New Series: EMR Diaries.

Golive PicIt’s time. After thousands of hours of hard work by the IT department, and lots of fretting by pretty much everyone else, the time has arrived. Our hospital is going live with it’s EMR Stage 2 meaningful use system. And it’s starting during my turn in the hospital rotation. (I want to believe that this is purely coincidental, but if I see my office scheduler walking around with a new pair of shoes, I might have to say something.)

What is Meaningful Use? As part of the nearly $800 billion economic stimulus bill known as ARRA (American Recovery and Reinvestment Act) of 2009, the government sought to  electronify (yes, that’s a work, look it up!) medical records. To accomplish this CMS (Medicare/Medicaid) began giving out incentive payments to physicians and hospitals for electronifying their medical records, which would eventually transition into fines for not complying.

By now you’ve probably looked up “electronify” and found that it’s not really a word. My bad. But in a way, Medicare did the same thing. They realized that “electronic medical record” does not really have a definition, either. So they said “our bad” and came up with a set of parameters that would determine if your medical record could be used in a meaningful way, or whether it was just a note pad with a reading light attached to it.

To help decrease the pain of converting records, and doctors to a modern way of doing things, CMS planned in phase in these changes in progressive stages. In Stage 1 (which is now in place), ones medical record had to demonstrate a minimum amount of functionality to qualify for the incentives. Things like having an “on” button, and sending an electronic prescription, and doing successfully as least some of the time. (For further info on the goals of Meaningful Use, check out this link to

Now that we’ve been on board with Stage 1 for some time, our hospital is now in the process of making of EMR Stage 2 Meaningful Use compatible. One of the requirements of this stage is including physician order entry functionality into the system. Instead of writing orders in the chart, physicians will now enter orders through a computer.  This required a vast overhaul of the previous system with which we worked. Unlike other hospital systems which purchased systems like Epic, our hospital decided to rebuild our own system and try to make it work for Meaningful Use. In preparation for using the new order entry system, all physicians underwent a scheduled 4 hour training session. After the go-live date, IT support staff will be deployed through out the hospital to help support staff, and answer questions.

To the casual onlooker this sounds simple, I know. Doctors will simply put orders into a computer instead of writing them. But make no mistake, this is a huge undertaking, a fundamental shift in how we take care of patients. My mind begins to race as I think of all the things that could wrong.  An errant click, an extra zero, but then I stop.

No. This has to work. It has to. You’ll find out in future posts of EMR Diaries.

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