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    Tuesday, November 22, 2005

    Techno Slow: I missed this, but the BMJ posted a paper a couple of weeks ago that detailed Kaiser Permanente's experience with electronic medical record implementation in its Hawaii branch. The process made doctors and staff "talk stink":

    “It’s the natural culture of Hawaii to be very polite. We don’t beep our horn; we don’t cut our way in line. You never talk stink. That’s a phrase that’s used here, ‘You don’t talk stink.’ You don’t say bad things about other people. If you give constructive feedback—if somebody asks for it—they get a bit of a shock if they actually get it. So culture: big influence here.”—Implementation team member

    “Hawaii’s culture is very non-confrontational, you know, ‘Just be nice, agree’; so the feedback has been relative to that.”—Implementation team member

    ...“What got docs here frustrated was nobody really seemed to listen. And they had to compromise their values and ethics to help the system work. That’s where I saw very amiable, nice, quiet people starting to talk stink behind the scenes.”—Clinician

    The electronic record did not improve productivity, as other studies of other EMR's have shown:

    Seventeen respondents reported that CIS had reduced clinician productivity, primarily because of extra work, such as processing laboratory result reports, entering orders, and navigating through the system. Fourteen clinicians reported that the extra time burdens from using CIS (estimated to be 30-75 minutes a
    day) persisted even after the initial learning period and affected patient care (such as by making it more difficult to fit in “overload patients”). The reasons varied: eight respondents regarded CIS as poorly designed and requiring too many steps to accomplish simple tasks; 12 felt that the system was cumbersome and poorly designed to accommodate the range of clinical needs or patients with multiple problems and requiring multiple templates; and nine reported a lack of clinical capacity to absorb changes during implementation.

    “We don’t have enough [full time equivalents] of physicians. And we get complaints from patients: ‘Why can’t I see my doctor on time?’ That’s very common. Then we’re adding CIS. We don’t have enough time to begin with.”—Clinician

    In response, some doctors worked late or through lunch and reduced their routine contact with colleagues. Although the CIS implementation included temporary provision of extra clinicians to help with the initial additional workload, several respondents doubted whether they would be able to achieve pre-CIS productivity

    “We’d started out in the high 90th percentile in terms of our utilisation, so when we tried to add the constraints of the system, basically it broke.”—Clinician

    They also also calleld the electronic medical record Kaiser chose for them "a turkey." They must have been right, because after all that time, money, and grief, Kaiser dropped it and implemented another.

    Moral of the story: Successful implementation an electronic medical record requires a tremendous amount of cooperation and consultation with the people who are going to be using it. The bigger the group, the harder that's going to be.

    (via Health Care Renewal

    posted by Sydney on 11/22/2005 10:01:00 PM 0 comments


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