The barriers to electronic medical record systems and how to overcome them

Abstract

Institutions all want electronic medical record (EMR) systems. They want them to solve their record movement problems, to improve the quality and coherence of the care process, to automate guidelines and care pathways to assist clinical research, outcomes management, and process improvement. EMRs are very difficult to construct because the existing electronic data sources, e.g., laboratory systems, pharmacy systems, and physician dictation systems, reside on many isolated islands with differing structures, differing levels of granularity, and different code systems. To accelerate EMR deployment we need to focus on the interfaces instead of the EMR system. We have the interface solutions in the form of standards: IP, HL7/ASTM, DICOM, LOINC, SNOMED, and others developed by the medical informatics community. We just have to embrace them. One remaining problem is the efficient capture of physician information in a coded form. Research is still needed to solve this last problem.

Figure 1

Web browser display of RMRS patient data showing EKG measurement and diagnoses as well as links to the full tracing which can be viewed by clicking on the icons at the bottom of the figure.

Figure 2

Pocket rounds reports contain problems, action, allergies, orders, lab tests, vital signs, and weight in flow sheet format with brief impression of imaging studies.

Figure 3

Physician carrying pocket rounds in typical configuration.

Figure 4

Radio-linked portable computers on a rolling IV pole stand used for gathering nursing assessments on a regular basis, and physician's notes on an experimental basis.

Figure 5

Illustration of the islands of data created as a patient traverses the care system.

Figure 6

Vase/faces illusion. A question of focus.