Before your eyes start to glaze over, let me explain.
An EMR (Electronic Medical Record), of any type (Cerner, Eclipsys, Soarian, etc.) is an electronic representation of something we used to call a "medical chart".
Sounds simple, right?
The problem is that computers are unforgiving. There is no wiggle room.
- An electronic diet order requiring three different fields (diet, texture, liquid modification) to submit a diet will ALWAYS require three different fields.
- A paper diet order, even if there are blank spaces to fill in these three fields, can still be submitted with only one field completed - for better or for worse.
So what does this mean? The days of a physician writing "Regular diet" are ending.
So what does THAT mean? That you have to get a physician to understand other texture and liquid modifications, if they want to submit a diet order.
Yes, you read that right : Before, a doctor only had to know what a "regular diet" was. In the electronic world, suddenly, a doctor has to know what a "regular diet, dysphagia I, nectar thickened liquid" diet is.
This is the challenge of every CMIO.
Given the multiple things doctors suddenly need to learn, your doctors start to resent the amount of things they suddenly need to know, that they didn't even think about before. Your choices, to solve this problem, after you go electronic :
- Educate your physicians about the new things they will need to know in the electronic world.
- Create a new clinical policy that supports the speech-therapists and nutritionists to make the texture- and liquid-modification changes on their own, without doctor support.
- Ignore the problem and hope it will go away.
My advice for hospitals going to an EMR, who can't afford a CMIO :
Take a long hard look at solutions #1 and 2 above - Education, and new clinical policies.
This is the hidden cost of EMR adoption that most vendors don't tell you about. But you will be faced with these issues soon after you go EMR.
Education is a problem because, in general, it's hard to educate clinical staff to the level that you need to get docs/nurses/pharmacists nimble enough to feel comfortable with your EMR.
New clinical policies can be a problem because, in general, it's hard to identify what new policies you will need to support the various features of your software. Figuring out which hospital committees are adept enough to figure out the problem, and then champion a policy solution, can also be difficult.
A clinical informatics committee can certainly help address these issues.
A good CMIO can help you establish a solid committee to help address these issues. If you can't afford one, there are good consultants out there who can help you address these issues, but in the meantime, I'll just keep giving away this advice as long as people are reading. :)
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