Ehr at Aurora Sinai Medical Center

Introduction

The majority of this course project's information will stem from Margeret Haferman, health informatics executive, and Christopher Koblosky, registered nurse and staff trainer for the implementation of the EHR at Aurora Sinai Medical Center. Both staff members are familiar with the process and have sensitive involvement with the entire transition which started in August of this year.

Conversion

Question: Why has Aurora Sinai chosen to convert to the EHR/EMR?

Response (Koblosky): Well, with all of the high standardizations out there, Aurora wanted to make sure it kept pace with all other facilities. Our goal here is to continue to provide excellent patient care while committing to growing our organization by introducing technology. It has been a hot topic for the past 5 to 8 years. However, we did not know how to go about this entire thing because there was absolutely no [hands-on] experience anywhere in the staff. What little experienced staff we had was shipped to our corporate office to educate others. After receiving my BSN degree, I took a few classes for transcription, and it helped me to assist Aurora in steering its way to the EHR. (4)

Transition

Question: How has the planning, development, and implementation phase gone since the announcement of conversion was made?

Response: (Haferman): We had a lot of nervous staff members, of course. There are the ones who don't want to think about change, and the ones excited about change. Then, there are ones who are computer challenged, so we had to tackle this from all points of view. It was difficult, but I think we handle it well. We started off with the CPOE (computerized physician order entry) first to ease our physicians and nurses who have authorization to dispense prescriptions into the phasing. We do try our best to trouble-shoot along the way. (3)

Internal & External Parties

Question: Were there any user acceptance issues from Aurora staff, including external parties? If so, how did this get addressed?

Response (Haferman): Absolutely! Many older generation physicians who have been in the practice for years were the first to complain! Go figure, huh? Our younger physicians and residents are much easier to accept the process. I suppose it's because they are from the technology age. (3)

Response (Koblosky): Yes, I'd agree. The separation of generations definitely plays a factor into all of this. We have to be mindful that not everyone is tech-savvy and mindful that not everyone knows the importance between paper and electronic, primary data and secondary data so on and so forth. Patients are somewhat involved, but we know how convenient the WIR (Wisconsin Immunization Registry) is. Highlighting that is our goal to push forward with patient acceptance. (4)

Training

Question: What steps were taken to ensure staff comprehension of the EHR/EMR?

Response (Koblosky): We had to get an understanding of where everyone who would be directly working with the EHR, besides physicians, stood mentally. We didn't want to confuse or discourage the staff, so we started slowly. (4)

Question: Please elaborate on training?

Response (Haferman): As mentioned earlier, we have to be mindful that our staff comes from different backgrounds. We used a technique in June called "gap testing" where we had our staff complete a general questionnaire about EHRs so that we could grasp an understanding about where they were knowledgeably. From there, we came up with general courses, if you will, to begin to educate our staff on the basic, and we do encourage the hands-on approach. For those who needed less education and attention, we gave them "reminder courses", or classes and information that brushed them up on the now. This is done weekly. We'll hold these monthly starting in mid-December, three months after the first introduction on September 22nd. (3)

System Engineering

Question: When and how was the system developed? Please elaborate on CPOE, SmartChart, and Cerner/EPIC?

Answer (Koblosky): We have a team of Information Systems Specialists who were hired to determine what is best for our organization. CPOE was the obvious first choice at the time. Physician instruction is communicated over an interoperable network to the internal medical staff or to the hospital departments. It's kind of like an instant messaging thing. SmartChart started with implementation of computers in patient rooms which was about 80% complete going into the summer months. The bar code administration helps our nurses to scan wristbands for accuracy of identity and medication. Pharmacists can eliminate medication errors, as well, that occur with written or verbal orders. Other systems engineering is still into play and discussion at this time which does include systems like Cerner, Meditech, Epic, and McKesson. As our staff grows, we will begin to introduce new systems. Right now, we do place posters around so help patients and many staff members understand the conversion. Learning more than two or three can become a strain for those who are less tech-savvy than others. Some staff has taken initiative to learn about other programs while submitting suggestions to our IT team. (2,4)

Applications

Question: What applications are used (please include key functions and features)?

Response (Haferman): Let's see. Well. The key functions of the EHR are revolved around HL7 (health level 7) which is currently attempting to define the minimum functions an EHR should perform to help physicians practice better medicine and improve the bottom line. Some of these functions include, but are not limited to:

* Identify and maintain a patient record

* Manage patient demographics

* Manage problem lists

* Manage medication lists

* Manage patient history

* Manage