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The notion of a fully integrated electronic healthcare record across the entire health system is no longer pie-in-the-sky thinking. In reality, however, few hospitals have attained that level of technology penetration. But for those that have, the benefits are immense.
While there remain numerous obstacles preventing most health systems from the rapid adoption of multiple technologies such as computerized physician order entry (CPOE), bedside bar-coding, and the electronic medical administration record (e-MAR), more and more facilities are finding it easier to cost-justify the investment.
One health system that is reaping the benefits of a fully electronic health record is Citizens Memorial Healthcare in Bolivar, Mo. In December 2006 Citizens Memorial completed the final phase of its electronic integration initiative when it rolled out a bedside medication verification and bar-code technology component. The health system has had CPOE in place since 2003.
According to O'Bryan, the road leading to full integration began with an aggressive multidisciplinary campaign that engaged physicians early on in the process. "We set up the tools the physicians need to be able to do this," she noted. There is a resource room in the hospital where physicians can enter their orders electronically after they visit with patients. With CPOE, a physician's orders can be viewed by the lab and by radiology, as well as pharmacy. "Because of that we can see our patients at a clinic, in long-term care, or in the ER. Wherever patients go in our system, we know everything about them."
Pharmacy's role has been key in the process. O'Bryan has been involved in the entire drug dictionary process, which is designed to get the pharmacy module to communicate with the physician component. "That's critical," she said. "The way I build drugs in the pharmacy module affects what the M.D.s see on their end when they enter orders."
How effective is the new system in terms of helping to free pharmacists to do other tasks? For starters, commented O'Bryan, it allows pharmacists to get more involved in drug information, including making visits to patients' rooms. In addition, the new system has created a more multidisciplinary approach, which includes a greater collaboration among pharmacists, nurses, and physicians. "Pharmacy builds the module, physicians enter the order, and they have to trust the pharmacist to enter the data correctly." Nursing also depends on pharmacy to make sure the medication is identified out on the floor as nurses pass it to the patient.
As well as bringing greater efficiency to the process, a fully integrated electronic healthcare records system has monetary benefits. "We know we have a true documentation system, that medication is charged at the point it is given, and we know patients are being billed correctly because it's being documented at the point of care," O'Bryan said.
While the Citizens Memorial experience represents a case study in how a fully integrated electronic healthcare records system can work in the real world, industry experts note that more hospitals need to recognize not only its immense value but also that it's attainable.