Electronic Medical Records

INTRODUCTION

Today's healthcare manager is faced with similar pressures as managers from other industries, including the need to improve service, cut costs, increase efficiency and productivity, and increase profits. One of the areas that is the most labor intensive and inefficient for the hospital and nursing staff in the healthcare industry is the manual charting and reporting of patient records. The advent of bedside technology has enabled healthcare management to apply economies of scale across vast service areas when it comes to electronically charting patient records.

New technologies enable hospital information systems to be automated in a manner that increases accuracy, reduces barriers to access, cuts costs, reduces manual labor, and according to many studies it is responsible for elevating the level of patient care. The following analysis will discuss the following: impact of computerized charting on the healthcare manager and industry, including types of electronic information systems; the manager's role in implementing such a system; the impact on hospitals and nursing staff; and, the benefits and drawbacks of such systems.

TYPES OF SYSTEMS

There are many electronic patient charting systems available on the market. One that has been implemented at Santa Teresita Hospital in Duarte, California, is known as ChartMaxx Electronic Patient Recording System by MedPlus, Inc. One of the biggest obstacles with information systems that are manual is the absence of a centralized source of data which necessitates a cumbersome paper trail that increases labor and economic inputs while increasing the chance for error. This system is designed to eliminate these flaws of conventional patient charting while providing a information system flexibility and options never before available to healthcare management:

The system employs computer output to laser disk technology, discrete data capture and imaging to form an enterprisewide data repository that stores all clinical, financial and administrative information for each patient chart. Once a patient is discharged, the medical records department immediately scans the chart into ChartMaxx so it is accessible to all authorized users at the hospital. Benefits include decreased costs and increased productivity.

(Anonymous 1997)

The conventional method of patient charting continued to be an area of inefficiency and high costs because it required employees to spend enormous amounts of time writing and copying patient records, storing them in files, compiling charts, and making them available to doctors and others who requested them in ways that also were time consuming and costly (fax, mail, courier). The computerized information systems available today are designed to eliminate these processes and replace them with a technology-based options which also expand access, increase speed of exchange, eliminate costs, and increase efficiency. At Barnes Hospital in St. Louis, Missouri, healthcare management selected the EMTEK System 2000 Point of Care (POC) Electronic Medical Record System which is unique because of its distributed architecture. Some healthcare providers cannot afford a system that is elaborate and as complex as the enterprisewide ChartMaxx. The EMTEK offers an alternative because it can be expanded and allows an incremental implementation across various departments:

The system configuration consists of EMTEK Health Care System's comprehensive object-oriented database software running on intelligent workstations interconnected via a local area network. Starting with a small pilot project in its surgical ICU in 1990, Barnes has expanded the POC to 110 bedsides throughout 9 ICUs. In the automated environment, patient records are more complete, up-to-date, accurate, and accessible to designated caregivers at all times.

(Weiss and Hailstone 1)

ROLE OF MANAGEMENT

The role of management in implementing computerized patient charting systems is a vital and complex one. One of the biggest decisions is to implement an enterprisewide system or construct one in an incremental, piece-meal fashion. Authorization and access to the records will be a consideration, particularly who will have authorization to access such sensitive information. With the ability to manage thousands of accounts per year, these systems will require onsite management from a technology/programming end as well as a patient chart systems manager. The selection of proper hardware and software systems, methods of transmission, and other technological factors are crucial. As one manager who implemented Physician Micro Systems Practice, Inc.'s Partner Patient Records EMR system at his hospital reveals:

We knew from the beginning that in order for us to make the most out of the system, we would need to take the time and effort involved in incorporating this central clinical tool. Our efforts extended back to the time of purchase�We also made smart hardware decisions, ensuring ready access and high speed�One of our goals was to go live with as much patient data as possible already in the EMR. We achieved this by saving our dictated notes to a disk, which established the basis for creating complete electronic charts�months before our actual usage of the EMR.

(Maxwell 2)

In addition to these management issues, there is the issue of employee training in order for those who have authorized access to understand how to be the most efficient and accurate on the new system of patient charting. So, too, budget constraints are a considerable management issues, one that is often the sole reason why healthcare providers who have not implemented computerized patient charting systems have not done so "Healthcare's tight economic constraint is a major factor adding to the slow market penetration for point-of-care systems. Return on investment is another important factor" (Stefanchik 1). Still, because of many studies which show that implementing computerized patient charting decreases costs while increasing productivity and efficiency, they remain one of the most sought after requests of healthcare managers "The number of hospitals interested in bedside systems as a tool to promote increased nurse productivity increased to 41% in the 1990 survey. With documentation occupying nearly � of a nurse's patient-centered activities, it is no surprise that charting topped the top 10 priority list" (Stefanchik 1).