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IT IN HOSPITAL
Important factors for adoption of an EMR Dr. Rajesh Gupta, Healthcare IT Executive
There any many key success factors in any EMR adoption such as Detailed workflow study (“as is” and “to be”), User Expectation Management, Clear Requirement & Scope Definition, Adequate Super/End User Training, Department User Champions, Change Management, Management’s Commitment & Support, Governance Structure for project steering & monitoring, Proper Communication Strategy, Right Go-live Approach, Adequate Hospital IT Manpower, And so on…
However, the most important factor that ensures adoption of an EMR is its features and usability. I am briefly describing what an EMR should be able to do in order to ensure a sustained adoption:
User Friendly Interface – Presentation makes the first impression and is as important as the content is. Simple and neat user interface always attracts the user, Google being the prime example. There should be right balance of color coding on screens as users love different color coding on screen to easily classify the activities.
Charts and Graphs – Colorful Vitals/IO Charts and Graphs for quantitative lab reports, vital signs, medicine dosages, etc for clinicians to be able to see the trend over a period of time. It can also help then in preparing research papers and presentations.
Longitudinal patient Record (flow chart) – Clinicians prefer to scroll through entire patient record without having to navigate too much. EMR should be able to configure the flow charts for different specialties based on their needs.
Computerized Physician Order Entry – This is one of the modules which should be extensively used by clinicians, therefore needs to be extremely user friendly with options like favorite orders, order sets, protocols, delayed orders, etc.
Alerts & Reminders (Clinical Decision Support System) – EMR should be capable of providing alerts and reminders such as drug to drug, drug to lab, drug to food interactions; duplicate orders alert; order instructions; allergy alerts, health check due reminders, immunization reminders and other clinical reminders to reduce medical errors and enable meaningful usage of the system.
Bar Coded Medication Administration – to ensure RIGHT medicine in RIGHT dosage is given to RIGHT patients at RIGHT time by RIGHT medical personnel. Studies have proved that BCMA reduces medication administration errors by 63%. BCMA also confirms that the prescription by clinician is carried out exactly as per his instructions. Deviations in prescription, if any also get recorded.
Specialty Based EMR – a General Medicine EMR cannot meet the requirements for other super specialty. For example, prescribing a chemotherapy regimen is completely different from prescribing a generic prescription. Similarly, a pediatric or obstetrics history is quite different from a general surgery history. Therefore, the more an EMR fulfills the clinical requirement nuances for each specialty, the better clinician adoption is achieved. These specialist clinicians always look for solutions to their workflows and feel disappointed which leads to ignorance/avoidance of the EMR.
Tightly linked Work-flow based System – to address clinical protocols and clinical pathways related requirements where system should prompt next action automatically based on diagnosis and selected protocol.
Work-list based Single Screen Operation – Giving each user a single screen workflow not only makes it very easy to use, but reduces training effort also. Users do not have to navigate between menus and screens to do their job and all their activities are brought into single screen.
Real-time Dashboard for HODs – HODs keep asking what is there in it for them as what they really needs is a dashboard to be able to monitor how their department is functioning and what the areas of improvement are.
Pre-Configured System with default data and templates – Data collection and validation is one of the major challenges in EMR implementation. EMR system should have pre-configured data and templates which can be modified based on the requirements. This reduces the implementation time and therefore the cost.
Clinical Documentation with least typing – It is absolutely must for EMR product to support template building and statement generator functionalities to create templates exactly as required by clinicians and to be able to fill it with minimum clicks.
Automated Discharge Summary – EMR should be capable to automatically filling the discharge summary from the information already captured by various users across organizations. It reduces the discharge time and increases bed turnover rate.
Extensive Audit trails – To find of out errors and improve on those quickly.
Centralized Appointment System – to organize the time of clinicians, especially surgeons who need to manage their schedule between OPD, IPD and OT.
Patient Record Confidentiality – EMR should be very flexible in setting patient record confidentiality at different levels such as attending physician, specialty, medical team, surgical team, all clinical users, all doctors etc.
Web based Applications – Accessibility and availability as and when needed from any location increases the adoption rate.
Others – use of voice recognition, medical transcription helps to a great extent.
Nothing can help EMR adoption more than EMR itself. EMR product managers need to ensure these features are available in their products and are easy to use. I firmly believe that an EMR does not need to be sold; an EMR needs to be told.