MUSC’s system of recording medical information will be changing from pen and paper to bits and bytes

Start saying goodbye to paper charts, handwrit ten lab orders and prescriptions, and printed treatment reports. And while you’re at it, get ready to say goodbye to lost records, and long delays that make important patient care information practically inaccessible.

During the next year or two, MUSC’s system of recording medical information will be changing from pen and paper to bits and bytes with the roll-out of a new Electronic Medical Records (EMR) system. EMR will make patient information available on designated computers, giving select medical personnel immediate access to the information they need to provide quality care.

“Patient records will reside in a virtual records center, making them accessible to anyone who needs patient information at any time they need it,” explained Victor Del Bene, M.D., chair of the Clinical Information Systems Steering Committee. He added that the system will include MUSC Medical Center sites only, including Carolina Family Care, University Medical Associates and the outpatient units in the newly renovated Rutledge Tower. Plans to move paper records and radiology films to the Rutledge Tower would make the present manual delivery system even more difficult.

“Quality suffers and costs are increasing under the present system,” said EMR project director Dave Northrup. “More often than not, patient care information is unavailable to clinicians on a timely basis or it’s not delivered properly.” He said that sometimes tests that have already been done are reordered, or procedures are duplicated because the original information could not be found, or it was not in the patient’s chart that it was ever done.

An EMR system also will provide for the information technology services and data needs to support MUSC’s clinical research and education missions, and it will help facilitate and unify a group practice. The current paper approach, Northrup explained, encourages autonomy of practices. Its inefficiency compels each clinical department, division or specialty to manage and control its own records, making access of a patient’s records by another department difficult.

“This has been a long time coming,” Del Bene said, recalling the mid-1980s when plans were forming and the system’s infrastructure was being assembled. “Everything we’ve been doing has been progress to this point. The infrastructure is in place, wires have been run and installation of fiber optic and high speed copper wiring is taking place daily. We’ve been adding to it in a logical and consistent way, and a new high speed network infrastructure is being developed,” he said, pointing to a computer monitor on his desk. “It’s ready to roll out.”

An EMR system roll-out is no easy task. First, it involves overcoming people’s apprehensions about what the system can do. “And we need to be careful not to promise more than the system can deliver,” Del Bene said. Computer workstations will have to be installed throughout the medical center and other select sites. Software will have to be written to interface with OACIS, allowing records, transcriptions and lab data to be entered in real time as it is accumulated. “And people will have to be trained in how to use the system.”

Del Bene said that once the EMR system is more than 90 percent available, a goal he hopes to see reached by December 1998, MUSC will be among the first tier of academic medical centers in the United States regarding electronic records.

Key issues to be addressed in an EMR roll-out:

• There’s still the possibility of an affiliation with Columbia/HCA, which would require collaboration.
• Training and use of the computer by faculty and clinicians: Some physicians may rely on support staff in the hospitals and clinics to retrieve and communicate or print key data and never personally use the electronic medical record. Planners expect this reliance to diminish over time.
• Rutledge Tower will need the EMR. Without it, the delivery of paper charts and radiological films to and from the facility will be inefficient and have an adverse effect on quality of care.
• New policies and procedures are being developed by a Medical Center task force to ensure security and confidentiality. The policies will include incorporating computer security and auditability into the EMR.
• Future information technology needs: Continued investments will ensure implementation of MUSC’s on-campus clinical needs while following the College of Medicine’s strategic plan to concurrently plan and fund logical follow-up work, such as research and educational needs and integrate off-campus clinical enterprises.
• Windows 95 will be a prerequisite for the EMR rollout in July 1998.