by Julia Casey, BN RN CVAA(C),
Manager, Clinical Education Team
Citation: Casey, J. (2024). How I helped design an EMR and lived to tell the tale: A nurse’s adventures. Canadian Journal of Nursing Informatics, 19(4). https://cjni.net/journal/?p=14011
It is important to involve front-line staff in developing new EMR systems right from the start and throughout the design, development, and launch phases. This helps make sure the system addresses a wide range of needs and is built based on how it *will* be used, not just how it *should* be used. Too often, nurses are brought in too late to make real changes, which leads to systems that do not work well for nursing or patient care. That ends up causing workarounds, extra manual tasks, and frustration for everyone.
My goal was to design a system that, from the ground up, considered the complexity of medical orders, nursing and patient needs across different treatment types, and allowed flexibility for future growth and changes.
I work for a national, privately owned infusion clinic company. I started as an infusion nurse 14 years ago and have since taken on various roles, including managing teams and overseeing clinics. After advocating for a new system for years, I was asked to join the project team as the clinical subject matter expert (SME).
We have been using an internally designed system for over a decade, but it’s become outdated, lacking integration capabilities, automation, and strong data collection features. Even though the need for a new system had been discussed for years, the project only got formal approval in early 2022.
As the clinical SME for the project, I worked with the design team to explain how our processes and systems work, and alongside the Operational SME, we reviewed potential solutions and identified any gaps. We also made sure to get input from our nurses by asking for their feedback on different design decisions, like hardware setups in the clinics. This way, we avoided making assumptions about what they would prefer and helped build more buy-in for the new system.
We started by mapping out both our current processes and the future state we wanted.
Working closely with nurses and Regional Nurse Managers, I pushed for a few key system features:
There were many challenges along the way:
Although our new system is still in development, my experience with this project has made it clear that having an experienced nurse involved from the start was essential to creating a system that truly supports nurses rather than complicating their work.
Nurse-driven technology development makes a big difference by ensuring healthcare tools, like EMR systems, are built with real-world experience in mind. When nurses are involved, the systems end up being more practical and user-friendly, which helps both patient care and day-to-day workflows. Plus, it empowers nurses by recognizing their expertise and encouraging teamwork, setting the stage for future innovations that better support healthcare professionals and patients.