As technology continues to evolve within the medical field, health care systems across the country are making the switch from paper charts to electronic health records.
To make capturing patient information more efficient, and to achieve “one patient, one record,” Lutheran Health Network switched to Cerner this spring. As of 2018, Cerner products were in use at more than 27,000 facilities worldwide.
Dr. Matthew Bilodeau, an interventional cardiologist at Lutheran, has familiarized himself with many health record systems over the years, ranging from McKesson to Allscripts.
“I think one of the most difficult things with electronic health records is there's a learning curve to any of them. They basically all sort of function the same way, but they come from different file cabinets,” Bilodeau said. “Figuring out where all that stuff is, and to be able to efficiently access that information, is probably one of the most challenging things for anybody.”
With Cerner, records can be accessed through a laptop or desktop, although this is not the first time physicians in the network have used laptops in exam rooms.
The technology can also be used on an iPad, which the health care system hopes to explore this year.
In the past, Bilodeau said there was a separate chart at the hospital and office.
If a patient note was created in a chart in the operating room, it would remain in that location, meaning the information entered would not appear in the office chart.
To have notes added to the office chart, physicians would have to request a fax then manually scan the information into the office chart.
The new program eliminates that, saving the patient's information to the larger network.
Within the last few months, the health care system has merged all of its providers, whether hospital or office, onto the same IT platform.
“You're always challenged by which environment you're in, trying to access the records from the other environment, because you'd have to log in separately,” Bilodeau said.
“Now it's literally there. When they ask you, 'What did my hemoglobin look like?', you can immediately get it, whether it was done on the hospital side or in the office.”
For Dr. Kanika Jaggi, a family practice physician, Cerner offers context for providing care.
“I open up the chart, look at their vitals, their past medical history, look at their previous notes or past visits to get an idea of what we did at that time,” Jaggi said. “We can kind of get an idea of their current issues, if any medications need to be prescribed and order tests. All of that is done through the electronic health record.”
The electronic health record system has changed the way Bilodeau and Jaggi work with patients, as it increases the ease of accessing information.
Doctors no longer have to try to read each other's handwriting, and within the system, they can see detailed notes from every physician the patient has visited, making follow-up care easier to determine.
“I don't have to ruffle through papers or look through other doctors' files,” Jaggi said of one of the benefits of the electronic system. “It also makes it easier to give better care to the patient, because I can pull up stuff right away and talk to them about it.”
While electronic health records have improved accessibility, some patients have felt left out of the conversation.
One of the biggest issues Bilodeau sees is how physicians interact with both patient and record at the same time, many struggling to engage with their patient while typing away on their laptop.
Both he and Jaggi said good typing skills can help improve efficiency and a patient's experience.
“How do you input information in real time and be efficient about it, and make the patient feel like you're not just focused on getting that data in the computer?” Bilodeau said. “They're still a real part of the conversation, because they are the conversation.”
Bilodeau said the Dragon Medical One app, which records what patients say, can help dictate medical notes directly into the electronic record.
Using more mobile devices, such as an iPad, would also improve care, Bilodeau said, because nurses and doctors could use those at the patient's bedside instead of waiting for an open computer or carrying around a bulky laptop.
Bilodeau and Jaggi hope to see a cohesive electronic health record system not just within the Lutheran network, but one that could bridge hospitals around the world.
“These things are behemoths. I can't imagine the amount of brainpower behind generating what they've created now,” Bilodeau said. “It's definitely getting better and will continue to get better as we build a system in a direction that suites our program.”