Patients and insurers can avoid repeating studies that, for example, expose people to additional radiation and

incur unnecessary costs. Providers can instantly access patient histories that are relevant to future care and patients can take ownership of their medical records. In general, EMRs o_er the potential for greater privacy and better access to records when they are needed

When data is stored in the cloud, some of these distributed archive systems can create a unique identifier for each block or ‘data object’, which becomes part of the metadata index that’s shared across all locations. These data objects can then be replicated to other locations to support data protection policies. When a file is needed, the requesting location uses its local metadata index to determine the best physical location from which to access the needed objects. Also, retrieval times can be minimized by streaming data objects as they become available, instead of waiting until the entire requested file or data set is retrieved. Skip to main content

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Electronic Medical Record (EMR) systems promise to help fix these problems. Programmer and Business Analyst. software. hipaa. development.. and using the OpenEMR medical record system.• • • • Activities Podcasts IBM Champion program • • • • • • More about Community Briefings Webcasts Find events (briefings. electronic_medical_record. We conclude by installing.) More about Events Close [x] Close [x] • • • • developerWorks Technical topics Industries Technical library Taking medical records into the digital age Solving traditional system challenges with OpenEMR Sreevidya Krishna (sreevidya. and security. she aims to bridge the gap between businesses and technology. openemr. In the past 6 years. Summary: Traditional. and construction clients develop their software. ). medical_record_keeping. automotive. In this article we examine the disadvantages in using traditional medical record systems and explore various open source medical record systems and how they handle the most pressing issues in data storage.. Sreevidya is proficient in the practice of Agile fundamentals to provide real value to customers. configuring.. maintenance. Freelance Sreevidya is a programmer turned business analyst. paper-based medical record systems fail to keep up with the increasing demands placed on a healthcare industry already burdened by a growing and aging populations. conferences. open. Tags for this article: american_recovery_and_reinvestment_act. With her computer science and MBA background. healthcare. webcasts..krishna@gmail. Sreevidya helped healthcare. more tags More tags: systems systems Tag this! Update My dW interests (Log in | What's this?) Skip to help for Update My dW interests .

Transcription cost. With open source software solutions readily available. and prescription writing are virtually eliminated. . and can help them offer much better service to more patients. Each division of the hospital has its own set of records. Back to top Traditional methods in medical record systems In a traditional medical record system. real-time paperless system. It can allow the physician to be more efficient. previous medications. This technology has changed the patient-physician relationship dramatically over the last several years. and drug allergies) through a traditional system. lab results. manual note taking. the pressure on doctors and hospital staff has increased drastically in the last decade. Most of the EMR systems comply with HIPAA standards. • Let's take a detailed look at how the traditional system works in the activity diagram shown in Figure 1. paperbased system to a more reliable. allowing hospital personnel to retrieve and update the information of any patient with a click of a button. dictation time. thus reducing medical errors and ensuring data privacy and security. An EMR system promotes the evolution of healthcare transactions from an inefficient. let's eliminate emergency situations in a hospital and concentrate on how the system works on a regular basis. you can easily use the EMR system to overcome the traditional system's challenges. These records are called charts. the patient's information is stored in one of two ways: • Paper-based system: Every test. medication. The solution is an Electronic Medical Record (EMR) system that allows doctors to find and store information instantly. and visit for a patient is manually recorded on paper. File system: The complete patient record is maintained in a single file on the computer. safer. For simplicity's sake. It has become very difficult for a physician to track a patient's medical history (including past visit information.Date: 30 Nov 2010 Level: Intermediate PDF: A4 and Letter (970KB | 25 pages)Get Adobe® Reader® Also available in: Korean Spanish Activity: 10811 views Comments: 1 (View | Add comment .Sign in) Average rating (25 votes) Rate this article Introduction With a growing population and an increase in the number of patients. and more secure manner. An EMR system helps physicians and hospitals function in a smoother. It is not uncommon for patients to have labs repeated because of improper lab records. The doctors and administration can then concentrate more on the patient's problem than on the patient's records and administrative tasks.

Activity diagram for the traditional system When the patient calls or comes to the hospital the administrative assistant asks the patient for personal information. The physician prescribes the necessary medication after verifying the patient’s complete medical record. If the patient requires any tests the hospital staff passes on the patient’s information to the administrative assistant using the traditional methods like the telephone.Figure 1. the assistant checks if he has an appointment. The hospital then contacts the patient to discuss the lab results and the medication. the patient is again asked for his or her information for verification before the necessary tests are done. The physician evaluates the patient's condition and determines whether they need any tests. prescription refill or the administrative services. If the patient has an appointment then the assistant notifies the physician. The patient can request for the type of service needed like appointment with physician. If the patient wants to meet the physician. Once the medication is ready the pharmacy notifies the . The results are sent to the physician (in most of the cases) or to the patient (in a very few cases) using the traditional methods. This prescription is sent to the administrative assistant. who in turn sends it to the pharmacy using the traditional methods. fax or post. Based on the information provided by the patient the assistant pulls the medical record. After arriving at the lab. The administrative assistant notifies the laboratory with the patient’s details and the list of tests to be carried out. If the patient does not have an appointment the assistant books a new appointment and notifies the patient.

An assistant has to go through the entire file to retrieve certain records and then be sure to re-file them at the appropriate place in the file. the pharmacy or laboratory informs the assistant who in turn notifies the patient — a slow and error-prone process. Patient data cannot be accessed by multiple departments within the hospital: In this system the patient's data cannot be accessed by more then one department at any given time. if the patient changes doctors. If the doctor wants to compare the blood work of the patient from the past five years. the new doctor must hunt for information regarding previous conditions and treatments. wasting valuable time. If the patient requests a prescription refill. the need for stronger security systems increased. If he does not have the refills the pharmacist notifies the physician. imagine the time the assistant spends retrieving all the data and the time the doctor spends analyzing it. When the prescription or the test results are ready. or mail. Scattered patient data: The patient's records are maintained in charts at various locations. Then the assistant notifies the patient. the doctor has to pass the information to an administrative assistant who in turn informs the pharmacy or the laboratory. And after the records are reviewed. Difficult data storage and retrieval: It is very difficult to maintain a single file containing all the different forms of medical records such as X-rays. Back to top Challenges with a traditional system Security of the data is the main concern in the traditional systems. the administrative assistant notifies the pharmacy. once the medication is ready the pharmacy notifies the administrative assistant. similarly. All this leads to delay in the treatment of the patient and to potential mistakes. . With growing population and exchange of huge medical data. In this scenario. In many cases the patient's information is either misplaced or misfiled. the doctor and the assistant must re-file every single piece of information properly. The patient’s data is again verified and the pharmacist check’s if the patient has any refills. The hospital administration updates its copy of patient records when the patient visits them. For example. and prescriptions. who notifies the patient. With a paper-based system. all the laboratories and pharmacies that the patient visits have their own set of paper records. fax or mail. who notifies the patient. The patient is asked to verify personal information at every department to access the correct record. then the orthopedics department has to wait until the file is released by the general medicine department. Now let's examine some of the major challenges when using the traditional system. if the patient's file is with the general medicine department. The communication between a department and the patient is through a traditional method like the telephone. fax. Slow data exchange: Data is exchanged mainly through calls. For every lab test and every medicine prescribed. important information such as drug allergies or recent surgeries is not easily accessible. consider a patient who has been going to a hospital for ten years. blood work. This hospital will have all of the information about the patient from the past ten years in a single file. As the records are scattered across various locations. CT scan reports. That information is recorded and stored within different departments in different formats.administrative assistant. the whole process of data storage and retrieval becomes very labor intensive for the hospital staff. If he has the refills for the prescription. For example.

1 percent increase in the use of EMR systems from 2001 to 2008 as physicians switched from traditional systems to EMR systems.8 percent (see Resources). as the rate of medical data exchange increased. Figure 3 provides a detailed picture of the percentage of the office-based physicians using EMR systems in the United States from 2001 through 2008 and part of 2009. A simple EMR system With data being readily available to any one at any given point of time.5 percent of office-based physicians reported using an all electronic or partially electronic medical record system while. Figure 2. and time: A paper-based system requires a lot of physical space to store all the patient records. The hospitals spend an enormous amount to maintain all of the hard copies. the response time is reduced dramatically and the quality of treatment for patients is improved accordingly. as seen in the examples in Figure 2. these systems were developed for clinical use. The doctor cannot start the diagnosis or treatment until the assistant pulls the medical record. This survey shows that there was a 23. Back to top Electronic Medical Record (EMR) systems and existing open source solutions The increasing challenges in the traditional system led to the rise of EMR systems. it was 20. According to the Centers for Disease Control and Prevention (CDC). 41.Space. the National Ambulatory Medical Care Survey conducted by the National Center for Health Statistics (NCHS) showed that. cost. EMR systems efficiently and reliably store patient data electronically in a central data repository that can be accessed by various people at the same time. in 2008. in 2004. Now let's take a look at EMR systems in detail and their advantages over traditional systems. This system works very poorly in an emergency situation. EMR systems were initially developed to manage a patient's billing and insurance data but. . This delays treatment and may even cost the life of a patient.

electronic data storage eliminates the paper storage costs. This eliminates the repetition of patients data across the departments. Percentage of office-based physicians using Electronic Medical Records in United States from 2001 through 2008 and preliminary 2009 Let's look at some of the major advantages of using an EMR system: • Long term cost reduction: Even though the setup cost is high. over a period of time. the data exchange is very fast and effective. Open source software solutions: Open source software solutions are free and offer high quality service. the physician can analyze the previous health conditions and provide better care. No repetition: The EMR systems stores the data centrally where all the departments can access it. Also. Many small institutions are adopting EMR systems using open source • • • • • • . the cost is much less than the traditional system. Effective communication: Since the patient. since email is the main mode of communication. and laboratory are all centrally connected they can communicate with each other in a much faster way than the traditional system. hospital. pharmacy. Higher quality treatment: Properly-stored electronic records cannot be misfiled or misplaced. Reduced waiting time: The data is available at your finger tips with EMR systems so you don't wait for the patient's data for the diagnosis and treatment. With the entire patient history in hand. Data accuracy: An EMR system eliminates the issue of understanding the illegible hand writing of the doctors or nurses.Figure 3.

the syntax rules. patients did not have access to their own data. secure. not only can patients view all of their data. The EDI Standards define the vocabulary. they also have information about how to access their data. In this article. These standards mainly focus on billing and invoicing. Privacy Rules: These rules deal with providing the patient with his own medical data. Back to top Software medical standards The key aim of EMR systems is the efficient. national standards body for the development and maintenance of Electronic Data Interchange (EDI) standards. we will concentrate on the OpenEMR software and see how to overcome the challenges of the traditional system using this open source system. HL7. and safe storage and retrieval of data. and the structure of electronic documents. • HL7 (Health Level Seven): HL7 focuses on the standard format for electronic information exchange between medical applications. ANSI X12 EDI: ANSI X12 is the official designation of the U. All developers of the EMR system should make sure that they work within the scope of HIPAA standards. To achieve this. the data transfer between two (or more) computers systems using different data formats is made possible. the federal government started investing money and effort to promote EMR systems. With the help of EDI Standards. HIPAA (Health Information Portability and Accountability Act): The HIPAA standards focus mainly on the privacy and security of a patient's data. There is a huge variety of these solutions available for EMR systems (see Resources). The major sections in HIPAA include: • Security Rules: Data security is one of the main concerns while dealing with health information. The government wants to make sure that EMR systems are secure. The information sent using this standard is a collection of various messages containing either a medical record or a patient's health information. Now. The EDI acts as a bridge between the systems. Some of the notable open source offerings include: • • • • OpenEMR OpenMRS VistA GNUmed Most of these systems comply with the software medical standards advocated by the federal government through the National Health Information Infrastructure. we will discuss the it is very important to implement all the security rules laid out by HIPAA. and that the data is shared only among authorized departments. The HL7 standards are a set of rules that allow a consistent and secure data exchange between different health care systems. and the ANSI X12 EDI standards. For the HIPAA compliant developers. In this article. the federal government laid out a certain set of rules and standards for the EMR systems. that user privacy is well maintained. In recent years.S. Until HIPAA included the privacy rules. .

OpenEMR is licensed under the GNU General Public License. This reduces the time and cost for the hospital to gather information. Allows customization of the application at no It is available for both Linux and Windows platforms. FreeBSD. If not. Back to top Downloading and installing OpenEMR OpenEMR software is available for free as a download (see Resources for a link). MySQL. Provides access to important medical information gathered from over 70 different medical software vendors. and PHP installed. Apache. OpenEMR system The OpenEMR system is an open source software solution for EMR systems. and the ANSI X12 EDI standards. In this article. we will explore several features in detail. This will take you to the login screen as shown in Figure 4. OpenEMR is one of the more widely used software solutions in more than thirteen countries including the United States. This ensures the quality of service offered by the system. Back to top Getting started Open a Web browser to the OpenEMR software at http://servername/openemr/. OpenEMR is built upon what is commonly known as the LAMP architectural platform. In this section we will download. we will log in as administrator with a . OpenEMR is compliant with HIPAA.2. The OpenEMR system has a lot of user and developer support. known as the Windows OpenEMR XAMPP package (see Resources for a link). Effectively supports the interoperability between different EMR applications. openemr-3. and standard medical terminology at every level in the application. It focuses on applications such as medical billing. we will focus on the medical records. • • • • • • Reduces the cost of the EMR systems as it is completely free. In this article we will use the XAMPP package for installation. LAMP is an acronym for Linux. which allows you to install and configure the OpenEMR application along with Apache. In this article. Assuming that you have downloaded and installed OpenEMR. This is a versatile system that operates in Linux. OpenEMR has an all-in-one package. Let's take a look at some of the advantages of this system. install.Many of the EMR systems comply with these standards. efficient medical information exchange. Download and install the appropriate version. In this article we will focus on OpenEMR for the Windows platform. MacOS X. If you already have MySQL. you can install OpenEMR using the original Windows package. configure. HL7. prescription writing. Apache. The commercial and open source solutions ensure the data security. and explore the OpenEMR System. and medical records. It is designed to make the EMR systems available to more and more people. and Microsoft Windows. and PHP. MySql and Php/Perl/Python.

) Setting up the hospital data A successful login will take you to the appointment calendar.default username admin and default password pass. as shown in Figure 5. we will use the tree view (the default view). OpenEMR login screen OpenEMR offers three navigation views: traditional. Click Edit to the right of Edit Facilities. or radio buttons. OpenEMR has a default clinic already built in that you need to update with the correct information for your clinic. . Select Administration > Facilities in the navigation tree on the left. Figure 4. You can change the password by selecting the Password from the navigation bar on the left. (You can switch to one of the other views by editing the file openemr/interface/globals. In this article. tree view.php.

Figure 5. Figure 6. Updating the default clinic's data . as shown in Figure 6. Edit link in the facility administration page This will open the Edit Facilities page where you can update your clinic data.

There will be a number of users accessing the hospital information and you add them by clicking Administration > users. Click the Update button to save the user information. this will open the settings page as shown in Figure 8. Add another user by clicking Administration > users again.After you have updated the default clinic. Figure 7. . User Administration screen There are a number of pharmacies and insurance companies associated with the hospital. The information about the pharmacies can be entered by clicking Administration > Practices. you can add all of the different facilities associated with it by clicking Facilities under Administration in the Navigation tree. Here you can enter the information about a user and also their Access Control role. which will open the User Administration Screen as shown in Figure 7. In this article you will see how an OpenEMR system links the pharmacies to the hospitals.

.Figure 8. The pharmacy data can be added as shown in Figure 9. Settings Page to add the pharmacies to the hospital Click Add a Pharmacy to enter the contact information for your hospital's pharmacy.

Adding pharmacy data Click the Update button to save the record. Next. Address book showing all the existing records in the system . as shown in Figure 10. After successfully adding the record the same page is then available for another entry.Figure 9. The address book can be opened by clicking Miscellaneous>Addr Book in the navigation tree. This will show all the contacts stored in the address book. Figure 10. You can add a new record or search the existing records by clicking the Add New or Search buttons. you add hospital staff information to the address book in the OpenEMR system.

More demographics can be added by navigating to the Medical Record section under Patient/Client. Back to top Adding patient's data To add new patients. Figure 11. medical records. . the contact information. A sample patient record with demographics is shown in Figure 11. employer information. and patient ID cards that are scanned or saved on the system. You can add these by clicking Patient/Client>Medical Record>Documents. you can view the schedules of all the practitioners. This will open the Search or Add Patient screen. Here you can enter various demographics for the patient including basic information. click Patient/Client>Management>New/Search. A sample patient record with demographics Some patient information is in documents such as lab reports. When logged in as an administrator. and so on.Once you have entered all of the necessary clinical information you can go ahead and add the patient records. Managing schedules OpenEMR allows you to manage and schedule appointments in a very effective way.

Figure 13. virtually any part of the user interface can be customized for a particular organization. Figure 12. Sample schedule of the providers The features discussed above are some of the important features of the OpenEMR system. Anyone with a basic knowledge of PHP will be able to extend the system.php. Because the software is open source.php and openemr/includes/config. . A sample event is shown in Figure 12. The customization can be done by making changes to openemr/interface/globals. This will open the Add Event window where you can add the details of various kinds of appointments for the providers. the schedule of all of the providers on a particular day can be viewed by the administrator as shown in Figure 13. Adding a new event to the schedule of the practitioner Once the events are added. this is not a comprehensive list and there is still a lot to explore. However.You can add an appointment by clicking on the time of the appointment under the provider's name.

Back to top Solving the traditional system challenges with OpenEMR The physicians' frustration with keeping track of a patient's medical records is coming to an end with the help of EMR systems. Data is well organized: OpenEMR maintains the complete data of the hospital and the patient's record in a central data repository. The time involved in searching for a piece of information is reduced to the click of a button. As all of the departments. By maintaining the records electronically. we will see how to solve the challenges of a traditional system using OpenEMR. pharmacies. thus eliminating the waiting time for data transfer. Hospital administration can find the patient's data more quickly. The doctors have access to the . Figure 14. In this section. and laboratories are interconnected. the hospitals cut down the cost and space involved in maintaining the records on paper. Reduces space. Figure 15 shows an example of a patient's history. Patient's demographics on a single page The complete history of the patient including the lab reports and medication can be found at a single place. The patient's demographics pop up on a single page when the patient's details are opened. they can share the patient's data electronically. as shown in Figure 14. cost and time: OpenEMR enables the doctors to concentrate on patients instead of paperwork and information technology needs.

consider that a doctor is searching for a patient named "Bobby Flay". For example.complete history of the patient just by the click of a button. Complete history of a patient OpenEMR also allows the doctors to search for a particular patient's record from the data base. . This information helps the doctors analyze the patient's health in a more efficient way. Figure 16 shows the retrieval of a patient's record by external ID. The doctor can search the record by either External ID or SSN as they are unique for every patient. Figure 15.

Last Name and others.Figure 16. which is time consuming. The hospital staff has to manually search the files based on name. This eliminates the following errors: • • • Scheduling more patients than providers at a given time Scheduling the appointments for the doctors when they are out of the office or on vacation Overbooking the appointments for a doctor . The OpenEMR system allows you to view and edit the schedules of all doctors when logged in as an administrator or as hospital staff. When logged in as a doctor. they can have access to their own schedule. In the traditional systems. as shown in Figure 17. Along with the date and time the duration of the appointment can also be entered while adding an event in the schedules. DOB. which is not available in the traditional system. Retrieval of patient record by External ID Patient records can be searched based on various fields in "Search or Add Patient" page like SSN. Effective scheduling: OpenEMR Systems provides a complete overview of the doctor's schedules. this can not be achieved.

Example showing the missing data of a patient No repetition of data: . If a vital piece of information like the Date of Birth (DOB) is missed. consider the data entry of a patient. the system makes sure that the necessary information is entered before saving the file. The doctor has to wait for the nurse to gather this information from the patient. As all the data entered is analyzed. For example. on the other hand. With the help of OpenEMR. unless the doctor realizes the missing data. Complete overview of the schedules of all the doctors No misplaced or missing data: With the use of OpenEMR systems there is less or no chance for any data getting lost. An example is shown in Figure 18. thus delaying the process of treatment. there is no way that the information is re-recorded. the system prompts for missing data when the update button is clicked.Figure 17. Figure 18. in a traditional system.

Federal Government for EMR systems. due to misplaced or misfiled records. we have seen how we can overcome the challenges of the traditional system using an OpenEMR system. they don't have to maintain individual records for the same patient. We introduced OpenEMR. We discussed the standards like HIPPA and HL7 mandated by the U. We have seen that traditional systems are more error prone.The traditional system involves a lot of data repetition. and the patient's record can be updated using this unique ID. insecure. and installed the software. OpenEMR is a low cost. reliable and efficient.S. It improves the hospital staff's efficiency by reducing manual errors and maintaining the integrity of the system. (55) End of Popular tags . an open source solution for EMR systems. This allows the doctors to view and analyze patient's data even after hours. extensible. and unreliable. data can be accessed from anywhere at any time. downloaded. We have seen how EMR systems are overtaking the traditional systems. In today's world with its huge volume of medical data. This is eliminated by using the OpenEMR system since all records are electronically stored. Each patient is identified by a unique ID. Access to records from multiple locations: Because OpenEMR is a Web-based solution. and flexible medical record system that tackles the major challenges of the traditional system.. the traditional system affects the quality of service offered by doctors. and exceeds what can be done with a traditional system. and briefly discussed important features. The doctors can log into OpenEMR with a valid user name and password from a system that has an Internet connection. Since all of the departments are centrally connected. configured. In this article we have briefly explored how the paper based traditional system works. Finally. Back to top Conclusion EMR systems are smart.. • • xslt (45) xslt_(xsl_tran.

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