Electronic medical record systems at academic health centers

Abstract

The growth of managed care has fueled expectations for a more coordinated delivery of clinical services and a reduction of unnecessary utilization. Among the most important issues that constrain these expectations is the transfer of medical information. Electronic medical record (EMR) systems appear to offer substantive advantages over paper records for both containing costs and improving the quality of care. However, incorporation of EMR systems into practice settings has languished. Among the barriers to implementation are software problems of codification and entry of data, security issues, a dearth of integrated delivery systems, reluctant providers, and prohibitive costs. The training programs of academic health centers (AHCs) are optimal environments for testing and implementing EMR systems. AHCs have the expertise to resolve remaining software issues, the components necessary for integrated delivery, a culture for innovation in clinical practice, and a generation of future providers that can be acclimated to the requisites for computerized records. The authors critically review these and other issues of implementing EMR systems at AHCs and propose four necessary steps for financing their implementation.

What to expect from electronic patient record system implementation: lessons learned from published evidence

“…Initially, difficulties were technical (integration, security and purchase cost),15 but subsequently barriers were predominantly operational and behavioural, including physician engagement, workflow and cost of maintenance/upgrades. Indeed, several studies report major issues surrounding workflow changes when moving from paper-based systems 8 , 11 , 16…”

Barriers to proliferation of electronic medical records

“…6,7 Substantial literature exists regarding the barriers to the implementation of electronic health records/electronic medical records (EHR/EMR) in medicine. 1,3,[8][9][10][11][12][13][14] Identified barriers include lack of ability to exchange data, high cost, lack of standardisation and multiple organisational issues. Despite the identification of these barriers and attempts at solutions, such as medical record data exchange standards like HL7, the proliferation of these technologies in medicine has not proceeded to the extent that it has in other industries.…”

“…15 Even the 'successes' have major ethical, training, disaster preparedness and sustainability problems. 12,14,16,17 Under the present circumstances, a patient is likely to have a longer life than the software on which their medical record is stored, making access to these vital data difficult or impossible. 18 A systematic examination of reasons for the failure of widespread use of clinical computing software in medicine is an important step in improving the penetration of these vital technologies.…”

e-Health? Clinical information network interest and impediments in a community paediatric setting

“…Alternatively, Intranet technology can expedite access to the specialized, evidencebased information that is required. These electronic clinical information networks have the potential to improve both the effectiveness and efficiency of services by facilitating physician access to a multitude of clinical and decision-making support resources (1)(2)(3)(4)(5)(6)(7)(8).…”