Implementation of An Electronic Medical Record At San Francisco City Clinic

Background: City Clinic is San Francisco's only municipal STD clinic.  Each patient receives an extensive risk assessment and clinical examination.  These data are used for reporting to funders for surveillance projects in addition to guiding clinical care. Since 1992, all data from the risk assessment and clinical evaluation had been recorded in paper charts and manually entered the next day.  The creation and filing of the charts required significant resources, including clinic space and a full-time data entry clerk. 

Objectives: Our goal was to develop an electronic medical record (EMR) that clinicians could use to record data themselves during the exam.  This would reduce labor, improve accuracy of data recorded, and increase availability of data from previous encounters.  It would also allow us to introduce real-time quality assurance of data as they were recorded (i.e., checks for validity, consistency, and completeness).

Project Description: The EMR was developed entirely in-house using our own internal database to record the data and Microsoft Access as the interface.  The system was refined using input from the clinical staff regarding ease of use and organization.   Extensive testing was conducted before implementation, and trainings were conducted with the clinical staff. 

Findings: The EMR was well received by clinical staff.   Its success has allowed us to streamline the registration process and to reallocate data entry and registration staff to more important tasks.  An original plan to use tablet PCs was technically problematic, however.

Conclusions: The success of our EMR shows that useful systems can be developed locally using commercially available software.  Success depends on communication with users and finding ways to incorporate their feedback so that clinical needs and program analysis needs are all met.

Implications for Programs, Policy, and Research: Other project areas should consider our internal approach before committing to expensive outside vendors.