EHR Success story: a large California facility’s experience with EHR

With EHR, the record is available when and where I need it. Paper charts used to get lost; thats not a problem anymore.

“With EHR, the record is available when and where I need it. Paper charts used to get lost; that’s not a problem anymore.” That’s how Anne Thompson of Palo Alto Medical Foundation sums up her experience with EHR, as someone who has been intimately involved with the foundation’s changeover from paper to electronic records and in subsequent training and upgrades.


The Palo Alto Medical Foundation for Health Care, Research and Education (PAMF), in Palo Alto, CA, is part of a not-for-profit health care organization with more than 1000 doctors serving some 700,000 patients. Founded in 1930 as Palo Alto Medical Clinic, the organization evolved into the not-for-profit PAMF in 1981. Joining forces with two other area clinics in 2008, PAMF became part of the Sutter Health group.



Embracing the electronic



The foundation was ahead of many San Francisco Bay area hospitals and clinics when it decided to shift from paper records to EHR. PAMF went live with a pilot EHR system in 1999; it was fully rolled out by 2002.



An R.N. named Anne Duffy Thompson was the first employee to train others on the system after learning it herself. As supervisor of the training team, Thompson strives to give providers the training they need to become compliant with requirements to understand and use EHR, and is working on Meaningful Use compliance implementation. Thompson is the foundation’s go-to resource for information about Meaningful Use. In turn, she says, “everything I need to know, I get from the CMS website (Centers for Medicare & Medicaid Services; see ).”



“We are currently working to complete the integration of our clinical, administrative and technical systems,” according to PAMF’s website, “Plans are already underway to implement seamless access to care across the PAMF network and include adoption of a single electronic health record that will enable retrieval of patient information from any PAMF facility throughout Alameda, San Mateo, Santa Clara and Santa Cruz Counties.”



Smoothing the way



To avoid overwhelming hard-working providers and continue to deliver good care to their patients, PAMF deployed its EHR system using a rolling implementation, making sure that training support personnel were always readily available to providers during system implementation. The foundation reduced provider patient numbers and clinical responsibilities during his time.



PAMF started with an Epic EHR system, and has never switched vendors; the foundation installs upgrades about once a year. The Epic system facilitates



CPOE (computerized physician/provider order entry), which allows physicians to issue  medical orders online, from the doctor’s office or a hospital room (or any clinical setting in their network).



Rolling with the changes



The EHR system has had its implementation issues, Thompson says, especially in the early days; for example, it took years to successfully incorporate radiology images, and some providers are still unhappy with this feature (see But sometimes the old ways are better).  Currently, PAMF is working on fully integrating lab data with the EHR system.



But the biggest problem, Thompson says, was provider “buy-in struggles.”



“If you’re lucky, you have admin support that [encourages] early adopters.
We’ve had that kind of admin support, and good change management as well.”



“My record is there for me wherever I go”



Most hospitals and health clinics in Santa Clara County can share information as needed, thanks to their integrated EHR systems. For example, the county offers pediatric immunizations in its “safety net” clinics for the homeless. “If you qualify, you can register and find out if your child needs immunization and when he’s had what shot,” says Thompson.



Thompson’s work sometimes requires her to visit very large medical groups such as Kaiser Permanente or Stanford University Medical Center. Thanks to good communication between their Epic EHR systems, she says, “Stanford can see our records and we can see theirs. My record is there for me wherever I go.” These records are only shared under strict HIPAA regulations and with patient consent, Thompson says.




Watching EHR in action at PAMF




Dr. Douglas Blayney, an oncologist, wanted to observe hands-on usage of EHR, so he arranged a visit with his colleague, Dr. Peter Yu, at PAMF. Blayney chronicled his observations in an article for the 2010 ASCO (American Society of Clinical Oncology) website.



A… patient… with long-standing myeloma now on lenalidamide, Peter saw emergently for cough and dehydration… Peter showed me their CPOE implementation, which he used to order a chest X-ray, CBC and biochem panel. He was also warned about drug interaction between the levofloxacin he was prescribing and the warfarin that the patient was taking, and he produced a report for the patient which he handed to him, instructing him on how to adjust his warfarin.



“Each exam room has a computer terminal mounted on the wall; the keyboard is set to be used in the standing position, and the monitor swivels so it can be viewed from most parts of the room… Peter was able to navigate through the screens and programs with alacrity, and his three visits that day would have, in aggregate, met the current iteration of ‘Meaningful Use,’” Blayney observed.



But sometimes the old ways are better



However, Blayney goes on to note another doctor’s dissatisfaction with EHR, even though the other doctor was younger than Blayney and “thus putatively more computer savvy than my generation.” But “EHR slowed him down in the office: whereas in the paper world, his medical assistant would line up the X-rays on the view box, now he had to wait for his [EHR system] to load the images…; formerly he would have documented his findings on one page of paper, whereas now he had to point and click, dictate, and type his way through a note…”



For the most part, it’s all good



Overall, PAMF’s EHR system “seems to do what we need it to do. The software package is fairly well put together. It’s very complex; it takes a lot of training,” Thompson says, but says it’s well worth the effort.



System outages, while they occur at some facilities, are very rare at PAMF, says Thompson. Except for planned outages for maintenance, “I don’t remember the last time we had an outage. It’s very stable.”



Thompson emphasizes that she speaks only for herself, not for PAMF or any affiliated organizations.





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