When I was junior resident, the Naval Hospital in San Diego (NHSD) began implementing its electronic medical record. I had just returned from a couple of years with a Marine infantry battalion, so using computerized medical records was like going to Mars. The Navy mandated the EMR against the wishes of many attending physicians at NHSD. We residents, fresh from the fleet, just saluted and got on with the work.
In my current role, it’s hard not to be a little jealous of the admiral’s power. Surprisingly, the system had several immediately apparent strengths. For example, EMR flow sheets for critically ill patients were far superior to the paper flow sheets. So, the EMR was accepted quickly.
For Bridgeport Hospital, things are not that simple. Our medical staff is large and complex, most members have privileges at multiple hospitals, and membership is voluntary. Changes over the past decade in how medicine is practiced mean that for some physicians, the “Refer and Follow” category is clearly the best choice. If that is the right choice for you, I encourage you to move into that category.
For those who continue to come to the hospital, there is good news. We have been using an EMR for years. The coming change is mostly a change in vendor and how the medical staff writes progress notes – which will be electronic. We’ll have challenges, but it is absolutely certain implementation will be successful, unlike the NHSD in 1990 when there was doubt.
One important difference is that while the rest of the community (nursing, pharmacy, etc.) has moved to a fully electronic record, regrettably physicians are bringing up the rear. For instance, even visiting nurses enter notes electronically. So, it’s time for physicians and advanced practice providers to recognize that EMRs are the future, which is now, and it is time to assume a leadership role.
I acknowledge that transitioning to the Epic EMR may affect efficiency for awhile. The challenge is to adapt, make the system efficient and use the EMR in novel ways that allow us to improve. Those who accept the challenge and find answers will be leading the way.
Like the NHSD staff almost 25 years ago, we will make the switch and be better for it. I hope you’ll come along.
Michael Ivy, MD
Chief Medical Officer