Background:
"Human roles and distribution of responsibilities, process workflow and decision making, and technology infrastructure are tightly interrelated. A change in one requires a change in the others" (Rethinking Electronic Health Records to Better Achieve Quality and Safety Goals, William Stead, 2007). When patient-entered medical data are introduced to the daily clinical work stream, new issues and relationships are encountered. A comprehensive cancer center recently implemented an enhancement to the electronic medical record (EMR) as a part of the existing EMR strategic goal. The enhancement provided a portal to collect patient-entered electronic medical history data and ancillary health screening through an existing patient Web portal, myMDAnderson.
Program Plan:
As the change was implemented, patients were encouraged to complete their health history prior to their initial cancer center visit via their home computer or by using a hospital-provided computer at their visit prior to their physician appointment. Several months after the initial implementation, the patients were provided with the tablet computers to complete their ongoing ancillary health screening tool in the clinic, if it had not been done at home prior to their appointment. In both the home and clinic work stream processes, the patient-provided electronic information is available in the EMR for clinician review with the patient to support care planning and intervention.
Evaluation:
Moving from a paper process to an electronic process presented challenges for the patients, caregivers, and clinical staff. The workflow changes and patient and clinician perspectives during implementation of a new electronic process will be summarized. Organizational decisions to ensure compliance with HIPAA standards for privacy, security, and data communication will be shared.
Impact:
As patients and healthcare providers begin to use technology in collaboration to manage illness, new issues surface in the areas of user support, workflow, and system support. The technology link between the Web portal and the electronic record will be shared. The timeline and lessons learned during the implementation journey will be shared from clinical, operations throughput, and patient perspectives. The vision for implementation of future patient-entered medical record data will be conveyed.