Steps to implementing an electronic record

So if you've decided to implement an electronic medical record (EMR), what is your first step? Do your homework, said Kenny Bozorgi, MD, CASC, chief operating officer, Magna Health Systems, Chicago. He also is a candidate for a master's degree in medical information from Northwestern University in Evanston, IL.

Find out what EMRs exist that are specific to your type of facility, sources suggests. Melodee Moncrief, BSN, RN, CASC, administrator of Big Creek Surgery Center in Middleburg Heights, OH, spoke on this topic at this year's meeting of the Ambulatory Surgery Center (ASC) Association. If you're in an ASC, don't purchase an EMR built for hospitals, Moncrief advised. "There's a big difference there, because then it's not actually working for your needs," she said. Also, there might be a dramatic difference in costs, and you won't want to pay for features that you don't need, sources say.

An EMR needs to fit into a clinical pathway system that allows you to take info gathered at intake and add it into the record, says Mark Mayo, corporate director of ASC operations for Magna Health Systems in Chicago and executive director of the Surgery Center Association of Illinois. Also, the EMR should ask you several questions that may affect decisions on the course of care or offer additional steps to take, he says. "For example, if a patient has a history of deep vein thrombosis, what steps should be taken such as compression stockings, etc., to avoid a clot?" he asks.

You also want an EMR that is as flexible as possible so it can be designed and customized to your needs, Bozorgi said. For example, you might want a medication reconciliation process that allows you to push a button at the end of the day and print a reconciliation sheet, he said. It also might automatically fax that information to surgeons and referring physicians, Bozorgi said. Also look for the ability to automatically generate benchmarking data, state reports, and association reports, he said.

Find an EMR that is integrated with your management system, sources suggest. Mary Griskewicz, MS, FHIMSS, senior director of ambulatory information systems, Healthcare Information and Management Systems Society (HIMSS), said to look for these features:

  • ability to assist with or be easily integrated with scheduling;
  • integration with laboratory results and care coordination between specialty and primary care practices;
  • just-in-time information to assist with clinical decisions and reporting.

Finally, have hands-on demonstration of as many electronic medical record solutions as you possibly can, and include as many clinical and nonclinical staff as possible, said Bozorgi. "Basically, take as much time as you need to explore options before the final decision," he said.

Look for a vendor that has been around for a long time, examine its financial health, and ask about its long-term goals, Bozorgi advised. "Find out if they're planning to get bought out in the next year or two, and you'll deal with a whole new organization, or stay independent," he said. "There's pros and cons to both approaches."

You need dedicated staff and "superusers" to assist with the training and support,

Griskewicz advised. "The implementation of an EMR system is like building a house: You must have a general contractor, or in this case a project manager, capable of assisting to plan, design, test, and implement to the requirements of the center," she said.

Additional infrastructure needs to be in place before you implement an EMR, Bozorgi advised. "That infrastructure includes things like uninterrupted power supplies, which can give you many hours of protection against widespread power loss," he said. "That would allow you to print medical records."

You need refined data backup capability and, ideally, the option of accessing your records remotely in the event of an evacuation, for example, Bozorgi said. "At the end of the day, a paper backup plan, well thought out and rehearsed, should always be in place," he said.


For resources on electronic medical records (EMRs), contact:

  • The American Health Information Management Association. Web: Under "HIM resources," see "vendor and exhibitor directories" and other resources.
  • The Certification Commission for Healthcare Information Technology. Certifies EMR systems and will certify personal record sites in the future. Web:
  • Department of Health and Human Services. Web: Click on "resources" to access reports, fact sheets, and other materials.
  • The Healthcare Information and Management Systems Society. Produces a free newsletter titled "Healthcare IT News." Go to Under "HIMSS Insider," click on "subscribe to Healthcare IT News online."
  • KLAS. Evaluates, certifies, and compares EMRs and offers a free vendor directory. Web: