Electronic Medical Record in Pediatric Intensive Care: Implementation Process Assessment

The implementation of an electronic medical record (EMR) is a high-priority project in a majority of industrialized countries. The Healthcare Information and Management Systems Society (HIMSS) Analytics established an eight-stage EMR Adoption Model (EMRAM) to track progress against health care organizations across a country. In Canada, 36.5% of the hospitals are at the stage 3 or higher, whereas 0.2% have reached the seventh stage. To assess the impact on the safety and caregivers' satisfaction of a stage 7 EMR in a Quebec Pediatric Hospital initially at the EMRAM stage 3, a pilot customized implementation of paperless pediatric intensive care EMR was performed and evaluated. Six months after implementation, there was a nonsignificant decrease in severe medical incidents in comparison to the same period of time, the previous year. Most pediatric intensive care unit (PICU) staff were very or completely comfortable with the EMR, but the EMR satisfied 33.9% of all staff (everyday users [internal staff] and occasional user [external staff]) and 41.9% of internal staff only. The information gathered with this pilot EMR implementation using a 20-month preparation period and a continuous monitoring including change management ("living lab approach") after the "go live" helped in the success of the implementation but did not improve significantly caregivers' satisfaction, in the first 6 months of this dramatic change in practice.