Electronic medical records: a path forward.

Health systems are moving to implement comprehensive electronic medical record (EMR) systems, or significant pieces of them, in the belief that EMR can be integrated into clinical practice and lead to improved patient outcomes and enhanced safety. There are substantial roadblocks to implementing EMR, including significant cost, the competency needed to implement, the political environment, organization infrastructure and culture, and how organization leaders understand return on investment. Complicating factors include the drive to implement EMR to meet meaningful use standards to qualify for a federal incentive program and recently publicized studies that question the value equation of the EMR as it relates to patient care improvements. We offer our experiences on the successful implementation of the EMR across the large health systems we lead. We offer practical advice and tips on how to achieve successful implementation, evidence that successful implementations improve patient care and safety, and a glimpse of how EMR is a significant foundation in a future of collaborative models that provide continuum-based care.

Electronic health records and the board's connection.

As hospitals spend millions on information technology, boards have an important oversight role to play from system selection to implementation.

Building and sustaining a systemwide culture of safety.

BACKGROUND: In 2002, Sentara launched a systemwide initiative to significantly reduce events of harm to patients and employees. The initiative began at Sentara Norfolk General Hospital. Since then, the safety principles piloted there have been instituted throughout Sentara's integrated health care system of hospitals, nursing homes, and physician practices. ACCELERATING THE PACE OF IMPROVEMENT: Implementation at each local site begins with a thorough assessment of its safety culture. Four core areas of focus include (1) establishing safety as a core value, (2) creating Behavior-Based Expectations (BBEs) for error prevention that are tailored for staff, leaders, and physicians, (3) developing a state-of-the-art root and common-cause analysis program, and (4) implementing an approach to focus and simplify work processes and procedure documentation. KEYS TO SUCCESS: Senior leadership demonstrated a commitment to making safety a core value by embedding safety into strategic priorities, incentives, rewards and recognition, and human resources policies and procedures; prioritization of operational goals to ensure the availability of time and resources to make the safety initiative the key focus; involvement of employees and medical staff each step of the way; establishment of site-based safety initiative teams of operational leaders with the responsibility for leading the safety initiative implementation and ensuring effective communication across the organization; and a willingness to learn and try successful techniques from high-reliability organizations outside health care.

Forward motion. Interview by Mary Grayson.

AHA chair-elect, David L. Bernd, CEO of Sentara Healthcare, Norfolk, Va., discusses the current state of health care and his hopes for the future.

Forward motion. Interview by Mary Grayson.

David L. Bernd, CEO of Sentara Healthcare, Norfolk, Va., believes that with active, involved leaders health care can confront many of its most daunting challenges, and he sees opportunities in innovations now emerging. In this article, the new chair-elect of the American Hospital Association discusses the current state of health care and his hopes for its future.