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[E182]Electronic Medical Records Implementation
by Peter Polack, Pet

So often I hear the question, "Why is it taking you so long to implement your EMR?" It is true that our scheduled eighteen month project did actually take three years in order to implement. However, although our gingerly approach seemed overly cautious to some of our associates, Project Management professionals commended our attention to care. The fact that about half of all IT systems implementations projects fail is known quite well. A strong plan is essential for success, and must account for significant changes of circumstance and other barriers to completion along the way.

Your EMR systems vendor will be able to refer you to someone who can help guide you through the implementation process. This person may be someone who knows about the electronic medical records system, or someone with experience rolling out Internet Technology projects at medical offices.

I'd recommend hiring on a certified project manager to handle this critical task. A professional project manager can transform your project into a resilient process which can adapt to multiple delays and setbacks. Standard project scheduling can't really do much in the way of accomplishing this. The primary advantage of using a work breakdown structure is that any glitches that pop up don't completely ruin your goal to successfully implement the EMR system. Of course, at a small practice there is more schedule flexibility. A hard deadline should most certainly be set, as part of the plan for EMR roll-out. However, with a proper plan structure your plan can roll on with the punches instead of simply rolling over.

We first implemented a Project Manager to plan the location for our new office. Our employees could use what was learned from the process, which includes how to use mind-mapping software. We have used these techniques for all major projects at our practice since then, including implementation of the electronic medical records (EMR). When we finally arrived a a place when staff had training, we posted the hard deadline to go live. There was a simulation date on a Saturday which occurred two days before launch; both dates were mandatory to attend. Although theoretically we could have pushed the launch date back, these dates helped to keep us working together and exposed risks that were faced. Now we're about 5 months into our roll-out. The stress levels have begun to settle a bit, and we're now tweaking our templates and getting ready for the next wave of patients to introduce to electronic medical records.

So, although people may wonder when you'll finally get around to implementing the electronic medical records system, at least you'll know that you have the best possible chances for a successful implementation when the time is right. This is the most important result, and the plan should be flexible in order to eventually arrive at this conclusion. Remember, hiring a certified Project Manager on from the start, to develop a resilient plan that accounts for unexpected hurdles, is the most important factor in making sure that your EMR implementation is a success.


For years controversy has surrounded whether electronic medical records (EMR) would lead to increased patient safety, cut medical errors, and reduce healthcare costs. Now, researchers at the University of Pennsylvania School of Medicine have discovered a way to get another bonus from the implementation of electronic medical records: testing the efficacy of treatments for disease.

In the first study of its kind, Richard Tannen, M.D., Professor of Medicine at the University of Pennsylvania School of Medicine, led a team of researchers to find out if patient data, as captured by EMR databases, could be used to obtain vital information as effectively as randomized clinical trials, when evaluating drug therapies. The study appeared online last week in the British Medical Journal.

Our findings show that if you do studies using EMR databases and you conduct analyses using new biostatistical methods we developed, we get results that are valid,? Tannen says. ?That's the real message of our paper ? this can work.

In January 2009, President Barack Obama unveiled plans to implement electronic medical records nationwide within five years, arguing that such a plan was crucial in the fight against rising health care costs. Of the nearly $900 billion in Obama's planned stimulus package currently before the United States Senate, $20 billion is proposed for electronic health records.

Tannen says he and his group recognized that the large EMR databases containing compiled medical information could potentially give researchers the ability to study groups reflective of the total population, not just those who participate in clinical trials, and circumvent studies too costly or unethical for clinical trials. However, such databases contain observational information, which critics argue do not offer the same level of control as randomized trials.

"Our study cautiously, yet strongly, suggests that enormous amounts of information within electronic medical records can be used to expand evidence of how we should or shouldn't manage healthcare," Tannen says.

To address criticisms of observational studies, Tannen's group had to first determine a way to use EMR databases for insights on therapy efficacy and then prove the results they found were valid.

Beginning six years ago, Tannen's team selected six previously performed randomized trials with 17 measured outcomes and compared them to study data from an electronic database -- the UK general practice research database (GPRD), which included the medical records of roughly 8 million patients. Treatment efficacy was determined by the prevalence of cardiovascular outcomes, such as stroke, heart attack and death.

After using standard biostatistical methods to adjust for differences in the treated and untreated groups in the analysis of the database information, Tannen found that there were no differences in the database outcomes compared to randomized clinical trials in nine out of 17 outcomes.

In the other eight outcomes, Tannen's group used an additional new biostatistical approach they discovered that controlled for differences between the treated and untreated groups prior to the time the study began. By using the new biostatistical method instead of the standard approach, the researchers showed there were no differences between the outcomes in the EMR database study compared to the randomized clinical trials.

Though Tannen warns the ability to use EMR databases from the United States to measure the efficacy of therapies will take more than 10 years of national data, he says the results of his study should serve as a catalyst for more researchers to explore the accuracy of the information that can be obtained using EMR database studies.

"An appropriately configured EMR database could offer an invaluable tool, but we need to get to work now on how to configure it properly," Tannen says. "If we don't worry about this issue right now and promote a higher investment in the area of EMR research, we'll lose an opportunity, an enormous health opportunity."

Mark Wiener and Dawei Xie from Penn are co-authors on this study. This research was funded by a grant from the National Institutes of Health.
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Both Peter Polack & Tawana Wall are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Peter Polack has sinced written about articles on various topics from Wedding Photography, Computers and The Internet and Information Technology. Peter J. Polack, M.D., F.A.C.S., is founder of emedikon, a medical practice management consulting firm and president of Protodrone, a software development company specializing in medical practice applications. He is managing partner of Ocala Eye, a large. Peter Polack's top article generates over 5400 views. to your Favourites.

Tawana Wall has sinced written about articles on various topics from Attracting Mate, Cars and Credit Check. For more information about ,
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