Nurses are key to a great EMR Success

Most of the EMR sales effort is clearly oriented towards the doctors and administrators of a practice. They are the ones who control the money, the gatekeepers.

If the salesperson can get past the MD, or administration, they declare “Success!” and move on to the next practice or hospital.  The effects of the EMR system (for good or bad) remain with the clinic.

In an outpatient oncology clinic, a good portion of revenue comes from the actual treatment of patients; from nursing and drug delivery. This is also an area where many mistakes are possible and a vast assortment of safety precautions must be made.

In order to perform these documentation and safety requirements, the EMR has to work and just stay out of the way. Nurses cannot be bothered to wrestle with an EMR that was not built for their specialty or was just poorly designed (A lot of EMR systems are designed for the front office and MD encounter than for a treatment floor.

Sometimes a lack of productivity is a training issue. Sometimes it is not. The EMR that Carolina Oncology had was nigh-unusable in the treatment area.  Chemotherapy order sets could not be altered easily. It was difficult to document start and stop times for infusions.  Any contraindications made were imperceptible unless the employee was specifically looking for them. After a while, the nurses at Carolina Oncology threatened to quit.

They went back to paper charting.


Apparently this story is becoming more common, or at least more visible. Nurses at Sutter hospital system took several issues with their EMR implementation.

• A patient who had to be transferred to the intensive care unit due to delays in care caused by the computer.

• A nurse who was not able to obtain needed blood for an emergent medical emergency.
• Insulin orders set erroneously by the software.
• Missed orders for lab tests for newborn babies and an inability for RNs to spend time teaching new mothers how to properly breast feed babies before patient discharge.
• Lab tests not done in a timely manner.
• Frequent short staffing caused by time RNs have to spend with the computers.
• Orders incorrectly entered by physicians requiring the RNs to track down the physician before tests can be done or medication ordered.
• Discrepancies between the Epic computers and the computers that dispense medications causing errors with medication labels and delays in administering medications.
• Patient information, including vital signs, missing in the computer software.
• An inability to accurately chart specific patient needs or conditions because of pre-determined responses by the computer software.
• Multiple problems with RN fatigue because of time required by the computers and an inability to take rest breaks as a result.
• Inadequate RN training and orientation.

Some of these are problems with Reality, like slow lab tests or incorrect orders, but others indicate real shortcomings with the software, such as accuracy and usability.  I hope this hospital system can iron out these issues.


In facilities with inpatient or outpatient care, nurses are the troops on the ground. They interact with anxious and frustrated patients. When things go wrong or patients get annoyed, they are the ones who hear about it. You have to supply them with the correct tools or they can’t do their jobs.


When we start marketing Ankhos in a broader playing field, I will make 100% sure that I have clinical staff buy-in before a sale. Otherwise you are just selling brochures to doctors, not offering a tool to make a more efficient, cohesive and communicative office.

Win the nurses and the rest will follow.


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