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The Electronic Medical Record at the University of Illinois Medical Center – Ten Years of Progress
by Jim Di Giorgio
A goal being pursued by almost every healthcare organization is the implementation of some form of an electronic medical record (EMR). On a daily basis, the healthcare press writes about the effort to replace the longstanding paper record with ‘bits and bytes’. Estimates report that less than fifteen percent of hospitals have achieved this goal, however many more are engaged in considering adoption of an EMR. The US Government is strongly encouraging the adoption of an electronic medical record as a top priority to improve the quality and cost effectiveness of the nation’s healthcare system. The government itself is spending ever increasing sums on research, development and implementation of EMR projects such as the VISTA system which is an EMR system for the Veterans Administration. In the Chicago area, one of the organizations with a long history of including leading edge technologies as part of their pursuit of an electronic medical record is the University of Illinois Medical Center (UIMC). According to Patricia Cunningham-Brooks, RHIA Director of Health Information Management and Privacy Officer at UIMC, "UIMC embarked on its EMR efforts back in 1997." She continued outlining the various progressive steps UIMC has taken over the years toward the goal of having an EMR. "We implemented the capability to do direct note entry in 1997. In 1998 we began interfacing ancillary results such as lab, pathology, radiology, EKG, into the electronic record. In 1999 UIMC added CPOE, computerized physician order entry, for inpatients. In 2001 we included a transcription interface for dictated reports. More recently we have implemented nursing documentation and an upgraded document imaging system (2004)." As the next step in their march toward an electronic medical record, the University of Illinois Medical Center recently initiated a new effort to put online all the documents related to an inpatient stay. Ms. Cunningham-Brooks described the current effort, "As of January 1, 2006, all paper documentation for inpatient discharges is being scanned. The goal of the project is to make available on-line all the paper documents relating to a patient’s inpatient stay. We currently scan paper documentation from the ER, Surgi-center and Centers. At the University of Illinois Medical Center we now achieve automation for the medical record through interfaces with ancillary systems, transcribed notes, direct note entry and document imaging. The inpatient chart was the final piece of the puzzle that got us there in terms of 100% of patient documentation being available online." She continued, "The scope of the project also includes scanning identification cards and insurance cards at the point of registration and scanning finance documents such as ABNs and referral forms."
eMedicalRecords.org
Planning for the 2006 scanning project began in 2004 when the then existing document imaging system at the time was no longer supported by the vendor. The first major step was to design and plan the conversion and import of the 25 million existing images into the new system. The second largest task was forms standardization. Every one of the over 200 forms used in the institution was reviewed and bar-coded. Bar-coding assists in matching the document correctly in the EMR to the document type and patient. The planning process also developed a roadmap for progressing from the current to the future state, including building and testing the system as well as training the staff which involved major workflow changes. Planning and implementing the project was a collaborative effort among multiple departments including HIM, Information Services, organization leadership, medical staff committees, and representatives from ancillary departments, Materials Management and the forms vendor. Commenting on this scope of this undertaking, Mrs. Cunningham-Brooks said, "For a project of this magnitude to be a success, you must ensure that the major stakeholders are involved. When an institution embarks upon automation it is important that the leaders of the organization support the effort and make it an organization wide priority and the University of Illinois Medical Center leadership has done that." Reaction of the clinical staff to this project has been overwhelmingly positive according to Mrs. Cunningham-Brooks. Clinicians were involved in providing suggestions on note types and the flow of the documentation once it is scanned into the EMR. She comments, "It is critical that the clinical user understand how to get to the information and that it makes sense from a patient care perspective."
Regarding the impact of the project on the organization, Mrs. Cunningham-Brooks reports, "The benefits range from time savings for the clinical user, to more information available sooner which improves clinical decision making, and more information available to the organization to meet JCAHO and other regulatory requirements. We no longer order chart folders, labels or chart inserts. While the HIM Department has experienced a reduction in staff, I have to caution organizations in assuming that a large reduction will occur in HIM. What actually occurs is a shift in the skill set required? For instance we no longer required file clerks because there was no paper to file. However, the FTE compliment in the imaging section went from 12 FTEs to 19 FTEs. No additional personnel were hired, but FTEs were shifted from the filing section to the imaging section." Looking at the future of electronic medical records in U.S. healthcare institutions, Mrs. Cunningham-Brooks says, "It is not a matter of ‘if’ but ‘when’. You find more and more incentives for having an EMR from third party payers and the federal government is supporting numerous task forces to look at functionality and standardization in using the EMR." "I believe that strategically organizations have to decide where, from and EMR perspective, they want to be in five years, and in ten years and then plan for that goal. Long range planning is critical to success, planning for a moment in time can lead to disastrous results in the short and long term. Also, infrastructure is critical. The investment in equipment to manage the EMR is probably the most important piece. Imaging what importing 25 million images can do to performance if adequate storage has not been planned. Having everything on-line is not effective when it takes five minutes to view a result or a progress note." Mrs. Cunningham-Brooks concluded, "At the University of Illinois Medical Center the future holds further automation including Emergency Room documentation, PACS, surgery documentation and CPOE in outpatient among others."
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Patricia Cunningham-Brooks is the Director of Health Information Management and Privacy Officer at The University of Illinois Medical Center. She can be reached at (312) 996-2271 or pcunning@uic.edu |
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