Improving tribal healthcare through a secure, interoperable EHR
Moving to a modernized electronic health records (EHR) system carries with it the promise of significant improvements in the quality and efficiency of patient care. But as two Leidos leaders experienced in implementing EHRs explained in a recent webinar, how the system is planned and set up can make a big difference in an EHR project’s success.
The webinar, presented on the TribalHub website, was aimed at informing tribal healthcare stakeholders and others about the benefits and challenges of EHRs. Those benefits are considerable, emphasized Patty Peterson, Leidos Chief Nursing Officer.
“An EHR provides a more complete picture of the patient’s status,” Peterson explained, “as all the patient information and previous results are readily available. This also makes it easier for clinicians to do their jobs."
Including connectivity to remote devices such as mobile phones and bedside clinical monitors can transform EHRs into more powerful tools, added Leidos Senior Program Manager Craig Schaefer.
“Alerts can be set up in the EHR to alert staff of critical data and changes in patient status so that clinicians can immediately provide the needed care,” he said.
Schaefer pointed out that an EHR also enables looking at historical and trend data for a patient so that the clinician can adjust the treatment plan as appropriate. Barcode readers can be incorporated as well, he said, so that the system can track the location of equipment and supplies, match the usage of specific items to different patients, and even automatically set up reordering when an item is running low. A patient care benefit of barcode readers is a decrease in medication errors, he explained, as the bar code scanning supports the "five rights": right patient, right medication, right dose, right time, and right route.
Peterson noted that one of the biggest advantages of an EHR is the ability to better manage population health.
“By compiling the EHR data across a population, managers can determine what practice changes could lead to better care,” she said. “And you can develop programs to address the specific needs of different communities and groups of patients.”
Getting it right early on
Ensuring a successful EHR deployment largely revolves around the early planning work, Schaefer emphasized. One key question is which data to include in the initial iterations of the EHR.
“While all patient data needs to become accessible in the patient records, it's important to determine upfront what previous patient information to upload for go-live so that you don't overload providers," he said.
He notes that at go-live new EHRs often focus on "PAMPI" data: problems, allergies, medications, procedures, and immunizations. It is also important that the data is “clean before importing it,” he emphasized.
During the design of the new electronic record, it is critical to pull in the right data, along with other decisions about how the system will work, added Peterson. That requires bringing the right people into the planning and development process early on.
“You need to understand what’s important not only to your clinicians, but also to your patient populations,” she said. “That means that in the design of the workflows and content you want to capture cultural nuances and other information about the care delivered and resources available in the community.”
Schaefer also emphasized the importance of building in the tightest possible security into the EHR by limiting all users’ access to the types of information they are authorized to see, as well as to the records of the specific groups of patients they’re supposed to work with.
“It’s essential for patients to have confidence that their data is protected,” he said.
He also noted that it’s important to make sure the EHR can work with outside “health information exchanges” that serve to interconnect different providers’ EHRs. That interoperability enables making patient data available to authorized clinicians outside the organization. It also allows clinicians to bring the results from tests and clinic visits performed outside their primary location back to their primary clinic so their primary provider don’t have to repeat tests as they have all the clinical information to further provide care.
One way to help make sure that clinicians end up with a system that works well for them, Schaefer explained, is to bring a group of clinicians into the development process early on as “superusers.”
"Superusers are the site's change agents," he said. "They are trained early and have early insight into the configuration of the system. The intent is to have them help the rest of the site's users become more comfortable with using a new system."
Collaboration is key
Above all, the planning and development processes should involve a close collaboration between IT and the clinician community, said Peterson.
“The most successful implementations are the ones where things aren’t run as if they’re IT projects,” she explained. “They should be run as joint clinician-IT projects, with clinicians involved in every stage from the very beginning.”
In the end, noted Schaefer, a successful EHR deployment will be as important to patients as it is to clinicians.
“With an EHR, patients will be able to participate more fully in their care through patient portals and other tools,” he said. “It’s really about the patients, and a good EHR will help deliver an improvement in patient satisfaction and outcomes.”