Question

Case study

St. Luke's Medical Center set out to implement a digital medical record, planning to do so in three phases. Phase 1 would involve establishing a clinical data repository, a central database from which all ancillary clinical systems would feed. Phase 2 would consist of the implementation of CPOE and nursing documentation systems, and Phase 3 would see the elimination of all outside paper reports through the implementation of a document imaging system. St. Luke's staff felt that if they could complete all three phases, they would have, in essence, a "true" electronic or digital patient record. The implementation team did not, however, clearly define the scope of its work. Was it to complete phase 1 or all three phases? Likewise, the implementation team never defined what it hoped to accomplish or how implementation of the digital record fit into the medical center's overall mission or organizational goals. It never answered the question: How will we know if we are successful? Some project team members argued that a "digital" record was not the same as an EHR and questioned whether the team was headed down the right path. The ambiguity of the implementation team's scope of work led to disillusionment and a sense of failing to ever finish the project.

Based on the case study, develop an implementation plan to address the situations that are reported in the case and jeopardize the success of the project.

Answer 1

The implementation plan can be given as:

Phase 1

• Development and validation of central database for patient data input and
• give 2 days training to atleast 3 practitioners from each department
• Implement the use of that database as a trial, along with hard or physical records for 2 weeks; this could probably be a little add on only to their work load rather than a large drastic change
• Evaluate the difficulties and accountability

Phase 2- add on to phase 1

• Introduce computerised physician order entry
• If needed a clinical pharmacist can be appointed for cross verification of drug order as well as discharge medications.
• The works once done by the clinical pharmacist, should be locked by the hospital pharmacist digitally, so as to ensure freedom from bias as well as reliabilty of the data.

Phase 3

• Any outside reports or data if produced by the patients, should be scanned and imputed to the corresponding slots in the database and the patients should be instructed to keep the records with them.
• The maintenance of physical medical records in recommended by stacking in a separate department for reproducibility of the data in case of any technical issues.

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