Use of more than one electronic medical record system within a single health care organization

T. Payne; J. Fellner; C. Dugowson; D. Liebovitz; G. Fletcher

doi:10.4338/ACI-2012-10-RA-0040

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2012; 03(04): 462-474
DOI: 10.4338/ACI-2012-10-RA-0040

Research Article

Schattauer GmbH

Use of more than one electronic medical record system within a single health care organization

Authors

T. Payne

¹Departments of Medicine, Health Services and Biomedical & Health Informatics, University of Washington, Seattle, WA
J. Fellner

²Department of Family Medicine, University of Washington, Seattle, WA
C. Dugowson

³Department of Medicine, University of Washington, Seattle, WA
D. Liebovitz

⁴Department of Medicine, Northwestern University
G. Fletcher

³Department of Medicine, University of Washington, Seattle, WA

Abstract

Summary

Healthcare organizations vary in the number of electronic medical record (EMR) systems they use. Some use a single EMR for nearly all care they provide, while others use EMRs from more than one vendor. These strategies create a mixture of advantages, risks and costs. Based on our experience in two organizations over a decade, we analyzed use of more than one EMR within our two health care organizations to identify advantages, risks and costs that use of more than one EMR presents. We identified the data and functionality types that pose the greatest challenge to patient safety and efficiency. We present a model to classify patterns of use of more than one EMR within a single healthcare organization, and identified the most important 28 data types and 4 areas of functionality that in our experience present special challenges and safety risks with use of more than one EMR within a single healthcare organization. The use of more than one EMR in a single organization may be the chosen approach for many reasons, but in our organizations the limitations of this approach have also become clear. Those who use and support EMRs realize that to safely and efficiently use more than one EMR, a considerable amount of IT work is necessary. Thorough understanding of the challenges in using more than one EMR is an important prerequisite to minimizing the risks of using more than one EMR to care for patients in a single healthcare organization.

Citation: Payne T, Fellner J, Dugowson C, Liebovitz D, Fletcher G. Use of more than one electronic medical record system within a single health care organization. Appl Clin Inf 2012; 3: 462–474

http://dx.doi.org/10.4338/ACI-2012-10-RA-0040

Keywords

Electronic health records - medical records systems - computerized

Full Text

References

References
1 Blumenthal D. Launching HITECH. N Engl J Med 2010; 362: 382-385.
2 Charles D, Furukawa M and Hufstader M. Electronic health record systems and intent to attest to meaningful use among non-federal acute care hospitals in the United States: 2008–2011. ONC Data Brief No. 1 February 2012. Office of the National Coordinator for Health Information Technology.
3 Committee on Data Standards for Patient Safety.. Key capabilities of an electronic health record system. Bethesda: The National Academies Press,; 2003
4 Payne TH. Architecture of clinical computing systems. In: Payne TH. (ed). Practical guide to clinical computing systems. Design, operations, and infrastructure.; Oxford: Elsevier: 2008
5 Snyder-Halpern R, Hoyman K. Clinical information system implementation. Challenges across two merged hospitals. Comput Nurs 2000; 18: 157-161.
6 Kuperman GJ. Health-information exchange: why are we doing it, and what are we doing?. J Am Med Inform Assoc 2011; 18: 678-682.
7 Clayton PD, Sideli RV, Sengupta S. Open architecture and integrated information at Columbia-Presbyterian Medical Center. MD Computing 1992; 9: 297-303.
8 Hermann SA. Best-of-breed versus integrated systems. Am J Health Syst Pharm 2010 Sep 67. 17 1406, 1408, 1410.
9 Bates DW and Gawande A. Improving safety with information technology. N Engl J Med 2003; 348: 2526-2534.
10 Bates DW, Leape LL, Cullen DJ. et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998; 280: 1311-1316.
11 Salanitro AH, Osborn CY, Schnipper JL. et al. Effect of patient- and medication-related factors on inpatient medication reconciliation errors. J Gen Intern Med 2012; 27: 924-932.
12 Nelson SJ, Zeng K, Kilbourne J, Powell T, Moore R. Normalized names for clinical drugs: RxNorm at 6 years. J Am Med Inform Assoc 2011; 18: 441-448.
13 Hamm RA, Knoop SE, Schwarz P, Block AD, Davis 4th WL. Harmonizing clinical terminologies: driving interoperability in healthcare. Stud Health Technol Inform 2007; 129 Pt 1 660-663.
14 Bouhaddou O, Warnekar P, Parrish F. et al. Exchange of computable patient data between the Department of Veterans Affairs (VA) and the Department of Defense (DoD): terminology mediation strategy. J Am Med Inform Assoc 2008; 15: 174-183.
15 Smith PC, Araya-Guerra R, Bublitz C. et al. Missing clinical information during primary care visits. JAMA 2005; 293: 565-571.
16 Stewart BA, Fernandes S, Rodriguez-Huertas E, Landzberg M. A preliminary look at duplicate testing associated with lack of electronic health record interoperability for transferred patients. J Am Med Inform Assoc 2010; 17: 341-344.
17 Weiner SJ, Barnet B, Cheng TL, Daaleman TP. Processes for effective communication in primary care. Annals of Internal Medicine 2005; 142: 709-714.
18 Federman AD and Keyhani S. Physicians’ participation in the physicians’ quality reporting initiative and their perceptions of its impact on quality of care. Health Policy 2011; 102: 229-234.
19 Goldberg HI, Tarczy-Hornoch P, Stephens K, Larson EB, LoGerfo JP. Internet access to patients’ records. Lancet 1998; 351: 1811.
20 Mandl KD, Kohane IS. Escaping the EHR trap –the future of health IT. N Engl J Med 2012; 366: 2240-2242.
21 David R. State health information exchange boards grapple with a dense thicket of policy questions. Healthc Inform 2012; 29 (18) 20-1.