Sparrow Health System in Lansing, Mich., went live with its electronic health record (EHR) system at its main hospital on Dec. 1, 2012. For a year and a half, the system was untapped, innovation-wise. Very few features were turned on, and it sat relatively idle with regard to quality improvement. Hospitalists and others used the EHR, but not ambitiously. Everyone, essentially, used the post-launch period to catch their breath. Some even decided it would be the perfect time to retire, rather than confront the new reality of the EHR.
“It took a good 6 months, probably longer for some, for people to feel comfortable, to start smiling again and really feel like, ‘This isn’t so bad and actually might be working for us,’ ” said Carol Nwelue, MD, medical director of Sparrow’s adult hospitalist service.
Dr. Carol Nwelue
Then, the gears started moving. Gradually, Dr. Nwelue and Chris Nemets, Sparrow’s chief nursing informatics officer, began to field questions like, “I want to do this with the EHR; why can’t I do that?” The staff wanted more out of the new system, and Sparrow’s use of its EHR, Epic, began to evolve.
Although Sparrow is now probably ahead of the curve when it comes to maximizing its EHR use, its story carries themes that are familiar to hospitalists and to the medical field: The beginning is scary and bumpy; there typically is a long getting-used-to period; and then some hospitalists get ansty and try to get more out of the system, but only gradually – and not without pain.
The bottom line is that most hospitals have a long way to go, said Venkataraman Palabindala, MD, a hospitalist and assistant professor of medicine at the University of Mississippi Medical Center in Jackson.
“We are nowhere close to using the technology to maximum benefit,” said Dr. Palabindala, also a member of the Society of Hospital Medicine’s information technology committee.
How well hospitalists are maximizing their use of EHRs varies from center to center and doctor to doctor. But, for those that are more advanced, Dr. Palabindala and other advocates of better EHR use mention these characteristics that drive the change:
- They have hospitalist leaders with a strong interest in IT who like to tinker and refine – and then share the tricks that work with others at their center.
- They belong to EHR-related committees or work at centers with hospitalists with a big presence in those committees.
- They keep their eyes on what other centers are doing with EHRs and use those projects as models for projects at their own centers.
- They are willing to make changes in their own processes, when feasible, so that they can better dovetail with the EHR.
- They keep their lines of communication open with their EHR vendors.
- They attend user meetings to get questions answered and share information and experiences.
At Sparrow, two committees – one nurse-led and one physician-led – guide EHR enhancement. The committees are a place where, yes, doctors can vent about the EHR (the phrase they use is “pain points”), but also a place where they can get constructive feedback. The committees also keep an eye out for EHR projects elsewhere that they might be able to do themselves.
EHR: a CAUTI example
In 2014, Sparrow doctors and nurses wanted to lower their number of catheter-associated urinary tract infections (CAUTI). With the EHR that had gone live 2 years before, they had the data that they needed. They just had to figure out how to turn the data into a workable plan. Ah, if only things were so simple with EHRs. As any health center that has gone through the great transition from paper to digital can attest, having the data only puts you at the foot of the mountain.
But using a program that Texas Health System had developed as a model, Sparrow got its CAUTI program up and running. The new system included not just a placement order, but the discontinuation order, too. Advisories on best practice were built into the work flow, including alerts on when catheters had been in for 48 hours, and metrics were created to track how well the whole thing worked.
Chris Nemets
Implementation was simple, but the refinement took some time, said Ms. Nemets, the chief nursing informatics supervisor, who helped oversee the project.
“Once the data [were] obtained and validated, it was quickly shown that more needed to be done within this clinical program to impact our CAUTI numbers,” she said. “With collaboration from end users, the system was tweaked more and BPAs (best practice advisories) were added and removed in certain areas and shifted the focus from physician-facing to nursing-facing in most areas.”
It appears to be working: CAUTI incidence at 836-bed Sparrow Hospital has dropped from a total of 52 in 2014 to 11 over the first 3 quarters of 2016.
Sparrow has also built programs to better use its EHR for sepsis, medical reconciliation, and methicillin-resistant Staphylococcus aureus screening, and one is being developed for heart failure.