Getting to the Inevitable

Despite the benefits of EMRs, there will always be some clinicians who don’t want to change. That’s where CIOs must rely on executive backup: a mandate, straight from the top, that everyone—no exceptions—will use the EMR and CPOE systems.

Hospital administrators "need to communicate the target and hold a gentle, steady pressure to achieve it," VA’s Kolodner says. "After about six months, if you’ve put in a system that meets the providers’ needs, it becomes self-sustaining. The peers start saying, Would you please put your notes in there? I don’t want to have to get the records because it slows me down."

This mandate is hard enough to enforce at places like the VA facilities, where physicians are on staff and rely on paychecks. But it’s most difficult at community hospitals that don’t have power over doctors who aren’t employees.

Just ask Maimonides’ Sullivan. "We went live with an electronic record order-entry system on Dec. 15, 1996," she says. "I remember the day well. One doctor walked up to me in the hospital. He said that because of the system, he was going to retire."

Fortunately, he was the only doctor who left. Today, Sullivan’s systems are cranking away—saving money, saving lives. In the emergency department, the floor and hallways are crowded with patients on stretchers. Police keep close guard over one patient, while another, blood caked below one eye, yells "doctor" every few seconds. The scene seems chaotic, but appearances can be deceiving.

Dr. Steven Davidson, chairman of the emergency medicine department, logs on to a computer. At a glance, he can see the locations of all the ER patients, the severity of their conditions, the status of their treatments. He knows that an elderly woman in the hallway needs to be assigned a room, that another patient’s chest X-ray is back from the lab. Dressed in a bow tie and lab coat, Davidson is imposing order on the chaos. "[I knew] there had to be something medicine could use from the business model," he says over the racket.

He was right.