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

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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).
 
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 developed 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 of 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).  
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The OMR development goals were developed 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 of 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). --[[User:Kjbracey|Kjbracey]] 19:48, 17 January 2011 (CST)[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655996/]5.
  
 
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.
 
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.
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4. Bohmer R, McFarlan FW. [http://harvardbusiness.org/product/information-technology-and-clinical-operations-at-beth-israel-deaconess-medical-center/an/607150-PDF-ENG Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center]. Harv Bus Rev 2007 Jun 4;(Prod#:607150-PDF-ENG).
 
4. Bohmer R, McFarlan FW. [http://harvardbusiness.org/product/information-technology-and-clinical-operations-at-beth-israel-deaconess-medical-center/an/607150-PDF-ENG Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center]. Harv Bus Rev 2007 Jun 4;(Prod#:607150-PDF-ENG).
  
[[Category: EHR]]
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5. Wilcox,A [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655996/ Physicians Use of OutpatientElectronic Health Records to Improve Care].  AMIA Annu Symp Proc 2008;809-813.
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Revision as of 01:48, 18 January 2011

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 developed 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 of 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). --Kjbracey 19:48, 17 January 2011 (CST)[1]5.

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. In 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. Psychiatric notes are stored online, demonstrating confidence in the established security measures.

Beth Israel informaticians and clinicians never foresaw some of the fundamental changes that were to be brought on medical practice by the implementation of the electronic medical record. It demonstrated the ability to improve the quality of care, decrease medication errors, save time for physicians and nurses, improve 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)

In 2009, Beth Israel reported a seven-fold increase in the number of notes/addenda per day for a staff of five-hundred clinicians at the site of the Harvard Medical School as a result of a nine month implementation of a new EMR. [Beth Israel New Electronic Documentation System] A graph of the data from January, 2008, to January, 2009 illustrates the dramatic results. Such results bode well for the increasing adoption rate of EMR in healthcare. Among the lessons learned reported by Beth Israel: face-to-face discussions with all disciplines involved was key to keeping the project on track, and including ancillary services helped the team achieve the goals of this project. Recommended next steps, including audit documentation, recommendations for additions to the database, and format template notes for other services, testifies to the incremental and iterative nature of EMR evolution. MikeField 20:15, 16 January 2010 (CST)

References

1. Safran C, Rury C, Rind DM, Taylor WC. Outpatient medical records for a teaching hospital: beginning the physician-computer dialogue. Proc Annu Symp Comput Appl Med Care 1991:114–118.

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

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. J Palliat Med 2006 Dec;9(6):1320-8.

4. Bohmer R, McFarlan FW. Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center. Harv Bus Rev 2007 Jun 4;(Prod#:607150-PDF-ENG).

5. Wilcox,A Physicians Use of OutpatientElectronic Health Records to Improve Care. AMIA Annu Symp Proc 2008;809-813.