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University presidents call for restructuring of UCSF Stanford Health Care
Not the "Last Word"
by Lawrence M. Shuer
Just when we thought we were safe and were becoming comfortable with our Clinical Data Base (CDB), we are being told it is to be replaced with "Last Word."
Last Word, of course, isn't last but is instead the next important step toward a record system that will offer virtually all of the medical information we need at one workstation.
I'm convinced that the changes are really part of a rational, evolutionary process. For practicing physicians, the system should bring continual incremental improvements in our work environments as we move toward a truly beneficial objective: the electronic medical record.
To understand what's happening here, we need to recall a bit of history. The CDB, which we've used for nearly three years, was the first step toward the evolution to an electronic medical record and was a great improvement over SMIS (Stanford Medical Information System).
The CDB has become invaluable to busy clinicians in both the inpatient and outpatient settings as we retrieve lab results, X-ray reports, path reports, microbiology data and transcribed reports from workstations around the medical center. I personally use the CDB almost every day I am involved in patient care. The CDB was developed and customized to be responsive to our needs by a medical staff task force that did a marvelous job of making this software work in a fashion that made sense, was intuitive and was reasonably reliable.
So why are we getting rid of the CDB instead of making improvements to this existing resource? Unfortunately, the system is not Y2K compliant. And the company with which we worked on this project lacked the backing to meet deadlines that would keep our transition to an electronic medical record on track.
Last Word's software is already Y2K compliant, has the backing of a major company in the medical software industry and is already in place at a number of major medical centers across the country. We are entering a partnership with Last Word's creator, IDX, a national corporation headquartered in Burlington, Vt., to tailor a product to work for our needs.
Best of all, Last Word is the first step toward a truly integrated electronic medical record - the Enterprise Clinical Information System (ECIS).
Last Word will officially be available for your use at Stanford Hospital and Clinics workstations on Oct. 3.
An efficient, flexible web-based training program is now available to help familiarize us with this new resource. The orientation program allows its users to proceed at their own pace and schedule from medical center workstations via the latest version of Internet Explorer. The training can be broken up into segments, allowing us to stop in the midst of the program and then restart at the place we left off at a later time or day. Those who are computer savvy will probably whisk through faster than those who rarely use computers, but most of us should be able to complete the self-taught orientation quickly. The training module is estimated to take most physicians about an hour to complete. For those who wish to have personal instruction, there will be drop-in training sites at key locations throughout the hospital open 12 hours each day during the month of September.
With Last Word, physicians will be able to customize their own patient lists and graph lab values to look at such things as trends. The new system will also be integrated with scheduling so we will know when our patients are here for tests or clinic visits, etc.
And there is more to come. The next phase of the transition to the electronic medical record is expected shortly after the October launch of Last Word. Called Med Rec, this feature is the missing link that will allow us to integrate paper records into the electronic chart. Data not entered electronically into Last Word, such as EKGs and handwritten progress notes, will also be scanned into the computerized medical record and will be retrievable at workstations throughout the medical center. It's important to note that until Med Rec goes live, we must continue to rely on Chart Vision and go to the Health Information Management Services Department (Medical Records) or request a printout of the scanned-in material. Once Med Rec is up, we will finally have a true paperless medical record, retrievable when we need it from workstations throughout the medical center.
Early next year, we can expect one of the most important enhancements to our electronic medical record evolution Ñ Physician Order Entry (POE). This system will allow us to enter our patient orders directly into computer workstations rather than transcribing them by hand.
Medical records finally will be "real time." Both information and decisions will reside in one place. The advantages for safety, efficiency and convenience are incalculable: automated online information regarding drug interactions, patient allergy alerts and proper drug dosing will be immediately available, hopefully helping to reduce errors and perhaps allowing us to offer medications more cost-effectively.
Once all of these segments of ECIS are implemented, I believe many of our current frustrations with medical records will be alleviated, and we will gain unprecedented levels of control in managing our patients. We should be able to retrieve information on patients when and where we need it, which will undoubtedly enhance patient care. We are in the information age. It is time for our medical information systems to be brought to the level that current technology will allow.
