggregate rate of adoption in our system is now about 70 percent, and that's substantially higher than most hospital systems are maintaining," post-rollout.
The key, he says, is the intensive process and workflow analysis and preparation that must be made before actual EMR implementation, a phase that has required two years at each Trinity facility. Kini adds that many hospital leaders have until recently either failed to correctly estimate the pre-implementation time and effort required, or been unwilling to invest in the financial and human resources to prepare successfully for EMR implementation.
What might surprise many in healthcare is the seemingly sudden acceleration in EMR implementations on the part of whole new categories of patient-care organizations nationwide. Though the EMR has been talked about and predicted for decades, only a handful of mostly academic institutions — large urban teaching hospitals, for the most part — had fully implemented EMRs, and few physician groups had created anything close to a comprehensive outpatient EMR. Numerous reports of high-profile flame-outs, most famously the one several years ago at Cedars-Sinai Medical Center in Los Angeles, may have also negatively affected adoption rates.
A new day for EMRs?
But a variety of market and policy forces are changing the landscape, says Trinity's Kini. "There is now sufficient momentum coming from the payers, federal government and market. Are we at a tipping point for the medical record? We are at a tipping point for order entry, and for documentation; I'm sure that we're at a tipping point for decision support."
Another key change in the past few years has been the realization that core operational performance and efficiency will depend on the implementation of EMRs in hospital organizations and medical groups, says Lewis Redd, managing partner in the North American Provider Practice of Accenture. For innovative academic medical centers and other patient care organizations, the point is not implementing specific vendor products, says Redd, "It's about clinical transformation. These hospitals are looking for operational and quality improvements. Eight years ago, it was all about cost reduction," says the Atlanta-based Redd. "Now, the agenda is, I need to improve my quality outcomes; I need to grow my market share; I need to have differentiable service results; and I need financial longevity."
The EMR is no longer seen as a "nice," "optional," or "idealistic" innovation, but rather an essential tool to achieve higher operational, clinical and financial performance, he says. Not surprisingly, Redd adds, CEOs, chief medical and nursing officers, and other senior executives are now fully engaged in facilitating EMR implementations.
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