Doctors must see benefits of electronic patient records, says Matthew Morgan.
Implementing the electronic patient record and integrated care record services is at the top of the NHS modernisation agenda.
The concept of an electronic patient record is the universal or longitudinal integration of all historical patient medical data, such as test results or drug allergies, into a single, secure electronic record available to care providers from hospitals to GP surgeries to community care facilities.
It promises a higher level of operational efficiency in patient care delivery, but the reality of implementing a working electronic patient record is no trivial task and offers abundant challenges. Not least of which is encouraging nurses and doctors to use it on a consistent basis.
Obtaining clinician buy-in must not be an afterthought. Doctors, nurses and other clinicians should be engaged from conceptual design down to implementation and maintenance. They must understand and champion the benefits and recognise and overcome the hurdles.
If clinicians are to embrace electronic patient records, they need to be convinced that the system is relevant to their working environment and offers tangible user benefits in terms of time saving, efficiency and patient care. It must also be ensured it does not result in another administrative headache on top of hectic schedules.
In addition to access to integrated patient data, other benefits include automated testing, prescription ordering, proactive decision support and best-practice reference data.
Electronic patient record systems should be easy to use and navigate, offer sub-second response times (busy doctors will not wait around if a system is slow to download) and be available at the point of care for data access and entry.
The importance of access to patient data is obvious, but it is also vital from the standpoint of data capture. Caregivers are less likely to enter clinical information in a timely fashion if the technology is unavailable at the point of treatment.
Additionally, the importance of computerised clinical order entry (or physician order entry in the US) applications are gaining increasing attention as the touchstone of a working electronic patient record.
As any patient record system is only as good as the quality of its clinical information, this is another good reason for ensuring clinicians are on board with entry procedures.
Another strategic component of successful implementation is having a clinical informatics advocate, often a practicing doctor, who will be dedicated to the project and oversee it from a clinical perspective.
The head of clinical informatics should be able to understand the worlds of IT management and medicine and bridge communication gaps to ensure the proposed systems are clinically relevant.
Doctors by nature are not averse to change, but will be unwilling to come on board until the advantages, in terms of better patient care, are demonstrated.
One of the ways the University Health Network achieved high levels of clinician support from the start of its patient record project was to build in facilities such as decision alerts to allow physicians to quickly see how electronic patient records allow them to reduce medical errors, improve patient care and save a great deal of time.
What do you think?
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Matthew Morgan is a practicing physician and director of healthcare informatics at Per-Se Technologies
This was first published in June 2003