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.

This article amplifies the emphasis on organizational workflow reignited by the Institute of Medicine reports on healthcare quality. The analysis of nursing workflow is central to understanding the power of technology to modify the fundamental constructs of nursing practice. The aim is to understand the evolution of nursing workflow and the concept of workflow from the management and computer science perspectives used in electronic health records and computerized provider order entry. The understanding of the workflow models within health information disciplines may improve the model of nursing workflow underlying the implementation of electronic health record systems. The article follows the Walker and Avant evolutionary method of concept analysis.

Selecting the right types and quantities of computers to support data entry to an inpatient Electronic Medical Record (EMR) can be challenging. In addition to software and hardware considerations, many other variables affect the decision including staffing levels, hospital workflows, and floor plans. Rush University Medical Center (RUMC) developed a tool to help identify the quantity of devices needed in a Patient Care Unit (PCU). RUMC successfully used the tool in selecting the quantity of devices needed for the implementation of a new EMR and Computerized Provider Order Entry (CPOE) system. This case study describes the use of the tool to determine quantities of PCU devices, the advantages and disadvantages of different types of computing devices for bedside documentation and areas that require special considerations in the selection of devices.

This article describes the conversion to electronic hospital notes at a large, multi-specialty group practice: Mayo Clinic in Rochester, Minnesota. Because of the size of the institution and the barriers to the adoption of electronic notes, the process was a gradual one that took several years. Making a convincing case for change to institutional leaders and maintaining their support was crucial to success. Equally vital was the careful investigation of user requirements and the development of software features that allowed providers to complete their notes quickly in the fast-paced hospital environment. Care providers discovered the value of having immediate access to legible hospital notes throughout the campus and from remote locations.

Understanding international approaches to certification of electronic medical records (EMRs) in an effort to achieve widespread meaningful use is particularly timely. Canada's 34,000 primary care doctors cover a population of 33 million in 13 jurisdictions. A recent survey suggested only 14 percent of Canadian doctors are utilizing EMRs in a clinically meaningful way. In order to accelerate EMR adoption, most jurisdictions have initiated EMR programs. The objectives of these programs are to 1.) certify EMRs to ensure they meet needs for high quality care delivery; 2.) provide funding for EMR acquisition, implementation and support; 3.) supply services to assist with EMR purchase and implementation; and 4.) measure adoption and impact of EMR use. In this article we review the impact of certification on the advancement of EMR use in Canada and discuss both the benefits that these programs have provided and the challenges that they have posed.

Quality of healthcare is a high priority for several years but there was no standard until recently. The standards body, HL7 released draft standard for Quality Reporting Document Architecture (QRDA) with an aim to develop an electronic data standard for healthcare information systems to use in communicating patient level quality measurement data across disparate systems. This standard would enable Healthcare providers those use Electronic Health Record (EHR) systems to generate Quality Reporting documents to be consumed by payer agencies such as Centers Medicare and Medicaid Services (CMS) replacing proprietary file formats that existed in this space previously, This paper discusses various features of this new standard, which promotes interoperability and easy adoption, the three categories proposed by the QRDA standard and their application in different contexts, measure sets and measures and finally the relationship of this QRDA standard to the HQMF (eMeasure) standard proposed by National Quality Forum (NQF) in collaboration with HL7 to standardize the Quality Measures across the healthcare landscape. This paper also provides high-lights on early adoption of QRDA standard by Centers Medicare and Medicaid Services (CMS) for their Physician Quality Reporting Initiative (PQRI) program.

It is widely understood why medical devices need to be regulated by the FDA and other governing bodies. However medical software does not typically require the same level of regulation. Currently the FDA is investigating whether one type of medical software, Medical Device Data Systems (MDDS), should require FDA clearance because of the potential risk they impose when interconnected with medical devices. Hospitals are looking to implement MDDS because the technology allows nursing staff to spend more time on direct patient care and reduces charting errors. This article will explore the FDA's proposal and will review the possible risks and provide a rationale for why MDDS should be regulated by the FDA and why MDDS vendors should have the right level of quality and risk management procedures in place to ensure that they are developing and bringing to market the safest products possible.

While the development of health information technology, particularly electronic health records (EHR), is a triumph for the advancement of healthcare, non-interoperable clinical data systems lead to fragmented communication and incomplete records. If interoperable HIT systems could be achieved integrated HIT could be leveraged to lessen medical errors, improve patient care and optimize epidemiological research. To understand the barriers to interoperability or health information exchange (HIE), we reviewed the literature on HIT and barriers to HIE. Our search yielded 492 articles, 25 meeting our inclusion criteria. In general, we found that the predominant barriers to HIE are need for standards, security concerns, economic loss to competitors, and federated systems. Research on interoperability is limited because most HIE programs are still in formative stages. More research is needed to fully understand interoperability of HIT, how to overcome the barriers to interoperability, and how to design HIT to better facilitate HIE.

Covered entities need to conduct risk assessments that cover the requirements of HIPAA, HITECH and Meaningful use, and create a process for steady and consistent mitigation of known gaps and vulnerabilities based on risk. Reducing risk of vulnerabilities of unauthorized access to your ePHI can be done via safeguards and controls, plus audits and monitoring. When reducing risk is outside of a covered entities control, audits and monitoring are required in order to demonstrate due diligence. Know where your ePHI is stored, where it is at risk, and take steps now to reduce or eliminate the risk. Encrypt vulnerable locations. Encrypt sensitive data. By doing so, you will be protecting your organization by reducing risk of breach of ePHI. Finally, don't forget what is sometimes considered to be the hardest part--documenting your compliance activities in order to demonstrate evidence of due diligence in and avoid major $$$$ penalties for negligence under the HITECH Act of 2009.