The IT advantage Featured

8:00pm EDT June 25, 2009

The adoption of electronic medical records (EMRs) by the health care industry is one of the key components of President Obama’s stimulus package, and will offer $17.2 billion in bonus payments to convince health care providers to replace their paper-based system with computerized patient records.

Smart Business revisited Barry Arbuckle, Ph.D., president and CEO of MemorialCare Medical Centers (see February 2008 issue) to learn more about the state of information technology and how his health system’s leadership and innovations are setting a national example for others to follow.

What has been the progress in information technology since we last talked?

Early next year, MemorialCare Medical Centers will have implemented comprehensive EMRs at all our major hospitals. That translates into improvements in safety, clinical outcomes, quality and satisfaction for patients; better efficiency, accuracy and productivity for staff; and tremendous engagement and satisfaction among physicians who can easily retrieve patient information.

At our campuses using EMRs, less than 4 percent of physician orders are written. Eliminating written orders means elimination of almost all transcription errors and a marked improvement in turnaround times and efficiency. Turnaround time for initial physician orders of ‘stat’ medications has been slashed from 41 to 6 minutes. Fewer phone calls to clarify physician orders and increased efficiency of documentation means more time for clinicians at the patient’s bedside. Improved patient and nursing satisfaction resulted in a decrease in turnover of nurses and other staff. And a million fewer sheets of paper copied each month support our goal of becoming a ‘greener’ health system.

We implemented other digital innovations as well, including best practice alerts and protocols, a collaborative practice model among our physicians and employees and documentation tools that enable physicians to produce comprehensive records while eliminating redundancy.

How else has staff reacted to this major transformation?

Cutting edge systems require significant staff education and training, as well as changes to the clinical and administrative workflow. More than just automating work processes, EMRs require continual review and reengineering to fix inefficient processes and create new ways to process, store and retrieve information used every second of every day. Our 1,500-bed, multi-hospital system has 10,000 employees and nearly 3,000 affiliated physicians. Transformation to a paperless system demands changed workflows and learning new methods of entering and obtaining data, ordering medications and accessing test results, plus multiple other activities. As extensive training continues, clinical staff also receives change resilience training. Being change resilient helps them weather change while remaining confident and task-oriented.

What is occurring nationally?

While research shows that hospitals quick to adopt these technologies have better outcomes in treating patients and that three of four Americans want health providers to use EMRs, only 7 percent of U.S. hospitals meet standards for fully implementing these systems. The major reason is the price tag. Extraordinary purchase, maintenance and implementation costs are often outweighed by reduced reimbursement to hospitals and doctors as well as labor, facilities, supplies and life-saving equipment costs that are doubling and tripling.

For MemorialCare, the EMR budget totals about $70 million, but proven gains are priceless. A recent national study showed that the fastest adopters of health care technology have better risk-adjusted, one-year patient survival rates than the slowest adopters. The ability to improve patient safety and quality, simplify access to patient information, make diagnostic results readily available to scores of clinicians and reduce turnaround time critical to patients and staff makes the investment worth every penny.

What does the future hold for physician and ambulatory electronic medical records?

Due to financial, labor and training costs, physicians and outpatient programs in the U.S. are very slow to adopt new technologies. MemorialCare, however, continues to expand into new arenas. We were the first health system in the world to implement Care Everywhere, which connects EMRs at physician practices and outpatient settings to our inpatient system. Physicians and their staff can also access myCare, the MemorialCare Ambulatory EMR, for scheduling, registration, billing, ordering and clinical documentation.

How can employers get involved?

Partner with local hospitals, physicians and outpatient programs to learn how information technologies impact the health of your work force. Offer programs to educate your employees and their families. Promote efforts to create standards for sharing data among health care providers through legislative advocacy. Encourage government, foundations and other organizations to financially support health information technology acquisition and implementation (visit memorialcare.org and go to Government Relations page for details). While President Obama’s economic stimulus plan is an important start, it’s a long road ahead as these technologies move from an option for the few to a necessity for all health care entities.

BARRY ARBUCKLE, Ph.D., is president and CEO of MemorialCare Medical Centers (www.memorialcare.org) and past chair of the California Hospital Association. Reach him at arbuckle@memorialcare.org or (562) 933-9708. MemorialCare Medical Centers include Saddleback Memorial Medical Center in Laguna Hills, Orange Coast Medical Center in Fountain Valley, Anaheim Memorial Medical Center, Long Beach Memorial Medical Center, Miller Children’s Hospital in Long Beach and Saddleback Memorial Medical Center in San Clemente.