impliment EMR

[xiphoid2010]

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Finishing up my PGY-1 residency, been offered very attactive pharmacy manager position at a small hospital. During the onsite interview, I loved the people there, but was a little shocked by the all paper system they used. Guess I'm spoiled by training only at paperless medical centers.

So if I take the job, the one of the things I want to do is get a basic EMR system going. I was wondering what are the options out there. Given a limited budget, what's a system that doesn't require a large upfront cost, yet still flexibile enough to interface with other functionalities later (e.g pyxis, CPOE, bar-code administration, etc).

I know a little bit about computers, so I could try gerry rig a wireless network and learn to build a MS access database with few basic functions that's accessible by MD, RN and Pharmacy. It'll be cheap, but don't know if that's going to run into HIPAA and other problems.... <sigh>

Any experience and info would be appreciated.

 

[nikkai]

I'm gonna selectively quote parts of your statement and answer accordingly.

I loved the people there, but was a little shocked by the all paper system they used. Guess I'm spoiled by training only at paperless medical centers. Welcome to 60-80% of the rest of America (last time I checked).

So if I take the job, the one of the things I want to do is get a basic EMR system going. I was wondering what are the options out there. Given a limited budget, what's a system that doesn't require a large upfront cost, yet still flexibile enough to interface with other functionalities later (e.g pyxis, CPOE, bar-code administration, etc). Why go after an EMR first? Less data to show cost savings/increase in patient safety compared to Pyxis, CPOE, Bar Code, eMAR... EMR just makes it easier for you OR a regulatory agency to audit you

I know a little bit about computers, so I could try gerry rig a wireless network and learn to build a MS access database with few basic functions that's accessible by MD, RN and Pharmacy. It'll be cheap, but don't know if that's going to run into HIPAA and other problems.... <sigh> So wait... you're going to store EMR in MS Access? Not a good idea... And why wireless? I am not quite sure what you're trying to do. And yes, you will definitely run into issues of patient data responsibilities

Any experience and info would be appreciated.

I would say this: Find out what the institution wants. Ask P&T/your DOP what the goals are. Ask other institution what they rolled out and how they did it. There's a ton of money out there right now for CPOE/bar code funding and many have started basic implementation. Don't reinvent the wheel if someone else has already done it. This is a massive project, and your best bet is to bring in the thought-leaders of your institution. And in the end, you'll need to justify why you're going to spend the oodles of money on the tech - b/c EMR is a luxury, not a necessity, IMHO. The others (CPOE etc) offer more cost-savings/increased safety.

 

[Its Z]

Implement not impliment.
Congrats on the job. Rule #1 on hospitalwide IT project including medication delivery system : Nursing and IT drive the project not some new hot shot fresh out of residency pharmacy manager. They will decide and choose the system and pharmacy will play an integral part in implementation. Don't walk into a new small hospital and start rocking the boat.

 

[Its Z]

Oh forgot to mention this project wont fly unless its in the capital investment budget for the fiscal year. If not, IT will have to add for next year which the board will have to approve. You ready to present this? Don't be surprised if they ask if the project has been approved by the med exec committee.

 

[type b pharmD]

I say go with barcoding for your first project. Likely to be cheap compared to full scale emr and will save you time money and patient safety will improve. Cheaper than going with full scale emr and falls more under your jurisdiction than a hospital wide overhaul of record keeping. We switched from nothing electronic to a barcoding system a few years back and it was fun being involved with, and it ended up savingg us significant labor hours when all was said and done although it came with its own set of issues

 

[xiphoid2010]

I say go with barcoding for your first project. Likely to be cheap compared to full scale emr and will save you time money and patient safety will improve. Cheaper than going with full scale emr and falls more under your jurisdiction than a hospital wide overhaul of record keeping. We switched from nothing electronic to a barcoding system a few years back and it was fun being involved with, and it ended up savingg us significant labor hours when all was said and done although it came with its own set of issues

Thank you for the invaluable input. As you can see, PGY-1 obviously doesn't prepare me with this kind of knowledge. I thought of EMR just because it was the most glaring difference I noticed, every patient I want to look up I have to hop over to the nursing station, hoping to find the chart where it was, and then try to decipher the unrecognizable MD hand writing. Thought that creates a lot of inefficiency and possible errors. But seems like you and Z are in agreement that this is likely something more than I can chew. Thank you very much for that.

They do need a bar code scanning system as well, the nurses are giving drugs based off of paper MARs, and hopefully to the right patient. I was horrified to hear that the nurses often miss antibiotics. At the VA where I was trained, the system prompts nurses when it's due. Would a bar-code system able to provide function such as this?

Looks like I came to the right place. Thank you for your input. And yes, you too, Z.

 

[spacecowgirl]

Check your state for grants for implementation - rural health or health disparity grants if you're not rural. It probably won't be enough to fully fund anything, but it always works for me to approach admin if I can bring some of "my" money to the table.

FYI - Epic is the best 😍

 

[deleted129840]

I know a little bit about computers, so I could try gerry rig a wireless network and learn to build a MS access database with few basic functions that's accessible by MD, RN and Pharmacy. It'll be cheap, but don't know if that's going to run into HIPAA and other problems.... <sigh>

Any experience and info would be appreciated.

Don't want to burst your bubble, but in no way should any application that is going to impact people's lives be designed by someone who "knows a little bit about computers." Call up IT or whatever passes for that at your institution.

Computer are fun and everyone should know a bit about programming. If you want to play around with computers, make up a fan page for your favorite band. Or write an application to print name tags for the local 5K run.

 

[xiphoid2010]

Don't want to burst your bubble, but in no way should any application that is going to impact people's lives be designed by someone who "knows a little bit about computers." Call up IT or whatever passes for that at your institution.

Computer are fun and everyone should know a bit about programming. If you want to play around with computers, make up a fan page for your favorite band. Or write an application to print name tags for the local 5K run.

I do realize that, it was just an thought. MS Access can be used within compliance of HIPAA, we used it (within department of pharmacy) where I did my residency, and it's easy enough to learn how to program for. We used it for tracking antibiotics stewardship and dosing, also non-formulary request/reviews. If it could be expanded to allow nursing and MD access, it could be made into a quasi CPOE/eMAR.

Again, I was just thinking out loud. Thanks for the input, I will likely go talk to whoever does IT there, but there is unlikely to be fully dedicated IT department there. Besides, the other two old guards already talked me into going for bar-code system first. 😀

 

[xiphoid2010]

Check your state for grants for implementation - rural health or health disparity grants if you're not rural. It probably won't be enough to fully fund anything, but it always works for me to approach admin if I can bring some of "my" money to the table.

FYI - Epic is the best 😍

yeah, Epic is good. That was the system at the hospital where I did my internship. VA has CPRS and BCMA, which while isn't as pretty lookin, but are great fully integrated paperless system. Alas, there is no way this hospital could afford Epic just like that. It will have to be a slow piece meal transition. But it will have to happen somehow, I think EMR is mandated by 2014/15.

 

[Its Z]

Bar coding is no different than EMR and CPOE. Pharmacy isn't the end user therefore you will not decide to implement this nor will you choose it for nursing. This also is a major financial investment for a hospital. We understand you have a job offer and you're excited but don't get ahead of yourself.

 

[type b pharmD]

Bar coding is no different than EMR and CPOE. Pharmacy isn't the end user therefore you will not decide to implement this nor will you choose it for nursing. This also is a major financial investment for a hospital. We understand you have a job offer and you're excited but don't get ahead of yourself.

ya. listen to Z about the implementation. I was gonna say this as well. My pharmacist had toget the entire executive board involved and it was not her decision so to speak, but she was able to convince them in the end that it would be a good idea.. but only because they had the money and were on board as far as spending.

Barcoding i would argue is slightly different at least compared to EMR, in that as a pharmacist you can likely present a case for its implementation that relates more to your pharmacy practice and med safety, and workflow/labor cost improvements. For us, the biggest benefit was not having to spend hours auditing/fixing all of the stupid mistakes that were made when nurses gave the wrong med. However, we ended up spending time fielding calls regarding why x or y med didnt scan properly, why nurses had to do overrides of the barcoding system, etc. But 3 years later, it is running smoothly and has saved everyone some headaches.

Quick tip to the OP.. start a personal or workplace log of serious med errors and incidents if they are not being logged effectively atm. If you can come to the board with a list of serious incidents that would have been preventable with some type of electronic system, you'll have a much better case. This is what my boss did. At one point, a handful of near-miss situations that could have resulted in patient death, as well as a situation that involved significant patient injury , were what she needed to make it a slam-dunk so to speak for the execs.

 

[xiphoid2010]

Thanks guys. I guess I am a little too excited. Thank you for the good advice. I do need time just to get to know the job, warm up to the people and establish a firm footing. Oh god, I have to learn to work in an all paper system. YIKES. 😱

 

[deleted129840]

I do realize that, it was just an thought. MS Access can be used within compliance of HIPAA, we used it (within department of pharmacy) where I did my residency, and it's easy enough to learn how to program for. We used it for tracking antibiotics stewardship and dosing, also non-formulary request/reviews. If it could be expanded to allow nursing and MD access, it could be made into a quasi CPOE/eMAR.

Again, I was just thinking out loud. Thanks for the input, I will likely go talk to whoever does IT there, but there is unlikely to be fully dedicated IT department there. Besides, the other two old guards already talked me into going for bar-code system first. 😀

I didn't mean to sound quite so snarky -- you should definitely keep looking for creative ways to improve your computer skills if your interests lie that way. Start with something small that you can set up on your own computer -- maybe something that you use to organize your own job that will produce a report that you can hand on to your boss. If your hospital has or will buy you Microsoft Project, that is a great thing to learn. You want to sit tight for a while until you have the lay of the land, then see if you can get involved in learning more about the medical informatics side, code sets, etc. A working pharmacist would be a great addition to the implementation team when a changeover to an EHR is contemplated.