Implementation Of Electronic Medical Record Research Articles

Managing Innovations: A Study of the Implementation of Electronic Medical Records in Dutch Hospitals

Innovation projects are prone to “escalation of commitment” (the tendency to continue projects even if it is clear that they will be unsuccessful). In this study, we introduce a construct measuring the escalation prevention potential (EPP) of innovation projects as perceived by individuals in the organization. EPP consists of three components: (i) goals, (ii) process, and (iii) ability, to shield projects from escalation to commitment. A survey was conducted among 1062 clinicians working in hospitals implementing Electronic Medical Records. The empirical results show that the three theoretical components of EPP sum up to a single measure. Four organizational characteristics of organizations (organizational routines, authentic leadership, employee involvement and support staff quality) explain a large share of the variation in EPP.

Electronic Medical Record Implementation Challenges for the National Health System in Greece

The purpose of this work is to expose challenges related to the implementation of quality electronic medical record (EMR) systems in public hospitals in Greece, a country where the national health system (NHS) has already acquired electronic medical records (EMRs). The level of EMR implementation, together with organizational maturity at a hospital level, are explored. What is discovered is that there are different adoption levels, not recorded in a systematic manner. The majority of physicians are either reluctant to implement EMRs or do not know options available to them. Implications include not continuous flow of events, cut off of critical information, lower quality of health services, patients not empowered to carry with them clinically significant information, unnecessary repetition of medical procedures and higher costs. It is concluded that focus should be paid on enabling the use of quality, interoperable and secure EMRs to better support medical decision, in an effort to improve the health of the population and to better control costs.

Success factors for implementing and sustaining a mature electronic medical record in a low-resource setting: a case study of iSanté in Haiti.

Electronic health information systems, including electronic medical records (EMRs), have the potential to improve access to information and quality of care, among other things. Success factors and challenges for novel EMR implementations in low-resource settings have increasingly been studied, although less is known about maturing systems and sustainability. One systematic review identified seven categories of implementation success factors: ethical, financial, functionality, organizational, political, technical and training. This case study applies this framework to iSanté, Haiti's national EMR in use in more than 100 sites and housing records for more than 750000 patients. The author group, consisting of representatives of different agencies within the Haitian Ministry of Health (MSPP), funding partner the Centers for Disease Control and Prevention (CDC) Haiti, and implementing partner the International Training and Education Center for Health (I-TECH), identify successes and lessons learned according to the seven identified categories, and propose an additional cross-cutting category, sustainability. Factors important for long-term implementation success of complex information systems are balancing investments in hardware and software infrastructure upkeep, user capacity and data quality control; designing and building a system within the context of the greater eHealth ecosystem with a plan for interoperability and data exchange; establishing system governance and strong leadership to support local system ownership and planning for system financing to ensure sustainability. Lessons learned from 10 years of implementation of the iSanté EMR system are relevant to sustainability of a full range of increasingly interrelated information systems (e.g. for laboratory, supply chain, pharmacy and human resources) in the health sector in low-resource settings.

Preparing for Electronic Medical Record Implementation: Carolina Care Communication in an Electronic Environment.

This article describes 1 organization's successful approach to mitigating the potential negative effects of a new electronic medical record on patient experience. The Carolina Care model, developed at the University of North Carolina Hospitals to actualize caring theory in practice, helped to structure and greatly facilitate this work. Seven focus areas were integrated to create the "Communication in an Electronic Environment" program with a strong emphasis on nurse-patient communication.

Understanding User Adaptation toward a New IT System in Organizations: A Social Network Perspective

Social networks can be a vital mechanism for users to adapt to changes induced by new IT systems in organizations. However, we do not adequately understand the effect of social networks on post-adoption IT use. Drawing on coping theory and the social network literature, we develop a cognitive-affective-behavioral classification of user adaptation and identify seeking-network closure and giving-network closure as key network characteristics pertinent to post-adoption IT use. Thereafter, we establish a theoretical link from seeking-network closure and giving-network closure to post-adoption IT use through the underlying mechanisms of user adaptation. We operationalize the research model using a field survey of a newly implemented electronic medical record system in a hospital in Northeast China, where we collected network data and objective system logs of 104 doctors. We found that seeking-network closure was positively associated with cognitive adaptation but negatively associated with affective adaptation and behavioral adaptation, whereas giving-network closure was negatively associated with cognitive adaptation but positively associated with affective adaptation and behavioral adaptation. Moreover, cognitive adaptation and affective adaptation were determinants of post-adoption IT use, but behavioral adaptation was not. We discuss our study’s theoretical and practical contributions.

Achieving Optimal Specialty Cerebrospinal Fluid (CSF) Testing: Are Electronic Medical Record Order Sets Helpful?

BackgroundSpecialty PCR testing has become available for lumbar puncture to determine the cause of infectious meningitis and encephalitis. Testing with low pre-test probability may increase antimicrobial therapy while results are pending and create increased direct costs. We aim to describe the appropriateness of testing before and after the implementation of electronic medical record (EMR) order sets designed to reduce excessive testing of CSF by creating two lists of tests: (1) a routine panel for all patients and (2) a list of optional specialty tests designed to be utilized after the nucleated cells are resulted.MethodsRetrospective study of adult patients undergoing lumbar puncture with suspicion for CNS infection pre-and post-implementation of EMR order sets from January 2016–March 2017. Consecutive patients with complete charts were reviewed from a tertiary care center. Data collected included demographics, co-morbid conditions, clinical presentation, and lumbar puncture results. The primary outcome of interest was the frequency of CSF specialty testing in patients with ≤ 10 nucleated cells/µL in the CSF.ResultsTwo hundred patients had ≤ 10 nucleated cells/µL in the CSF (n = 108 in pre-EMR group; n = 92 in post-EMR group). Of these patients 74% and 48.9% had Herpes Simplex Virus (HSV) PCR testing done pre and post EMR changes (P < 0.05). Enterovirus PCR testing remained similar among both groups (37% pre-EMR order sets vs. 36.9% post-EMR order sets, P = 0.99). Lyme PCR testing decreased between pre- and post-groups (26.8% vs. 9.7%, P < 0.05). CSF Epstein-Barr virus PCR testing also dropped significantly from 26.9% to 7.6% (P < 0.05). All specialty PCR testing that was performed on patients with ≤ 10 nucleated cells/µL in the CSF were negative. Paradoxically, HSV antibody testing increased post-implementation of EMR order sets (21.7% vs. 0%, P <0.05). Total costs of tests on average decreased by $70.71 per patient post EMR changes.ConclusionIn this cohort, CSF specialty testing was common but decreased after EMR changes. Laboratory stewardship can be improved with EMR changes but further education is needed to prevent unnecessary tests. Unwanted tests (HSV antibodies) may be increased as prescribers are unable to locate familiar tests.Disclosures M. D. Nailor, Astellas: Scientific Advisor and Speaker’s Bureau, Consulting fee and Speaker honorarium. Merck: Grant Investigator, Research grant.

Exploring patients satisfaction after the implementation of an electronic medical record system at Al-Wakrah primary health center, Qatar, 2016

Background: The healthcare industry has focused much attention on patient satisfaction with the quality of healthcare services. However, there remains a lack of research on patient satisfaction towards the implementation of an electronic medical record system at a primary healthcare setting. This study aimed at assessing the level of patient satisfaction regarding primary health care services after the implementation of an electronic medical record (EMR) system. Methods: A descriptive cross-sectional study was conducted at the Al-Wakrah health care center, with a random/convenient sample of 52 patients attending the center. Furthermore, the investigators interviewed the participants, in the waiting area, regarding their satisfaction with the primary health care services provided following the EMR system implementation. A structured interview-based questionnaire for measuring patient satisfaction was employed. Results: The vast majority of participants indicated that the overall service at the health center greatly improved after EMR implementation. Furthermore, most interviewees were totally satisfied with the overall workflow at the health care center such as the time spent at the registration desk (76.9%), before seeing a physician (65.4%), while the physician used the computer (76.9%), physical examination (69.3%), laboratory testing (73.1%), and collecting the medication (65.4%). Regarding health education and informativeness, the participants found that labeling medication bottles was quite informative. However, less than two-thirds (61.5%) of the patients were satisfied with the health education delivered by physicians. Conclusions: The results revealed that although overall patient satisfaction was relatively high, certain aspects of the health care service remained to be a source of dissatisfaction. Thus, this study demonstrated patient acceptance and support for the electronic medical record system at the primary health care setting.

Probiotic guidelines and physician practice: a cross-sectional survey and overview of the literature.

Probiotic use by patients and physicians has dramatically increased over the last decade, although definitive evidence is often lacking for their use. We examined probiotic-prescribing practices among health care providers (HCP) at a tertiary medical centre and compared these practices to clinical guidelines. HCP at the Stanford Medical Center received a survey on probiotic prescribing practices including choice of probiotic and primary indications. A broad overview of the literature was performed. Among 2,331 HCP surveyed, 632 responded. Of the 582 of these who routinely prescribed medications, 61% had recommended probiotic foods or supplements to their patients. Women and gastroenterologists were more likely to prescribe probiotics (odds ratio (OR): 1.5, 95% confidence interval (CI): 1.0-2.1; OR: 3.9, 95% CI: 1.5-10.1, respectively). Among probiotic prescribers, 50% prescribed inconsistently or upon patient request, and 40% left probiotic choice to the patient. Common indications for probiotics, particularly Lactobacillus GG, were prevention and treatment of antibiotic-associated diarrhoea (79 and 66%, respectively). Probiotics were often prescribed for 'general bowel health' or at patient request (27 and 39% of responders, respectively). Most respondents (63%) thought an electronic medical record (EMR) pop-up would change probiotic prescribing patterns. However, a review of published guidelines and large trials found inconsistencies in probiotic indications, dosages and strain selection. Probiotic prescribing is common but lacks consistency, with choice of probiotic frequently left to the patient, even for indications with some strain-specific evidence. Implementation of EMR pop-ups/pocket guides may increase consistency in probiotic prescribing, although the lack of clear and consistent guidelines must first be addressed with large, well-designed clinical trials.

Applying STOPP Guidelines in Primary Care Through Electronic Medical Record Decision Support: Randomized Control Trial Highlighting the Importance of Data Quality.

BackgroundPotentially Inappropriate Prescriptions (PIPs) are a common cause of morbidity, particularly in the elderly.ObjectiveWe sought to understand how the Screening Tool of Older People’s Prescriptions (STOPP) prescribing criteria, implemented in a routinely used primary care Electronic Medical Record (EMR), could impact PIP rates in community (non-academic) primary care practices.MethodsWe conducted a mixed-method, pragmatic, cluster, randomized control trial in research naïve primary care practices. Phase 1: In the randomized controlled trial, 40 fully automated STOPP rules were implemented as EMR alerts during a 16-week intervention period. The control group did not receive the 40 STOPP rules (but received other alerts). Participants were recruited through the OSCAR EMR user group mailing list and in person at user group meetings. Results were assessed by querying EMR data PIPs. EMR data quality probes were included. Phase 2: physicians were invited to participate in 1-hour semi-structured interviews to discuss the results.ResultsIn the EMR, 40 STOPP rules were successfully implemented. Phase 1: A total of 28 physicians from 8 practices were recruited (16 in intervention and 12 in control groups). The calculated PIP rate was 2.6% (138/5308) (control) and 4.11% (768/18,668) (intervention) at baseline. No change in PIPs was observed through the intervention (P=.80). Data quality probes generally showed low use of problem list and medication list. Phase 2: A total of 5 physicians participated. All the participants felt that they were aware of the alerts but commented on workflow and presentation challenges.ConclusionsThe calculated PIP rate was markedly less than the expected rate found in literature (2.6% and 4.0% vs 20% in literature). Data quality probes highlighted issues related to completeness of data in areas of the EMR used for PIP reporting and by the decision support such as problem and medication lists. Users also highlighted areas for better integration of STOPP guidelines with prescribing workflows. Many of the STOPP criteria can be implemented in EMRs using simple logic. However, data quality in EMRs continues to be a challenge and was a limiting step in the effectiveness of the decision support in this study. This is important as decision makers continue to fund implementation and adoption of EMRs with the expectation of the use of advanced tools (such as decision support) without ongoing review of data quality and improvement.Trial RegistrationClinicaltrials.gov NCT02130895; https://clinicaltrials.gov/ct2/show/NCT02130895 (Archived by WebCite at http://www.webcitation.org/6qyFigSYT)

Evaluation of the cost of dictation after implementation of a standardized electronic medical record

Evaluation of the cost of dictation after implementation of a standardized electronic medical record

Barriers and facilitators to Electronic Medical Records usage in the Emergency Centre at Komfo Anokye Teaching Hospital, Kumasi-Ghana.

IntroductionThe use of paper for record keeping (or a manual system) has been the order of the day in almost all health care facilities in resource poor countries. This system has presented numerous challenges, which the use of Electronic Medical Records (EMR) seeks to address. The objectives of the study were to identify the facilitators and barriers to EMR implementation in Komfo Anokye Teaching Hospital’s (KATH) Emergency Centre (EC) and to identify lessons learned. These will help in implementation of EMR in ECs in similar settings.MethodsThis was a non-interventional, descriptive cross-sectional and purely qualitative study using a semi-structured interview guide for a study population of 24. The interviews were manually recorded and analysed thematically. EMR implementation was piloted in the EC. Some of the EC staff doubled as EMR personnel. An open source EMR was freely downloaded and customised to meet the needs of the EC. The EMR database created was a hybrid one comprising of digital bio-data of patients and scanned copies of their paper EC records.ResultsThe facilitators for utilising the system included providing training to staff, the availability of some logistics, and the commitment of staff. The project barriers were funding, full-time information technology expertise, and automatic data and power backups. It was observed that with the provision of adequate human and financial resources, the challenges were overcome and the adoption of the EMR improved.DiscussionThe EMR has been a partial success. The facilitators identified in this study, namely training, provision of logistics, and staff commitment represent foundations to work from. The barriers identified could be addressed with additional funding, provision of information technology expertise, and data and power back up. It is acknowledged that lack of funding could substantially limit EMR implementation.

Barriers to electronic medical record implementation: a comparison between ophthalmology and other surgical specialties in Canada

ObjectiveIn the present study, the barriers limiting widespread adoption of electronic medical records (EMRs) among Canadian ophthalmologists were evaluated in comparison with physicians from other surgical specialities. The published literature regarding EMR use in ophthalmic practice was also reviewed. DesignPopulation-based, cross-sectional study. ParticipantsA total of 1199 Canadian surgeons participating in the 2014 National Physician Survey (NPS). MethodsData regarding speciality surgeons’ adoption of EMR programs were extracted from the 2014 NPS, a nationwide survey of practicing physicians in Canada. The data were entered into a spreadsheet, and basic statistical analyses, including χ2 analyses, were performed to compare the responses of ophthalmologists to other surgeons. ResultsCompared with other surgeons, ophthalmologists surveyed were significantly more likely to identify the following barriers to EMR adoption: “no suitable product for my practice” (p = 0.01), “too costly” (p = 0.0006), “too time consuming” (p < 0.0001), and “planning to retire soon” (p = 0.001). No statistically detectable differences were found between ophthalmologists and other surgeons for the following barriers: privacy concerns, reliability concerns, and lack of training. ConclusionsThe barriers that limit increased EMR adoption among Canadian ophthalmologists are different from those of other surgeons. This may be attributed to unique features of the field, including heavy reliance on hand-drawn figures in documentation, high patient volume, and the high costs associated with independent practice. Given the well-established benefits of EMR technology, consideration should be given to implementing strategies to mitigate these barriers. Additional research may help determine which specific improvements can be made to increase the use of EMR systems by ophthalmologists.

Implementation to optimization: A tailored, data-driven approach to improve provider efficiency in using the electronic medical record.

123 Background: The increasing use of Electronic Medical Records (EMR) has been coupled with a growing focus on physician dissatisfaction. A recent study revealed physicians spend twice as much time working on the EMR and related tasks as they spend with patients. Physicians also spent time at night on EMR-related work. Nine months after the implementation of a new EMR at Dana-Farber Cancer Institute, providers expressed frustration with the EMR burden. Following three group training sessions, providers requested individualized training. We sought to enhance efficiency in clinical review, documentation, placing orders and to reduce after hour use. Methods: Each provider was sent their EMR system usage by time of day and activity. Providers were also surveyed to elicit content for training and to gauge confidence. Prior to training, a trainer reviewed the survey results and system usage data. System usage data and a post training survey were utilized to quantify changes against baseline. Results: A total of 114 MDs, 37 NPs and 8 PAs completed training. Providers reported an increase in confidence across all activities. Almost all providers (98%) agreed the training enhanced their efficiency. Overall confidence rose from 58% to 94% strongly agree or agree post training. Overall time in system (TIS) per appointment and TIS reviewing a patient’s chart significantly improved. TIS spent on documentation, placing orders, or after hours did not significantly change. Conclusions: A tailored data-driven training approach improved overall efficiency and confidence. While changes to TIS were not significant across all activities or reduce after hour usage, ongoing training may continue to improve these measures. [Table: see text]

Quantifying the electronic medical record implementation to stabilization curve.

140 Background: The implementation of electronic medical records (EMR) has been noted to disrupt clinical workflows as providers acclimate to a new EMR. On May 30, 2015, Dana-Farber Cancer Institute (DFCI) implemented a new EMR. Using our Real Time Location System (RTLS), we sought to identify the time required to stabilize the experience for providers. We identified factors that may speed the stabilization rate to guide EMR implementations elsewhere. Methods: DFCI uses an RTLS to timestamp patient and provider locations throughout the day. To adjust for variation in appointment types, we measured the ratio of the actual exam duration (recorded by the RTLS) to the scheduled exam duration. We compared to a 3-month baseline average to quantify the immediate impact of implementation. We tracked the ratio over time to identify when stabilization occurred and compare to baseline performance. To infer influential factors, we performed a regression analysis based on RTLS data from the first 6 months post implementation. Results: The stabilization curve fits the “classical” power function model. Rapid improvement over the first ten days of clinical practice was followed by a gradual period of ongoing stabilization. The EMR impact on exam duration required approximately 30 clinical days for each provider to reach the baseline value with continued improvement over the next 30 clinical days. Factors with a potential to improve the rate of stabilization were provider type (MD, NP or PA), provider gender and provider age. Conclusions: The first ten clinical days experience a fast rate of improvement. Thus, while the initial impact is disruptive, operations improve rapidly. Initial improvement may be attributed to fixing “bugs” in the EMR and rapid learning by providers. Our presentation will explore factors that impact the rate of improvement. Understanding the stabilization rate and factors can aid organizations in training, implementation, and ongoing improvement to minimize the impact of EMR disruption. [Table: see text]

ANALISIS STRATEGI PENGEMBANGAN REKAM MEDIS ELEKTRONIK DI INSTALASI RAWAT JALAN RSUD KOTA YOGYAKARTA

Although developing countries are still concernin handling various infectious diseases but effective and efficienthealth care documentation process is needed (Kalogriopoulos et all, 2009). The implementation of electronic medical record (EMR) is a solution for effective and efficient documentation. Support of the electronic and transaction laws and Ministri of Health Regulation No.269 in year of2008 bright hope for the development of EMR. Provision of medical record file is still a problem in Yogyakarta General Hospital. In addition, medical records storage space is over capacity. Optimizing of medical records service provision need to be reviewed to minimize the use of paper and time efficiency.The purpose of this study was to analyze the development strategies outlined by EMR readiness analysis used instruments of DOQ-IT (Doctor's Office Quality-Information Technology) and strategy analysis used SWOT (Strengths, Weakness, Opportunities, Treats) instrument. This study used concurrent mix methode. Subjects in this study were 40 people who are the decision makers and users of EMR in Outpatient Installation of Yogyakarta General Hospital. The collection of data through interviews and questionnaires. The results showed that the Yogyakarta General Hospital in the moderately prepared category for EMR development. The results of the strategy analysis showed that Yogyakarta General Hospitals included in II quadrant, which showed a strong organization but faces many threats to develop EMR. The recomendation for thestrategies is diversification strategy.

Pharmacy student engagement in the evaluation of medication documentation within an ambulatory care electronic medical record

Background and purposeAn abundance of literature supports the benefits of electronic medical records (EMR) for improving overall healthcare quality. Identifying preventative care opportunities, reducing medical and medication related errors and incorporating clinical practice guidelines are just a few attributes of EMR implementation. The goals of this study were to engage experiential pharmacy students in the assessment of medication related documentation discrepancies in a newly implemented EMR system and to provide exposure to various aspects of conducting research. Educational Activity and SettingPharmacy students screened patient charts over a three-month period to identify documentation discrepancies, including omissions of medications and medical problems and duplication of medications. Students conducted medication reconciliation for a total of one-hundred thirty-four patients. FindingsMedication omissions were identified for 46% of patients, medical problem omissions were identified for 38% of patients, and thirty-two duplicate medications were identified. SummaryEngaging pharmacy students in the quality improvement project afforded an interactive learning experience, highlighting firsthand the challenges associated with electronic documentation and the associated potential negative implications to patient care. Additionally, students gained exposure to various components of research including data collection, assessment, entry, analysis and future implications.

Progress in the Enhanced Use of Electronic Medical Records: Data From the Ontario Experience.

BackgroundThis paper describes a change management strategy, including a self-assessment survey tool and electronic medical record (EMR) maturity model (EMM), developed to support the adoption and implementation of EMRs among community-based physicians in the province of Ontario, Canada.ObjectiveThe aim of our study was to present an analysis of progress in EMR use in the province of Ontario based on data from surveys completed by over 4000 EMR users.MethodsThe EMM and the EMR progress report (EPR) survey tool clarify levels of capability and expected benefits of improved use. Maturity is assessed on a 6-point scale (0-5) for 25 functions, across 7 functional areas, ranging from basic to more advanced. A total of 4214 clinicians completed EPR surveys between April 2013 and March 2016. Univariate and multivariate descriptive statistics were calculated to describe the survey results.ResultsPhysicians reported continual improvement over years of use, perceiving that the longer they used their EMR, the better patient care they provided. Those with at least two years of experience reported the greatest progress.ConclusionsFrom our analyses at this stage we identified: (1) a direct correlation between years of EMR use and EMR maturity as measured in our model, (2) a similar positive correlation between years of EMR use and the perception that these systems improve clinical care in at least four patient-centered areas, and (3) evidence of ongoing improvement even in advanced years of use. Future analyses will be supplemented by qualitative and quantitative data collected from field staff engagements as part of the new EMR practice enhancement program (EPEP).

Use of electronic medical records and quality of patient data: different reaction patterns of doctors and nurses to the hospital organization

BackgroundAs the implementation of Electronic Medical Records (EMRs) in hospitals may be challenged by different responses of different user groups, this paper examines the differences between doctors and nurses in their response to the implementation and use of EMRs in their hospital and how this affects the perceived quality of the data in EMRs.MethodsQuestionnaire data of 402 doctors and 512 nurses who had experience with the implementation and the use of EMRs in hospitals was analysed with Multi group Structural equation modelling (SEM). The models included measures of organisational factors, results of the implementation (ease of use and alignment of EMR with daily routine), perceived added value, timeliness of use and perceived quality of patient data.ResultsDoctors and nurses differ in their response to the organisational factors (support of IT, HR and administrative departments) considering the success of the implementation. Nurses respond to culture while doctors do not. Doctors and nurses agree that an EMR that is easier to work with and better aligned with their work has more added value, but for the doctors this is more pronounced. The doctors and nurses perceive that the quality of the patient data is better when EMRs are easier to use and better aligned with their daily routine.ConclusionsThe result of the implementation, in terms of ease of use and alignment with work, seems to affect the perceived quality of patient data more strongly than timeliness of entering patient data. Doctors and nurses value bottom-up communication and support of the IT department for the result of the implementation, and nurses respond to an open and innovative organisational culture.

APPLICATION OF LOGISTIC REGRESSION IN ANALYSIS OF FACTORS THAT AFFECT IMPLEMENTATION OF ELECTRONIC MEDICAL RECORD

Electronic Medical Record (EMR) has now become a trend in the world of health care. Lot of obstacles and barriers that interfere implementation of EMR. This paper discussed the eleven factors suspected to affect the implementation of EMR, with a case study hospital in Banyumas. By using logistic regression analysis obtained eight of the eleven factors that significantly affect the implementation of RME. The eight factors are financial factors, Human Resources (HR), the process of changing, psychological factors, legal factors, the time factor, organizational factors, and ICT trends. Technology, infrastructure, and social is a factor that does not significantly affect the implementation of EMR in hospital. ICT trends are new factors that significantly affect the implementation of EMR in hosital.

The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study.

BackgroundElectronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking.ObjectiveThe goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization.MethodsThe setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence.ResultsMedication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings.ConclusionsEMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels.