Installing an electronic medical record

Construction report:

March 2010

Melanie Townshend, Project Executive Gilbane Building Company

When operating in the most efficient and effective mode, the electronic medical record (EMR) system in a hospital will be receiving data not just from the staff members typing it in, but also from clinical equipment and building-wide systems that are “smart” enough to generate the data and push it into the EMR. Similarly, the EMR can provide information back to the clinical staff in more ways than just having them peer into a computer screen. For this reason, the design team needs to design the technology into the building and the construction management team needs to coordinate the installation of all technology and systems in the appropriately integrated manner.

As an example, Gilbane is currently serving as program manager for an acute care hospital tower project and has responsibility for equipment procurement, technical coordination, and operational planning. There are 36 points of technology occurring in typical patient care spaces - devices that are controllable, iterative, data-generating, and/ or alarm-generating, such as the “smart” bed, nurse call devices, IT network devices, interactive patient television, physiological monitors, IV pumps, ventilators, medication scanner and more.

In order to make it all work, the process began with identification of the technologies to the design team so that the infrastructure could be included. Some of these are obvious points, like a network connection in the patient room, but some are more subtle, like picking up the fact that additional scanners, monitors, tablet docking stations, wireless devices may be needed in a hospital using an EMR as compared to one with a more traditional, less integrated way of documenting patient care. Gilbane has been doing this work through an Integration Team, where the clinical, business, and support service staff meet with the design and construction players to select and coordinate each item.

Then the team embarked on the procurement process, exploring with potential vendors how their equipment might work with other equipment and/or the EMR. Technology is changing rapidly, so a concerted effort is needed to keep current on what is available. The project team jokingly refers to part of the procurement process as the “info-mercials,” where they set aside blocks of time to have vendors give presentations to the Integration Team. This is preferable to having individual vendors target specific staff members or groups and promote their products behind closed doors.

Gilbane is in the final stages of developing a matrix to show what each item is, who provides it, who installs it, what else is it connected to, does it generate alarms, and does it feed data to the hospital’s electronic medical record, and how does it all work. While the company is developing this, the structured cabling installer is taking this information in to develop installation drawings – taking it a step beyond the “points” typically identified schematically by the design team. Simultaneously, a transition staff is working with each department to identify their operational workflow, taking all of this technology and communication into account.

Oh, and what happened to the IT department? They are pretty busy too, setting up the software and gathering the initial data inputs, but they understand that all is for naught if the devices are not being provided and supported at the right places in the facility. As with other major application roll-outs, the IT staff needs to help the users articulate their workflow so that the software and resultant data will support and enhance.

The IT department may want to put in a call to the design and construction team as well – once a hospital begins to run the electronic medical record, the old-style “computer room” is no longer sufficient. The EMR is a mission-critical function and will require an upgraded data center conforming to current best practices for 7x 24 reliability. Enhanced and redundant cooling, power supply, and room security systems are mandatory. The fully utilized EMR will quickly amass a great amount of digital imagery, so a data storage strategy, with physical space for growth, is mandatory.

Companies cannot start this type of coordination too early – more discussion is leading to more integration between different systems. Early coordination really gets the maximum benefit out of every dollar spent. The clinical staff also appreciates having a clear understanding of all types of alarms and having time to plan their response procedures; this is at the heart of meeting the Joint Commission recommendations and requirements for annunciation of clinical alarms. By pushing data directly into the new EMR, hospitals are beginning to see how technology integration benefits patient care and literally saves extra steps.