1.  How to Successfully Navigate Your EHR Implementation

Author(s): Adler KG

Source: Family Practice Management. 2007 Feb;14(2):33-39. 2007 Feb;14(2):33-39.

Summary: This article identifies the three major do's and don'ts of electronic health record (EHR) system implementation and explores the application of these components.  The author characterizes these areas as "the three T's": team, tactics, and technology.  Each EHR implementation team should have a physician champion who motivates others, a skilled and collaborative project manager, broad stakeholder involvement, and specific, measurable goals.  Tactics to employ for a successful implementation include: design a balanced scanning strategy, utilize a phased implementation, lighten workloads when going "live" and for a short period afterward, and enter data into the EHR electronically as much as possible.  Having proper speed and high network availability and capability, maintaining a test environment to mirror the live environment in case of problems, utilizing expert information technology (IT) advice when it comes to servers and networks, maintaining servers, and having a disaster recovery plan in place are all technology issues to address for successful implementation.

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2.  Electronic Health Record Systems: the Vehicle for Implementing Performance Measures

Author(s): O'Toole MF, Kmetik KS, Bossley H, Cahill JM, Kotsos TP, Schwamberger PA, Bufalino VJ

Source: The American Heart Hospital Journal. 2005 Spring;3(2):88-93. 2005 Spring;3(2):88-93.

Summary: Advances in information technology and recent national directives have the potential to support dramatic improvements in health care. Two key components are the implementation of functional electronic health record systems and widely accepted, evidence-based clinical performance measures for physicians. Midwest Heart Specialists, a 55-physician cardiovascular group at 14 locations in northern Illinois, has utilized an outpatient electronic health record system since 1997. Since 2003, the group has integrated cardiovascular measurement sets developed by the American Medical Association-convened Physician Consortium for Performance Improvement into its electronic health record system. With this integration, the group was able to capture data needed for internal quality assessment and improvement as part of routine outpatient care without the need for additional resources. Critical disease-management data for decision support are available continuously, resulting in improvements in health care. The reporting of these standardized data could be the foundation to support quality-based reimbursement strategies and physician office-based disease-management strategies.

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3.  Using Diffusion of Innovation Concepts to Enhance Implementation of an Electronic Health Record to Support Evidence-Based Practice

Author(s): Geibert RC

Source: Nursing Administration Quarterly. 2006 Jul-Sep;30(3):203-210.

Summary: The article identifies the explosion of clinical data that are available and how difficult it is for clinicians to find answers to clinical questions. Electronic health records (EHRs) are used increasingly to assist clinicians in this process; however, resistance to the implementation of technology-assisted care is not uncommon. The article reviews the diffusion of innovation research and provides the nurse manager with suggestions for applying these concepts to enhance the implementation of an EHR that can support evidence-based practice. Five characteristics of innovations are discussed as they help explain different rates of adoption. These characteristics go under the acroynm TACOS: Trialability (Can we try this on a small scale first?), Advantage (Is this an important goal for our unit?), Compatability (Will the practice work in our environment?), Observability (Can we see the practice in action at another site?), and Simplicity (How big a change will this be?). The five-stage innovation-decision process is studied as it relates to EHR implementations.

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4.  A Proposal for Electronic Medical Records in U.S. Primary Care

Author(s): Bates DW, Ebell M, Gotlieb E, Zapp J, Mullins HC

Source: Journal of the American Medical Informatics Assocation (JAMIA). 2003 Jan-Feb;10(1):1-10.

Summary: Delivery of excellent primary care--central to overall medical care--demands that providers have the necessary information when they give care. This paper, developed by the National Alliance for Primary Care Informatics, a collaborative group sponsored by a number of primary care societies, argues that providers' and patients' information and decision support needs can be satisfied only if primary care providers use electronic medical records (EMRs). Although robust EMRs are now available, only about 5% of U.S. primary care providers use them. Recently, with only modest investments, Australia, New Zealand, and England have achieved major breakthroughs in implementing EMRs in primary care. Substantial benefits realizable through routine use of electronic medical records include improved quality, safety, and efficiency, along with increased ability to conduct education and research. Nevertheless, barriers to adoption exist and must be overcome. Implementing specific policies can accelerate utilization of EMRs in the U.S.

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5.  The Regenstrief Medical Record System: A Quarter Century Experience

Author(s): McDonald CJ, Overhage JM, Tierney WM, Dexter PR, Martin DK, Suico JG, Zafar A, Schadow G, Blevins L, Glazener T, Meeks-Johnson J, Lemmon L, Warvel J, Porterfield B, Warvel J, Cassidy P, Lindbergh D, Belsito A, Tucker M, Williams B, Wodniak, C

Source: International Journal of Medical Informatics. 1999 Jun;54(3):225-253.

Summary: Entrusted with the records for more than 1.5 million patients, the Regenstrief Medical Record System (RMRS) has evolved into a fast and comprehensive data repository used extensively at three hospitals on the Indiana University Medical Center campus and more than 30 Indianapolis clinics. The RMRS routinely captures laboratory results, narrative reports, orders, medications, radiology reports, registration information, nursing assessments, vital signs, EKGs, and other clinical data. In this paper, we describe the RMRS data model, file structures, and architecture, as well as recent necessary changes to these as we coordinate a collaborative effort among all major Indianapolis hospital systems, improving patient care by capturing city-wide laboratory and encounter data. Our success represents persistent efforts to build interfaces directly to multiple independent instruments and other data collection systems, using medical standards such as HL7, LOINC, and DICOM.  To prepare for the future, we have begun wrapping our system in Web browser technology, testing voice dictation and understanding, and employing wireless technology.