Lessons Learned: Choosing and Implementing a Reliable Electronic Patient Record System

By Patty Edwards-Capella, ART

Selecting the right system is the most important decision you can make on the path to a paperless medical records environment. Choose wisely or you could be paying the consequences for years to come. We learned this lesson the hard way.

Dameron Hospital, a 225-bed facility in Stockton, California, began its migration from paper-based to electronic medical records when our old mobile shelving unit began to fall apart. It seemed the perfect opportunity to eliminate paper charts at our facility. The hospital’s on-site warehouse was overflowing with thousands of boxes of documents, and managing paper charts was becoming increasingly cumbersome. We decided against spending money to replace the unit and opted instead to purchase a simple optical imaging system to store and retrieve documents. Using the optical system, however, proved anything but simple.

The system was plagued with constant bugs, jams and errors with no messages to help users troubleshoot problems. It seemed the system was down most of the time and when it was up, it ran extremely slow. In fact, we are still recovering from a hardware and software crash in which we lost several charts. To make matters worse, our technical support had begun to deteriorate as our vendor lost most of its qualified support personnel. The company seemed to be in trouble, and we wondered if it would be around much longer to support us at all. With virtually no support, I was working 16-18 hours a day performing maintenance and programming to keep the system functional.

Finding a new system

It was evident a new system was needed. For more than a year, I searched through trade publications, visited the library and went to trade shows seeking as much information as possible on vendors. Dameron’s legal counsel performed an investigation of each vendor’s financial solvency. From this, we narrowed our choices to three systems.

Our department had several criteria for choosing a new system vendor. Dameron’s goal was to become entirely paperless within the next 10 years. Therefore, we needed a system that was not limited to imaging alone and could grow as our needs grew. Of primary importance was the vendor’s ability to convert the more than 75 gigabytes of data from our current imaging system. In fact, because of the problems we encountered with our previous vendor, we made payment contingent on the vendor’s ability to successfully perform the conversion. The new vendor would also be faced with the challenge of integrating its system with our various departmental information systems so we could begin capturing discrete data for future query and analysis and other purposes.

Above all, we required a company that was financially solvent and would be in business to support our product in the future. We needed a vendor that not only would take care of our data management needs, but also would continue to take care of the product and people involved, as well. Reliability, affordability, proven technology and 24-hour-a-day support were other essential criteria.

We selected ChartMaxx Enterprise-wide Patient Record System from MedPlus, Inc. (Cincinnati) because it met all of our criteria and was the only one that could perform the conversion. They also agreed to our provision that the conversion be successfully completed before any contract was signed. It took approximately two weeks for the vendor to convert the more than one million documents from our old database to ChartMaxx’s Oracle database, with very little downtime or inconvenience.

The system employs a client/server, scaleable architecture that allows us to grow our system in the future without needing to make changes to our systems’ infrastructure. It features a user-friendly Windows-based format that is familiar to our users ¼ making it easy to learn even for users who feel intimidated by computers.

We were impressed with the system’s capabilities. ChartMaxx serves as an enterprise-wide clinical data repository storing all clinical, financial and administrative data. It also includes an application that automates medical records activities, such as deficiency analysis, clinician chart completion, and release of information. In addition, there is an application for patient accounts that performs functions such as paperless registration and electronic remit processing.

The company’s biggest selling point for us, however, was its people. Many vendors we evaluated had only a few experienced programmers and technical support personnel. MedPlus had a proven track record of helping its clients successfully implement its electronic patient record system. We knew we’d have the technical expertise to back up the product in the event we needed it.

The implementation process

I had heard how difficult implementing an electronic patient record system can be, so I was surprised by the ease and smoothness of the process. The entire process took approximately two months with very little burden placed on our staff or myself.

I was extremely pleased with the technical support we received. Every person we encountered was extremely dedicated. They came in early and stayed late to get the job done. I was particularly impressed with their level of credentials and medical records backgrounds. They truly understood our challenges and expertly guided us throughout the process.

We were assigned a project manager who interviewed me about our needs and asked me to fill out a form with basic background information. The implementation team then proceeded to gather documents and other information to start the planning process. Another team of technicians then came to our hospital to establish an interface to our SDS Keane hospital information system and install the system on the 23 PCs in our medical records department and two PCs in ER. All PCs are connected to an Ethernet network, enabling our staff to concurrently access information from their PCs.

Training, performed by our project manager, only took a few hours since the medical records staff was already accustomed to a Windows environment. Once these individuals were trained, they were able to train new system users. Staff members were skeptical about the system at first due to our experience with the previous system. We quickly gained buy-in, however, once they started realizing the system’s benefits.

Keeping physicians happy

The system is currently managing more than a million-and-a-half documents in the medical records department and ER, and more records are being collected every day. When physicians request a chart, clerks can access it for them instantly. Physicians spend less time waiting for charts, resulting in improved satisfaction with medical record department’s services, and ultimately, improved patient care. ChartMaxx has proven very reliable, but we have 24-hour support in the event we do need service.

Dameron is now in the process of expanding our interfaces to include our laboratory information system and transcription system. Once these interfaces are established, physicians and nurses will be able to directly access transcribed documents via a workstation in the surgery room. This will also enable clinicians and staff members to retrieve lab results, any time day or night. By doing this, we will be able to eliminate the two FTE roles and utilize these individuals in other areas where we are understaffed.

Once all interfaces and upgrades are complete, Dameron’s staff of 500 physicians will be able to access and complete charts from a PC anywhere in the hospital, 24 hours a day ¾ without the help of medical records staff. We already have licenses in place for additional users so physicians can remotely access records from their offices. We have also placed terminals in the physician lounge, nursing stations and other point-of-care areas where physicians and nurses are located. When this final stage of implementation is complete, we will fully realize the increased efficiency, improved service and quality, and reduced costs achieved with ChartMaxx.