Electronic medical records are widely believed to reduce error, save money and improve patient safety by eliminating the paper trail. On Monday, the eRecord Extended Implementation Team, a group that oversees the implementation of medical software programs, informed 400 to 450 UR Medical Center community members about UR’s plans to implement an electronic medical record (EMR) system at Strong and Highland Hospital.

The implementation introduced eRecord to the URMC community on Monday during three events, two at Strong and one at Highland hospital. Presenters at the meeting included Chief Medical Information Officer David Krusch, Director of the eRecord project Dawn DePerrior and Northshore University’s Medical Advisor Medical Informatics Arnold Wagner.

‘This is the largest single IT project this medical center has ever done,” Krusch said in his opening remarks.

The orientations focused primarily on introducing a timeline of events for the next year for the implementation of the electronic record system. Patients will not be involved with the system until March 5, 2011 when Strong Hospital goes online. The Highland System will go online in October 2011.

During the meeting, Krusch showed URMC community members a comprehensive flowchart highlighting all the hospital departments that need to coordinate for effective patient care. Currently, each department has its own software that is not compatible with other departments. One example is when patients move from the emergency to an in-patient department. Information recorded on the emergency department computer system has to be re-entered into the new system, thus requiring the patient to have to repeat medical information entry, increasing the possibility for error, as information is potentially lost between departments.

Dr. Mark Taubman, acting CEO of URMC, went on to say that the project is a cornerstone of the University’s strategic plan for development.

‘EMRs really are not the future they are the present,” he said. ‘Almost 70 percent of U.S. hospitals are only two steps or less from deploying an integrated EMR.”

The American Reinvestment and Recovery Act funded $8 million of the $49 million project. Because of budgetary constraints, initially, the eRecord project will be limited to emergency, pharmacy, oncology and in-patient departments. Both hospitals will be on a single system, i.e. a person’s records will be available at both hospitals. URMC hopes to expand the system to all hospital departments as well as satellite its usage on URMC campuses.

After an 80-month process that led to completely eliminating paper records at NorthShore University, an EPIC system site in Chicago, Dr. Wagner spoke of patient safety success.

Recently, all patients on a recalled pharmaceutical drug were notified within four hours of the notification. Wagner credits electronic medical records with this timely response. Critics of the electronic medical records system worry about patient privacy and the security of personal information.
‘The privacy and security team has been front and center during this entire process,” DePerrior said in an interview. ‘The program will have several layers of security and will comply with HIPAA guidelines.”

The Health Insurance Portability and Accessibility Act is comprised of two parts a security rule and a privacy rule to protects patient personal health information.

The Health and Human Services Web site summarizes HIPAA’s privacy rule as providing ‘federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.”

It is enforced by the Office of Civil Liberties within the Department of Health and Human Services. Historically, HIPAA has suffered from under funding, confusing guidelines and lack of enforcement.

A 2005 study by the Agency for Health Research and Quality suggests that a major barrier to EMR implementation is a lack of clinician support.

According to DePerrior, the URMC project is 90 percent clinician-driven with doctors, nurses and technicians providing input at all stages of the project. She stressed that the implementation of eRecord will be a multi-step process that involves modifications of software, training of staff and optimizing the program even after the system goes live. Future challenges involve training the 9,000 employees from technicians to doctors at Strong and Highland to use the software in place of paper. Employees will need to be trained and pass a proficiency test in using the system before the 2011 launch.

Nationally, the Health Information Technology for Economic and Clinical Health Act (HITECH) involves a $20 billion investment in health information technology infrastructure and Medicare and Medicaid incentives. A portion of these funds will also be used to expand funding for the enforcement and expansion of HIPAA, but details are not yet available.

The U.S. population is covered by EPIC services with several hospitals planning to adopt the system. EPIC provides a series of workflow templates and models that can be customized to meet the individual needs of a department or medical center.

‘It [the software] provides standards with flexibility built around that.” DePerrior said. The Provider Advisor Committee, a 200-person UR team, unanimously chose EPIC as the best option in February.

Sahay is a member of the class of 2010.

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