title: Regenstrief Institute's Medical Gopher: a next-generation homegrown electronic medical record system.
abstract: OBJECTIVE
  Regenstrief Institute developed one of the seminal computerized order entry systems, the Medical Gopher, for implementation at Wishard Hospital nearly three decades ago. Wishard Hospital and Regenstrief remain committed to homegrown software development, and over the past 4 years we have fully rebuilt Gopher with an emphasis on usability, safety, leveraging open source technologies, and the advancement of biomedical informatics research. Our objective in this paper is to summarize the functionality of this new system and highlight its novel features.
  
  
  METHODS
  Applying a user-centered design process, the new Gopher was built upon a rich-internet application framework using an agile development process. The system incorporates order entry, clinical documentation, result viewing, decision support, and clinical workflow. We have customized its use for the outpatient, inpatient, and emergency department settings.
  
  
  RESULTS
  The new Gopher is now in use by over 1100 users a day, including an average of 433 physicians caring for over 3600 patients daily. The system includes a wizard-like clinical workflow, dynamic multimedia alerts, and a familiar 'e-commerce'-based interface for order entry. Clinical documentation is enhanced by real-time natural language processing and data review is supported by a rapid chart search feature.
  
  
  CONCLUSIONS
  As one of the few remaining academically developed order entry systems, the Gopher has been designed both to improve patient care and to support next-generation informatics research. It has achieved rapid adoption within our health system and suggests continued viability for homegrown systems in settings of close collaboration between developers and providers.
authors.affiliation: Regenstrief Institute Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA; School of Informatics and Computing, IUPUI, Indianapolis, IN, USA; Wishard/Eskenazi Health Services, Indianapolis, IN, USA. Electronic address: jonduke@regenstrief.org.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Duke
authors.affiliation: Regenstrief Institute Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA; Wishard/Eskenazi Health Services, Indianapolis, IN, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Morea
authors.affiliation: Regenstrief Institute Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA; Wishard/Eskenazi Health Services, Indianapolis, IN, USA.
authors.forename: Burke
authors.initials: B
authors.lastname: Mamlin
authors.affiliation: Regenstrief Institute Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Martin
authors.affiliation: Regenstrief Institute Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA; Wishard/Eskenazi Health Services, Indianapolis, IN, USA.
authors.forename: Linas
authors.initials: L
authors.lastname: Simonaitis
authors.affiliation: Regenstrief Institute Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Blaine Y
authors.initials: BY
authors.lastname: Takesue
authors.affiliation: Regenstrief Institute Inc., Indianapolis, IN, USA; Center for Implementing Evidence-Based Practice, Department of Veterans Affairs, Health Services Research & Development Service, Indianapolis, IN, USA; School of Informatics and Computing, IUPUI, Indianapolis, IN, USA.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Dixon
authors.affiliation: Regenstrief Institute Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA; Wishard/Eskenazi Health Services, Indianapolis, IN, USA.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Dexter
mesh_terms: D004282:Documentation / Q000639:trends*; D001330:Electronic Data Processing; D006785:Hospitals, University; D006801:Humans; D016247:Information Storage and Retrieval; D016347:Medical Records Systems, Computerized / Q000639:trends*; D005791:Patient Care; D012984:Software; D014584:User-Computer Interface
keywords: Clinical decision support systems; Computerized physician order entry system; Electronic health record; Health information technology