TAKING MEDICAL RECORDS INTO THE DIGITAL AGE

Solving traditional system challenges with OpenEMR

Traditional, paper-based medical record systems fail to keep up with the increasing demands placed on a healthcare industry already burdened by a growing and aging populations. Electronic Medical Record (EMR) systems promise to help fix these problems. In this article we examine the disadvantages in using traditional medical record systems and explore various open source medical record systems and how they handle the most pressing issues in data storage, maintenance, and security. We conclude by installing, configuring, and using the OpenEMR medical record system.

Introduction

With a growing population and an increase in the number of patients, the pressure on doctors and hospital staff has increased drastically in the last decade. It has become very difficult for a physician to track a patient’s medical history (including past visit information, lab results, previous medications, and drug allergies) through a traditional system. It is not uncommon for patients to have labs repeated because of improper lab records.

The solution is an Electronic Medical Record (EMR) system that allows doctors to find and store information instantly. This technology has changed the patient-physician relationship dramatically over the last several years. An EMR system helps physicians and hospitals function in a smoother, safer, and more secure manner, allowing hospital personnel to retrieve and update the information of any patient with a click of a button. The doctors and administration can then concentrate more on the patient’s problem than on the patient’s records and administrative tasks.

An EMR system promotes the evolution of healthcare transactions from an inefficient, paper-based system to a more reliable, real-time paperless system. Transcription cost, dictation time, manual note taking, and prescription writing are virtually eliminated. It can allow the physician to be more efficient, and can help them offer much better service to more patients.

With open source software solutions readily available, you can easily use the EMR system to overcome the traditional system’s challenges. Most of the EMR systems comply with HIPAA standards, thus reducing medical errors and ensuring data privacy and security.

Traditional methods in medical record systems

In a traditional medical record system, the patient’s information is stored in one of two ways:

  • Paper-based system: Every test, medication, and visit for a patient is manually recorded on paper. These records are called charts. Each division of the hospital has its own set of records.
  • File system: The complete patient record is maintained in a single file on the computer.

Challenges with a traditional system

Security of the data is the main concern in the traditional systems. With growing population and exchange of huge medical data, the need for stronger security systems increased. Now let’s examine some of the major challenges when using the traditional system.

Slow data exchange: Data is exchanged mainly through calls, fax, or mail. For every lab test and every medicine prescribed, the doctor has to pass the information to an administrative assistant who in turn informs the pharmacy or the laboratory. Then the assistant notifies the patient. When the prescription or the test results are ready, the pharmacy or laboratory informs the assistant who in turn notifies the patient — a slow and error-prone process.

Scattered patient data: The patient’s records are maintained in charts at various locations. The hospital administration updates its copy of patient records when the patient visits them; similarly, all the laboratories and pharmacies that the patient visits have their own set of paper records. In this scenario, if the patient changes doctors, the new doctor must hunt for information regarding previous conditions and treatments. As the records are scattered across various locations, important information such as drug allergies or recent surgeries is not easily accessible.

Patient data cannot be accessed by multiple departments within the hospital: In this system the patient’s data cannot be accessed by more then one department at any given time. For example, if the patient’s file is with the general medicine department, then the orthopedics department has to wait until the file is released by the general medicine department, wasting valuable time.

Difficult data storage and retrieval: For example, consider a patient who has been going to a hospital for ten years. This hospital will have all of the information about the patient from the past ten years in a single file. If the doctor wants to compare the blood work of the patient from the past five years, imagine the time the assistant spends retrieving all the data and the time the doctor spends analyzing it. And after the records are reviewed, the doctor and the assistant must re-file every single piece of information properly.

Space, cost, and time: A paper-based system requires a lot of physical space to store all the patient records. The hospitals spend an enormous amount to maintain all of the hard copies. This system works very poorly in an emergency situation.

ELECTRONIC MEDICAL RECORD (EMR) SYSTEMS AND EXISTING OPEN SOURCE SOLUTIONS

The increasing challenges in the traditional system led to the rise of EMR systems. EMR systems were initially developed to manage a patient’s billing and insurance data but, as the rate of medical data exchange increased, these systems were developed for clinical use.

Now let’s take a look at EMR systems in detail and their advantages over traditional systems.

EMR systems efficiently and reliably store patient data electronically in a central data repository that can be accessed by various people at the same time, as seen in the examples in the fig.

With data being readily available to any one at any given point of time, the response time is reduced dramatically and the quality of treatment for patients is improved accordingly.

Let’s look at some of the major advantages of using an EMR system:

  • Long term cost reduction: Even though the setup cost is high, over a period of time, the cost is much less than the traditional system. Electronic data storage eliminates the paper storage costs.
  • Reduced waiting time: The data is available at your finger tips with EMR systems so you don’t wait for the patient’s data for the diagnosis and treatment. Also, since email is the main mode of communication, the data exchange is very fast and effective.
  • No repetition: The EMR systems store the data centrally where all the departments can access it. This eliminates the repetition of patient’s data across the departments.
  • Effective communication: Since the patient, hospital, pharmacy, and laboratory are all centrally connected they can communicate with each other in a much faster way than the traditional system.
  • Higher quality treatment: Properly-stored electronic records cannot be misfiled or misplaced. With the entire patient history in hand, the physician can analyze the previous health conditions and provide better care.
  • Data accuracy: An EMR system eliminates the issue of understanding the illegible hand writing of the doctors or nurses.
  • Open source software solutions: Open source software solutions are free and offer high quality service. Many small institutions are adopting EMR systems using open source solutions. There is a huge variety of these solutions available for EMR systems

 

Some of the notable open source offerings include:

  • OpenEMR
  • OpenMRS
  • VistA
  • GNUmed

OpenEMR system

The OpenEMR system is an open source software solution for EMR systems. It focuses on applications such as medical billing, prescription writing, and medical records. In this article, we will focus on the medical records.

OpenEMR is one of the more widely used software solutions in more than thirteen countries including the United States. It is designed to make the EMR systems available to more and more people. Let’s take a look at some of the advantages of this system.

  • Reduces the cost of the EMR systems as it is completely free.
  • Effectively supports the interoperability between different EMR applications.
  • Allows customization of the application at no cost.
  • Provides access to important medical information gathered from over 70 different medical software vendors. This reduces the time and cost for the hospital to gather information.

The OpenEMR system has a lot of user and developer support. This is a versatile system that operates in Linux, FreeBSD, MacOS X, and Microsoft Windows.

Effective scheduling:

OpenEMR Systems provides a complete overview of the doctor’s schedules, which is not available in the traditional system. When logged in as a doctor, they can have access to their own schedule. Along with the date and time the duration of the appointment can also be entered while adding an event in the schedules.

This eliminates the following errors:

  • Scheduling more patients than providers at a given time
  • Scheduling the appointments for the doctors when they are out of the office or on vacation
  • Overbooking the appointments for a doctor

OPENMRS is a collaborative open source project to develop software to support the delivery of health care in developing countries.

OpenMRS is founded on the principles of openness and sharing of ideas, software and strategies for deployment and use. The system is designed to be usable in very resource poor environments and can be modified with the addition of new data items, forms and reports without programming. It is intended as a platform that many organizations can adopt and modify avoiding the need to develop a system from scratch.

OpenMRS, Inc. is a registered non-profit that is the owner of all OpenMRS materials and the maintainer of the software’s Public License. This entity will represent the OpenMRS project in legal and financial matters.

The software is licensed under of the Mozilla Public License version 2.0 with an added “Healthcare Disclaimer. It requires that recipients are entitled to freely access the source code, but allows binary distribution, modification of the code (under the same license) and bundling into larger products that are under different licenses