Difference between revisions of "Out-patient Medical Record (OMR)"

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The Beth Israel informaticians and clinicians never foresaw some of the fundamental changes that were to be wrought on medical practice by the implementation of the electronic medical record.  It demonstrated the ability to improve the quality of care, decrease medication errors, saved time for physicians and nurses, improved clinical precepting for residents and medical students, and supported collaboration in complex organizations.(2)
 
The Beth Israel informaticians and clinicians never foresaw some of the fundamental changes that were to be wrought on medical practice by the implementation of the electronic medical record.  It demonstrated the ability to improve the quality of care, decrease medication errors, saved time for physicians and nurses, improved clinical precepting for residents and medical students, and supported collaboration in complex organizations.(2)
  
Nowadays, five major components of the system are: the On-Line Medical Record, ePrescribing, Physician Order Entry, the Emergency Department "dashboard," and the Performance Manager. (4)
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Currently, the five major components of the system are: the On-Line Medical Record, ePrescribing, Physician Order Entry, the Emergency Department "dashboard," and the Performance Manager. (4)
  
 
==References==
 
==References==

Revision as of 02:58, 21 September 2009

The Out-patient Medical Record (OMR) was developed by informaticians working at the Beth Israel Hospital in Boston, MA. In February 1989, approximately 20% of Beth Israel Hospital's clinicians moved to a location physically disconnected from the main hospital. From this remote location it was not possible to transport the patient's paper medical record from the hospital.

To facilitate communication between the clinicians at this location and those at the hospital, they installed computer terminals in every clinician's office in this new setting and developed computer applications that allowed clinicians to enter, edit, and display patients' problems, medications, health promotion and disease prevention screening sheets, flow sheets, and progress notes that were problem oriented and displayed updates under the suitable active problem within the problem list. In addition, clinicians could rely on an automated set of influenza shot reminders associated with every patient older than 65 years or suffering from a chronic disease(1).

The OMR development goals were to facilitate workflow, support collaborative practice models, make clinical practice guidelines available, and create a paperless ambulatory office environment.(2)

Three months after introducing the system to the rest of the clinics at he hospital in July 1990, a study noted a discrepancy in the number of patients with updated medication and problem lists between the clinics at the hospital and the outside clinics. Almost three fourths of the patients taken care for at the hospital clinics were without any problem lists or medication lists. Unlike the distant clinics, where 70% of the patients had updated problem and medication lists (3). Moreover, even though it took more time to type the notes than to write them, clinicians typed twice as much words as they wrote in every note. Using problem lists generated by the system, providers were prompted to review, edit, and update clinical records. This shows that clinicians considered the notes that they wrote on the out-patient medical record more valuable and effective.

As of 1991, 20 staff physicians, 5 fellows, 64 residents, and 11 nurse practitioners had entered 15,121 active problems and 1996 inactive problems for 3524 patients. Additional plans were set to add modules for referral letters, rapid physical exam findings entry, and more.

As of 2001, over 1000 staff physicians, nurses, residents, and psychiatric social workers have made 1,278,484 progress notes, entered 391, 897 medical problems, and written 1,367,450 online prescriptions for at least 53,000 patients. Even psychiatric notes are stored online, demonstrating confidence in the established security measures.

The Beth Israel informaticians and clinicians never foresaw some of the fundamental changes that were to be wrought on medical practice by the implementation of the electronic medical record. It demonstrated the ability to improve the quality of care, decrease medication errors, saved time for physicians and nurses, improved clinical precepting for residents and medical students, and supported collaboration in complex organizations.(2)

Currently, the five major components of the system are: the On-Line Medical Record, ePrescribing, Physician Order Entry, the Emergency Department "dashboard," and the Performance Manager. (4)

References

1. Safran C, Rury C, Rind DM, Taylor WC. Outpatient medical records for a teaching hospital: beginning the physician-computer dialogue.

2. Safran C. Electronic medical records: a decade of experience. JAMA. 2001;285:1766. [1].

3. Cintron A, Phillips R, Hamel MB. The effect of a web-based, patient-directed intervention on knowledge, discussion, and completion of a health care proxy. [2]

4. Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center; Richard Bohmer, F. Warren McFarlan 24 pages. Publication date: Jun 04, 2007. Prod. #: 607150-PDF-ENG http://harvardbusiness.org/product/information-technology-and-clinical-operations-at-beth-israel-deaconess-medical-center/an/607150-PDF-ENG