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Where IT and clinical practice intersect EHRs hold a great deal of promise for healthcare organizations that want to achieve better quality and clinical care outcomes. These objectives will only be com- pletely realized when the technology and healthcare industries are able to fully integrate. Electronic health records need to be designed and aligned with a clinician’s


Dr. Geeta Nayyar is principal medical offi cer, Vangent. For more information on Vangent solutions: www.rsleads.com/001ht-204


workfl ow and viewpoint in order to be wholly effective and move an organization forward.


Current EHR systems are sometimes built with lim- ited clinical inputs, resulting in systems built with an em- phasis on documentation and billing when clinicians need more decision-making and logical documentation tools. Clinicians would prefer to harness these technologies in ways that would allow them to better achieve clinical care outcomes than to simply use these technologies for billing and medical documentation purposes. I’ve seen this disconnect between IT and clinical practice cause signifi cant disruptions in my own experi- ence as a physician. Without the marriage between IT and clinical practice, new technology initiatives can inadvertently hamper clinical care instead of enhanc- ing it. For example, the ambulatory care clinic where I practice medicine recently made electronic lab order entry mandatory. To order a lab electronically through our EHR, a provider must link the labs requested to a diagnosis on the chart. This linkage forces providers to keep an updated problem list in the patient chart in order to satisfy meaningful-use criteria. The problem with this function is that as a physician, I often order labs to help me make a diagnosis. The EHR function instead demands


Committees can champion tailored systems


To better engage with clinical staff, organizations should be knowledgeable about the latest health regulations and should be able to educate employees about how those could affect both business and clinical practice. One way to involve physicians is to encourage them to serve on an internal HIT committee. Many hospital systems are fi nding it important to have clinical committees comprised of provider champions to test out EHRs or give feedback on existing systems that can be improved from a clinical vantage point. These groups serve as a bridge between the organization’s IT and clinical staff. Increasingly, this need exists within hospital systems, and hospitals are hiring full-time chief medical informatics offi cers (CMIOs) to play this clinical translational role.


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that I make a diagnosis prior to having lab results. Forc- ing diagnosis before lab results encourages providers to document a hypothetical diagnosis that will support the command to order lab tests. This can be harmful to the patient, because a vague, unsubstantiated diagnosis listed in the chart will be viewed by other providers, thus infl uencing their clinical decision making around a patient’s symptoms. Additionally, providers have to wait for lab results to return and then actively update a diagnosis from the patient’s problem list in the chart. From a clinical perspective, this is a lot of imposed work and extra steps required just to order lab tests. More importantly, these imposed steps could actually lead to medical errors instead of preventing them.


Without the marriage between IT and clinical practice, new technology initiatives can inadvertently hamper clinical care instead of enhancing it.


As this example demonstrates, if EHRs are not ad- opted with an insider’s perspective in mind, workfl ows can experience serious issues. Unlike its original intent, this seemingly simple criterion for meaningful use is surprisingly complex for both clinicians and patients. The regulations set forth in the HITECH Act should not be adopted in isolation, but rather customized and tailored to organizations and their practitioners. It is through this understanding that disruptions in clinical workfl ow will be avoided and patients can be seen in a timely, effi cient and “meaningful” way. Hospitals must have a strong understanding of their clinicians and how they provide patient care in order to truly achieve meaningful use of these technology systems.


As I continue to practice medicine, I remain an advocate for both better patient care and the use of information technology tools, such as EHRs, to advance that mission. Ultimately, this is about healthcare, not technology, and what matters most is improving the lives of the patients and families I treat every day. Now is an exciting time for healthcare technologies, but organiza- tions must take a broader look at their unique situations and seek physician input when selecting a new system. Fully embracing these technologies with the right motiva- tions and advisors will prove incredibly benefi cial to both patients and healthcare organizations if done correctly. Finding the right technology partner that can bridge the gap between technology and healthcare delivery – using clinical know-how and the ability to employ a disciplined lifecycle to adoption – is pivotal to success.


HMT HEALTH MANAGEMENT TECHNOLOGY January 2011 17


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