This post was authored by Thad Waites, MD, FACC, past chair of the Board of Governors.
The ACC is launching a vigorous digital transition. In fact, the world is launching this transition. The House of Medicine and the health system in general has been said to be late going digital. But now with the Centers for Medicare and Medicaid Services’ (CMS’) Meaningful Use criteria, the federal government's encouragement, and the broad global rollout of new clinical technologies, we can’t afford not to move forward. Unfortunately, even the computer world is learning how difficult it is for Medicine to go digital.
In the microcosm of my clinic in Hattiesburg, MS, we have transitioned to a new electronic medical record (EMR) system, and there are certainly some lessons learned. My clinic consists of 250 multispecialty doctors with satellite clinics and a close connection to a single hospital system. Before we transitioned, we already had a very acceptable web-based software program that was modular, served our needs fairly well, but was outpatient. We needed to evolve into a larger program and would that also could be seamless with the hospital's system.
The decision to buy a new EMR from one of the major software vendors was not an easy decision. The cost was high, and the work required to transition was immense, it pulled professionals away from their jobs in the clinic. At some point personnel and physicians from every area had to train at the software vendor's campus. Additional costs were also involved, not to mention it was difficult to convince 250 physicians that this was the right thing to do.
The project was painstakingly done. It took two years to fully transition and involved carefully established timelines. It was important to have a physician champion as the leader of the project and it also helped that this physician was on the clinic governance board.
The clinic transitioned on a single launch date. Expecting the unexpected certainly applied to the first several days after the launch. Our servers malfunctioned, users were being shut down throughout the day for several days, and doctors, who had already reduced their workload for the transition, were greatly affected. Needless to say, there was a great deal of consternation. Fortunately the problem proved to be software glitches and not hardware problems. Since we had major brand servers and one of the leading software vendors, it was a surprise that these glitches had not been encountered before in other launches. Once the initial problems worked out, it has been relatively smooth sailing ever since. However, since doctors were seeing fewer patients, the entire system experienced a decrease in the bottom line during that time.
There were several lessons to be learned in our launch. Transitioning from regular dictation to voice recognition dictation or template notes has been a vital but difficult part of the transition. In addition, going from check-off order sheets to a computerized physician order entry (CPOE) has been critical but difficult as having to find the right name for a procedure, the associated diagnoses, and even where to sign the order takes time. Whether it is better to launch in one fell swoop rather than unit by unit is definitely open to debate. It is important that all issues post launch are handled by a helpdesk that is specific to EMR issues and that has adequate personnel to handle the load. It has also been vitally important for the end users to help each other.
We are now approximately 9 months into the transition and from what I hear our production is within 5 percent of what it was prior to the launch. This may or may not be a permanent decrease in production, but based on conversation with other health systems, this may just be a permanent effect of “going digital.” As for the hospital, we are now gearing up for the transition to the same EMR software.
There is no doubt that if we could transport ourselves into the future, all of American medicine will be digital. This will be beneficial to patients, the system, and even the providers. It is the going over, however, that can be quite bumpy. I therefore will end with a quote from William Shakespeare: "I am in blood steeped in so far that should I go no more, returning were as tedious as the going o’er."