EHR Transition Through the Eyes of a Physician Assistant

Our hospital has an excellent emergency health record system with all the bells and whistles, and an ability to go completely paperless. 

I currently serve on hospital medical staff committees that are stakeholders in this process. In fact, we have set an aggressive timeline for all who currently chart on the inpatient record, with March 2012 being the date of conversion to a completely paperless system.

The emergency room is already fully using the electronic charting system with templates for procedures and presenting complaints, and with fully integrated voice recognition. It was a difficult transition, but folks of all technological levels made the leap and are using the system effectively.

As the person in our medical group who definitely does a significant amount of the administrative work associated with admitting, managing, and discharging our burn and reconstructive patients, I have made the leap to the fully electronic charting system early and have been using it for two months. I love it, but worry about the learning curve for our surgeons and others on the medical staff based on my experience.

We need to spend as much time, money, and effort in training physicians and other members of the hospital medical staff, as we do buying the software and computers. The hospital administration can also ease this transition by putting significant resources into making portable devices such as hand held tablets fully function in their systems, and pre-populating user accounts with a broad variety of charting templates for managing medical, surgical, and ISU/SICU patients, to reduce the amount of work that members of the medical staff have to do to make this transition.

When a member of the medical staff has 20 sick hospital patients on which to round each day, we need to ensure that as we transition to fully integrated EHRs, that we make the jobs of our medical staffs easier, and more enjoyable, and not more work and drudgery. It is in everyone’s best interest, especially to the patients that we serve.

For me, in a specialized surgical practice, there is less challenge as we care for the same problems over and over again, doing the same things at the same times during the course of an admission. The system allows the development of infinite “templates,” which are somewhat time consuming to set up and refine, but make charting a progress note a matter of clicking the buttons and adding a few prewritten macros.

I have Citrix Server on my iPhone and iPad, and while the iPhone is not very practical, the iPad is an excellent tool for rounding as I can complete all of my charting using this tablet device. It is reasonable and functional as long as I have a starting template and don’t have to do a lot of typing. Every piece of data a clinician could want is at my fingertips. From labs, x-rays, and reports, to the input of ancillary services at the hospital, I never have to hunt for anything, as I know right where it is in the EHR.

Think about this problem from the standpoint of a hospitalist or intensivist who sees a much broader array of patients, with multiple comorbidities. The difficulty of completely shifting the paradigm of how information is collected, recorded, and retrieved in a hospital environment is underestimated in my opinion. I work with a broad variety of clinicians every day, and I know that this transition will be difficult and resisted, even though they intellectually know that EHRs are safer, better and result in better outcomes for the patients.

Unfortunately, that may not be enough of enough of an incentive for harried and overworked hospital medical staffs, to so dramatically change how they manage their hospital patients.

We need to make physicians’ lives easier, not harder in the sorts of transitions that are inevitable in modern medicine information management.

Stephen H. Hanson, MPA, PA-C, is a 30-year PA currently practicing full time in Bakersfield, Calif. His present clinical position is in plastic and reconstructive surgery with the Grossman Burn Centers. Hanson, a 1981 graduate of the Stanford University Primary Care Associate Program in Palo Alto, Calif., has served in many specialties during the span of his career including public health, obstetrics and gynecology, occupational injury, urgent care and emergency medicine.

This blog was provided in partnership with the American Academy of Physician Assistants. For more information, visit www.aapa.org.