Accelerating Electronic Health Record Adoption

Over the past 3 years, we've recognized that the use of an Electronic Healthcare Record is a prerequisite to quality, effective, ad personalized healthcare. Our Medical Executive Committee changed the Medical Staff Bylaws to require use of our home-built ambulatory care record by all physicians working at BIDMC sites by July 30, 2008.

The justification we used to change the bylaws was:

*Improved documentation - legibility and accuracy
*Support for patient safety initiatives such as medication reconciliation, communicating test results and immunization recording.
*Maintenance of a consolidated, active problem list
*Anytime, anywhere availability to ALL providers including secure access
*Decision support features such as health maintenance reminders
*Supports documentation that contributes to quality patient care
*Templates available for standard documentation by specialty
*Allows for continuity of care with regard to practice/on call coverage and referral communications
*Ability to universally apply documentation improvement techniques
*Moves away from the paper chart, stored in a practice under lock and key, thereby not available for urgent care issues
*Dictation easily imported to notes/letters, etc
*Provides for easier audits vis-a-vis compliance with regulatory statutes
*Forward Communication of patient’s health information to referring MDs
multiple providers can view/access/document in the record simultaneously-Attending/Residents/RNs

We defined "use" of an electronic medical record as 100% compliance with:

*Online Ordering
*Medication Management including e-Prescribing
*Electronic clinical documentation of visit notes
*Problem List management
*Results viewing and sign off

Our change management approach to move clinicians from paper-based workflows included:

*Intense planning and customization with each department
*Group and Individual Training
*Presentations to Faculty by Physician Super Users-interactive presentation/discussion
*On-line Web OMR Tutorial and Self Help modules
*On site support at Go-live for 2 weeks –Amb Services and I.T. staff partnership
*Refresher training as needed
*Web OMR User Group Developed - focus to improve and prioritize updates to electronic record for clinician users

Our governance model for the effort has been the webOMR user's group, which is the multidisciplinary committee comprised of the practices and providers that use the tool. It is the primary vehicle to ensure that webOMR meets the needs of the clinicians and ensure good communication, education & support It's mission is:

*To provide stewardship for setting priorities for development of the Web OMR application
*To communicate relevant information and recommendations for enhancements to the Web OMR Development team
*To improve quality utilization through communication and training for the user community

We also established the webOMR Advisory Group, a multidisciplinary team incorporating Legal and Compliance that was created as the guiding body for decision making and policy development.

We're nearing the finish line on getting 100% compliance for use of electronic health records by physicians at BIDMC sites. The metrics we've developed to monitor our users and departments illustrate the uptake of e-prescribing - nearly 30% of all prescriptions are electronically routed at this point and that number is growing every day.

As I've described in my blog over the past few weeks, our next challenge is the rollout of an EHR for community physicians at non-BIDMC sites. For convenience, the folks at Solaris Health System packaged all my blog entries about EHRs into a single handy PDF. Feel free to use it!