The barriers to developing a fully integrated, highly accessible, accurate, and secure electronic medical record (EMR) may seem as insurmountable as scaling Mt. Everest barefoot. Just as one challenge is resolved, another appears. The task is critical to efficient and effective patient care but the complexities of providing information management across the healthcare enterprise cannot be underestimated.

Amith Viswanathan, senior industry analyst for healthcare information systems at Frost & Sullivan (San Jose, Calif.), explains that the field of medical records has undergone a major transformation over the past five years as information systems (IS) vendors shift towards integrated, centralized systems capable of capturing, storing and retrieving data from a variety of sources.

“Literally 96 percent of all systems that are in place right now operate through a legacy network or some kind of in-house configured database, almost always at a department level,” says Viswanathan.

This scenario is likely to change as demands increase towards deployment of fully integrated, secure systems that capture data from all departments in a healthcare setting, and provide access to that data throughout the enterprise and beyond.

“The complexity of our patient care has increased significantly over the past 50 years, with more data elements than we’ve ever had to maintain before,” says Manuel T. Lowenhaupt, M.D., vice president at consulting firm Cap Gemini Ernst & Young (New York, N.Y.) “We have new pressures around efficiency and productivity, yet our typical hospital system has not fundamentally changed the way we record data in a medical record over the last 50 years.”

With the driving forces of increasingly complex patient care, and the need for effective, efficient care from providers, the days of a maintaining individual paper-based medical record filled with clipped-in single slips of paper are numbered.

“Radiology is probably the area that has advanced furthest in terms of electronic medical automation from a physician point of view,” continues Lowenhaupt. “Radiology has moved to being the leading specialty that uses dictation onto electronic media and digital tools in their daily work.”

Integration is critical to success
Historically, most hospitals began by adopting computerized records based on the function of a specific department. Clinical laboratory software was developed to address physician order functions and reporting of results. Pharmacy required a system that facilitates medication administration. Radiology embraced picture archiving and communications systems (PACS) to manage medical images and radiology information systems (RIS) to control patient information and workflow issues. The primary challenge involves smooth communication between all of those systems into a single source of information for all to use in the disease management process.

Please refer to the August 2002 issue for the complete story. For information on article reprints, contact Martin St. Denis