The Legalities of the Electronic Medical Record–Customizing the Vendor’s Product

Most EMR’s offer a series of templates that are customizable by the organization, whether it be a hospital, an office practice, or a clinic.  The templates are often specialty specific.  For example, a pediatrician’s product is going to include things like immunizations and growth charts but the cardiologists’s product is going to have other information critical to that area of medicine.  The important thing to keep in mind is that you want to be able to customize your product to suit your needs.  This is no small task, especially if your EMR is going to be used across a network of practice areas.

After our hospital administrators had chosen a vendor, we convened a group of clinicians from all six of the hospitals in our network. We had representation from all disciplines from all the hospitals.  The process began by having the vendor demonstrate the product to our large group.  This actually took quite a while, because as you might imagine, there was resistance and a lot of “It’ll never work” type of reaction. 

After we learned enough about the product to know what needed to be adapted for our organization we got to work on the customization process.  Our goal was to standardize the EMR for all six sites.  I’m an employee of Hospital A but theoretically, I should be able to walk into hospital B, C, or D and be able to document my patient care without skipping a beat.  In the end we had to compromise on several areas.  For example, on the nurse’s status board, which is an overview of the patient assignment, one can see the patient’s name, room number, date of birth, allergies, etc.  After the basics, there are sections that can be customized–do we want to see the patient’s  height/weight on the status board, the date of the last BM, the next time blood work is due, etc.  It was truly amazing to learn what was so important to each individual nurse.  It was quite a challenge to meet the needs of nurses across six hospitals, especially since some of the facilities are small community hospitals and others were large teaching institutions. Other areas of customization are found on the actual documentation screens.  For example, on our cardiovascular screen we have additional assessments that allow us to  document on procedure specific data, like cardiac catheterization or a pacemaker assessment.  Not all of the sites need these screens, so these menus are collapsible and only need to be accessed as necessary by the end-user. 

A 2006 study by the Department of Family and Preventative Medicine, University of South Carolina, found that institutions that had a  comprehensive EMR saw improved care and  a reduction in medication errors.  These improvements were found only among the facilities that had the ability to alter and customize their EMR and had a sysem that included decision support tools and reminders.  Other studies have found that it’s not so much the use of the EMR but rather the functionality of the EMR that makes the difference.  Dagraso, D. et al, in their article “Implementation of an Obstetrics EMR Module: Overcoming User Dissatisfaction” point out that trying implement a cumbersome EMR product that does not meet the end-user’s needs or meet his work-flow requirements will not be successful.  It can be safely assumed that documentation will be incomplete if it does not support the end-user.  We’ve all heard “if it wasn’t documented, it wasn’t done” since we began our careers. EMR vendors must be challenged to provide a product that enhances our practice rather than dictates it.  EMR users must insist on a package that is customizable, safe for the patient, and provides a way to document the patient’s story in a fluid fashion.  Unfortunately, I don’t think we’re there yet.