EHR Lessons Learned: Week 3

Posted by: Navy Capt. Michael Weiner | DHIMS Deputy Program Manager and Chief Medical Officer

Thursday, April 15, 2010

In the last couple of weeks, I have been sharing some insight into electronic health records and some of the lessons learned as a military doctor within the Military Health System. To recap, I’ve examined the work flow and the importance of testing out a system prior to deploying; this week I want to focus on choosing a technology. The lesson is: newer isn’t always better.

Hardware matters

Any piece of software that is selected for your EHR must have hardware that can run it; whether it is a desktop, laptop, tablet or slate, the hardware has to be there. When choosing your EHR, not only should you test out the software for how it fits the work flow, but also how it works on different hardware and what type of hardware is the best fit. Anyone who is expected to use the software solution should be comfortable with ergonomics of the hardware it will be running on.

Consider these examples of how hardware needs differ: Nurses may want a computer on a cart to be able to move from office to office while physicians may want a wireless tablet to best emulate the way they have historically documented on a paper chart. Administrators may prefer a desktop with an ergonomic keyboard to best support their daily activities. The newest piece of hardware sold off the shelf may not always be the best solution.

Choosing hardware that best fits the work flow needs is much more important than always choosing the smallest, fastest or most portable option. After all, a powerful, large desktop would be difficult for a physician to carry from patient room to patient room, while a touch screen tablet wouldn’t be that convenient for an administrator at a static desk. Hardware selection remains a key component of a successful EHR deployment. Again, this is one of those lessons you learn after you have tried basing your system on the data rather than the work flow. Did I mention work flow again? Yes, I did because when you get right down to it, the main lesson here is that not only does the software have to meet your daily work flow for smooth and semi-painless adoption, but so does the hardware.

That is enough about hardware fitting work flow for now. Next week my topic is acquiring EHRs that are intuitive to the users.

Category:

Tags technology OCIO EHR electronic health record

2 Comments »

Nicole said:
4/22/2010 4:18:52 PM: You bring up a very important topic, and one that is often overlooked when physicians rush into purchasing an EHR before completing a thorough readiness assessment. Assessing the technology needed to run a specific EHR is an integral component of this preparation phase, and I agree that this assessment will reveal very different results depending on the role of the person that will be using the hardware- physicians, nurses, administrators, etc. I found an excellent resource for readiness assessment. There are educational videos on readiness assessment available here: http://www.ehrtv.com/category/educational/
Mark Porter said:
4/21/2010 4:44:39 PM: Great capture of how important hardware is. I would like to tell you a true story from a recent go live for the Navy, relating to your very point about workflow and hardware. It was day one of the go live, late afternoon, when the support staff got the call to respond to a problem in pharmacy. As I and another local trainer showed up the entire pharmacy staff are in great need of some training the hospital had surprised them with a week early go live and they were lost. There super user was off that day, and wards were screaming at them to except Essentris orders, but they had very little training to go on. So I huddled them all around a ragged old PC with a resolution of about 800x 600 and started the normal pharmacy training showing how only pharmacists could verify orders and there pharmacy tracking board. In the huddle was also the head pharmacist as well and in unison, the group asks well what the pharmacy tech does in Essentris. Well from all my Army MTF experience, the tech never had a role. But them something really amazing happened Instead of the normal clamp down of well then we can’t use Essentris something amazing happened. The head pharmacist said well can we modify this or request a software change. At that moment I realized that there work process had not really been tried and perfected. So right then and there with the group we started exploring their work process. Come to find out as we compared there paper process with how Essentris could work for them. A simple extra column in the order entry screen was requested and a change to the pharmacy stat board worked. Letting pharmacy tech place the orders in CHCS for later pharmacist verification with a traceable who did what. The one glitch to all of this was a central screen that everyone could look at so that the 4 or 5 pharmacy techs in the large room could all see at once to get the latest update. Hence a request for a large screen TV that would display the status board for the techs. Not sure if they ever got there large screen but it was an honor to watch this lead pharmacist role with change develop a work around that captured his techs in the workload. This kind of workload capture at the tech level is very likely to be a best practice at the DOD level no other pharmacies that I know of Army wide or in the DOD include there techs in workload roles like this Navy pharmacy did. Most pharmacy put all the order entry on pharmacist shoulders alone while there techs go underutilized. I have been at 90 % of all Army go lives from Lahnstol to FT Knox this is one example where a large screen monitor was defiantly a combat multiplier. A great example of how the right hardware can change pore performance into state of the art quality and faster service to the patient needs.

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