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I’ve been asked for opinions on what the best EMR system would be for a hospital. While I can’t provide the answer due to a conflict of interest, I will list the most popular systems currently used in the United States (in no particular order):

  • Cerner
  • McKesson
  • CPSI
  • Epic Systems
  • GE Healthcare
  • MEDITECH
  • QuadraMed
  • Siemens
  • Eclipsys
  • MEDPLUS

Some of the problems I’ve noticed with hospitals during their implementation phase and selection of an appropriate EMR is the lack of research in the area of implementation ease. While extensive research is put into cost and how well the system handles hospital’s needs, there are areas in which hospital administrators fail to ask themselves:

  • How are the online tutorials for the EMRs?
  • What is the support structure i.e. would the hospital be able to find enough consultants who have used the system to help them when they “go live?”
  • Can the EMR handle a large-scale hospital?
  • Diverse Team: You need a diverse team consisting of physicians, medical residents, nurses, pharmacist, technicians etc who need to be “Lead Coordinator” i.e. the go-to person or persons. A physician will not know the needs of the pharmacy, the pharmacist will not know the needs of a nurse, etc. Different roles, different work flow, different needs…

The most important advice, create a diverse team of healthcare professionals who are technologically savvy to begin with. The implementation of EMR requires speed and most importantly, efficacy. It is better to work with someone who has some sort of technical background either playing with websites, programming, or what Silicon Valley-ers like to refer to as ‘hackers’ (someone who knows or dips their hands in technology during spare time, and can make the computer do what they want, whether or not it wants to) than someone who doesn’t even know how to install a program in Windows.

Because when problems arise, you will need someone who isn’t afraid to act or at least is tech-savvy enough to search for the answer on forums instead of waiting for customer service in the morning. After all, in hospitals, time is life.

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ABC’s World News reports that the health IT at the Veterans Health System is considered by most experts as “one of the best health care systems in the country.”

Most private hospitals repeat 20% of their lab tests because physicians are unable to find the patient’s results. However, unlike the VA system, the lab results are kept in an EHR, saving millions of dollars from repeated lab tests. Along with the superb EHR is the use of an electronic band.

Patients are provided with a band that looks like a typical hospital ID. This band is an electronic monitoring device that when scanned, provides a photo of the patient along with his current treatments.

Video available here.

[Source: ABC World News]

Comments
The VA Medical System’s EHR is superb. It takes less than 5 minutes for a new VA healthcare professional to figure out where to find lab results. However, it is not just the VA’s user friendly EHR that reduces costs, it’s also their operation and approach to patient care.

Unlike a lot of private hospitals, the VA is heavy on utilizing a multi-disciplinary approach. Each medical team consists of a a clinical pharmacist who rounds with the medical residents. So you have your doctors who are the diagnosing experts along with the pharmacist who is the drug specialist. During each patient case review, nurses are also involved in the discussion of the patient’s everyday progression. This allows for a detailed approach towards caring for the patient.

In addition to their multi-disciplinary approach is their drug-check system. Every order inputted by a medical resident or attending is sent to the inpatient pharmacists who double-check the drug dose, allergies, use, proper dosage according to lab results and so forth. This reduces errors as well as provides improved patient care.

When conferencing with friends who are physicians ranging in a variety of clinical practices from radiology to primary care, I am often asked the same question “Can you create an affordable EMR record for my office?” I would usually point them to an opensource electronical medical record (opensourceEMR) system. OpensourceEMR is a topic that I’ve been researching for some time now,especially since analyzing a variety of EMR interfaces is crucial in fine tuning commercial EMR systems (Cerner, Epic, Mckesson etc).

While there is no perfect opensourceEMR currently available, physicians do have a wide variety of selections to choose from. I’ll write a separate profile for each one as there’s a lot of of them available. You can find a compiled list of opensourceEMR in the tabs above (OpenSourceEMR) as the articles are written.

OpenEMR
According to the developer:

“OpenEMR is a medical practice management, electronic medical records, prescription writing, and medical billing application. It is a replacement for medical applications such as Medical Manager, Health Pro, and Misys. It features support for EDI billing to clearing houses such as MedAvant and ZirMED using ANSI X12. Medical claim and accounts receivable are accomplished through SQL-Ledger, which has been customized. Calendar features include categories for appointment types, colors associated with appointment types, repeating appointments, and the ability to restrict appointments based on type. There is an advanced medical claim management interface, accounting for Explanation of Benefits entry, clearing house support for automated 835, customizable medical encounter forms, support for voice recognition software, electronic or scanned digital document management for records, and support for HL7 messages.”

System
Web-based PHP, MYSQL, APACHE

Features

  • Appointment Scheduling
  • Patient Registration
  • Payment and Insurance Tracking, Processing and Collecting
  • Charting and Record Keeping
  • Integration with Other Applications
  • Prescription Writing
  • Laboratory Tracking
  • Patient Check-In/Check-Out, Tracking and Handling

Notes

  • To gain access to a demo of OpenEMR on the official website, you’ll have to fill out a short form. Login/Password will be sent to you in 5 minutes, providing you access for a week.
  • I’ve seen much more developed OpenEMR systems. This version is very bare bones and lacks a supportive community behind it (i.e. forum). However, it does provide the bare minimum requirements to run an office.

openemrnet2.jpg

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[Last modified: 12/08/07]