Respondents Share Pros and Cons of EMRs in Survey

Clinical documentation systems prove to be a topic of much interest

May 19, 2014 - An initiative is underway within BJC to evaluate electronic medical record (EMR) systems with the goal of transitioning our hospitals onto a common clinical IT platform and EMR system.  BJC is considering four potential vendors:  Allscripts, Epic, Cerner and Siemens, with a decision expected by the end of 2014.

To help make that decision, an electronic survey was sent out April 2 to supervisors and above across BJC HealthCare asking them to evaluate the electronic medical record system that they use. They were also asked to pass along the survey link to their employees, and it could also be accessed on BJCnet.

Respondents were asked to rate what worked well with their current EMR system, any challenges, and what capabilities an EMR of the future should have.

When the survey closed 11 days later, 2,686 individuals had responded, and of those, 2,512 were actively involved in clinical documentation.

The most responses were from received from physicians (34%), followed by nurses (26%). Other respondents included therapists, social workers, patient service representatives, pharmacists and other caregivers, as well as individuals from information services. Eighteen percent were employed by Washington University School of Medicine.

Respondents were able to choose multiple answers within each question. When asked what is working well with their current EMR system, the top responses were:
  • Is available when needed (40 percent)
  • Has the information needed to provide quality patient care (29 percent) 
  • Supports communication between physician and nurses (29 percent)

Challenges expressed with their current EMR system were:

  1. Current systems don’t “talk” to each other (72 percent)
  2. Requires duplicate entries and redundant steps (51 percent)
  3. Does not allow access to a patient’s comprehensive medical record throughout BJC HealthCare (47 percent)

Over 75 percent of respondents agreed with the following statements:

  • I believe it is important to have a standardized approach to clinical documentation
  • Using evidence-based order sets can improve outcomes for our patients
  • An integrated clinical documentation system will make it easier for me to provide safer patient care
  • Having multiple EMRs reduces patient satisfaction (it appears we do not communicate between hospitals or organizations)

When asked to rank those things most important to them with an EMR, the following statements were most often ranked:

  • Patient’s information is all in one place (23.3 percent)
  • Intuitive -- easy to use (22.8 percent)
  • Speed/responsiveness of the system (22.6 percent)
  • Reduce the number of logins (11.7 percent)
  • Easy to create reports (11.1 percent)
  • Reduce planned downtime for upgrades/maintenance (8.3 percent)

There were also 860 comments left by those who took the survey. Some of the comments were:

“The new EMR should be easy to use and efficient. I want it to eliminate paper use in chart with more comprehensive and user-friendly order sets. The EMR should be a tool that I use in caring for my patient and adjust to my workflow.  I should not have to adjust my workflow around the tool.”

“Be sure that whatever EMR system is chosen it fulfills the needs of all BJC facilities.”

“I think having one EMR for the entire BJC system – HSO, physician practices, home care, etc. is one of the most important steps in allowing standardization, best practices and efficiency across the system. It will help us to work as one integrated health care system.”

“The more intuitive the better! The faster the better!”

Information from the survey and interviews conducted one-on-one with individuals are being analyzed and the input will be used to craft a document of needs and expectations for vendors.
Speaking to an advisory committee of 80 individuals from across BJC and Washington University School of Medicine February 27, Steve Lipstein noted the importance of comprehensive input in the decision making process from a broad base of clinicians. He shared with the advisory committee that this is not an IT solution, but a clinical solution and that participation from across BJC will help ensure a better decision.

EMR Selection Process Being Conducted in Phases 
The first phase, including project planning, committee creation, developing guiding principles and drafting the vendor evaluation framework, began in February and is complete.  

Phase 2, currently underway, involves conducting interviews with peer organizations that are using one of the four candidate EMR systems. This will aid in the preparation of a “Request for Proposal” to be issued in late May.  

Phase 3 in the third quarter of 2014 will involve vendor engagement, site visits, and demonstrations.  

In the final phase, expected to be completed by the end of the year, BJC will finalize vendor selection and begin contract discussions with the chosen EMR vendor.