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Gundersen's CEO was impressed. He told Lathrop and Rislow to put a computer in every office and examining room within two years. Today the clinical workstation network stretches across more than 5,000 terminals, and electronic records have completely replaced paper charts (except when older records need to be consulted).
Even today only a minority of hospitals have moved as fully into the digital realm as Gundersen. According to Forrester, only 17% of doctors use computers for clinical applications, while a mere 10% write electronic prescriptions. But ironically, hospital execs are more likely to view IT as a strategic asset than execs in other industries (85% versus 63%).
"We were and are one of the very few health care organizations to have fully implemented electronic records," Rislow says. "Many organizations were waiting for the product to arrive on the market. Most haven't moved because the vendor market hasn't moved. We just decided to build it."
The pioneer days when Gundersen had to invent a system are over. Rislow says that vendors such as Epic Systems, Cerner, McKesson and Siemens are now offering off-the-shelf solutions that are more cost-effective. Although it took the hospital eight years to develop its own EMR system, Rislow says Gundersen will eventually migrate to a vendor offering.
"Ten years ago, there were no systems," she says. "In the last three years, we've finally seen vendors step up to the plate with truly innovative systems. The market has risen to our level of expectation. It's no longer cost-effective for Gundersen to develop. It's not a great business decision to create a wheel when it already exists."
This year, for example, the hospital is working on a request for proposal for a $10-million in-patient management system that would replace a mishmash of programs for tracking admitted patients. "We have good systems, but they're fragmented," Rislow says. "It will be a huge implementation, and we expect huge returns."
Healthy Results
Dr. Lathrop's world used to revolve around paper. Besides waiting for, reviewing and signing charts, he had to go through the same ordeal with lab results every time he ordered a test. Doctors are legally required to review and act on tests, but traditionally every physician handled labs in his own fashion. "My secretary used to wait for all the labs to come in a pile and send them to me," says Lathrop. "I'd look at the labs and dictate a letter. It took two weeks."
Now whenever a doctor logs onto his computer, labs pop up on his My Results intranet page. The doctor reviews the results, clicks that he's done so, and clicks again to send an automated e-mail or letter to the patient. "There were a hundred different ways of doing labs before," Lathrop says. "This entirely changed the way every physician deals with labs. It took two weeks. Now it's a day, and there's no secretary in there." There is also a patient-facing version called My Care, which lets patients view their labs, make appointments and e-mail their doctors. The e-mail becomes part of the patient's chart, which wasn't the case with the old form of communication: telephone calls.
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