Patient Safety is the key reason for the adoption of electronic medical records. Even though the health care industry has been able to raise considerable doubts about the cost savings and efficiency gains of EMRs, the patient safety components of EMRs have stayed a very powerful argument in support of their adoption.
101 tips for purchasing an EMR is just a scratch of the surface. Purchasing a new EMR can be very complicated and will have a long lasting effect on the service, quality, safety, efficiency, and finances of your practice. This table shows you the first segment of tips and questions to think about when you engage an EMR vendor.
The 101 tips are broken down into Support, Quality, Safety, Finance, and Efficiency. Some questions will have more or less relevance to your practice based on the size and electronic maturity of your environment.
Tips & Qs
Ensure work flow can be hard coded when necessary, and not hard coded when necessary
Having the ability to hard code fields (ensure a particular bit of information is required per field), is a major component of patient safety in the EMR. If fields are just free text, they tend to get all sorts of different data in the fields. At the same time, you will want to have specific fields that you can make into free text. Determining if your EMR can handle hard coding the work flow will take a pretty deep dive into the system. Make sure you set aside the time to do the diligence when you are evaluating a product.
You can move to population based medicine
Many aspects of patient care can be enhanced by a move to population based care. Even though it is possible to manage populations in paper environments, the EMR simplifies the management and cross data comparisons massively.
Safety is created by design
Patient Safety is not always inherently built into EMRs. You will often have to design safe procedures in the electronic environment. Don't take the EMR's original setup as the endpoint in safety.
Medication Reconciliation should be a simple process
Medication Reconciliation is a JCAHO requirement. It is also key to the Meaningful Use dollars. Your EMR should not only embrace the process, but make it easy to perform. Electronic medication lists and the ability to compare/contrast with outside ambulatory or inpatient sources will be necessary. You will also need a simple (probably paper, hopefully a portal) way to get the information to the patient outside your organization.
CPOE is important, but every EMR will have it.
How complex is CPOE to actually use?
Make sure adverse drug events reporting is comprehensive
Adverse drug event reporting is extremely important. Your EMR will need to be able to manage drug to drug, drug to allergy, etc.
Make certain drug interactions are easy to manage for the physician
Drug interactions need to be in the physicians face (e.g. a BIG popup that says their is an interaction), but make sure the physician can bypass the interaction checking easily when necessary. Also ensure that audits are available when a physician bypasses the interaction screens. It is always better to cover everyone's behind with audit logs, especially in a med-error case.
Ensure integration to other products is possible
It is rare to find a situation where the EMR is the one and only application being used in the facility. Typically numerous third-party applications are used to augment particular aspects of the EMR. You will want to ensure you can integrate (or at least interface) these systems together. Items like demographics, labs, rads, meds, etc will be essential to share between apps. Failure to integrate will mean the chance of error between systems will go up significantly.
Ensure information sharing is easy
Your safety strategies are heavily dependent on timely, easy to obtain, information. Look for an EMR that has easy to use sharing tools and options for putting your data into standard types that can be easily formatted.
Remember that the EMR is only part of the safety problem
The EMR won't wash your hands. Remember that your organization's safety strategies should include the EMR as a tool, not be reliant on the EMR as a silver bullet.
Errors should be easily reportable
Just like all of the other information, errors should be easy to get to and be very transparent. You shouldn't have to wait for month end, or employ an expensive IT guy just to get to medical error information. This information should be at the fingertips of all clinical leaders.
Use data to show both individual and system safety metrics
Another very common problem with EMRs is their inability to segment data. Make certain you can separate data by system and individual provider.
Record management in the EMR is just as important as in paper
Record management is a key to patient safety. Make sure your HIM teams can manage records in the EMR in a safe way.
Evaluate decision support tools for a fit to your needs
Decision support tools come in many varieties and types. They range from self-registration with pre-diagnosis to medication dosage tools. You will want to ensure that the decision support tools used in your EMR meet the needs and goals of your org. Many EMRs use third-party decision support toolsets. You will want to do a deep dive to ensure you are getting what you the salesman told you about.
Care coordination is much easier in an EMR and should be evaluated to be used
Care coordination is often difficult for patients to grasp. "You mean you are going to talk to each other when you manage my care? Aren't you doing that already?" -- I have heard that from patients already. Care coordination will be central to the future of patient centered medical homes. Your EMR needs to be able to take PCMH and specifically care coordination processes in mind. Look for Care plans and action plans within the notes or team notes.
Take advantage of E-Health tools
E-Health tools come in many shapes and sizes. The one common factor is they can be great patient safety enhancers. From Web enabled scales for CHF patients to iPhone programs that can perform sleep studies, you can keep a much closer eye on patients without having to actually be right next to them.
Make certain all caregivers know that logs are kept for any system overrides
Logs aren't just "to pin on someone" they tell people what happened. When something goes wrong everyone needs to know that you can go back in the system and do a root cause analysis. Many organizations want to downplay that they have logs of events, but I believe it is much better to make certain providers know they are there. That way providers can ask for traces from the system when they want to discover what happened in a given process for a given patient. Logs can often be a primary system for learning and fixing and discovering issues within the system.
Give caregivers the ability to override the system when necessary
Often times EMRs are setup with certain safety checks to ensure certain actions are not taken. This is an important safety model, but it is also important that the providers be able to override those checks when necessary. The EMR program can't take every single possibility into account so it must have the capability to give providers and caregivers the final word on care, not the program. Just make sure you have logging when the provider overrides the system so that you can address the issue later.
Develop a root cause analysis process for the EMR
You very likely already have a root cause analysis model for your practice. You will need to adopt that model to the EMR. If you don't, you will create a likelihood for the same errors to continually repeat. The EMR process is different than a usual root cause analysis. You will need to take into account interfaces, security roles, single sign on, and several other things beyond the "simple" human process.
Data collaboration is key to patient safety
Whether it is a state Health Information Exchange, or making information move within your own organization, data collaboration is key to patient safety. Make certain that your specialty clinics are notified when patients have Urgent Care or Emergency visits, make certain that data can flow between your systems seamlessly so providers don't need to look it up in multiple systems. Simple data flow is a huge safety area. The biggest key is to make sure specialists are notified when there are changes in their patients, and to make sure all of the clinical data is available in one place.