Regenstrief Medical Record System (RMRS)
Orginally developed in 1972 by Clem Mcdonald, Regenstrief Medical Record System (RMRS) is a complex system that involves manipulation, transfer, and storage of data in and associated with electronic medical records. It is the first EMR to generate reminders to physicians about its own content. The goal was to
(1) eliminate the logistic problems of the paper record by making clinical data immediately available to authorized users wherever they are—no more unavailable orundecipherable clinical records; (2) to reduce the work of clinical book keeping required to manage patients—no more missed diagnoses when laboratory evidence shouts its existence,no more forgetting about required preventive care; (3) to make the informational ‘gold’ in the medical record accessible to clinical, epidemiologic, outcomes and management research. The system was to complement, not replace, the paper medical record.
It began in 1972, in a diabetes clinic with only 35 patients. As of 1999, the RMRS carried 200 million separate coded observations,3.25 million narrative reports, 15 million prescriptions and 212,000 electrocardiographic (EKG) tracings. The RMRS carried records for 1.4 million patients in addition to all data generated from several thousand ambulatory and inpatient encounters per year,
As of now, the RMRS is still operating, which carries 660 million distinct observation. This makes RMRS one of the longest operating EMRs in the world. The RMRS is being accessed more than 10 million times every year by Wishard Health Services and 20 million times per year at Clarian Health in Indianapolis.
The RMRS has been best studies and it is well known nationally and internationally to be the model for a number of commercial and academic EMR systems.
This system serves four hospitals on the Indiana University Medical Center campus and forty outreach practices in the city of Indianapolis.
The systems success can be attributed to it's strong foundation in 3 areas.
1. Support/Commitment of leadership, 2. Commitment to the mission and vision of high quality and excellence in health care, and 3. Continuous quality improvement and incorporation of user feedback to guide this improvement.
The data repoistory is the key component of the system. It originally called for no data entry for physicians' observations. Creator Clement McDonald, M.D. and his co-authors note that physicians were reluctant to perform data entry. The system developers first enlisted physicians for data entry with a physician orders system because orders are more easily structured for data input than observations.
References
The Three-Legged Stool: Regenstrief Institute for Health Care. Clement McDonald, M.D.
McDonald CJ. The Regenstrief Medical Record System: a quarter century experience. International Journal of Medical Informatics. 1999. 54(1999)225-53.
