By Emerson Posadas MD MBA PGY-2
This is the first of a series of blog posts about administrative and management aspects of the Emergency Department. The first blog in this series describes the transition from one electronic medical record (EMR) system to a new one in our own Emergency Department and all the challenges we faced.
As part of the American Recovery and Reinvestment Act, all pubic and private healthcare providers were required to adopt electronic medical records in 2014. There have been multiple articles on the transition from paper charting to EMR. However, not much has been discussed regarding the transition from one EMR system to another one. With an ever-increasing amount of electronic platforms available, EMR transitions are a common challenge faced by many hospital systems. At University Medical Center of Southern Nevada (UMC) we recently transitioned from McKesson software to EPIC software as our primary EMR system. With this, there were multiple opportunities to improve our workflow and operations in the emergency department. However, as with all transitions this was not as seamless as envisioned.
This transition period was preceded by months of preparation, as we customized the EMR system to our needs. We attempted to develop efficient pathways in the EMR to improve patient care and bring efficiency benefits. This involved multiple meetings with the EMR representatives, gathering input from all staff including physicians, nurses, and pharmacists. We received several notifications in the preceding months that we were “going live” on December 1st 2017. Staff was informed that there would be multiple EPIC “Superusers” available to us in the emergency department during the first month of transition period. Luckily, I was scheduled to work the night we went live.
I was in the middle of a busy night shift. We had been informed that at 3:00 am our current EMR system would be disabled, and there would be a downtime before the new EMR went live. However, we found that the downtime started to occur much earlier than we expected, and by 1:00 am our original EMR had gone down. Orders were no longer going through the computer system. Radiology reports were not being received. Further, there was no electronic tracking board to display which patients had been placed in a bed, discharged, or admitted. In the already chaotic environment of the Emergency Department, another layer of disarray had been added.
However, what occurred next was actually a marvelous display of problem solving and teamwork that was a testament to the preparedness of our Emergency Department. We dusted off old containers that held old paper order forms. The clerks got in contact with the radiology reading room to fax over any reads, and the nursing staff constantly printed and brought them to the physicians. The charge nurse created a makeshift tracking board on a white board that was constantly updated. We were going old school, and it was working. I credit the staff and administration for converting what could have been a terrible situation into something that was manageable. Further, I was able to peer into a time before computers and electronics dominated the healthcare environment. It was simple, but it worked. Over the next few hours, our new EMR system slowly started to become “live.”
Over the next few weeks, there were growing pains with incorporating the new system to our workflow, but I believe the transition has been a good thing. It has been an opportunity to address core issues in the emergency department to increase efficiency, processes, and ultimately deliver the best possible patient care.
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