title: The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study.
abstract: BACKGROUND
  Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking.
  
  
  OBJECTIVE
  The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization.
  
  
  METHODS
  The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence.
  
  
  RESULTS
  Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings.
  
  
  CONCLUSIONS
  EMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels.
authors.affiliation: Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada.|Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Sanaz
authors.identifier: http://orcid.org/0000-0001-8969-9038
authors.initials: S
authors.lastname: Riahi
authors.affiliation: Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada.|Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Ilan
authors.identifier: http://orcid.org/0000-0002-7485-9681
authors.initials: I
authors.lastname: Fischler
authors.affiliation: Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada.
authors.forename: Melanie I
authors.identifier: http://orcid.org/0000-0003-3478-1469
authors.initials: MI
authors.lastname: Stuckey
authors.affiliation: Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada.|Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Philip E
authors.identifier: http://orcid.org/0000-0001-6841-2763
authors.initials: PE
authors.lastname: Klassen
authors.affiliation: Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada.
authors.forename: John
authors.identifier: http://orcid.org/0000-0003-0453-3085
authors.initials: J
authors.lastname: Chen
keywords: electronic health records; health information management; medical informatics; mental health; organizational innovation; psychiatry; quality improvement