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At Colorado’s Poudre Valley Health System in Fort Collins, some 1,000 nurses are participating in 18-hour training sessions for the integration of an electronics medical records platform with a busy emergency department, inpatient facilities, and some outpatient clinics.

“The greatest impact is the positive effects it will have on nursing practices,” says Craig Luzinski, RN, MSN, chief nursing officer and head of the technology project. “It’s not about computers. It’s more about process change. The electronic medical record technology allows us to gather and share information in a consistent manner that adds to the quality of care we give patients. We hope to heavily populate the database with better processes.”

While electronic nursing documentation of patient records goes “live” in February at Poudre, other key elements — such as having physician prescription orders available online, scanning and bar coding of medications and radiology/lab data — won’t be fully functional until late 2005.

Catch the wave

The growth of EHRs is evident. In Nevada, North Vista Hospital recently became the seventh of 11 hospitals in Las Vegas to launch an EHR as part of a $40 million rollout to 15 hospitals in five states by IASIS Healthcare. Spokane, Wash.-based Inland Northwest Health Services, meanwhile, manages EHR and ancillary services such as physician orders entry for 2.6 million patients at 32 hospitals in Washington and Idaho.

The VHA hospital network launched its CPRS in 1999 to provide a single interface to integrate EHR information in a health data repository. The system, called VistA, was designed for clinicians to review and update medical charts and to place and track orders for prescription drugs, lab tests, and special procedures. Since November 2003, the system has allowed veterans Internet access to portions of their medical charts to view medication use, test results, and allergies. In early 2005, veterans will be able to refill prescriptions and make medical appointments online.

Emrich says the EHR infrastructure makes it possible for a bedside workstation to use a software program to continually monitor and record a critical care patient’s vital signs — heart rate, temperature, blood pressure, cardiac indexes — and download the minute-by-minute data to the patient’s files for clinician review.

“In the past, nurses had to stay with a patient and write every figure on a big spreadsheet,” Emrich says. “The compatible monitoring technology frees up nurses to be with other patients.”

With President George Bush pushing for a national electronic medical records network by 2014, the open-source software of the VHA’s inpatient and ambulatory VistA technology is being touted by the agency as a “low-cost building block” toward reaching that goal.

The VistA platform contains dozens of applications, including a nursing component with modules for a variety of functions. For administration, it can track staff information, generate management reports on employees, accumulate daily statistics on the number of patients treated, and provide miscellaneous patient acuity reports. A clinical module generates patient classification reports by bed section and unit. It also helps nurses to generate a patient care plan based on national standards and identified needs, and lets users enter a patient’s vital signs, height, and weight.

Emrich says the VistA technology also is improving the way medical researchers gather patient data, study diseases, and seek cures.

Kaiser, Sutter Health, and other large providers will have networkwide EHR systems in place long before the 2014 federal deadline. However, there are formidable barriers involving technology standards and security issues to overcome before reaching one milestone for patient safety — 24-7 access to a patient’s complete electronic medical record at any health care facility in any section in the country.

At the regional level, Sutter Chief Information Officer John Hummel credited nurses with helping to implement the critical clinical and workflow processes necessary for a state-of-the-art digital records network.

“The ultimate goal is to integrate community-based medical records with hospital records so that patients can access the information and become more empowered to manage their health care needs.”

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