Safe use of electronic medical records (EMRs) is enhanced when physicians focus their EMR implementation on quality of care improvements. Effective communication among the staff about these key goals creates a positive environment that serves as a catalyst for successful use of the EMR. In addition, large healthcare systems and small physician offices are both less likely to encounter patient safety issues when they align their health information technology (IT) strategies to quality of care goals.
Case Study: Several years ago the leadership of an Accountable Care Organization (ACO) formed between a local healthcare system and a multi-specialty physician group began working collaboratively on a common vision for patient safety excellence. System-wide integration and use of medication reconciliation were top priorities. The EMR used by the hospitals have an ambulatory component that meets all of the critical requirements determined by the physician board members. If implemented, the ambulatory and hospital EMRs could be integrated and share the same master patient index, drug formulary, medication index, allergy index and set of clinical decision support rules. However, the physician board, influenced by several leading opinion-makers who favored an alternative EMR, convinced ACO leaders to allow the physicians to purchase their own ambulatory EMR and use system resources to purchase and develop a data repository that could send/receive (bi-directionally) and store data between multiple sources. The vendors involved promised they could provide the infrastructure and tools necessary to capture and manipulate the data. Two years later a patient suffers a severe anaphylactic reaction after receiving an antibiotic injection in one of the physician offices. An investigation reveals that although the EMR had properly displayed the allergy, the antibiotic order had not triggered an allergy alert. Further research reveals multiple ways for an allergy to be entered into their customized, bi-directional medication reconciliation tool that would successfully display the allergy in the ambulatory EMR, but not trigger an alert during the ordering process. Their conclusion is that the use of different EMRs with multiple drug formularies, multiple medication and allergy indices and different clinical decision support rules is more complex than anticipated. They suspended use of the medication reconciliation tool until they could determine whether they could more effectively execute their current strategy.
Key Points: Effective organizational characteristics and a focus on quality of care are important catalysts for safe EMR use.
Cultivating a culture of safety, promoting transparent communications and alignment of strategic planning with prioritized goals to improve quality of care are examples of organizational characteristics that facilitate safe EMR use. In this case the organization did well creating a shared vision with common goals/priorities regarding quality of care. However, organizational alignment fell apart when the unbalanced interests from one part of the organization created the perceived need for an alternative strategy. Although the new strategic plan was plausible, the organization did not have the resources or organizational discipline to effectively execute plans that were considerably more complex. It will be paramount for ACOs to effectively manage such issues in the future. Similarly, even the small, individual physician practice is more likely to be successful with an EMR implementation when they develop a strategy to improve quality of care through the implementation of an EMR.
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