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Adding It Up

September 1, 2007
by Suresh Gunasekaran
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Implementing an EMR is one thing, documenting the financials along the way is another

This article is the third in a series detailing the journey to implement an electronic medical record (EMR) at UT Southwestern Medical Center University Hospitals in Dallas. The first two articles appeared in the July and August editions of HCI.

Suresh Gunasekaran

Suresh Gunasekaran

At UT Southwestern University Hospitals, we have commenced the first phase of our electronic medical record project. The design and build of the unified pharmacy system for our two hospitals has begun in earnest. Key masterfiles are being built, environments have been set-up, and current operational workflows have been documented. We are particularly focused on the set-up of our drugs database and the design and build of our medication files. We have also begun the design of our electronic medication administration record (eMAR).

The management burden of beginning the EMR implementation has been rather significant on our IT departments. Our meetings are dominated by the constant talk of project plans, budgets, staffing plans and contracts. Across all of these activities, this past month has had one common theme: the desire for "numbers." The organization has realized that this project represents "big" things: big opportunities, big expenses, and big challenges. The desire for numbers is a natural extension of the organizational need to quantify what needs to be done to complete the task at hand: a means of understanding how "big" this is really going to be.

Below, I've summarized our best efforts to quantify some of the top numbers in our world. These numbers are subject to change as we move forward, but they are a reflection of our current best estimates.

1. How many IT staff members does it take to implement an EMR?

We are a 450-bed two hospital health system with a common management structure. We have a 100 member health system IT department. We have allocated 17 FTEs in IT to implement the EMR. This includes project managers, builders, trainers and technical staff. This does not include an additional four to five IT consultants and four to five FTE vendor application staff members.

2. How many physicians does it take to develop the clinical content?

It takes one physician. Actually, we have budgeted a team of five physicians that will each devote 20 percent of their time on the EMR project. This multi-disciplinary team will be responsible for order-set development, CPOE workflow, and physician messaging workflow. More than five physicians will be ultimately involved in the EMR project; there will be a physician representative from each clinical service that will approve each clinical pathway. However, the five physician team will drive the development of the starter set.

3. How many nursing informaticists are necessary to design the workflow?

We will have six fulltime nursing informaticists dedicated to the EMR project. They are assigned by clinical service and each will have responsibility for two to three services. Each informaticist will be responsible for the design of the clinical workflow (ordering, documentation workflow, performance reporting), the validation of the corresponding build, coordination of user testing, and oversight of user training for clinical services.

4. How long will it take to implement the EMR?

It will take us 24 months to implement all currently scoped components as part of the EMR project. In the first year, we will implement six major EMR capabilities: enterprise pharmacy system, eMAR, results reporting, emergency department orders and documentation, house-wide nursing flowsheets, and unit clerk order entry. In the second year, we will implement advanced nursing documentation, CPOE and physician documentation.

5. How much will it cost to train the hospital staff on the EMR?

Almost $500,000 in staff labor expense (we will charge staff time to attend training to the project) will be incurred by the time we are done. We have over 1,000 patient-care services staff members to train through the course of the project. The majority of these members will require at least eight hours of classroom training on the new information system. Many of them will require supplemental computer skills training, because they have very little computer interaction today.

6. How much should we pay the physicians for their efforts in developing the EMR?

This has been a particularly contentious topic on our campus. There is universal agreement that the physicians should be compensated for their efforts. However, what they should be compensated for is far from a consensus. At this time, we have taken the approach of compensating dedicated EMR team physicians. We will not compensate physicians for their participation in oversight committees or for their time in applications training.

7. How much of the total EMR budget should be spent on IT infrastructure?

Roughly 20 percent of our EMR investment will go towards physical infrastructure. More than half of that investment will be in places that a user will not directly see: data center, disaster recovery, storage, networking and database/operating systems. The remainder is budgeted for bedside hardware and ergonomic equipment.

I have been happy to provide our hospital customers with the "numbers" they have asked for. However, it is too early to report the outcome of the most significant numbers effort on the EMR project at UT Southwestern Medical Center. Our EMR steering team is currently identifying and documenting 10 metrics to track EMR effectiveness before and after our implementation. We hope to have these ready by next month. These numbers should help focus the organization on the only true numbers in our business: clinical core measures, staff productivity, and financial profitability.

Would you like to write your own Transformation Diary for HCI? If so, e-mail Editor-in-Chief Anthony Guerra at

Suresh Gunasekaran is assistant vice president and CIO, University Hospitals & Clinics, UT Southwestern Medical Center, Dallas

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