April 14, 2003

First phase of system-wide electronic records completed

By Ron Sauder

Emory Healthcare (EHC) has reached the first milestone in a multiyear, multimillion-dollar project to achieve a system-wide, paper-free electronic medical record (EMR). The adoption of EMRs is a key goal for many of the country’s largest hospitals and health systems in their quest to improve quality of care, lower the incidence of medical errors, increase patient and provider satisfaction, and adopt standardized decision support and treatment pathways based on medical literature.

EHC began developing the infrastructure for the EMR in 1992. For the past several years, both inpatient and outpatient records have been entered, stored and retrieved electronically from the same underlying, secure database, said Dedra Cantrell, EHC chief information officer.

Now, all new patients are assigned a unique identifier that eliminates the need to re-enter the same information in different care settings. Cantrell said she believes Emory’s is the first large hospital system in the Atlanta area to achieve this degree of data integration for both inpatients and outpatients.

This system embraces patient data for Emory University Hospital, Crawford Long Hospital, The Emory Clinic, the Wesley Woods Center and will include the Emory Children’s Center, amounting to more than 40,000 inpatient admissions and 1.1 million outpatient visits a year.

Meeting this important milestone means that EHC is on target to implement system-wide computer-based physician order entry (CPOE) by December 2004, said William Bornstein, chief quality/medical officer for Emory Hospitals and medical director of information services for EHC.

“The Emory EMR system, which will include CPOE, and full outpatient and inpatient care systems, will allow us to capture real clinical data in the process of care,” Bornstein said. “We will be able to feed this clinical data into a common database that will allow us to do very robust analysis and reporting from a research- and patient-outcomes perspective. In this way, continual performance improvement and quality assurance will be built into the cycle of care.”

CPOE has been advocated by healthcare quality improvement organizations, which see it as a key step in minimizing errors. Not only does CPOE eliminate imprecise and incomplete communication between doctors, nurses and pharmacists, but it also provides real-time clinical decision support, which helps to reduce adverse drug events and other errors.

Bornstein noted that another important feature of this system will be the seamless capture and documentation of insurance and other administrative information, which increasingly occupies doctors’ and nurses’ time.

“Rather than technology interfering with the high-touch aspects of health care, we think technology will actually enhance it, by off-loading multiple documentation requirements, managed care formularies, and all those things that can interfere with the personal aspects of a patient encounter,” Bornstein said.

The end of all paper patient records at Emory in both the inpatient and outpatient setting will be an important milestone of what is projected as a $27 million program, launched in July 2002 and ending sometime in 2012.

“This is not about going electronic for the sake of going electronic. This is not about automating the paper medical record,” Cantrell said. “Although a byproduct will be elimination of the paper medical record, this initiative is really all about transforming care at Emory.”