A CLINICALLY USEFUL DIABETES ELECTRONIC MEDICAL RECORD - LESSONS FROMTHE PAST - POINTERS TOWARD THE FUTURE

We have analysed the deficiencies of paper medical records in facilita ting the care of patients with diabetes and have developed an electron ic medical record that corrects some of them. The diabetes electronic medical record (DEMR) is designed to facilitate the work of a busy dia betes clinic. Design principles include heavy reliance on graphic disp lays of laboratory and clinical data, consistent color coding and aggr egation of data needed to facilitate the different types of clinical e ncounter (initial consultation, continuing care visit, insulin adjustm ent visit, dietitian encounter, nurse educator encounter, obstetric pa tient, transplant patient, visits for problems unrelated to diabetes). Data input is by autoflow from the institutional laboratories, by des k attendants or on-line by all users. Careful attention has been paid to making data entry a point and click process wherever possible. Oppo rtunity for free text comment is provided on every screen. On completi on of the encounter a narrative text summary of the visit is generated by the computer and is annotated by the care giver. Currently there a re about 7800 patients in the system. Remaining challenges include the adaptation of the system to accommodate the occasional user, developm ent of portable laptop derivatives that remain compatible with the par ent system and improvements in the screen structure and graphic displa y formats.