The document discusses key considerations for the successful implementation of electronic medical record (EMR) systems, emphasizing the importance of needs assessment, design, testing, and system functionality. It highlights common reasons for EMR failures such as poor communication and resistance to change, as well as essential questions to evaluate the effectiveness of the systems. The document advocates for a structured approach involving stakeholder involvement, independent evaluation, and ongoing support to enhance outcomes.

1. EMR Implementation
Considerations
Y. SINGH
NELSON R. MANDELA SCHOOL OF MEDICINE
DEPARTMENT OF TELEHEALTH
SINGHY@UKZN.AC.ZA
HIBBs is a program of the Global
Health Informatics Partnership
Content licensed under Creative Commons Attribution-Share Alike 3.0
Unported

2. Learning Objectives
 To give you an idea of how to assess the
value of a medical informatics solution
 Make you aware of some of the questions you
need to ask before rolling out any type of
electronic medical record system
 Points that will help ensure the successful
implementation of an medical informatics
solution

3. An Example
 Information systems too manage
medical information is beneficial
 Peter Littlejohns BMJ
2003;326;860-863
 Three quarters of information systems
fail
 Limpopo Province
 IBM 134 million rands

4. Why do EMRS Fail
 Poor communication
 Developers unaware of the environment
 No change management in place
 Perceptions (resistance to change)
 No support from government
 To high expectations

5. Essential Considerations
 Needs assessment
 Design
 Testing
 Implementation
 Functionality

6. Needs Assessment
 Most important part  directly results
in success or failure
 High end and sophisticated technology
is not always the correct solution
 Where are the developers from
 Workflow Analysis
 Actual vs perceived benefit
 Collecting data without analysis or
using it, is not beneficial to you

7. Design
 Ensure that you are fully involved
 Remember … you need to tell the
developer what you want
 Insist that the developer uses the
spiral development model
 Must take into account the
environment
 Flexible

8. Testing
 Testing must not be done in a lab
 Have a trial run of the system in the
actual environment with the full
participation of the developers
 Independent evaluator

9. System Functionality
 Comprehensiveness of information
 Does the system capture and store all the necessary
information
 Degree of structure of data
 Retrieval and analysis of the data
 Ubiquity of access
 Multiple read privileges

10. System Functionality
 Backups
 How are they done
 How often are they done
 Where is it stored
 What happens if the system fails
 Second system with essential functionality
 Paper based batch entry back-up
 Ease of use and flexibility

11. System Functionality
 Efficiency
 Robustness
 Add benefit to the clinical environment
 Security
 Confidentiality
 Integrity
 Privacy

12. System Selection
 Open source vs. commercial systems
 Actual costs
 Available support
 Small print

13. Implementation
 Phased rollout
 Training
 User support
 Finding champions
 Creating super users
 Celebrating successes and learning from
mistakes
 Adequate budget

14. Ask Questions
“Studies have shown that holding and
caressing animals can dramatically
speed a person’s recovery”

15. Important Questions
 Is there clinical need for the system?
 Do all the components function?
correctly
 Is it reliable?
 Is it accurate?
 Is it fast and accurate?
 Is the system well built?
 Are people likely to use it?

16. More Important Questions
 Which parts cause what effect?
 How can it be maintained?
 How can it be improved?
 Is the interface intuitive and easy to
use?
 Does it communicate effectively with
other components/hospital systems?
 Is it robust?

17. Thank You
HIBBs is a program of the Global Health
Informatics Partnership
www.ghip.net
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