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Letters to the Editor

July 24, 2008
by root
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Dear Mr. Guerra,

As a reader of Healthcare Informatics, I have a question.

What is being done to better automate document management for EHRs? No matter how much one envisions a paperless environment under various standards, the key issue is to have those documents reviewed and stored in a logical manner. What is absent from our records system is a taxonomy for what type of document it is, a tag that is machine readable for the patient's identity, and a machine-readable system to identify the originating source.

Where is the industry going? Are you planning any issues about this issue of document management? I think it is important, because numerous systems are on the market without a good automated document management component.

Jeffrey L. Kaufman M.D. FACSSpringfield

Hi Jeffrey,

We recently did a story on document management which can be found here – ‘Corralling Documents’ (



My concern is broader. All the hospitals with electronic systems in place in my region (Cerner, Meditech mainly) have arrived without a high-volume scanning solution. This is proving to be a very serious omission. In addition, the lack of national standards for document identity and taxonomy are harmful. The CCHIT system does not sanction an EHR that lacks scanning functionality, and that is ridiculous. That is why I wrote. It is a plea for someone to get off the starting pad and fix the problem.


JL Kaufman

Mr. Guerra,

I work as an Internal Consultant in Quality & Informatics for a large non-profit healthcare system that provides both medical coverage and care. We have been using an EMR in our outpatient clinics for the past five years, and will be implementing an inpatient EMR into our hospital units within the next year.

Our hospital is older and was not designed for the use of computers for inpatient care. The biggest challenge is determining the placement of computers for our Family Birthing Unit (FBU). The whole FBU department has very little free space, has a fast paced and crowded nursing station which limits the amount of staff that can be present at one time. Due to the chaotic nature of the department, nursing management has requested no additional computers at the nursing station.

There are currently computers in the patient's rooms using a labor and delivery program that will be interfaced to the new EMR. The problem arises where to put additional computers for the many doctors, residents, midwives, nurses, nursing students and the delivery room specialists to use when the mother and baby are sleeping without going through the expense of a major remodel.

We have discussed mounting the computers on the walls in the hallway by the patient's rooms. Our issues with this proposal are finding a computer that will fit within the three inches allowed by the fire code and medical record security concerns. Computers on wheels are out of the question because the FBU does not have space to store them.

Has anyone experienced this problem, of the placement of computers, in an older hospital that was not designed for computer use with patient care workflow? What has worked well for them and what would they have done differently? Any ideas or suggestions would be greatly appreciated. Thank you.

Nancy L. Smith


Quality & Informatics

Healthcare Informatics 2008 August;25(8):16