EMR hits bumps on road to reality

The elusive electronic medical record (EMR) isn't pure hype, but it hasn't become reality either, an audience at the HIMSS meeting learned Tuesday.

"The EMR is a plausible idea that needs a lot of hard work to become a reality," said Karen J. Ondo, retired CIO of North Broward Hospital District (NBHD) in Pompano Beach, FL.

The problem is EMR projects have eluded their own success for the past 25 years, she said. Even in its most simple incarnation, the EMR is complicated and multidimensional. It requires a serious, sustained commitment of human resources, process engineering, technology, and money.

At the macro level, some believe that only legislation can inspire an EMR that is truly shared across the nation. Yet much can be done at the micro level to implement an EMR within an individual organization.

"This is a journey, and we are only at the beginning," Ondo said. "There is no doubt that once EMRs are readily accessible the practice of medicine will not be the same."

She admitted, however, that the Health Insurance Portability and Accountability Act (HIPAA) has stimulated several social issues that must first be resolved:

?Who "owns" the EMR versus who "holds" it?
?What policy and procedures must be in place to ensure privacy?
?Are there really technical solutions to data security?
?Will privacy and security demands impede EMR use?

NBHD, which began its EMR journey in 1996, first felt the hype, in the form of $16.2 million in get-the-job-done funding. Momentum from initial enthusiasm pushed the project onto a six-month fast track.

Then came the reality.

First, the district hit the Y2K sinkhole. Soon after came technology speed bumps (device issues, interfaces, fat client or thin client questions, relational database design, file optimization, hardware scalability, growth), functionality issues (access, technology adoption rate, ROI, match and tag logic of data feeds), and other surprises.

NBHD persisted in spite of these challenges and now views its accomplishments to date with pride. The district measures its progress not only from a technological perspective but also using the system's adoption rate, especially by physicians.

"Today, NBHD's EMR strategy includes such things as PDAs, physician order entry, document management, emergency and ICU documentation automation, and PACS," Ondo said.

Future interfaces and data feeds include ECGs, stress lab, physician credentialing, labor and delivery, medical records workflow, and imaging.