Lawrence Memorial Hospital, Revolutioninzing the Way They do Healthcare

Patient A is admitted into the ER. As she lays in the taut, paper-lined bed, she watches her assigned nurse punch numbers into a computer screen, not turning around to offer a quick smile or explanation of test results. Hours later, as Patient A is wheeled into an elevator on her way to her new room in the orthopedic wing, she lifts her good arm to notice a barcode on her identification wrist band. The next day, she pretends to understand the medical jargon her doctor is throwing at her and is discharged a day later after surgery. Curious, she has a desire to look at her EKG readings and X-Ray the medical staff took of her now casted arm. Instead of taking the trip back to the hospital and dealing with the administrative staff in the medical records department, she can now sit at her own computer in the comfort of her home and access her medically documented journey through the hospital - so can her nurse, doctor, and radiology techs.

     Gone is the day of charting at the end of shifts, frantic physician phone calls to overworked nurses, and working the maze of accessing the tree-killing closet of medical records. Now, with a simple log in, medical records are now at patients, nurses, and doctors' fingertips.

     EMR, Electronic Medical Records, are revolutionizing the way medicine is practiced, and locally, it has already made a huge impact on how Lawrence Memorial Hospital operates on a daily basis.

"We started this about 10 years ago," said Belinda Rehmer, Communications Coordinator at Lawrence Memorial Hospital. She reported that LMH is no longer in the beginning stages and is currently up and running on an EMR system throughout the hospital and in conjunction with practices that they own including Eudora Family Practice and Mt. Oread Family Practice. "We've been up and running for over a year now - at least a year".

     But it wasn't an easy process. Cost was one of the major roadblocks in jump-starting this process. "Implementing the software is not cost neutral because the physicians would have to buy the software out of their own expenses," said Rehmer.

     Dr. Stephen Myrick, general surgery, at LMH has yet to take advantage of the EMR system 10 years after the idea reached LMH. "I don't use EMR because I don't have the software or no-how to do it. I am, however, in the process of converting over. I'm the research phase and I need to know which way is most cost effective".

     Clinical Informatics Liaison and Nurse Administrator Jessica Wright believes that the end users are most affected by the new EMR system. The end users include physicians, nurses, and patients alike. Wright emphasized her frustration with the common misconception of the EMR. "We have to recognize that this is neither time saving or time neutral".  In the long run, using EMR is fast when pulling up these files, but now, Wright says, the end user has to log on, and sometimes transcribe what a machine reads.

     Down in the medical records department, Director of Health Information Management Nancy Knaggs gave another perspective. "We started the actual process in 2004," Knaggs said. "We are still building hybrid plans right now; we still have paper". At first, the department tried to compromise with unwilling-to-change physicians' requests by fulfilling both paper and electronic records, but after a year in 2005 the department stopped. "They've adapted fairly well and this is a huge change for physicians and some aren't very happy," Knaggs said.

     The main part of the challenge for the medical records department is that some things are still paper while another part of the record is electronic. "I still think we're moving the same amount of records, just less paper in each," Knaggs said.

Knaggs agrees with the step-by-step process it has taken LMH to get everyone on the EMR system. "It's too hard to change everything at once - especially for a community hospital like us. Our step by step process is better in the long run".

"It has also turned the nurses world upside down," Wright said. Rehmer noted that at first the nursing staff was 50% for the EMR conversion, but now it's about 98%. Before, nurses would go about their day, taking notes in their notebooks and charting at the end of the shift. Now, because of EMR, they must now chart in real time. Because of the mobility factor that comes with the EMR, physicians can log on at home and see their patients' updated statuses based on what the nurses are putting into the electronic chart. An EKG taken five minutes ago is now available to a doctor who may be on the opposite end of the hospital or at home and he or she no longer needs track down the paper chart and read the paper slip attached to the record.

     Likewise, reorientation of bedside manner is underway. "We have to teach the nurses not to be so focused on the computer in the patients' rooms. They have to learn how to both transcribe updates into the computer system and stay focused on the patients' needs and trust," Wright said.

     Elsewhere, Family Physician Dr. David Doran at the Heartland Clinic expresses his enthusiasm in going digital. "I never really liked the paper records. It would only be available to one person at a time. EMR has certainly changed our workflow and how we interact with each other in the office and with our patients. More than 75 percent [of our patients] are online and can log into the EMR to view their own records, communicate with us, schedule visits, etc".  Voran went on to explain that he didn't like in the past how only ten percent of his records couldn't be found because of misfiling and accidental shredding. "Those who don't change their workflows aren't seeing some of the same benefits we're seeing," Voran said.

     "I like the switch," Wright said. "Improving our overall charting decreases the likelihood of human error".

     Voran said that patients usually love the implementation of the EMR. "Having the same access to the same system that I do is key. Being able to see their records being created, managed and also to see digital X-rays and communicate electronically with us has been a huge satisfier."

     Wright, who has worked in the ICU as a nurse and has now focused her clinical skills into improving the healthcare system via technology, contemplates on the future. "My goal would to make everything automatic," Wright said. "Not to minimize nurse responsibility, but to eliminate human error. Imagine if the EKG could tell the computer what it was reading. Yes the nurse would have to verify the results, but the step of reading the monitor and entering that data into the computer by hand has now been erased."

     The EMR system and LMH is not perfect, and many of its users are still converting and making it better. But because LMH remains one step ahead of the game in the healthcare industry, they are now offering more efficient healthcare through the implementation of EMR