Ralph Lawson

“Information technology and business are becoming inextricably interwoven. I don’t think anybody can talk meaningfully about one without talking about the other.” 

—Bill Gates


Nurses and physicians engaging in a tug-of-war over a patient’s chart—a common scene in hospitals throughout the country that have not yet adopted electronic health records (EHRs). This scene is depicted in a photo featured in a presentation by Baptist Health South Florida CIO Mimi Taylor, where she addresses the reality of just such a conflict.

Before the advent of clinical information systems, the paper chart was the centerpiece of patient care in hospital nursing units. That bulky three-ring binder, complete with notebook dividers and replete with (often illegible) handwritten notes, was the only record of a patient’s care. Charts were filed in specially designated bins in the nursing stations, and signs were posted admonishing clinicians not to take them off the unit. After patients were discharged, though, many charts languished in limbo, labeled as incomplete until physicians finished their documentation (days or even weeks later) and then consigned to deep storage, their potentially valuable information lost to follow-up.

During the years when paper charts reigned supreme in hospitals, we knew that automation would improve things, but we did not truly appreciate the potential of the EHR. We did not realize that the ability to capture clinical information electronically and share it across care settings and over time would usher in a new era of health care. And we did not realize that the fundamental challenges associated with clinical record-keeping would carry over into this new era, albeit in different forms.

We now know that IT systems may prevent paper-chart errors, such as mistakes stemming from illegible handwriting, but they also have the potential to introduce new ones. We recognize that over-reliance on the accuracy of EHRs can lead to grievous errors if a patient record contains wrong information. Furthermore, although privacy and security risks have changed since the era of three-ring binders, we are now concerned about hackers, identity theft, unauthorized access, and corruption or alteration of patient data.

Although these and other challenges continue, there is broad consensus that health IT will be the solution that helps clinicians manage care more safely and effectively. Getting IT right drives value. Without IT, the transformation from volume to value is impossible.

So let’s have an honest discussion of experiences with actual IT systems and the problems caused by those that are poorly designed. Let’s demonstrate our willingness to change and to accept what the EHR and our business intelligence tools reveal. The success of the implementation of meaningful EHRs will ultimately depend on our organizations’ ability to take action on the information our IT systems provide. Now that clinical information is no longer moldering in paper charts left to gather dust in basement storage rooms, it is up to us to make the best use of it. A solid working relationship between finance and IT leadership is a good place to start. Leadership Matters!

Publication Date: Friday, February 01, 2013

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