Life After a Disastrous Electronic Medical Record Implementation

2011 ◽  
pp. 153-168
Author(s):  
Karen A. Wager ◽  
Frances Wickham Lee ◽  
Andrea W. White
Keyword(s):  
United States ◽  
Primary Care ◽  
Family Medicine ◽  
Medical Record ◽  
Electronic Medical Record ◽  
The Other ◽  
Negative Experience ◽  
System Failures ◽  
The Impact ◽  
New System

The majority of users of an Electronic Medical Record (EMR) at a family medicine clinic located in a small city in the western United States are currently quite dissatisfied with the system. The practice experienced a disastrous implementation of the EMR in 1994 and has not recovered. Although the level of dissatisfaction varies among the practice employees, several influential physicians are pushing to “pull the plug” and start over with a brand new system. The authors of this case studied this practice during a more comprehensive qualitative study of the impact of an EMR system on primary care. The practice’s negative experience was particularly noteworthy, because the other four practices in the larger study were satisfied with the EMR system. As with most system failures, there are multiple organizational and other factors that have contributed to the frustrations and dissatisfactions with the use of EMR within this practice.

Life After a Disastrous Electronic Medical Record Implementation

2011 ◽  
pp. 153-168 ◽  
Author(s):  
Karen A. Wagner ◽  
Frances Wickham Lee ◽  
Andrea W. White
Keyword(s):  
United States ◽  
Primary Care ◽  
Family Medicine ◽  
Medical Record ◽  
Electronic Medical Record ◽  
The Other ◽  
Negative Experience ◽  
System Failures ◽  
The Impact ◽  
New System

The majority of users of an electronic medical record (EMR) at a family medicine clinic located in a small city in the western United States are currently quite dissatisfied with the system. The practice experienced a disastrous implementation of the EMR in 1994 and has not recovered. Although the level of dissatisfaction varies among the practice employees, several influential physicians are pushing to pull the plug and start over with a brand new system. The authors of this case studied this practice during a more comprehensive qualitative study of the impact of an EMR system on primary care. The practices negative experience was particularly noteworthy, because the other four practices in the larger study were satisfied with the EMR system. As with most system failures, there are multiple organizational and other factors that have contributed to the frustrations and dissatisfactions with the use of EMR within this practice.

Life After a Disastrous Electronic Medical Record Implementation

2011 ◽  
pp. 285-300
Author(s):  
K. A. Wagner
Keyword(s):  
United States ◽  
Family Medicine ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Western United States ◽  
Small City ◽  
Medicine Clinic

This case describes how a majority of users of an Electronic Medical Record (EMR) at a family medicine clinic located in a small city in the western United States are currently quite dissatisfied with the system. The practice experienced a disastrous implementation of the EMR in 1994 and has not recovered.

scholarly journals Assessing the impact of a primary care electronic medical record system in three Kenyan rural health centers

2015 ◽  
Vol 23 (3) ◽  
pp. 544-552 ◽  
Author(s):  
William M Tierney ◽  
John E Sidle ◽  
Lameck O Diero ◽  
Allan Sudoi ◽  
Jepchirchir Kiplagat ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Health Centers ◽  
Hiv Care ◽  
Record System ◽  
Time Motion ◽  
Public Health Reporting ◽  
The Impact

Objective Efficient, effective health care requires rapid availability of patient information. We designed, implemented, and assessed the impact of a primary care electronic medical record (EMR) in three rural Kenyan health centers. Method Local clinicians identified data required for primary care and public health reporting. We designed paper encounter forms to capture these data in adult medicine, pediatric, and antenatal clinics. Encounter form data were hand-entered into a new primary care module in an existing EMR serving onsite clinics serving patients infected with the human immunodeficiency virus (HIV). Before subsequent visits, Summary Reports were printed containing selected patient data with reminders for needed HIV care. We assessed effects on patient flow and provider work with time-motion studies before implementation and two years later, and we surveyed providers’ satisfaction with the EMR. Results Between September 2008 and December 2011, 72 635 primary care patients were registered and 114 480 encounter forms were completed. During 2011, 32 193 unique patients visited primary care clinics, and encounter forms were completed for all visits. Of 1031 (3.2%) who were HIV-infected, 85% received HIV care. Patient clinic time increased from 37 to 81 min/visit after EMR implementation in one health center and 56 to 106 min/visit in the other. However, outpatient visits to both health centers increased by 85%. Three-quarters of increased time was spent waiting. Despite nearly doubling visits, there was no change in clinical officers’ work patterns, but the nurses’ and the clerks’ patient care time decreased after EMR implementation. Providers were generally satisfied with the EMR but desired additional training. Conclusions We successfully implemented a primary care EMR in three rural Kenyan health centers. Patient waiting time was dramatically lengthened while the nurses’ and the clerks’ patient care time decreased. Long-term use of EMRs in such settings will require changes in culture and workflow.

SCENARIOS FOR AN EXPANDING DEMAND OF TOURISM ON THE COASTS OF CUBA

2017 ◽  
Author(s):  
Oscar Gutiérrez-Bolívar ◽  
Oscar Gutiérrez-Bolívar ◽  
Pedro Fernández Carrasco ◽  
Pedro Fernández Carrasco
Keyword(s):  
United States ◽  
The Other ◽  
Sudden Increase ◽  
Tourist Destination ◽  
Other Hand ◽  
The Usa ◽  
The Impact

The opening of relationships between United States and Cuba could be a drive for a huge increase in the affluence of tourism to Cuba and especially to the coast areas. Cuba has been for many years an important tourist destination for people from many countries, but almost forbidden for US citizens. The proximity of the USA, its amount of population as well as their great acquisition power will increase in a very substantial way the demand for accommodation and other uses in the proximity of the coasts. There will be a need to implement a package of measures that reduce the impact of such sudden increase in the coastal line. On the other hand that augment in tourism could be an opportunity to improve the standard of life of Cubans. The consideration of different possibilities of such development, the analysis of the damages that each one could cause as well as the measures that could avoid, ameliorate or compensate such effects are the goals that are going to be presented in this paper.

scholarly journals Adult Learning Principles and Peer Delivery Improve Satisfaction of Electronic Medical Record Onboarding Education

ACI Open ◽  
2020 ◽  
Vol 04 (02) ◽  
pp. e114-e118
Author(s):  
Joanna Lawrence ◽  
Sharman Tan Tanny ◽  
Victoria Heaton ◽  
Lauren Andrew
Keyword(s):  
Adult Learning ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Junior Doctors ◽  
Free Text ◽  
Organizational Safety ◽  
Adult Learning Principles ◽  
Learning Practices ◽  
Learning Principles ◽  
The Impact

Abstract Objectives Given the importance of onboarding education in ensuring the safety and efficiency of medical users in the electronic medical record (EMR), we re-designed our EMR curriculum to incorporate adult learning principles, informed and delivered by peers. We aimed to evaluate the impact of these changes based on their satisfaction with the training. Methods A single site pre- and post-observational study measured satisfaction scores (four questions) from junior doctors attending EMR onboarding education in 2018 (pre-implementation) compared with 2019 (post-implementation). An additional four questions were asked in the post-implementation survey. All questions employed a Likert scale (1–5) with an opportunity for free-text. Raw data were used to calculate averages, standard deviations and the student t-test was used to compare the two cohorts where applicable. Results There were a total of 98 respondents in 2018 (pre-implementation) and 119 in 2019 (post-implementation). Satisfaction increased from 3.8/5 to 4.5/5 (p < 0.0001) following implementation of a peer-delivered curriculum in line with adult learning practices. The highest-rated factors were being taught by other doctors (4.9/5) and doctors having the appropriate knowledge to deliver training (4.9/5). Ninety-two percent of junior doctors were motivated to engage in further EMR education and 90% felt classroom support was adequate. Conclusion EMR onboarding education for medical users is a critical ingredient to organizational safety and efficiency. An improvement in satisfaction ratings by junior doctors was demonstrated after significant re-design of the curriculum was informed and delivered by peers, in line with adult learning principles.

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