ATLANTA – Yes, electronic medical records (EMRs) are out there. Somewhat rarely in the individual and small physician practice groups, most often in large hospital systems.

But whether involving small or large systems, implementation of the EMR is a "life . . . fought in the trenches," said Dedra Cantrell, RN, chief information officer at Emory Healthcare (Atlanta).

A member of a panel on the future of EMR technology – during a healthcare IT "summit" sponsored here last week by the Technology Association of Georgia (Atlanta) – Cantrell said that over the past several months she has been "living the life that previous speakers have talked about."

That life has been focused on choosing, implementing and providing training in the use of an EMR system across Emory Healthcare, which is providing a variety of healthcare services through a range of facilities and venues, as well as linking to other healthcare services in the Atlanta region.

That effort has been dubbed EeMRI, for Emory e-Medical Record Initiative, and Emory has been "truly in the trenches of this huge strategic initiative," Cantrell said, calling it an initiative mainly focused on "making people healthy."

Cantrell told the summit attendees that Emory has invested $15 million in EMR implementation, and she outlined a rather long list of steps the organization has taken – as well as ongoing steps – which underlines the difficulties of developing EMRs in any system, large or small.

That effort has involved moving a huge legacy depository of data, by "migrating 112 million rows of discrete results into a new repository," linking it with the organization's other IT systems and, ultimately, developing a broad-based EMR that will aid both patients and physicians.

Besides the goals of "improving [patient] care, quality, efficiency, consistency [and] patient satisfaction," she said the new system would advance the organization's research and "push [healthcare] information to physicians at the right time."

Cantrell emphasized using the experience of other programs, but using only what fits.

"What works at Clarian [Indianapolis] or Duke [Durham, North Carolina] doesn't mean it's going to work at Emory," she said.

The implementation effort has come in three phases.

Phase I, she said, involved creating a "technical infrastructure and a technical layer, on top." This meant dealing with "five medical record numbers for each person" and, importantly, "to connect all of those record numbers to the right person."

Phase II, she said, had been completed in February, with the system "going live" with seven applications and 10 data migrations, which she called "a huge milestone for us."

What "never ends," Cantrell said, is Phase III.

"When you really get the momentum started, everybody wants a piece, everybody wants to participate," she said, adding the caveat to be "careful about managing the scope so that it doesn't take 15 years to implement."

The core of Phase III, she said, is "care transformation."

She somewhat downplayed return on investment, indicating that a financial analysis indicated the payback might not come for seven years.

"ROI is going to be there, a nice thing from the financial perspective," she said. "But it's really about patient care and patient quality of care."

Cantrell similarly downplayed the usual emphasis on the EMR as simply a movement from a paper to a non-paper environment.

"Let's get rid of paper – it's not about that," she said. "It's about automating the workflow with enabling technology that promotes that process.

"Focusing on process is key," she added. "We look at current workflow, the future state of workflow, the gaps where technology can't provide automation . . . You have to understand your workflow and how your workflow is going to change."

An emphasis of her presentation was encouraging the involvement of many players, "stakeholders," in the effort and doing it in an orderly way.

"The team has to be pulled together," Cantrell said. "There's way too much [in the way of] dynamics and dialogue on the fly. If you're not together, you really miss things and slow the process down."

Besides 50 people "continuing on the project full-time," she said that the team holds "daily tactical sessions, daily warring sessions" and that anyone on the project team can "call a war session when faced with an obstacle that they couldn't make progress on."

As other healthcare project leaders have frequently said, big projects need "champions," and Cantrell said the EeMRI effort had "very strong executive-level champions."

She credited Cerner [Kansas City, Missouri] with being a valuable "partner" for EeMRI, but she also agreed with another panel member (Medical Device Daily, March 31, 2005) that "you do not let the vendor drive the process. The vendor is a partner along the way, but you have to own and embrace it [yourself] for it to be successful."

Overall, she describe the project as highly successful, though not yet "portable" to other systems when a patient moves outside the Emory system.

"We're working on that," she said.

Cantrell noted that the largest challenge has not been technological but cultural, especially in promoting a culture change "particularly in an academic health system," where many, often conflicting voices demand to be heard.

"You have 28 CEOs, just in the clinical practice, that you have to bring together in a collaborative way to move things forward." And in developing an integrated system, "you have to make decisions together; any decision may impact several departments or areas down the line."

She also emphasized testing as "something that can't be underestimated as you implement an EMR. It's easy to test for the way things are supposed to work, but . . . you need to think about what happens when you put technology in front of people. They're going to try all kinds of things."

And in passing, Cantrell said that the EeMRI project has meant "challenging the past every single day" and particularly that there is "never a dull moment."