Optimizing Electronic Medication Administration Records

In June, BIDMC goes live with Electronic Medication Records (EMAR) on one ward to be followed
by 3 other wards, ensuring we meet our 10% Meaningful Use Stage 2 target by the reporting period October 1-December 31, 2013.

We built a web-based, mobile friendly EMAR system that includes many visual cues and seamless integration (not interfacing) with all our existing clinical information systems.

In modeling the workflow, we had to chose appropriate hardware devices to support various use cases.    Here's what we decided:

iPhones for mobile viewing of patients, upcoming medication tasks, and dashboards of medications given.

iPads mounted near the Omnicell devices for easy verification of medications to be dispensed.

Wall mounted computers with bar code readers on extension arms near each bed to enable easy scanning of patient wrist bands (bar code enabled positive patient ID), scanning of medications, and entry of confirming passwords.

Computers/Workstations on wheels (COWs/WOWs) as a backup only in the case of failure of wall mounted systems.  In general we've found that clinicians do not like COWs/WOWs because they are awkward to move around and also have to be recharged frequently.   They will only be used as backup systems.

The strategy is summarized in the graphic above.

We'll learn a great deal about the user experience by formally studying how often and when these various devices are used.   It will then inform our rollouts across the hospital.

We've also provided a few different user interface options for nurses including a "shopping cart" view of bar coded verified medications to be administered, a checklist which pre-populates the shopping cart with medications to be verified, and a grid of next doses that can be easily clicked to record administration or a reason for delay.

One of our residents has been assigned to document usage patterns and stakeholder feedback so that we can refine the user interface prior to broad rollout.

At BIDMC we build 25% of our applications and buy 75%.   EMAR is a perfect example of why we build.  How many iPhone/iPad friendly cloud-hosted web-based EMAR systems exist that are built by clinicians for clinicians with refinements to usability made after production experience?   We'll let you know what we learn in June.