Background:
NYC's Bureau of Sexually Transmitted Disease (STD) Control implemented an Electronic Medical Record (EMR) in its 10-clinics in 2004. STD-EMR was built in-house, and in 2007, was redesigned to achieve greater stability and capacity for growth. This included restructuring of data tables, addition of a laboratory results interface, and clinical decision support tools to improve user-utility and quality of care.

Objective:
Describe unanticipated challenges associated with use and expansion of STD-EMR, and associated human and electronic resource needs. Demonstrate the importance of system flexibility to accommodate changing clinical requirements.

Method:
The presenter will demonstrate STD-EMR version 2, highlighting clinical tools and interfaces, and will discuss lessons learned and considerations for EMR implementation.

Result:
Between September 1, 2005 and September 1, 2007, STD-EMR recorded 272,734 visits (131,057 in the first year, 141,677 in the second). Re-design improved speed and stability, facilitated navigation, and enabled addition of fields to reflect changes in laboratory and clinical services. Quality assurance measures revealed the need for clinical decision support tools such as risk-factor prompted reminders for oral and anal GC cultures. Introduction of these tools, as well as an interface with laboratories to permit electronic transfer of results has improved efficiency, convenience and utility. Support of STD-EMR consists of one ¼ time programmer, one ¼ time IT Manager, one ½ time Project Manager and one full-time Data Manager, as well as full-time on-site hardware and software support.

Conclusion:
Re-design of STD-EMR was necessary to ensure stability and flexibility in response to changes in clinical services and changing legal requirements. Sustained human and electronic resource support is critical to EMR success.

Implications:
Whether or not an EMR is designed in-house, STD programs considering computerized medical records should plan for substantial resource allocation, and the need for flexibility and scalability.