Clinicians Bridging the Paper to Electronic World

HIMSS Clinical Informatics Insights

Over the past five years, health information technology (IT) infrastructure has continued to evolve as electronic health record (EHR) deployment becomes more ubiquitous. Within Baylor Scott and White Northern Division (legacy Baylor Health Care System) in North Texas, we have gone from modest deployment of our EHR system for results reporting and nursing documentation at a few select facilities to all hospitals utilizing a more advanced version of our EHR system for computerized provider order management (CPOM) and clinical documentation. This transition in health IT infrastructure over the past several years has required changes to our governance and creation of new tools for improving care.

Prior to experience with EHRs and our appreciation of the dramatic impact of these systems on workflows, the paradigm was separation of clinical expertise from technical know-how. Quality committees and other groups of clinical experts provided requests built upon paper-based processes. Technologists – wanting to be responsive – would take the largely unformed requests without significant opportunity for interaction. Questions about how to define success and what were acceptable tradeoffs went unanswered. Changes to the system often fell short of expectations – resulting in numerous revisions and inefficient use of limited IT resources. Creation of multiple workgroups, co-lead by a technologist and an informatics expert with relevant clinical experience (i.e. nurses, pharmacists, or physicians), became the key to bridging the divide between clinical aspirations and development of workable solutions within the EHR.

One workgroup that Dr. Brett Stauffer helps to lead focuses on Clinical Decision Support (CDS). With the deployment of CPOM and clinical documentation, capabilities within the EHR can be leveraged to encourage and facilitate guideline compliant care. Take the example of Patient Controlled Analgesia (PCA) orders. Previously, a paper-based order set was used to promote correct dose selection and associated safety measures to prevent over-sedation. Simply moving content from paper to the screen resulted in a clunky, unsafe mechanism in the EHR for placing PCA orders. The CDS workgroup was able to translate the intent of the paper order set into an electronic tool that allows physicians to designate via 2 clicks – a risk class and drug of choice – the necessary information for the computer to provide recommended dosage parameters and associated safety orders. Markers of success for these CDS tools facilitating PCA ordering include adoption at all facilities and associated reduction of over-sedation events. Changes in governance and better tool development continue to improve the benefits derived from the EHR.

About the Contributors
Dr. Brett Stauffer is the Director of Clinical Decision Support, Center for Clinical Innovation, Baylor Scott & White Health and Lynn Finck, MAOM, SCPM, CPM, is the Director of Medical Informatics Administration, Office of the Chief Medical Informatics Officer, Baylor Scott & White Health.