The Mini Electronic Medical Record: A Low-Cost, Low-Risk Partial Solution
Electronic medical records (EMRs) offer many advantages. However, there are also risks involved with adopting a full commercial EMR. These include high cost, the disruption of clinic routines, and poor or no vendor support. We created and implemented a partial, or miniature EMR (mini EMR) based on Microsoft Access 97 (Microsoft Corporation; Redmond, Wash). This program serves as an electronic front sheet for the patient chart that records International Classification of Diseases—9th revision codes and chronic medications and allergies, and provides reminders for prevention procedures. The mini EMR has been inexpensive, adaptable, easy to maintain, and very well accepted, and it has caused little interruption of our clinical activities. We believe the program can serve as a bridge to a future commercial EMR once that market has matured.
Using the Mini EMR in Other Practices
There are several lessons we learned from developing and implementing the mini EMR. The first is to start with a subset of your most committed practitioners. This group will be most forgiving of the inevitable growing pains associated with adopting a new system. Such an approach may also induce nonuser envy. Second, the development of a sense of ownership of the program was very important. We believe implementing users’ suggestions increased acceptance.
Although a general purpose relational database may be inappropriate for practice networks with many providers and locations, adopting the mini EMR in a smaller practice should be relatively easy. A person with good knowledge of Access would be required for initial setup, for the link to your current computer system, and for any desired modifications. A small network can easily be created, as described by Levin.11 Although we have not attempted to import data from the mini EMR into a commercial EMR, the widespread use of Access should make interfacing with a commercial EMR relatively simple.
Conclusions
The mini EMR has given our practice many of the advantages of a full EMR with few of the accompanying disruptions and at a much lower price. The simplicity of the design, coupled with the many attributes of Microsoft Access, make it easy to maintain and modify. We believe this program will serve our practice well for several years and then act as a bridge to a full commercial EMR once that software market has matured.
