Implementing an EMR is challenging, and it takes a systematic approach and expertise to implement one successfully. In this study, we present our experience implementing an EMR at the Binaytara Foundation cancer center (BTFCC) in Madhesh Province of Nepal.
A committee composed of the Chief Medical Information Officer (CMIO), physicians, nurses, and administrative staff was formed. A physician and an administrator were selected as superusers- who served as the experts. They worked with the technology team to configure the software to suit the requirements of the BTFCC. The team determined the need for note templates and order sets. In addition, they addressed the issues and feedback from the clinical staff. The implementation team provided onsite and virtual training sessions to the BTFCC staff. The EMR was finally launched. The team established a bi-weekly audit system and a monthly feedback system to ensure proper utilization of the EMR.
The committee recognized the attitudinal constraints as the most significant challenge as most of the staff did not have prior experience using a comprehensive EMR. The hospital leadership updated the medical record policy reflecting the documentation requirements in the EMR and new staff members were recruited only after clarifying expectations. A descriptive analysis of audit reports revealed improvement from September to December. The documentation of history of presenting illness increased from 26.5% to 87.5%. Likewise, physical examination was documented 67.5% more in December as compared to September. Proper documentation of assessment, plan, and follow-up for patients was done in 100%, 87.5%, and 100% each during December as compared to 26%, 46%, and 35% during September, respectively.
A standardized stepwise approach and an audit system is essential to ensure easy adaptability and a smooth transition from a hybrid electronic-paper medical record system to an electronic system.