Hospitals Tackle Rocky Road to Paperless Communication
A quick e-mail message offers a quick fix when a birthday card doesn’t make it into the mail on time, but the speed and efficiency of paperless communication in hospitals can save lives. In 2004, President George W. Bush’s called for interoperable electronic health records—personal health records that patients, physicians and other health care providers access via the Internet from any location—to be adopted nationwide within 10 years. The U.S. Department of Health and Human Services (HHS) picked up the challenge, putting information technology at the top of the priority list for the American health care system. This June, HHS created an organization dedicated to this vision, the American Health Information Community.

Also in June, 18 Ohio hospitals gathered in Columbus to begin an ongoing dialogue about technology and look toward the future of electronic health records (EHR) in Ohio. In Ohio and across the country, EHR systems continue gaining positive momentum. The Institute of Medicine stamped its approval on EHRs in 2004, identifying them as a major tool in preventing medical errors. Efficient and accessible information also translates into more time caregivers can spend providing direct care. An Agency for Healthcare Research and Quality study showed computerized information could decrease the time nurses spend on documentation by 52 minutes during an eight-hour shift, increasing the time they spend with patients by nearly an hour.

Agreeing on the ability of these systems to improve patient care, Ohio’s hospitals will work to confront the following barriers to the adoption of EHR systems.

Barrier: Lack of Finances
For the fifth straight year, a national panel of health care CEOs, executives, strategists, marketers and communicators identified lack of finances for information technology as the most significant barrier to successful implementation of technology at their organizations.¹  Costs for EHR systems can exceed $100 million in large hospitals and health systems, and many rural hospitals face the same technology needs as larger facilities with smaller overall budgets.

Barrier: Implementation
The expense of purchasing new technology is just the start—often the administrative challenges and expenses of implementing a new system or way of doing things raise the most difficult hurdles. Staff must be trained, new equipment installed and entire processes overhauled to make the initial switch to a different routine. Hospitals must also consider and work out kinks to ensure the interoperability of new and existing systems.

Barrier: Personnel Shortage
Though much is being done to alleviate the shortage of key hospital personnel, Ohio still faces high vacancy rates among positions such as medical technologists, pharmacists, radiologist technologists, respiratory therapists and registered nurses. Technology investments and staff recruitment must compete for dollars, and running a hospital with fewer than necessary medical professionals drains resources for training and implementation of new systems. However, technology has the potential to ease paperwork burden on staff and create simpler communication among members of the health care team.

Barrier: Culture Change
Change can be good, but the initial transition often can be difficult. When electronic communication made its debut, few people could envision a world where letter-writing, phone communication and paper shuffling would all be condensed into the click of a keyboard button, and many resisted the change. System-wide changes face the challenge of moving to a new process that all those working at the hospital, from direct caregivers to receptionists to volunteers, embrace and understand.

Barrier: No Common Model
Currently no common model for EHRs exists, though efforts continue on both the national and state levels to establish protocols and definitions to facilitate the implementation of this technology.  HHS asked Health Level 7, a not-for-profit organization, to develop a common model or definition of an EHR. Following the initial June meeting on this issue, OHA and Ohio’s hospitals will continue discussions on the future of EHRs in the state.

Tough challenges still stand between Ohio’s hospitals and the statewide implementation of EHR technologies, but several hospitals have overcome these obstacles and others are in the process. With the growing national emphasis and statewide efforts gathering steam, the path to more efficient and patient-focused care may soon be a lot smoother.

¹Futurescan: Healthcare Trends and Implications 2004-2008, American Hospital Association, American College of Healthcare Executives, Solucient and VHA, Inc.

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