In this video, Anne Peach, vice president of nursing, Orlando Health and chief operating officer, M.D. Anderson Cancer Center of Orlando, talks with What is Meaningful about using, embracing and customizing EHR technology from the start. Below is the video and a transcript of the interview.
What is Meaningful Editor: What is the key to achieving meaningful use of EHR?
Anne Peach: I think to use technology you have to embrace it right from the start. You have to own it, no matter what the product is and you have to customize it. You have to have your team on board, and the team has to be committed right from the start that they’re not only going to use the technology but they’re going to use it in a meaningful way. They’re going to identify issues that may come up with the technology and work with their partners to solve them.
WIM: How does M.D. Anderson apply its EHR, and what have you accomplished with the solution?
Peach: I’ll tell you – going to an electronic health record has been a very positive experience for us at M.D. Anderson. I remember the days, years ago, when we would have patients who would see different physicians: a medical oncologist, a radiation oncologist and a surgeon. And we would have to seal their chart so they could take it with them to the different appointments. And, then at the end, we had to figure out well where did that chart go? So we’d be sending out pages looking for charts. Now with technology, with the electronic health record, the physicians can pull up the information from visit to visit. The nutritionist can pull the information and the research team. So not only has it been positive in terms of all our patients’ data being there, but providers can look at the chart at the very same time. We work with M.D. Anderson in Houston, Texas – that is actually where our name came from – and we’ve used the electronic record in terms of what we call concordance studies looking at the quality of care that we deliver in Orlando measured against the Houston team and it’s been absolutely terrific. We have continued to move ahead looking at how we can improve the quality of care in the central Florida community and the electronic health record has been a great part of that.
WIM: To what would you attribute your success with EHRs and the relationship with your vendor?
Peach: I think our success has been because it’s been a partnership. First of all, I don’t think there’s a product that you ever take off the shelf and don’t do something to customize it. That’s not just electronic health records, that’s probably most things we do in health care. And it truly has been a partnership, sitting down, looking at what we need to do to make it work for our clinicians. And, so I think the customization of the product, on things that we needed to change has been absolutely ideal. One of the avenues that we went down was nursing documentation, besides CPOE, just documentation as a whole. And being able to have evidence-based charting has been a tremendous help not only for our experienced clinicians but for our new nurses, to be able to click and see the reason for the care, to have prompts there on things that they should document has been tremendous. And, actually last week, I was upstairs on one of our oncology floors with a brand new nurse and she was telling me how comfortable she is actually in charting – that it actually was helpful to her to have the prompts there.
WIM: Can you talk about the clinician buy-in to using EHRs?
Peach: One of the things that we did to look at success in adoption of technology in the electronic health record is that the senior executive team owned it. Actually I was one of the executives assigned to the project of implementation of the electronic health record so it wasn’t just a responsibility of the CIO, it was a responsibility of operations. And we actually talk about it every single week. We have what we call the Medical Staff Leadership breakfast so every week we talk about it. We publish the results of percentage of CPOE. We identify the issues with CPOE. At M.D. Anderson, we actually have a multi-disciplinary team that meets every single month looking at what our progress is, what are the issues and things that we need to deal with. For us, we had a big issue looking at chemotherapy order sets. We have spent quite a bit of time saying how are we going to address that because I believe that the electronic health record is key to patient safety. It’s key not only to making sure that the right care is delivered to the patient, because we all know that handwriting orders and handwriting notes is not the wave of the future. In fact, we could all tell a story of how we used to hold the chart out about three feet seeing if you could identify whose handwriting it is, what they might say. We know that’s not safe. So we know an electronic health record is better. But we also know that there’s work to do. No one likes change. And believe me, healthcare people are right in that group who don’t like change. Even though the current system didn’t work, it was their current system that they used for 20, 30, 40 years. And, so, we’ve had to deal with the change process. We’ve been through storming and we’re in norming right now saying, okay, what do we need to do to move ahead?
In terms of nursing, we established a nursing technology group that is actually a partnership with the informatics team. It is head by a chief nursing officer who I would say is as proficient as any IT person. She owns it. She embraces it. She has had staff nurses involved looking at how the system works, what we need to change, and so we’ve embraced and said we need to be part of the solution to make this work. Are we perfect? Absolutely not. Do we still have people that we’re having to drag along who don’t want to use an electronic record? You bet. But we’re committed that this is the way we’re going and we’ll be successful because of it.
WIM: How important is it to have agility in your systems and in how you operate?
Peach: Well, I think agility in systems is very, very important. I mean the government is looking not only at healthcare reform but it’s looking at transparency. It’s looking at the quality of care and patient safety. I actually sit on the Florida Hospital Association Quality and Safety Committee and one of the things we were discussing are the areas that we do need to measure in the state. We identified four areas that we want to measure. I’m pretty comfortable that Orlando Health can easily participate, because we do have an electronic health record. We can mine data, and I think the key today is to be able to not only provide the care in a safe way but be able to look at the data and find new ways to improve. So agility is absolutely key.
[End of of video transcript]
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