There is a story that embodies the spirit of Emory Healthcare's Electronic Medical Record (fondly referred to as EeMR). That is the story of a boy on the beach, seen throwing beached starfish back into the ocean, one at a time. When challenged on the futility of his efforts and ridiculed that he would not make a difference, he defiantly returned a starfish to the surf and stated, “I made a difference for that one.” EeMR has been like that for us—we are making a difference for patients, one at a time.
When our EeMR implementation started in 2001, a foundation was there to build on. We started our electronic medical record by working as a development partner with a healthcare vendor in 1991 to build a “clinical data repository.” By 2001, we had about a fifth of the total paper record in an electronic format (primarily results). But providers did not like moving between the computer and paper, at first because it was inconvenient, but later because it just wasn't enough. We were starting to throw back our “starfish” and found that the use of the EeMR could make a difference for patient-care delivery.
We moved beyond a “paperless” vision of converting records to save money on storage. We moved beyond it's “nice to have” results on the computer. The first time, the paper record was in someone's office and could not be easily located, but the electronic results of the most recent labs and radiology results were readily available for the doctor visit—we made a difference in that patient's life. And we have been throwing back starfish ever since.
More than 34 distinct projects and phases (and an EeMR core staff of about 25) with an approximate $30 million capital investment to date, our implementations continue to be about throwing back starfish—quickly, efficiently and without doing damage. We started to recognize that each starfish is a bit different—some break when we try to pick them up, and sometimes they are hurt if we throw them back too hard or too far. But each phase of our implementation has enabled us to have more people throwing and new tools to help provide the directions on how best to throw back each particular starfish. We have added mobile devices, alerts to manage medications, big boards for display, allergy lists, problem lists and so on.
We made a difference for that unresponsive nursing home patient who came into the ED with acute respiratory failure to look at what tests or notes might provide insight as to why they were unresponsive. We've made a difference for the patient who knows they take a lot of meds, but can't remember what they are called. We've made a difference for that new cardiology patient, whose primary-care physician sent him for a “test” but does not know what test or what is really wrong with his “bad heart.”
As we continue to add more people (we have more than 7,000 EeMR users today) and better tools to help throw back starfish, we are embarking on some additional philosophies about what we've learned about throwing back starfish.
We want to better leverage our data, our research capabilities and our experience to fine-tune our processes, and maybe even keep the starfish from landing on the beach in the first place. We want to share these new tools as quickly as we can. We want these tools to be modified quickly, based on what happens to the starfish after we throw them back.
We want to move to beaches outside the one we know best, and have started helping with beached starfish in other locations—across the city, in South Georgia, on the other side of the country. We are developing and planning to participate in standards defined health information exchanges, personal health records data and communication exchanges and additional registries and surveillance programs.
During the next phases of our implementation, we hope to be supported in part by funding received from the stimulus Medicare and Medicaid incentive programs. We have updated our project list to include an indicator if a particular project will help in meeting meaningful-use criteria, but we can't assume this money is a given. We have put a lot of effort to get us where we are and will continue to do what we know are the right things to do next. When we are successful in meeting meaningful use, it will be like the payment from a class-action suit. At the end of the day, we do it because it's right, and maybe someday we can figure out why the starfish keep coming to the beach. In the meantime, we will keep throwing them back—and making a difference one at a time.
Dedra (Dee) Cantrell, R.N., is chief information officer at Emory Healthcare in Atlanta.
