Using an Evidence-Based Approach to EMR Implementation to Optimize Outcomes and Avoid Unintended Consequences.

Implementation of an electronic medical record (EMR) with computerized physician order entry (CPOE) can provide an important foundation for preventing harm and improving outcomes. Incentivized by the recent economic stimulus initiative, healthcare systems are implementing vendor-based EMR systems at an unprecedented rate. Accumulating evidence suggests that local implementation decisions, rather than the specific EMR product or technology selected, are the primary drivers of the quality improvement performance of these systems. However, limited attention has been paid to effective approaches to EMR implementation. In this case report, we outline the evidence-based approach we used to make EMR implementation decisions in a pragmatic structure intended for replication at other sites.

[1]  Y. Han,et al.  Han YY, Carcillo JA, Venkataraman ST, Clark RS, Watson RS, Nguyen TC, Bayir H, Orr RA. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics , 2011 .

[2]  Eric G. Poon,et al.  Research Paper: The Extent and Importance of Unintended Consequences Related to Computerized Provider Order Entry , 2007, J. Am. Medical Informatics Assoc..

[3]  Eric Widen,et al.  Computerized Physician Order Entry With Decision Support Decreases Blood Transfusions in Children , 2011, Pediatrics.

[4]  R M Gardner,et al.  Impact of CPOE on Mortality Rates – Contradictory Findings, Important Messages , 2006, Methods of Information in Medicine.

[5]  J. Benes,et al.  The impact of hospitalwide computerized physician order entry on medical errors in a pediatric hospital. , 2005, Journal of pediatric surgery.

[6]  Dean F. Sittig,et al.  Lessons From “Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System” , 2006, Pediatrics.

[7]  C. McDonald.  Protocol-based computer reminders, the quality of care and the non-perfectability of man. , 1976, The New England journal of medicine.

[8]  Jianhua Li,et al.  Theoretical, empirical and practical approaches to resolving the unmet information needs of clinical information system users , 2002, AMIA.

[9]  E. Balas,et al.  Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success , 2005, BMJ : British Medical Journal.

[10]  J. Heffner,et al.  Using intranet-based order sets to standardize clinical care and prepare for computerized physician order entry. , 2004, Joint Commission journal on quality and safety.

[11]  Y. Han,et al.  Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System , 2005, Pediatrics.

[12]  Gilad J. Kuperman,et al.  Synthesis of Research Paper: A Consensus Statement on Considerations for a Successful CPOE Implementation , 2003, J. Am. Medical Informatics Assoc..

[13]  Hagop S. Mekhjian,et al.  Implementation Brief: Key Attributes of a Successful Physician Order Entry System Implementation in a Multi-hospital Environment , 2002, J. Am. Medical Informatics Assoc..

[14]  Rainu Kaushal,et al.  To What Extent Do Pediatricians Accept Computer-Based Dosing Suggestions? , 2007, Pediatrics.

[15]  Maulik S Joshi,et al.  Getting the board on board: Engaging hospital boards in quality and patient safety. , 2006, Joint Commission journal on quality and patient safety.

[16]  Diane L. Seger,et al.  Viewpoint Paper: Tiering Drug-Drug Interaction Alerts by Severity Increases Compliance Rates , 2009, J. Am. Medical Informatics Assoc..

[17]  William R. Hersh,et al.  Viewpoint Paper: Who are the Informaticians? What We Know and Should Know , 2006, J. Am. Medical Informatics Assoc..

[18]  Christopher A. Longhurst,et al.  Rapid implementation of inpatient electronic physician documentation at an academic hospital. , 2012, Applied clinical informatics.

[19]  Paul J Sharek,et al.  The incidence of adverse events and medical error in pediatrics. , 2006, Pediatric clinics of North America.

[20]  A. Localio,et al.  Role of computerized physician order entry systems in facilitating medication errors. , 2005, JAMA.

[21]  C. Bailey.  Medication Errors and Adverse Drug Events in Pediatric Inpatients , 2002 .

[22]  Sterling T Bennett,et al.  Technical Brief: A Case for Manual Entry of Structured, Coded Laboratory Data from Multiple Sources into an Ambulatory Electronic Health Record , 2006, J. Am. Medical Informatics Assoc..

[23]  C. Longhurst,et al.  Impact of electronic medical record integration of a handoff tool on sign-out in a newborn intensive care unit , 2011, Journal of Perinatology.

[24]  Gary Frank,et al.  Improving physician communication through an automated, integrated sign-out system. , 2005, Journal of healthcare information management : JHIM.

[25]  Julie M. Fiskio,et al.  Real-Time Notification of Laboratory Data Requested by Users through Alphanumeric Pagers , 2001, AMIA.

[26]  Raymond E. Levitt,et al.  The effects of CPOE on ICU workflow: an observational study , 2003, AMIA.

[27]  D. Bates,et al.  Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. , 2003, Archives of internal medicine.

[28]  Jerald M. Jellison.  Managing the dynamics of change , 2006 .

[29]  David W Bates,et al.  Mixed results in the safety performance of computerized physician order entry. , 2010, Health affairs.

[30]  Christopher A Longhurst,et al.  An evidence-based approach to activating your EMR. , 2011, Healthcare informatics : the business magazine for information and communication systems.

[31]  S Andrew Spooner,et al.  Special Requirements of Electronic Health Record Systems in Pediatrics , 2007, Pediatrics.

[32]  Gideon Koren,et al.  Using a Preprinted Order Sheet to Reduce Prescription Errors in a Pediatric Emergency Department: A Randomized, Controlled Trial , 2005, Pediatrics.

[33]  Jeffrey S. Upperman,et al.  The Introduction of Computerized Physician Order Entry and Change Management in a Tertiary Pediatric Hospital , 2005, Pediatrics.

[34]  J. Feinglass,et al.  The epidemiology of prescribing errors: the potential impact of computerized prescriber order entry. , 2004, Archives of internal medicine.

[35]  D. Coplen.  Types of Unintended Consequences Related to Computerized Provider Order Entry , 2007 .

[36]  Thomas H. Payne,et al.  Viewpoint Paper: Viewpoint: Controversies Surrounding Use of Order Sets for Clinical Decision Support in Computerized Provider Order Entry , 2007, J. Am. Medical Informatics Assoc..

[37]  Matthew A. Eisenberg,et al.  Computerized Provider Order Entry Implementation: No Association With Increased Mortality Rates in an Intensive Care Unit , 2006, Pediatrics.

[38]  D. Bates,et al.  How can information technology improve patient safety and reduce medication errors in children's health care? , 2001, Archives of pediatrics & adolescent medicine.

[39]  J. Frankovich,et al.  Evidence-based medicine in the EMR era. , 2011, The New England journal of medicine.

[40]  Marc Berg,et al.  Viewpoint Paper: Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors , 2003, J. Am. Medical Informatics Assoc..

[41]  Joan S. Ash,et al.  Implementing computerized physician order entry: the importance of special people , 2003, Int. J. Medical Informatics.

[42]  L. Weed.  Medical records that guide and teach. , 1968, The New England journal of medicine.

[43]  Paul Sharek,et al.  Improved physician work flow after integrating sign-out notes into the electronic medical record. , 2010, Joint Commission journal on quality and patient safety.

[44]  Ervina Resetar,et al.  Implementing a Commercial Rule Base as a Medication Order Safety Net , 2003, AMIA.

[45]  Thomas H. Payne,et al.  Review Paper: Medication-related Clinical Decision Support in Computerized Provider Order Entry Systems: A Review , 2007, J. Am. Medical Informatics Assoc..

[46]  James D. Carpenter,et al.  Categorizing the unintended sociotechnical consequences of computerized provider order entry , 2007, Int. J. Medical Informatics.

[47]  Deena J. Chisolm,et al.  Moving from Good to Great in Ambulatory Electronic Health Record Implementation , 2010, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[48]  J C Russo,et al.  Medication error prevention by clinical pharmacists in two children's hospitals. , 1987, Pediatrics.