Issue link: https://viewer.e-digitaledition.com/i/101200
systems only work with other like systems. ���If there is not sufficient progress [toward vendor-to-vendor exchange] or we continue to see barriers that create data silos ��� we will revisit our meaningful use approach and consider other policies,��� he wrote in August. Policy changes and new regulations might force vendors to become more interoperable, he continued. That day may come soon, but for now, health care IT professionals may feel like they���re back in the days when Word wouldn���t talk to WordPerfect when it comes to transferring information between competing vendors��� EMRs. Quick ���x: Ask your vendors about compatibility, especially with systems you already own, such as pharmacy or emergency room programs. Long-term plan: In March, David Kempson, Vice President and CIO of Maricopa Integrated Health System, predicted that in 10 years, EMR would become a commodity, and a few big vendors would dominate the market, offering system-wide connectivity. If that���s true, and a practice���s current system (paper or electronic) is remotely functional, it may be smart to hedge bets and wait for a dominant EMR player or specification set to emerge. functionality, such as record-keeping, to extra work for the physician. The points at which systems, including human systems, interact tend to be the hinges where EMRs squeak, rust together or fall apart. These can be interactions between systems by different vendors, interactions within systems and, as in the example above, human/software interactions. Vendors Just don���t Play nicely Fa rzad Mostasha ri, M.D., Nationa l Coord inator for Hea lt h In for mat ion Technology, has promised an end to ���walled gardens��� where health care IT vendors��� Intra-op Irritation Sometimes, problems arise even when the same vendor provides two or more different systems. For instance, Harrison et al. cite a hospital order-entry system where orders had to be printed out and manually rekeyed into another system. Even systems that do share information electronically can cause headaches when the connections are horizontal. An example could be seen in an emergency room system that feeds into the inpatient system, which in turn feeds into the surgical system. As one system or another ���pushes��� or ���pulls��� for data, no central location manages the transactions or keeps a ���master record.��� A patient may exist in a slightly different narrative in each place. Another point where intra-system headaches occur is at upgrades. What if the new version doesn���t work or won���t talk to the old version? At the bare minimum, create and run a test image. Beyond that, try: Corporate mode: Get your vendor on your IT team. Make sure your contract spells out vendor compatibility with its own upgrades; EMR packages should include continuous support throughout upgrades. Maverick mode: Use an open-source EMR and you can write your own scripts. One good place to start is www.open-emr.org. Downloads for PC, Mac and Linux are free, and there���s a test demo. Tech support is community based and energetic but, of course, not guaranteed. Troubleshoot the users When IT experts think EMR, they should think users. How will the end users access, view, use and modify records? Who will need to push or pull what information? Do EMR worries stem from workflow concerns or anxiety that the EMR system is diluting user authority? Get stakeholders together up front and regularly to decide what they want from an EMR. What about those physicians who ignored the EMR functions other than free-data entry? They likely thought the EMR was usurping their decision-making authority. If people ignore, foil or stumble on EMR functions, find out why. Maybe the EMR template needs to be modified. Make sure you have a relationship with a vendor that lets you do just that. Every time: The Agency for Healthcare Research and Quality (AHRQ) suggests a response module to the ���Unintended Consequences��� problem. + Assess the problem. In other words, define the issue, gather information about it, and construct temporal and cause/effect timelines to determine what���s happening. Include both human and electronic information in factfinding. + Remediate the problem. Solutions can include software changes, training, configuration updates, programming and policy changes. Be sure to address unintended consequences of change! + Track the progress of the remediation plan. Monitor, log issues, assign corrective actions or tickets, and keep up with progress. Be sure to look at the success of your remediation plan against your overall goals, too. To see the Agency for Healthcare Research and Quality���s guide to predicting and averting EMR trouble, visit www.ucguide.org. ��� mdnews.com ��� md news Greater Kansas | 27