Implementing an Electronic Medical Record - 09/08/11

Doi : 10.1016/j.ccc.2007.05.001

Lloyd N. Friedman, MD ^a,^b,^⁎ , Neil A. Halpern, MD ^c,^d, James C. Fackler, MD ^e
^a Pulmonary and Critical Care Section, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
^b Intensive Care and Respiratory Therapy, Milford Hospital, 300 Seaside Avenue, Milford, CT 06460, USA
^c Departments of Anesthesiology and Medicine, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA
^d Critical Care Medicine, Respiratory Therapy, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
^e Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Blalock 901, 600 N. Wolfe Street, Baltimore, MD 21287, USA

Corresponding author. Intensive Care and Respiratory Therapy, Milford Hospital, 300 Seaside Avenue, Milford, CT 06460.

Abstract

We consider the practical aspects of justifying, planning, implementing, and budgeting for an electronic medical record. Examples include the decision about integrating versus replacing old systems, the timing of implementation for each clinical area, preparation for installing computerized order entry, a discussion about how to implement physician progress notes, and a discussion about how electronic nursing systems interact with the EMR. Integration of other systems such as PACS and EKGs are discussed. Wireless integration and telemedicine also are addressed, as well as backup, redundant systems and budgeting. The reader will gain a full understanding of the scope of the problems involved in implementing an EMR, and will have a step-by-step description of how to approach the task.

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Plan

Efficiency, safety, and regulatory issues

Leapfrog Group, Institute of Medicine, Institute for Healthcare Improvement, and HCIT

JCAHO

FDA

HIPAA

Care standards, safety, and efficiency

Infection control

Develop a team and a plan

Develop an interdisciplinary working group and an initial assessment

Develop a list of vendors

Interfacing old systems versus replacing with a new system

Full versus stepwise implementation

Identify potential consultants

The request for proposals and the contract

The budget

Components of a full system

Initial components: laboratory, microbiology, pathology, radiology, and dictated reports

Pharmacy

Order entry and order history

Electronic medication administration record

Nursing

Notes and assessments from other services

Styles of progress note entry

EKG systems

Other clinical areas

Other data

Computerized physician order entry

Discharge procedures

Additional integration of ICU parameters into the system

Wireless data acquisition

Wireless in critical care

Installing a wireless network

Other departments

Data mining

Physician reminders notifications

Necessary computer hardware, networking, and backup

Computer hardware and networking

Tablets

Disaster planning, downtime procedures, maintenance, and backup

Remote access for physicians

eICU—remote critical care

Paper record and legal record

Online access to reference material

Summary

	Lloyd N. Friedman, MD: Scientific Advisory Board, Stock, Cardiopulmonary Corp., Milford, CT.
	Neil A. Halpern, MD: Medical Advisory Board, Instrumentation Laboratory, Lexington, MA; Global Care Quest, Beverly Hills, CA; Scientific Advisory Board, Cardiopulmonary Corp., Milford, CT.
	James C. Fackler, MD: Consultant, Stock Options, Cerner Corporation, Kansas City, MO; Medical Advisory Board, Stock Options, Global Care Quest, Beverly Hills, CA; Scientific Advisory Board, Cardiopulmonary Corp., Milford, CT.