Implementation of EPR, the Future of German Healthcare

Germany has been bringing up the rear in implementing the electronic patient record (EPR) for years. While the EMRAM score of German hospitals continues to be negligible on the international and European levels, there are signs of progress that give a reason for hope.

FREMONT, CA:The EPR is the cornerstone of digitalisation; paper records dominate most of the everyday routine in German hospitals. Significant funding is set aside for the deployment of EPR under Germany's new Future of Hospitals law.

Financial assistance is given primarily for digitising clinical and care documentation, medication, and connecting patients to a digital portal both during and after their hospital stay. 54 per cent of funding requests are for increasing digital documentation.

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By 2023, the so-called digital radar will be required to display implementation progress. Hospitals are under a lot of strain because this is a complex undertaking with a relatively short time frame. Experience has shown that implementing the EPR is a difficult task, largely due to the involvement of practically all clinical and care team members. Additionally, once the EPR is introduced, various documentation standards developed in the various departments and wards must be unified. However, since maintaining paper records differs greatly from maintaining electronic ones, the documentation process must also alter.

No tangible records need to be located or retrieved because a lot of data will be sent from medical equipment or labs directly into the EPR. On the other hand, since the product must be chosen and the dosage must be precisely calculated, computerised documentation can take more time for medications, for example. A technical foundation must be established so that anyone may access the EPR from anywhere. The EPR can be successfully implemented by taking the four stages listed below:

Create the Technological Foundation

The infrastructure in many German hospitals is out-of-date, and not all facilities have WiFi, which is necessary for employing mobile peripherals such as tables and carts, cell phones, and mobile medical instruments. However, installing cabling and access points is expensive, making WiFi infrastructure updates more costly.

Before any EPR implementation, this foundational technology and network architecture must be developed. It can be necessary to hire outside service providers since the internal technical and IT teams cannot always perform this time-consuming work on top of their other duties.

To upload all diagnostic results from the medical equipment directly into the EPR, a subsequent step requires that all medical devices be connected to the network through cable or WiFi. It must be confirmed that all medical equipment is network-capable. If not, new ones must be bought; this is an expense that must be planned for in the budget. Additionally, as the required peripherals are a component of the technical foundation, the hospital information system (HIS) supplier must be contacted for the best tablets, cellphones, and carts.

Develop a Documentation Standard

Defining a single documentation standard and building the technology underpinning is important. Many hospitals easily follow the hospital information system, but each HIS has its approach to documentation. Since many systems can be customised, the buyer must specify the parameters. This is frequently carried out through pilot departments and wards, which establish the basic framework for the documentation standard, whether intentionally or not.

Many hospitals are inclined to convert the paper record 1:1 into the digital version when EPR implementation is planned. This is a critical error because many current structures and procedures were created using the paper-based method and cannot be digitised.

Establishing a multidisciplinary team of clinical and nursing professionals is therefore highly advised to produce a single, unified documentation standard for the entire institution. Giving the IT department the reins and management of such a project makes little sense. Instead, the professions and professionals who will use it regularly must create the documentation standard, which includes patient vital signs, medication, and the clinical and care record.

Clear Project Organisation and Responsibility

The complete digitalisation of all patient data is the goal of implementing the EPR. Since a 1:1 transfer of analogue procedures never results in the EPR's potential increase in efficiency and decrease in workload, this goal requires a rethinking of all documentation processes. The IT department shouldn't direct the project unless that department is in charge of process development across the institution because the project's focus is on the processes. The hospital's specialised process development department should handle the implementation project if there is one. If there is no such department, an expert for documentation and clinical and care processes must be found. If there is no one with the right qualifications for the position, an experienced nurse or clinical staff member with a keen interest in IT and the project would be a good choice.

The project must be firmly established in an open project organisation. They advise using a three-level strategy with a steering committee, project management, and three subprojects. The two sub projects are responsible for building the technical and IT prerequisites and the documentation standards. These two side projects ought to operate concurrently. The third subproject, implementation, can begin once they have reached a specific stage.

The project manager needs to be knowledgeable about the creation and maintenance of documentation.

The steering committee, made up of representatives of the hospital's or hospital group's major decision-making units, will be constantly updated on developments and issues and will make decisions regarding critical actions to be done if the plan deviates from. The implementation process can be managed and enforced using such a structure.