Journal of Medical Systems

, Volume 36, Issue 3, pp 1193–1203

Design and Development of EMR Supporting Medical Process Management

  • Jing-Song Li
  • Xiao-Guang Zhang
  • Jian Chu
  • Muneou Suzuki
  • Kenji Araki


Current EMR system benefits physicians by facilitating order entry and reducing errors. It can improve the safety and effectiveness of medical services, but cannot manage the whole medical process and the quality of medical services. In addition to physicians, EMR should be designed for all medical professionals because medical services cannot be accomplished by physicians alone, but also requires the involvement of other medical professionals. Therefore, we applied PDCA, the famous quality management cycle to design a comprehensive and coherent EMR system which can be used throughout the entire treatment process. EMR with the PDCA Cycle can record every order state and every treatment procedure in order to monitor the whole medical process. This extends the safety from planning the treatment to fulfilling it. By analyzing the records, doctors and hospital managers can perfect the medical process and improve healthcare quality. The EMR we designed with the PDCA Cycle provides a record entry interface for physicians and a worksheet interface for nurses and other professionals. Every treatment procedure and every change of orders or tasks will be fed back to medical professionals. So information generated from the beginning to the end of treatment will link with each other to avoid any information islands. Furthermore, the EMR can display the additional information intuitively and real-timely without increasing the burden of medical professionals’ work.


PDCA EMR Medical process management 


  1. 1.
    Shortliffe, E. H., and Cimino, J. J. (2006) Biomedical informatics: computer applications in health care and biomedicine, 3rd ed, 447–475, Springer, 2006Google Scholar
  2. 2.
  3. 3.
    Buyl, R., and Nyssen, M., Structured electronic physiotherapy records. Int J Med Inform 78:473–481, 2009.CrossRefGoogle Scholar
  4. 4.
    Soop, M., Fryksmark, U., Köster, M., and Haglund, B., The incidence of adverse events in Swedish hospitals: A retrospective medical record review study. Int J Qual Health Care 21(4):285–291, 2009.CrossRefGoogle Scholar
  5. 5.
    Takemura, T., and Ashida, N., A study of the medical record interface to natural language processing. J Med Syst 26(2):79–87, 2002.CrossRefGoogle Scholar
  6. 6.
    Lillywhite, T. P. Implementing BS7799 in the UK National Health Service. Comput. Fraud Secur. (2):4–8, 2004.Google Scholar
  7. 7.
    Chang, J. I., and Liang, C.-L., Performance evaluation of process safety management systems of paint manufacturing facilities. J Loss Prev Process Ind 22:398–402, 2009.CrossRefGoogle Scholar
  8. 8.
    Labodova, A., Implementing integrated management systems using a risk analysis based approach. J Cleaner Prod 12:571–580, 2004.CrossRefGoogle Scholar
  9. 9.
    Bernardo, M., Casadesus, M., Karapetrovic, S., and Heras, I., How integrated are environmental, quality and other standardized management systems? An empirical study. J Cleaner Prod 17:742–750, 2009.CrossRefGoogle Scholar
  10. 10.
    Humphreys, E., Information security management standards: compliance, governance and risk management. Inf Secur Tech Rep 13:247–255, 2008.CrossRefGoogle Scholar
  11. 11.
    Ishii, K., Ichimura, T., and Ikeda, H., Development of educational program for production manager leading new perspectives on manufacturing technology. Int J Prod Econ 122:469–478, 2009.CrossRefGoogle Scholar
  12. 12.
    Lyu, J., Jr., Chang, S.-Y., and Chen, T.-L., Integrating RFID with quality assurance system—Framework and applications. Expert Syst Appl 36:10877–10882, 2009.CrossRefGoogle Scholar
  13. 13.
    Adler, P. S., Benner, M., and Brunner, D. J., Perspectives on the productivity dilemma. J Oper Manage 27:99–113, 2009.CrossRefGoogle Scholar
  14. 14.
    Jørgensen, T. H., Remmen, A., and Mellado, M. D., Integrated management systems e three different levels of integration. J Cleaner Prod 14:713–722, 2006.CrossRefGoogle Scholar
  15. 15.
    Chin, S., Kim, K., and Kim, Y.-S., A process-based quality management information system. Autom Constr 13:241–259, 2004.CrossRefGoogle Scholar
  16. 16.
    Caroly, S., Coutarel, F., Landry, A., and Mary-Cheray, I., Sustainable MSD prevention: management for continuous improvement between prevention and production. Ergonomic intervention in two assembly line companies. Appl Ergon 41:591–599, 2010.CrossRefGoogle Scholar
  17. 17.
    Li, B. N., Chao, S., and Dong, M. C., SIBAS:Ablood bank information system and its 5-year implementation at Macau. Comput Biol Med 37:588–597, 2007.CrossRefGoogle Scholar
  18. 18.
    BN, Li, S, Chao, and MC, Dong, Barcode technology in blood bank information systems: upgrade and its impact. J Med Syst 30:449–457, 30.Google Scholar
  19. 19.
    Kirscha, M., Vogg, I., Hosten, N., and Fleßa, S., Quality management in a radiological practice experiences with a certification for DIN EN ISO 9001:2000. Eur J Radiol 75:e1–e8, 2010.CrossRefGoogle Scholar
  20. 20.
    van der Eijk, I., Verheggen, F. W., and Russel, M. G., “Best practice” in inflammatory bowel disease: an international survey and audit. Eur J Intern Med 15:113–120, 2004.CrossRefGoogle Scholar
  21. 21.
    Thornlow, D. K., and Mcguinn, K., A necessary sea change for nurse faculty development: spotlight on quality and safety. J Prof Nurs 26(2):71–81, 2010.CrossRefGoogle Scholar
  22. 22.
    Scott, B. S., Wilcock, A. E., and Kanetkar, V., A survey of structured continuous improvement programs in the Canadian food sector. Food Control 20:209–217, 2009.CrossRefGoogle Scholar
  23. 23.
    Takeda, H., Matsumura, Y., and Nakajima, K., Health care quality management by means of an incident report system and an electronic patient record system. Int J Med Inform 69:285–293, 2003.CrossRefGoogle Scholar
  24. 24.
    Gray, M. D., and Felkey, B. G., Computerized prescriber order-entry systems evaluation, selection, and implementation. Am J Health-Syst Pharm 61:190–197, 2004.Google Scholar
  25. 25.
  26. 26.
    Intersystems, Caché Tech Guide,
  27. 27.
  28. 28.
    Gorman, P. N., Lavelle, M. B., and Ash, J. S., Order creation and communication in healthcare. Methods Inf Med 42:376–384, 2003.Google Scholar
  29. 29.
    Tange, H., How to approach the structuring of the medical record? Towards a model for flexible access to free text medical data. Int J Biomed Comput 42:27–34, 1996.CrossRefGoogle Scholar
  30. 30.
    Product quicktake-Intersystems Ensemble,
  31. 31.
  32. 32.
    Bleich, H. L., and Slack, W. V., Reflections on electronic medical records: When doctors will use them and when they will not. Int J Med Inform 79:1–4, 2010.CrossRefGoogle Scholar
  33. 33.
    Poissant, L., Pereira, J., Tamblyn, R., and Kawasumi, Y., The impact of electronic health records on time efficiency of physicians and nurses: A systematic review. J Am Med Inform Assoc 12(5):505–516, 2005.CrossRefGoogle Scholar
  34. 34.
    Chung, K., Choi, Y. B., and Moon, S., Toward efficient medication error reduction: Error-reducing information management systems. J Med Syst 27:553–560, 2003.CrossRefGoogle Scholar
  35. 35.
    Jha, A. K., DesRoches, C. M., and Campbell, E. G., Use of electronic health records in U.S. hospitals. N Engl J Med 360:1628–1638, 2009.CrossRefGoogle Scholar
  36. 36.
    DesRoches, C. M., Campbell, E. G., and Rao, S. R., Electronic health records in ambulatory care—a national survey of physicians. N Engl J Med 359:50–60, 2008.CrossRefGoogle Scholar
  37. 37.
    Blumenthal, D., and Glaser, J. P., Information technology comes to medicine. N Engl J Med 356:2527–2534, 2007.CrossRefGoogle Scholar
  38. 38.
    Davis, K., Doty, M. M., Shea, K., and Stremikis, K., Health information technology and physician perceptions of quality of care and satisfaction. Health Policy 90:239–246, 2009.CrossRefGoogle Scholar
  39. 39.
    Ludwick, D. A., and Doucette, J., Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries. Int J Med Inform 78:22–31, 2009.CrossRefGoogle Scholar
  40. 40.
    Uslu, A. M., and Stausberg, J., Value of the electronic patient record: An analysis of the literature. J Biomed Inform 41:675–682, 2008.CrossRefGoogle Scholar
  41. 41.
    Williams, F., and Boren, S. A., The role of electronic medical record in care delivery in developing countries. Int J Inf Manage 28:503–507, 2008.CrossRefGoogle Scholar
  42. 42.
    Sridhar, G. R., Rao, A. A., Muraleedharan, M. V., Jaya Kumar, R. V., and Yarabati, V., Electronic medical records and hospital management systems for management of diabetes. Diabetes Metab Synd Clin Res Rev 3:55–59, 2009.CrossRefGoogle Scholar
  43. 43.
    Helm, S., and Hansen, H. C., Information technology in the interventional pain practice: Electronic medical records, practice management software, and document management. Pain Physician 7:357–364, 2004.Google Scholar
  44. 44.
    Siika, A. M., Rotich, J. K., and Simiyu, C. J., An electronic medical record system for ambulatory care of HIV-infected patients in Kenya. Int J Med Inform 74:345–355, 2005.CrossRefGoogle Scholar
  45. 45.
    Grams, R., The “New” America Electronic Medical Record (EMR)—design criteria and challenge. J Med Syst 33:409–411, 2009.CrossRefGoogle Scholar
  46. 46.
    Delpierre, C., Cuzin, L., and Fillaux, J., A systematic review of computer-based patient record systems and quality of care: More randomized clinical trials or a broader approach? Int J Qual Health Care 16(5):407–416, 2004.CrossRefGoogle Scholar
  47. 47.
    Custers, T., Arah, O. A., and Klazinga, N. S., Is there a business case for quality in The Netherlands? A critical analysis of the recent reforms of the health care system. Health Policy 82:226–239, 2007.CrossRefGoogle Scholar
  48. 48.
    Iedema, R., New approaches to researching patient safety. Soc Sci Med 69:1701–1704, 2009.CrossRefGoogle Scholar
  49. 49.
    Campbell, E. M., Guappone, K. P., and Sittig, D. F., Computerized provider order entry adoption: Implications for clinical workflow. J Gen Intern Med 24(1):21–26, 2008.CrossRefGoogle Scholar
  50. 50.
    Mir, C., Gadri, A., and Zelger, G. L., Impact of a computerized physician order entry system on compliance with prescription accuracy requirements. Pharm World Sci 31:596–602, 2009.CrossRefGoogle Scholar
  51. 51.
    Ghahramani, N., Lendel, I., Haque, R., and Sawruk, K., User satisfaction with computerized order entry system and its effect on workplace level of stress. J Med Syst 33:199–205, 2009.CrossRefGoogle Scholar
  52. 52.
    Kennedy, A. G., Littenberg, B., and Senders, J. W., Using nurses and office staff to report prescribing errors in primary care. Int J Qual Health Care 20(4):238–245, 2008.CrossRefGoogle Scholar
  53. 53.
    Eslami, S., de Keizer, N. F., and Abu-Hanna, A., The impact of computerized physician medication order entry in hospitalized patients—a systematic review. Int J Med Inform 77:365–376, 2008.CrossRefGoogle Scholar
  54. 54.
    Dalton, G. D., Samaropoulos, X. F., and Dalton, A. C., Improvements in the safety of patient care can help end the medical malpractice crisis in the United States. Health Policy 86:153–162, 2008.CrossRefGoogle Scholar
  55. 55.
    Cooperberg, M. R., Birkmeyer, J. D., and Litwin, M. S., Defining high quality health care. Urologic Oncology: Seminars and Original Investigations 27:411–416, 2009.CrossRefGoogle Scholar
  56. 56.
    Chao, C. C., Jen, W. Y., Hung, M. C., Li, Y. C., and Chi, Y. P., An innovative mobile approach for patient safety services: The case of a Taiwan health care provider. Technovation 27:342–351, 2007.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Jing-Song Li
    • 1
  • Xiao-Guang Zhang
    • 1
  • Jian Chu
    • 1
  • Muneou Suzuki
    • 2
  • Kenji Araki
    • 2
  1. 1.Healthcare Informatics Engineering Research CenterZhejiang UniversityHangzhouChina
  2. 2.Department of Medical InformaticsMiyazaki University HospitalMiyazakiJapan

Personalised recommendations