EMR Implementation Considerations Y. SINGH NELSON R. MANDELA SCHOOL OF MEDICINE DEPARTMENT OF TELEHEALTH SINGHY@UKZN.AC.ZA Content licensed under Creative Commons Attribution-Share Alike 3.0 Unported
Learning Objectives • To give you an idea of how to assess the value of a medical informatics solution • Make you aware of some of the questions you need to ask before rolling out any type of electronic medical record system • Points that will help ensure the successful implementation of an medical informatics solution
An Example • Information systems too manage medical information is beneficial • Peter Littlejohns BMJ 2003;326;860-863 • Three quarters of information systems fail • Limpopo Province • IBM 134 million rands
Why do EMRS Fail • Poor communication • Developers unaware of the environment • No change management in place • Perceptions (resistance to change) • No support from government • To high expectations
Essential Considerations • Needs assessment • Design • Testing • Implementation • Functionality
Needs Assessment • Most important part directly results in success or failure • High end and sophisticated technology is not always the correct solution • Where are the developers from • Workflow Analysis • Actual vs perceived benefit • Collecting data without analysis or using it, is not beneficial to you
Design • Ensure that you are fully involved • Remember … you need to tell the developer what you want • Insist that the developer uses the spiral development model • Must take into account the environment • Flexible
Testing • Testing must not be done in a lab • Have a trial run of the system in the actual environment with the full participation of the developers • Independent evaluator
System Functionality • Comprehensiveness of information • Does the system capture and store all the necessary information • Degree of structure of data • Retrieval and analysis of the data • Ubiquity of access • Multiple read privileges
System Functionality • Backups • How are they done • How often are they done • Where is it stored • What happens if the system fails • Second system with essential functionality • Paper based batch entry back-up • Ease of use and flexibility
System Functionality • Efficiency • Robustness • Add benefit to the clinical environment • Security • Confidentiality • Integrity • Privacy
System Selection • Open source vs. commercial systems • Actual costs • Available support • Small print
Implementation • Phased rollout • Training • User support • Finding champions • Creating super users • Celebrating successes and learning from mistakes • Adequate budget
Ask Questions “Studies have shown that holding and caressing animals can dramatically speed a person’s recovery”
Important Questions • Is there clinical need for the system? • Do all the components function? correctly • Is it reliable? • Is it accurate? • Is it fast and accurate? • Is the system well built? • Are people likely to use it?
More Important Questions • Which parts cause what effect? • How can it be maintained? • How can it be improved? • Is the interface intuitive and easy to use? • Does it communicate effectively with other components/hospital systems? • Is it robust?