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For the Froedtert & Medical College of Wisconsin
CIO, implementing electronic medical records and other systems is simply one way, albeit a powerful one, to develop teaching, research and clinical care.
"Research is our mission, and technology can help us facilitate that," he said.
Fulfilling that mission requires balancing time, money and effort in different parts of the organization. With electronic medical records, ambulatory and clinical setting take priority at Froedtert & Medical College, because patients on the move can leave long, complicated paper trails in short periods of time.
"We're trying to solve the problem of paper medical records being scattered all over different clinics," Dykehouse said. "Literally, we'll have patients who go to three or four clinics in a day."
FMC is a research environment in a medical college that comprises 40 or 50 clinics. Sometimes the staff at one clinic must create a "shadow chart" for a patient since their paper records could be anywhere in physical space, except where most needed. These disjointed records cause delays system-wide with no manual way to correct them.
Electronic medical records are the only way to streamline patient information, Dykehouse said. And once electronic medical records run smoothly for outpatient care, he expects the records will change for inpatients as well.
Some major money sinks that electronic medical records address are supplies, bills and transcripts and the exorbitant costs in tracking them all with paper. These processes place a burden on facilities that have long employed people to pass what amount to gigantic streams of notes.
Whenever a patient gets a shot, a pill or a new bandage, someone documents it. Staff may inadvertently sideline this documentation process, over the course of a hectic day, to care directly for the patient. Digital information allows for constant documentation because it fits tightly into routines. It provides easy checkpoints for staff to, say, place item stickers on patient charts, which are later scanned to record use.
"Systems can capture more completely what's happening with the patient. For example, where a person wasn't charged for all flu shots
the electronic medical records would make this more accurate and timely," Dykehouse said.
Billing gets easier too. In the paper world, charts sat stacked on the practitioner's desk after a patient visit, Dykehouse said. Electronic records can potentially take processing time down from weeks to days.
Then there's medical transcription. As one of the most clandestine practices relieved by digital records, Dykehouse says it costs some facilities millions of dollars per year. Health care facilities pay this big money because transcripts typed documentation of individual doctor visits involve an elaborate "loop" of events, Dykehouse said.
First, physicians hand-write the chart with a patient's history, physical and doctor information. Then they recite the visit into a recorder before someone types it and returns it to the physician to read, sign and file.
"That whole dictation-transcription loop can be reduced if not eliminated with electronic medical records," Dykehouse said.
In cases of long patient files such as visits by diabetics electronic records save the most money. Patient history is a large part of patient care, and comprehensive transcripts are the most expensive.
Designing a friendly interface
Like all CIOs in the health-care field, Dykehouse meets the challenge of introducing an abrupt change to many of the most experienced practitioners.
"[Digital technology] changes everything about how they documented the care for the patients for 20 to 30 years and it's a lot to say 'okay, drop the paper and pick up the mouse,'" he said.
Nevertheless, Dykehouse must work with the leadership to convince their colleagues. Communication from these experienced staff, he said, helps him to introduce technology facility-wide. At the moment, he said the most resistant staff members have tech experience but are not necessarily ready to mix it with their medical expertise.
To some new practitioners, technology is second nature. In fact many new doctors grew up with IPods and mice, Dykehouse said, and this group expects digital framework before considering a facility.
Overall, Dykehouse works to include staff in decisions about best practice with technology. Pharmacy and nursing staff at Froedtert & Medical College, for example, felt Intellidose was the best way to deliver medications in a timely way, and so he said the technology was selected in a thoughtful manner.
It's easy for organizations today to get carried away in the latest technology. But Dykehouse says focusing on these technological developments does not equal best practice.
"Be careful not to chase after technology for the sake of technology," he said.
Rodney Dykehouse does not chase technology.