Implementing electronic health records

EHM’s Peter Krasniqi talks to William Phillips, CIO of University Health System, in San Antonio, Texas, about the challenge of implementing electronic health records and measuring ROI on healthcare IT.

EHM. You have recently implemented electronic health records at University Health System, University Hospital. How did the implementation go, and what were your biggest challenges?
WP. We have completed implementation of an EMR/CPOE system in ambulatory and acute care. The implementation consisted of one hospital and seven community clinics. We are currently expanding to other areas outside of our original project scope to include correctional health facilities. We are processing over 400,000 electronic orders per month and more than 865,000 electronic patient documents per month. By implementing acute care and ambulatory we maintained the continuum of care between these settings.

Physician acceptance and workflow change were the two biggest issues we faced. The number one complaint we heard was that you’re changing the way we practice medicine, you’re changing and turning physicians into a more clerical role. We were implementing a computerized physician order entry system, therefore the physicians would be required to enter their own orders and notes. This was a big hurdle to get over in the ambulatory areas.

Workflow was another issue. You can’t implement an EMR by taking what you have on paper and expect to duplicate it in an electronic environment.A CPOE system will definelty highlight any inefficiencies you have in work flow and processes.You have to change the workflow to make it truly successful.

EHM. IT expenditures are one of the top three in healthcare. It’s very important for patient care and safety reasons, however, many are frustrated with the return on IT investment. What is your opinion on that?
WP. There are some things in IT that you just can’t measure ROI on; there are hard dollars and soft dollars. Hard dollars are items that you can clearly measure and show financial gain. Soft dollars deal with patient safety, reduced medical errors and improved outcomes. These items can be measured, but are truly difficult to put a clear dollar amount on.

A good example of this is what we do now in our emergency center for chest pain. Prior to our EMR, if you presented in our emergency center with chest pains, you would receive an EKG and a blood draw to check your Troponin level. You would wait for an individual to review your labs to see if you had a heart attack. With a heart attack, time is muscle and the longer it takes to find out you had a heart attack, the more muscle damage occurs in your heart.

Today if you come into our ED and present with chest pains, you will receive the same tests but now what takes place is as soon as Pathology processes your lab; and if your Troponin levels are elevated, the system automatically pages the PCC in the Emergency Center. This results in a faster diagnosis, enabling physicians to administer treatment sooner.

So when you talk about ROI, what’s the value of those lives in the amount of patients we save? There’s a lot of soft ROI in healthcare, and it’s really hard to put a value on a patient’s life.

EHM. What do you think will happen to the US healthcare system with regard to technology in the future?
WP. I’m very optimistic. Healthcare entities are starting to drive technology direction with vendors. Patient safety is and will remain the long-term goal of healthcare.Both patients and providers expect that data will be readily shared across settings and be available at the point of care.

Homehealthcare will continue to increase, so that patients with mobile issues won’t have to leave their home for healthcare. Patients will take control of their own healthcare. They willelectronically transfer information like blood glucose levels, weight, blood pressure, and cardiac information to their physician’s office.

William Phillips is VP and CIO for University Health System in San Antonio, Texas. His responsibilities include direction and oversight for the organization’s IT division, including system operations, applications, strategy, planning and integration for University Hospital and its community clinics.