2005-10-26 00:00:00

Clinical Information Systems - Tell me how you REALLY feel

When the conversation turns to Clinical Information Systems (CIS or EMR) you can almost feel the polarization in the room. Ask two different groups of health care professionals these two key questions and you’ll walk away with the answer - a resounding “maybe”.

  • Does the implementation of a clinical information system decrease the time clinicians spend on documentation of care?
  • Does the implementation of a clinical information system increase the quality of care by allowing clinicians to spend more time with patients instead of paperwork?

It’s not that the profession is wishy-washy on the subject. It’s more like the correct answer depends upon who you ask and what specific experience they’ve had with a particular CIS. One thing is for sure; hardly anyone has “no opinion”. Here’s why:

New Attitudes, Broad Latitudes

The introduction of any new technology into the workplace causes some degree of stress among those who must adapt. It is not unusual to see an overall decline in productivity as new work patterns evolve and as the cultural resistance begins to give way to the “ah ha” factor.

As with any major computerization effort, success is more about managing people and their expectations than it is about hardware and software. In the early stages of adaptation even the best CIS is going to be an order of magnitude more difficult for health care professionals to get their hands around than paper-based notes and charts are. It’s up to the organization’s major stakeholders to see that a transition plan is put in place and that it works.

And therein lies the rub. For organizations who have successfully implemented a CIS program, and who measure that success by the amount of time that health care practitioners have to spend with patients as well as the increase in the quality of care that those patients receive, the answer to the two questions posed earlier are a resounding “Yes”. At least according to Siemens, a CIS vendor who reported the following statistics after a 2003 CIS implementation at the Cincinnati Children’s Medical Center:

  • Generation of complete, unambiguous, legible care orders
  • Reduced clinician and service provider pages and phone calls to clarify orders
  • Eliminated transcription errors in medication orders
  • A 35% reduction in all medication errors
  • An overall 52% improvement in medication turnaround times
  • A 50% improvement in response time for urgent x-ray
  • A 24% reduction in verbal orders for controlled substances
  • 100% compliance with pain assessment documentation requirements defined by state regulatory agencies

For those who would answer our two questions “No”, it is very likely that their organizations failed to take the necessary steps to mitigate these most common points of CIS implementation failure as reported by a Journal of American Medicine special report entitled “Determinants ofSuccess of Inpatient Clinical Information Systems : A Literature Review”

  • System development problems
  • Implementation process problems
  • Failure to address the culture and characteristics of the organization.

It seems that in the end, the health care profession is more or less the same as any other when it comes to computers in the workplace. If you match the system to the user’s requirements, and you properly prepare and train the users, the end result will be an increase in productivity and an increase in the quality of service level commitments.

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