Transition from paper to electronic inpatient physician notes
Electronic Health Record (EHR) is usually very challenging considering several factors within the implementation. Transition from paper to electronic is also very difficult in the beginning. Resistance from providers, Electronic Medical Records (EMR) limitations and patience in using the system are very common during the process. However the authors have witnessed Teaching Hospitals move from paper to electronic physician inpatient notes.
The purpose of this study is “to describe what we believe to be the single most important step we took leading to physician adoption of electronic notes: our efforts to speed note entry.” . They aimed to provide a baseline and reference for other US Hospitals that are still on paper and planning to transition into electronic notes. They have implemented a unified approach that would help a successful transition.
They started with a transition by piloting Inpatient Medicine Teams at HMC using PowerNote. “PowerNote, a semiencoded note-entry application provided by our vendor (Cerner) in which both narrative text and encoded “clickable” elements are used to create the note.” . Other services were not implemented until hardware and software issues were addressed. Surgical Services were next to start with electronic notes. The implementation into a new service was added every 2 every two weeks until all units in three hospitals were able to adopt. During the process, another note-entry application was provided by the vendor that uses a simple text editor. Most Medicine Services liked this tool and apparently moved to Clinical Note Editor Template. This allowed them to created templates for Progress Notes with the addition of a script that would automatically pull some elements such as current meds, allergy list, vitals, etc. This helped providers create their notes in a better and faster way. They also found the fastest way to write notes which is “to select the patient from a system-generated patient list, and to configure the software to open the Clinical Note Editor default template when the user clicks an icon to start a new note.” they refer this one as the “one-button template.” .
Post a 2-year transition, almost all Inpatient physician notes were electronically entered and about 1500 physician notes entered daily. Minimal challenges remained on time spent in creating the note and easier access/location in the chart. About “16% were entered by attending physicians, 58% by residents, 11% by mid-level practitioners, 7% by medical students, and 8% by fellows and others.” .
I do admire the pilot implementation plan of electronic power notes that they did. Since almost everyone is very resistant to change, it is important that the implementation is done slowly where full support was provided in order to gain better adoption and acceptance of the change. The significant number of electronic notes created post conversion proved that adoption is getting better and better. This happened because of special and talented IT Support Personnel who have done tremendous jobs in customizing templates into an easier, faster and suitable for all providers on their respective units. Most importantly because of the Leadership Team who did a great in the pilot implementation plan and acknowledging certain conditions and limitations.
- Payne, T. H., Fletcher, G. S., & Labuguen, M. C. (2010). Transition from paper to electronic inpatient physician notes. Journal of the American Medical Informatics Association, 17(1), 108-111. Accessed from http://jamia.oxfordjournals.org/content/17/1/108/ 04/01/2015./