Two colleagues in the United States were interested in learning about the experience of others with regards to electronic medical records and the ordering and documenting of blood transfusions.

1. A colleague in Southern California wants to know what experience others have had with computer order entry systems for ordering of blood products, including the use of 'electronic' signatures by the physician who is prescribing the transfusion. The Californian is of the understanding that some hospitals allow nurses and clerks to input orders for blood products into a hospital information system, provided the orders have been 'written' by a physician.
2. A colleague in Florida reports that his health system will be opening a new "paperless" hospital in February 2005. The hospital will have an electronic medical record, physician computer order entry, wireless handheld devices for recording vital signs, drug administration, etc. In the short run the Floridian does not see any way around printing unit tags to label components for transfusion, even though there will be no patient chart on which to place a completed unit tag! Scanning a handwritten completed unit tag and placing a digital image into the patient's electronic record is an option until their Information Systems team can develop an electronic form to capture all of the information that is normally recorded on a completed unit tag. The Floridian would be interested to learn from the experience of any transfusion service that has already developed an electronic blood administration record, and how they went about this. Key issues for discussion would be forms design, data fields, electronic signatures, as well as the actual logistics/process for nursing to complete the forms, the transfusion service to monitor completion, reporting of reactions, etc.

1. The Editor suggests that the information at:

• CBER Guidance for Industry - Part 11, Electronic Records; Electronic Signatures - Scope and Application. August 2003, Pharmaceutical CGMPs
• CDER Guidance for Industry - Part 11, Electronic Records; Electronic Signatures - Scope and Application. August 2003, Pharmaceutical CGMPs

and the e-Network Forum discussions:

• The effect of handwritten vs computer-generated labels on the rate of misidentified samples received for compatibility testing
• Maintenance, storage and retrieval of transfusion service records

may be germane to the present discussion.

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator