http://clinfowiki.org/wiki/api.php?action=feedcontributions&user=Akaplan&feedformat=atomClinfowiki - User contributions [en]2024-03-28T09:05:14ZUser contributionsMediaWiki 1.22.4http://clinfowiki.org/wiki/index.php/EncryptionEncryption2009-11-22T19:58:04Z<p>Akaplan: </p>
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<div>Encryption: Encryption is a process which is applied to patient data or other important data, and alters it to make it humanly unreadable except by someone who knows how to decrypt it.<br />
<br />
Encryption is a process that transforms information into an unreadable form unless you have a “cipherkey” to decrypt the data. Encryption software takes information and transforms it into unreadable form until it can be decrypted using the encryption key. In today’s world-wide computer networking, many forms of encryption exist to protect financial, personal, business and military data. Encryption was originally developed by the military for protecting national assets.<br />
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In the medical informatics, personal patient data must be protected against unauthorized viewing or changing. Encryption should be a vital part of every biomedical and bio-financial system. Encryption will help protect unauthorized use of information should physical security measure in place fail, such as loss of a laptop.<br />
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1 Jeff Tyson, How Encryption Works, http://www.howstuffworks.com/encryption.htm <br />
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2 Encryption and File Encryption http://searchsecurity.techtarget.com/sDefinition/0,,sid14_gci212062,00.html</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2009-09-26T10:23:07Z<p>Akaplan: </p>
<hr />
<div>== Example Vendor Evaluation Criteria ==<br />
<br />
<br />
=== Demonstrate Clinical Functionality (25%) ===<br />
<br />
* How well is the vendor able to demonstrate the clinical functionality required by [your organization]?<br />
* Is the software flexible enough to meet our current needs and allow for future changes?<br />
* Can a demonstration of the software successfully handle a scenario you have prepared?<br />
* Does the software have functions of supporting clinical decisions?<br />
* Does the software have functions of assisting nurses in documentations?<br />
* Is the vendor able to create interfaces for physicians' office EMRs to allow viewing and sharing of clinical, financial (insurance) and other data?<br />
* How easily and quickly can the embedded clinical decision support be modified when new published guidelines or evidence-based medicine studies are published? Will they be responsible for these updates (and at what cost) or will that be our responsibility?<br />
* Is the vendor software compliant with the Certification Commission of Healthcare Information Technology (CCHIT) criteria?<br />
* Can the company categorize users according to their characteristic and provide user-centered usability design? Old physicians usually have vision problem and do not like to use keyboard. <br />
* Can the company provide different levels of decision support based on user working experience? For resident, attending physician, the decision support should be different.<br />
* What capabilities does the application provide for patients with psychiatric, psychological, or severe behavioral disorders?<br />
* If your organization's mission includes clinical research, does the software include decision support and data query function sto support research?<br />
* Can the medical records be easily transferred to another clinic with patient approval?<br />
* With what other HIT software systems have you established successful interfaces? (organization may use a variety of systems for BCMA, clinical documentation, laboratory data, business functions that need to have data interchange)<br />
* What capability does the application demonstrate to produce information for patient education?<br />
* Does the system provide capability for patient portals (web access)?<br />
* What wireless functions has the system supported?<br />
<br />
=== Acquisition and Implementation Cost (25%) ===<br />
<br />
* What is the total financial investment required to acquire and fully implement the proposed solution? Break out costs for the following and detail any time or resource constraints for each item. If additional resources or time are required, what are the additional costs per unit?<br />
** Application<br />
** Per-user licenses (and tier pricing, if offered)<br />
** Database (if treated as a separate item)<br />
** Application documentation<br />
** Annual maintenance agreement<br />
** Training<br />
*** End-user<br />
*** System administrators<br />
*** In-house developers<br />
** Professional services:<br />
*** Project management<br />
*** Software development or customizations<br />
*** Technical support<br />
* What is the estimated time that it will take for the investment of the vendor to pay for itself based on projected savings?<br />
<br />
=== Hardware Platform and Technical Requirements (20%) ===<br />
<br />
*Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
<br />
* How well is the vendor able to meet our technical requirements ? <br />
* How flexible is the vendor to change requirements and what are the cost?<br />
* How hard is to implement new modules within the system? <br />
* How well is the vendor able to create and maintain interfaces to our existing systems?<br />
* How well is the vendor able to migrate our data from actual system to the new, if it is neccesary?<br />
* Is the vendors's software created with the most adequate developing technology? Platform? Language? Databases?<br />
* Will we do periodic updates, or will the vendor do this as part of the contract? How often are they released?<br />
* Do we plan on-site or remote hosting for the system?<br />
* If we plan to utilize remote hosting, how safe, sound, and accessible are these data?<br />
* Is the hardware user friendly in all departments? (i.e. nursing, pharmacy, pulmonary,..etc.)<br />
* Will the vendor provide a mock system for testing?<br />
* What is the responding duration of each entry and information extraction? Is there any delay? <br />
* How the data structure for storing data? Is it expandable? Is it easy to be extracted for future analysis?<br />
*How often does the system need to be updated or serviced?<br />
*As the technology is changing and the hospital decides to upgrade their hardware, will your system be able to handles these changes or will we have to buy a new program?<br />
<br />
=== Implementability (15%) ===<br />
<br />
* How much time, effort, and resources will be required to successfully implement?<br />
* What is the vendors track record for successfully implementing its system in similar settings?<br />
* Do the vendors provide detailed plan for implementation, training and quality control?<br />
* Will the vendor supply on site support when we "go-live" and how long will they be available?<br />
* Do they have a backup or alternative plan if the system or partial of the system is not working? The situation could be out of energy or computer virus attack.<br />
* How long is the training that is required for each subgroup to fully implement the system?<br />
* What are the training requirements for the vendor? For the clinic/hospital?<br />
* What is the vendor's track record for successfully training a new system for your clinic/hospital size?<br />
* What training manuals, user guides, on-line training assets, and any other training materials will be made available to the clinic/hospital?<br />
<br />
<br />
=== Vendor Partnership and On-going viability (10%) ===<br />
*Create a list of vendor selection criteria, and evaluate the vendors and software: review responses to the RFP; schedule demonstrations; check references; and, use proven tools/templates for assessing and consistently comparing vendors. <br />
<br />
*Research available EMR systems and vendors: determine if your jurisdiction has a "pre-approved" vendor list; develop checklists & questionnaires to assist with product comparison; and, prepare a Request for Proposals (RFP). <br />
<br />
* What type of long-term relationship do we think we can expect from the vendor?<br />
* How stable is the company? <br />
** Request that the software source code be put in escrow with specific provisions established under which it could be accessed. <br />
* How many new contracts have they signed in the past year?<br />
* How many uninstall's have been done the last year?<br />
* Does word of mouth support that the company believes in service after the sale?<br />
* What is the vendor's cost per year after implementation?<br />
* How the vendor provides technical support? On site or remote? Package or individual project based?<br />
* What provisions exist in the contract for termination and/or penalties if the application does not perform as specified or if the vendor fails to provide any services that are agreed to?<br />
** Ensure that all application specifications that can be measured or quantified are incorporated into the contract.<br />
** Ensure that all services verbally offered by the vendor are incorporated into the contract.<br />
** Does the vendor have service level agreements (SLAs) with appropriate penalties for technical support of the application?<br />
<br />
=== Future Vision (5%) ===<br />
<br />
* What is the vendor's five-year strategic plan?<br />
* What percentage of revenue is being re-invested into R&D?<br />
* How does the company capture/communicate client concerns for re-engineering? i.e. Is this a learning company?<br />
* What "game changers" are on the drawing board? Are these related to one of our organization's core goals?<br />
<br />
*Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
<br />
<br />
=== Extra Credit (optional) ===<br />
<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
<br />
[[Category:EMR]]</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2009-09-14T12:53:31Z<p>Akaplan: </p>
<hr />
<div>== Example Vendor Evaluation Criteria ==<br />
<br />
<br />
=== Demonstrate Clinical Functionality (25%) ===<br />
<br />
* How well is the vendor able to demonstrate the clinical functionality required by [your organization]?<br />
* Is the software flexible enough to meet our current needs and allow for future changes?<br />
* Does the software have functions of supporting clinical decisions?<br />
* Does the software have functions of assisting nurses in documentations?<br />
* Is the vendor able to create interfaces for physicians' office EMRs to allow viewing and sharing of clinical, financial (insurance) and other data?<br />
* How easily and quickly can the embedded clinical decision support be modified when new published guidelines or evidence-based medicine studies are published? Will they be responsible for these updates (and at what cost) or will that be our responsibility?<br />
* Is the vendor software compliant with the Certification Commission of Healthcare Information Technology (CCHIT) criteria?<br />
<br />
=== Acquisition and Implementation Cost (25%) ===<br />
<br />
* What is the total financial investment required to acquire and fully implement the proposed solution?<br />
* What is the estimated time that it will take for the investment of the vendor to pay for itself based on projected savings?<br />
<br />
=== Hardware Platform and Technical Requirements (20%) ===<br />
<br />
*Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
<br />
* How well is the vendor able to meet our technical requirements ? <br />
* How flexible is the vendor to change requirements and what are the cost?<br />
* How hard is to implement new modules within the system? <br />
* How well is the vendor able to create and maintain interfaces to our existing systems?<br />
* How well is the vendor able to migrate our data from actual system to the new, if it is neccesary?<br />
* Is the vendors's software created with the most adequate developing technology? Platform? Language? Databases?<br />
* Will we do periodic updates, or will the vendor do this as part of the contract? How often are they released?<br />
* Do we plan on-site or remote hosting for the system?<br />
* If we plan to utilize remote hosting, how safe, sound, and accessible are these data?<br />
* Is the hardware user friendly in all departments? (i.e. nursing, pharmacy, pulmonary,..etc.)<br />
* Will the vendor provide a mock system for testing?<br />
* What is the responding duration of each entry and information extraction? Is there any delay? <br />
* How the data structure for storing data? Is it expandable? Is it easy to be extracted for future analysis?<br />
<br />
=== Implementability (15%) ===<br />
<br />
* How much time, effort, and resources will be required to successfully implement?<br />
* What is the vendors track record for successfully implementing its system in similar settings?<br />
* Do the vendors provide detailed plan for implementation, training and quality control?<br />
* Will the vendor supply on site support when we "go-live" and how long will they be available?<br />
<br />
=== Vendor Partnership and On-going viability (10%) ===<br />
*Create a list of vendor selection criteria, and evaluate the vendors and software: review responses to the RFP; schedule demonstrations; check references; and, use proven tools/templates for assessing and consistently comparing vendors. <br />
<br />
*Research available EMR systems and vendors: determine if your jurisdiction has a "pre-approved" vendor list; develop checklists & questionnaires to assist with product comparison; and, prepare a Request for Proposals (RFP). <br />
<br />
* What type of long-term relationship do we think we can expect from the vendor?<br />
* How stable is the company? <br />
* How many new contracts have they signed in the past year?<br />
* How many uninstall's have been done the last year?<br />
* Does word of mouth support that the company believes in service after the sale?<br />
* What is the vendor's cost per year after implementation?<br />
* How the vendor provides technical support? On site or remote? Package or individual project based?<br />
<br />
=== Future Vision (5%) ===<br />
<br />
* What is the vendor's five-year strategic plan?<br />
* What percentage of revenue is being re-invested into R&D?<br />
* How does the company capture/communicate client concerns for re-engineering? i.e. Is this a learning company?<br />
* What "game changers" are on the drawing board? Are these related to one of our organization's core goals?<br />
<br />
*Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
<br />
<br />
=== Extra Credit (optional) ===<br />
<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
<br />
[[Category:EMR]]</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2009-09-14T12:53:11Z<p>Akaplan: </p>
<hr />
<div>== Example Vendor Evaluation Criteria ==<br />
<br />
<br />
=== Demonstrate Clinical Functionality (25%) ===<br />
<br />
* How well is the vendor able to demonstrate the clinical functionality required by [your organization]?<br />
* Is the software flexible enough to meet our current needs and allow for future changes?<br />
* Does the software have functions of supporting clinical decisions?<br />
* Does the software have functions of assisting nurses in documentations?<br />
* Is the vendor able to create interfaces for physicians' office EMRs to allow viewing and sharing of clinical, financial (insurance) and other data?<br />
* How easily and quickly can the embedded clinical decision support be modified when new published guidelines or evidence-based medicine studies are published? Will they be responsible for these updates (and at what cost) or will that be our responsibility?<br />
* Is the vendor software compliant with the Certification Commission of Healthcare Information Technology criteria?<br />
<br />
=== Acquisition and Implementation Cost (25%) ===<br />
<br />
* What is the total financial investment required to acquire and fully implement the proposed solution?<br />
* What is the estimated time that it will take for the investment of the vendor to pay for itself based on projected savings?<br />
<br />
=== Hardware Platform and Technical Requirements (20%) ===<br />
<br />
*Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
<br />
* How well is the vendor able to meet our technical requirements ? <br />
* How flexible is the vendor to change requirements and what are the cost?<br />
* How hard is to implement new modules within the system? <br />
* How well is the vendor able to create and maintain interfaces to our existing systems?<br />
* How well is the vendor able to migrate our data from actual system to the new, if it is neccesary?<br />
* Is the vendors's software created with the most adequate developing technology? Platform? Language? Databases?<br />
* Will we do periodic updates, or will the vendor do this as part of the contract? How often are they released?<br />
* Do we plan on-site or remote hosting for the system?<br />
* If we plan to utilize remote hosting, how safe, sound, and accessible are these data?<br />
* Is the hardware user friendly in all departments? (i.e. nursing, pharmacy, pulmonary,..etc.)<br />
* Will the vendor provide a mock system for testing?<br />
* What is the responding duration of each entry and information extraction? Is there any delay? <br />
* How the data structure for storing data? Is it expandable? Is it easy to be extracted for future analysis?<br />
<br />
=== Implementability (15%) ===<br />
<br />
* How much time, effort, and resources will be required to successfully implement?<br />
* What is the vendors track record for successfully implementing its system in similar settings?<br />
* Do the vendors provide detailed plan for implementation, training and quality control?<br />
* Will the vendor supply on site support when we "go-live" and how long will they be available?<br />
<br />
=== Vendor Partnership and On-going viability (10%) ===<br />
*Create a list of vendor selection criteria, and evaluate the vendors and software: review responses to the RFP; schedule demonstrations; check references; and, use proven tools/templates for assessing and consistently comparing vendors. <br />
<br />
*Research available EMR systems and vendors: determine if your jurisdiction has a "pre-approved" vendor list; develop checklists & questionnaires to assist with product comparison; and, prepare a Request for Proposals (RFP). <br />
<br />
* What type of long-term relationship do we think we can expect from the vendor?<br />
* How stable is the company? <br />
* How many new contracts have they signed in the past year?<br />
* How many uninstall's have been done the last year?<br />
* Does word of mouth support that the company believes in service after the sale?<br />
* What is the vendor's cost per year after implementation?<br />
* How the vendor provides technical support? On site or remote? Package or individual project based?<br />
<br />
=== Future Vision (5%) ===<br />
<br />
* What is the vendor's five-year strategic plan?<br />
* What percentage of revenue is being re-invested into R&D?<br />
* How does the company capture/communicate client concerns for re-engineering? i.e. Is this a learning company?<br />
* What "game changers" are on the drawing board? Are these related to one of our organization's core goals?<br />
<br />
*Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
<br />
<br />
=== Extra Credit (optional) ===<br />
<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
<br />
[[Category:EMR]]</div>Akaplanhttp://clinfowiki.org/wiki/index.php/EMR_Benefits_and_Return_on_Investment_CategoriesEMR Benefits and Return on Investment Categories2009-09-11T14:01:27Z<p>Akaplan: </p>
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<div>The following EMR-related benefits have been identified within various health care organizations. Before one assumes that just because some other organization was able to realize a specific benefit that they will be able to achieve the same thing, one must ensure that they have the same EMR features and functions available AND the clinicians are, or will, use them at their organization. See related [[EMR Cost Categories]] page...<br />
<br />
== '''Common EMR Benefit Categories''' ==<br />
<br />
<br />
== '''Financial''' ==<br />
* EMR can prevent unnecessary duplication of diagnostic tests that might occur when a patient sees multiple healthcare providers. Reference: Evidence on the Costs and Benefits of Health Information Technology. http://www.cbo.gov/ftpdocs/91xx/doc9168/MainText.3.1.shtml#1096012<br />
<br />
* Charges for laboratory tests were 8.8% lower in the intervention group (P < 0.05) from: Tierney WM, McDonald CJ, Hui SL, Martin DK. Computer predictions of abnormal test results. Effects on outpatient testing. JAMA. 1988;259:1194-8.<br />
<br />
* With the use of EMR, record handling will be conducted in the office, records will not have to be sent to an outsource provider or to a transcriber for handling. This will ultimately help saving transcription cost. Reference: http://www.allscripts.com/casestudies/nffm.pdf<br />
<br />
* EMR can facilitate the efficient creation and transmission of reports that support patient safety, quality improvement, public health, research, and other health care operations. All of those will reduce the cost of healthcare.<br />
<br />
* EMRs can remove the middle man in different instances, cutting cost by eliminating the need for the middle man. For instance, automated dictation replaces the person that would type the dictation, thus reducing total cost.<br />
<br />
* Financial benefits under pay for performance (P4P) accrue to the highest quality providers, both hospitals and physicians. EMR's which allow for real-time quality data can enable organizations to better meet targets to earn quality bonuses on Medicare and private insurance reimbursement.<br />
<br />
* Many ambulatory EMR systems are integrated with e-Prescribing. For physicians who use this technology in 2009 and 2010 for at least 50% of their eligible patients, an addtional 2% will be added to their Medicare reimbursement. The amount drops to 1% for 2011 and 2012, and thereafter, non-use becomes a penalty. [http://www.cms.hhs.gov/PQRI/Downloads/PQRIEPrescribingFactSheet.pdf] <br />
<br />
* A major component of all hospital operating budgets is the purchase of drugs with IV and IM doses generally being considerably more costly per dose versus oral. EMR's can support early transition from parenteral medications to oral, thus decreasing costs per admission and length of stay (LOS).[Reference: Fischer MA et al.Conversion from intravenous to oral medications. Arch Int Med 163(2003):2585-2589.]<br />
<br />
*In a paper record, clinicians are not always thinking about optimizing charges. Omission of essential information makes it difficult to justify the charges. An EMR can help reduce billing errors and help prompt users to document fields that will be essential for billing. Wang et al, A Cost-Benefit Analysis of Electronic Medical Record.<br />
<br />
* Effective EMRs and clinical decision support systems help notify clinical nurse specialists of patients with pressure ulcers or risk for developing pressure ulcers and avoid unnecessary costs for hospitals. Timm JA, Chick KL, Peterson JA, Epps SI, Bleimeyer RR, Harris M. Using expert rules to automate pressure ulcer alerts for the clinical nurse specialist. AMIA Annu Symp Proc. 2008 Nov 6:1154.<br />
<br />
* Physicians alerted on computer-screen displays to the charges for each test, and the total charges for tests ordered that day, ordered fewer tests. "In the intervention group, physicians ordered 14% fewer tests (P < 0.005) and charges for tests were 13% lower (both P < 0.05)." Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl JMed. 1990;322:1499-504. [PMID: 2186274]<br />
<br />
* Showing doctors the results of previous tests on computer-screen displays, including the test dates, reduced the rate of ordering new tests. "The number of tests decreased significantly in both groups, but more in the intervention group (16.8% in the intervention group and 10.9% in the control group)." Tierney WM, McDonald CJ, Martin DK, Rogers MP. Computerized display of past test results. Effect on outpatient testing. Ann Intern Med. 1987;107:569-74. [PMID: 3631792]<br />
<br />
* Using a CPOE system reduced total hospital charges by $887, or 12.7%, compared to the control group. The average stay was 0.89 day shorter (P = 0.11). Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA. 1993;269:379-83. [PMID: 8418345]<br />
<br />
*Eliminating paper chart supplies and copying expense as well as costs associated with storing paper charts.<br />
<br />
* On average charts are pulled approximately 600 times a year. With an average cost of $5 to pull and re-file a chart, this is a savings of approximately $3000. Ref: A Cost-Benefit Analysis of Electronic Medical Records/Wang et al<br />
<br />
* Using an EMR can lead to reduced malpractice insurance rates for hospitals and clinical practices. Some insurance companies offer lower rates when clinicians use EMRs. Ref: http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm<br />
<br />
* EMR can reduce staff time used in preparing paper records. Brigham and Women's Hospital reported a cumulative saving of $0.6 million by automatically generating medication lists at patients' discharges using their EMR. Ref: Kaushal R et al. Return on investment for a computerized physician order entry system. J Am Med Inform Assoc. 2006;13(3):261-66.<br />
<br />
* Hillestad et al., estimated that at 90 percent adoption, the potential efficiency savings of the EMR for both inpatient and outpatient care could average more than $77 billion per year. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117 <br />
<br />
*Sixty-six percent of adverse drug events might be preventable with the use of ambulatory CPOE. Each avoided event saves $1,000–$2,000 because of avoided office visits, hospitalizations, and other care. Ref: D. Johnston et al., Patient Safety in the Physician’s Office: Assessing the Value of Ambulatory CPOE, April 2004, www.chcf.org/topics/view.cfm?itemID=101965.<br />
<br />
* Even though some research have shown considerable savings, up to billions of dollar after EMR adoption and implementation, the heavy initial investment and long term ROI still constitute one of the main barriers for implementing such systems for small size hospitals and physician offices. Thakkar and Davis suggest that specialized software systems such as EHR need to come with "one size fits all" version of the product to be massively adopted. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2047303&blobtype=pdf)<br />
<br />
* Can improve billing by allowing improved medical staff documentation and lack of lost or misplaced charts.<br />
<br />
* A study done by Hillestad et al explains that the cumulative potential net efficiency and safety savings from hospital systems could be nearly $371 billion while potential cumulative savings from physician practice EMR systems could be $142 billion. Both savings are calculated upon a course of 15 years. This potential net financial benefit could double if the health savings produced by chronic disease prevention and management were included. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117. http://content.healthaffairs.org/cgi/content/full/24/5/1103<br />
<br />
* With the use of the Eclipsys system, Lucile Packard Children’s Hospital identified $49 million in underpayments, collected $27 million of that amount, and saved $6.5 million in outsourcing costs. This was in between August 2002 and April 2006. Ref: http://www.eclipsys.com/ourclients/success_stories_details_LucilePackardChildrensHospital.asp<br />
<br />
* The estimated net benefit from using an EMR in promary care for a 5 year period was $86,400 per provider [Wang et al. A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine (2003)]<br />
<br />
== '''Clinical''' ==<br />
* EMR systems have been proven to decrease the amount of time nursing staff spends on documentation. Reference: A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database. Journal of Healthcare Information Management- Vol. 21, No. 1 p 67.<br />
<br />
* Alert and reminder programs in EMR's increase physician attentiveness to certain areas such as preventive medicine or more specifically drug level monitoring. Reference: Computer Physician Order EntryL Benefits, Costs, and Issues. Gilad Kuperman, M.D., P.h.D., Richard Gibson, M.D., P.h.D. Ann Intern Med. 2003; 139:31-39. <br />
<br />
* Interfacing EMR with hospital paging system allows critical laboratory results to be communicated to responsible physician timely. The system reduces the time between a critical result arises and the corresponding physician's responses. Ref: Kuperman GJ, Teich JM, Tanasijevic MJ, Luf NM, Rittenberg E, Jha A, Fiskio J, Winkelman J, Bates DW. Improving response to critical laboratory results with automation. J Am Med Inform Assoc. 1999;6(6):512-22.<br />
<br />
* Information on patient allergies and other medications, in combination with alerts and reminders, can decrease the number of medication-related adverse events and improve presribing practices of physicians and nurse practioners. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* Increased ordering rates for pneumococcal and influenza vaccine, prophylactic heparin, and aspirin at discharge. from: Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med. 2001;345:965-70.<br />
<br />
* With the quality EMR, quick access to patients records can be lifesaving during the emergency situation by helping emergency decision-making process.<br />
<br />
* EMR can help making medical history more efficient and accurate by providing templates that can decrease the time spent in documentation.<br />
<br />
* EMR can reduce the number of errors associated with transcription.<br />
<br />
* EMR will provide the integrated view of patient to clinician so that they can spent less time for getting patients’ history, lab and radiology results and medication information so that clinicians can make diagnosis more accurately and faster.<br />
<br />
* EMRs have the capability to dislay previous laboratory test results can significantly reduce the number of redundant tests ordered, not only saving money, but also the preventing the patient from undergoing unnecessary tests.[http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* By integrating guidelines and clinical information tools, EMRs improve the quality of outpatient care and safety of drug administration. Reference: Crane RM, Raymond B. Fulfilling the Potential of Clinical Information System. The Permanente Journal. 7.1 (2003). PP 63-64.<br />
<br />
* An effective EMR system helps clinical nurse specialists notify patients with pressure ulcers or risk for developing pressure ulcers in time and therefore improve quality of care. Timm JA, Chick KL, Peterson JA, Epps SI, Bleimeyer RR, Harris M. Using expert rules to automate pressure ulcer alerts for the clinical nurse specialist. AMIA Annu Symp Proc. 2008 Nov 6:1154.<br />
<br />
*Improved patient education through use of patient portal<br />
<br />
*Streamline communication both between patient and provider, and between clinicians<br />
<br />
*Process Improvement. EMR implementations allows to review the clinical processes management, customizing it for a better quality and delivered health care. University of Illinois Chicago Medical Center has published 75% reduction in chart pull requests, expected to increase, 12 paper forms eliminated and 100% availability patient records (previously 40%). The Gemini Project http://www.himss.org/content/files/davies_2001_uiccmc.pdf<br />
<br />
*EMR improves the patient safety by reducing medication discrepancies. Maimonides Medical Center, Brooklyn, New York, has published 58% decrease in medication orders and 55% decrease in medication discrepancies after EMR implementation. http://www.himss.org/content/files/davies_2002_maimonides.pdf<br />
<br />
*Overhage and colleagues demonstrated that compliance with the monitoring of drug levels doubled when automated ordering reminders were implemented. Ref: Overhage JM, Tierney WM, Zhou XH, McDonald CJ. A randomized trial of “corollary orders” to prevent errors of omission. J Am Med Inform Assoc.1997;4:364-75. [PMID: 9292842]<br />
<br />
*Teich et al found that CPOE with reminder feature increases the providers' compliance rate in using formulary and prophylactic heparin according to clinical guidelines and improves the appropriateness of dosage. Ref: Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of computerized physician order entry on prescribing practices. Arch Intern Med. 2000;160:2741-7.<br />
<br />
* EMR can be instrumental in the connection to national disease registries allowing practices to compare their performance with that of others, which in turn, might improve the quality of care and facilitate research. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117.<br />
<br />
*Health information exchange can be easily and safely achieved for patients with multiple chronic illnesses who receive care from multiple providers in many settings. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117.<br />
<br />
* Features such as remote access and electronic messaging were shown very usefull and successfull for primary care practice. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1839545&blobtype=pdf)<br />
<br />
* Secondary use of health data stored in EMR has potentials to protect and enhance public health, and facilitate health science research. Ref: American Medical Information Association. Secondary uses and re-uses of healthcare data: taxonomy and policy formulation and planning. 2007. http://www.amia.org/files/amiataxonomyncvhs.pdf<br />
<br />
* Can improve critical medical decisions by providing the most up-to-date clinical information at point-of-care.<br />
<br />
* According to a study performed by Work, the use of bedside medication scanning with EMRs decreased medication administration error rates by 67% at a pilot unit in Beloit Memorial Hospital. BCMA was then implemented to other units and measured to have decreased error rates to an average of 93% in the first four months of study and not counting the first month. Work M. Improving Medication Safety with a Wireless, Mobile Barcode System in a Community Hospital. Patient Safety & Quality Healthcare. 2005. http://www.psqh.com/mayjun05/casestudy.html<br />
<br />
* According to an article by the president of the University of Texas M.D. Anderson Cancer Center in Houston, a standardized nation-wide electronic medical record will ensure quality care for patients who see multiple providers at multiple sites. A national EMR could provide enormous opportunities for reducing overhead costs, identifying factors contributing to many illnesses (including cancer), determining optimal treatment, and detecting uncommon side effects of treatment. Mendelsohn J. Ten pieces to the cancer puzzle. Jan 24, 2009. http://www.chron.com/disp/story.mpl/editorial/outlook/6228636.html<br />
<br />
* Genome-enabled EMR can integrate resources such as OMIM and PharmGKB to facilitate the diagnosis, long-term and family member management of molecular and cytogenetic diseases. [Hoffman. The genome-enabled electronic medical record. Journal of Biomedical Informatics (2007)]<br />
<br />
* Electronic order sets, as part of CPOE, will improve compliance with nationally reported quality indicators e.g. core measures.<br />
<br />
* Clinical decision support regarding culture results can improve antibiotic utilization, reduce costs of unnecessary medications, reduce bacterial resistance rates and lessen the incidence of Clostridium difficile and fungal infections.<br />
<br />
* Studies have documented that CPOE can decrease costs, shorten length of stay, decrease medical errors, and improve compliance with several types of guidelines. [Kuperman, et.al., Computer Physician Order Entry: Benefits, Costs, and Issues, 2003]<br />
<br />
* An effective EHR/CPOE can prompt providers to prescribe generic medicine instead of more costly brand-name drugs. [Hagen, et.al., Evidence on the Costs and Benefits of Health Information Technology, Congressional Budget Office report, May 2008]<br />
<br />
* Health care practitioners are bombarded with changing clinical decision factors and are challenged to stay abreast of an ever-increasing knowledge base in specific areas of expertise. Current medical practice relies heavily on the unaided mind to recall a great amount of detailed knowledge - a process which, to the detriment of all stakeholders, has repeatedly been shown unreliable. CPOE systems maintained with current information and processes will help eliminate this problem. McDonald, CJ. Protocol-based computer reminder, the quality of care and the non-perfectibility of man, New England Journal of Medicine, 1976]<br />
<br />
== '''Operational''' ==<br />
<br />
* Overall, 6.2% increase in time spent ordering (not statistically significant); experienced users were time neutral with paperbased ordering. from: Overhage JM, Perkins S, Tierney WM, McDonald CJ. Controlled trial of direct physician order entry: effects on physicians’ time utilization in ambulatory primary care internal medicine practices. J Am Med Inform Assoc. 2001;8:361-71.<br />
<br />
* EMRs allow a physician to access multiple records at the touch of a button. Whether he or she is at a computer or in an exam room with a patient, the workflow is enhanced as less effort is required to retrieve information.<br />
<br />
* Protects patient data by preventing unauthorized individuals from accessing the clinical record. <br />
<br />
* Integrated communication and reporting support. EMR can facilitate the efficient creation and transmission of reports that relate to health care operations such as billing and charge information. Coiera, E (2003) Guide to Health Informatics (2nd Edition), Arnold Publishers Shortliffe, EH (ed) (2006) Biomedical Informatics (3rd Edition), Springer. pg. 119.<br />
<br />
* EMRs improve interdisciplinary collaborations and efficent communications between physicians and nurses via nursing documentation with greater clarity and additional information. Green SD, Thomas JD. Interdisciplinary collaboration and the electronic medical record. PMID: 18649812 [PubMed - indexed for MEDLINE]<br />
<br />
*documentation completed at conclusion of encounter.<br />
<br />
*Preventing the missing patient paper medical recodrs. Every time a paper chart gets stored, there is the chance it will be misplaced or maybe filed in a wrong place. This is very frequently is many hospitals, specially in those of the limited resources countries without EMR systems in where all paper medical records are located in a central repository room. EMR allows to prevents it by an unique electronic record and patient chart available in all time and stored into one central data repository server.<br />
<br />
* Eliminates lost orders and ambiguities caused by illegible handwriting, generating realated orders automatically, monitoring for duplicate orders and reducing time to o fill orders. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* EMR is time savings for physicians and staffs by reducing in documenting the chart. According to the statistics, the average saving time is 5 minutes which can be done in real-time, point of encounter and no need for longer appointments. The total ROI per physician per year approximately is $78,000. [Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]<br />
<br />
* EMR is improvements in medical coding. The approximately annual loss per physician is $40,000 - $50,000 by under coding due to fear of audit and lack of time to sufficiently document the level of care. The ROI of improvement in coding per year is approximately $54,000. <br />
[Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]<br />
<br />
* The benefit of an electronic medical record can increase the numerators and decrease the denominators. In addition, efficiency takes all of the duties involved in medical record medical office management divided by time and money. [Douglas. Thompson, Neil Fleming. Finding the ROI in EMRs. http://www.hfma.org]<br />
<br />
* Part of the money-saving nature of electronic medical record technology is the elimination of IT infrastructure and the streamlining of multiple databases. The infrastructure is simplified into one online database, even for multiple offices.[Douglas. Thompson, Neil Fleming. Finding the ROI in EMRs. http://www.hfma.org]<br />
<br />
* During the implementation phase of the EMR, was noted a closer cooperation between the clinical, and administrative setvices of hospitals. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2245928&blobtype=pdf)<br />
<br />
* Can allow for better appreciation of clinician performance for which can be used for employee bonuses.<br />
<br />
* The benefit of electronic medical record primarily accrued from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors. [Wang et al. A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine (2003)]<br />
<br />
* CPOE will automatically date and time physician orders, as recommended by regulatory organizations.</div>Akaplanhttp://clinfowiki.org/wiki/index.php/EMR_Benefits_and_Return_on_Investment_CategoriesEMR Benefits and Return on Investment Categories2009-09-11T14:00:13Z<p>Akaplan: </p>
<hr />
<div>The following EMR-related benefits have been identified within various health care organizations. Before one assumes that just because some other organization was able to realize a specific benefit that they will be able to achieve the same thing, one must ensure that they have the same EMR features and functions available AND the clinicians are, or will, use them at their organization. See related [[EMR Cost Categories]] page...<br />
<br />
== '''Common EMR Benefit Categories''' ==<br />
<br />
<br />
== '''Financial''' ==<br />
* EMR can prevent unnecessary duplication of diagnostic tests that might occur when a patient sees multiple healthcare providers. Reference: Evidence on the Costs and Benefits of Health Information Technology. http://www.cbo.gov/ftpdocs/91xx/doc9168/MainText.3.1.shtml#1096012<br />
<br />
* Charges for laboratory tests were 8.8% lower in the intervention group (P < 0.05) from: Tierney WM, McDonald CJ, Hui SL, Martin DK. Computer predictions of abnormal test results. Effects on outpatient testing. JAMA. 1988;259:1194-8.<br />
<br />
* With the use of EMR, record handling will be conducted in the office, records will not have to be sent to an outsource provider or to a transcriber for handling. This will ultimately help saving transcription cost. Reference: http://www.allscripts.com/casestudies/nffm.pdf<br />
<br />
* EMR can facilitate the efficient creation and transmission of reports that support patient safety, quality improvement, public health, research, and other health care operations. All of those will reduce the cost of healthcare.<br />
<br />
* EMRs can remove the middle man in different instances, cutting cost by eliminating the need for the middle man. For instance, automated dictation replaces the person that would type the dictation, thus reducing total cost.<br />
<br />
* Financial benefits under pay for performance (P4P) accrue to the highest quality providers, both hospitals and physicians. EMR's which allow for real-time quality data can enable organizations to better meet targets to earn quality bonuses on Medicare and private insurance reimbursement.<br />
<br />
* Many ambulatory EMR systems are integrated with e-Prescribing. For physicians who use this technology in 2009 and 2010 for at least 50% of their eligible patients, an addtional 2% will be added to their Medicare reimbursement. The amount drops to 1% for 2011 and 2012, and thereafter, non-use becomes a penalty. [http://www.cms.hhs.gov/PQRI/Downloads/PQRIEPrescribingFactSheet.pdf] <br />
<br />
* A major component of all hospital operating budgets is the purchase of drugs with IV and IM doses generally being considerably more costly per dose versus oral. EMR's can support early transition from parenteral medications to oral, thus decreasing costs per admission and length of stay (LOS).[Reference: Fischer MA et al.Conversion from intravenous to oral medications. Arch Int Med 163(2003):2585-2589.]<br />
<br />
*In a paper record, clinicians are not always thinking about optimizing charges. Omission of essential information makes it difficult to justify the charges. An EMR can help reduce billing errors and help prompt users to document fields that will be essential for billing. Wang et al, A Cost-Benefit Analysis of Electronic Medical Record.<br />
<br />
* Effective EMRs and clinical decision support systems help notify clinical nurse specialists of patients with pressure ulcers or risk for developing pressure ulcers and avoid unnecessary costs for hospitals. Timm JA, Chick KL, Peterson JA, Epps SI, Bleimeyer RR, Harris M. Using expert rules to automate pressure ulcer alerts for the clinical nurse specialist. AMIA Annu Symp Proc. 2008 Nov 6:1154.<br />
<br />
* Physicians alerted on computer-screen displays to the charges for each test, and the total charges for tests ordered that day, ordered fewer tests. "In the intervention group, physicians ordered 14% fewer tests (P < 0.005) and charges for tests were 13% lower (both P < 0.05)." Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl JMed. 1990;322:1499-504. [PMID: 2186274]<br />
<br />
* Showing doctors the results of previous tests on computer-screen displays, including the test dates, reduced the rate of ordering new tests. "The number of tests decreased significantly in both groups, but more in the intervention group (16.8% in the intervention group and 10.9% in the control group)." Tierney WM, McDonald CJ, Martin DK, Rogers MP. Computerized display of past test results. Effect on outpatient testing. Ann Intern Med. 1987;107:569-74. [PMID: 3631792]<br />
<br />
* Using a CPOE system reduced total hospital charges by $887, or 12.7%, compared to the control group. The average stay was 0.89 day shorter (P = 0.11). Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA. 1993;269:379-83. [PMID: 8418345]<br />
<br />
*Eliminating paper chart supplies and copying expense as well as costs associated with storing paper charts.<br />
<br />
* On average charts are pulled approximately 600 times a year. With an average cost of $5 to pull and re-file a chart, this is a savings of approximately $3000. Ref: A Cost-Benefit Analysis of Electronic Medical Records/Wang et al<br />
<br />
* Using an EMR can lead to reduced malpractice insurance rates for hospitals and clinical practices. Some insurance companies offer lower rates when clinicians use EMRs. Ref: http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm<br />
<br />
* EMR can reduce staff time used in preparing paper records. Brigham and Women's Hospital reported a cumulative saving of $0.6 million by automatically generating medication lists at patients' discharges using their EMR. Ref: Kaushal R et al. Return on investment for a computerized physician order entry system. J Am Med Inform Assoc. 2006;13(3):261-66.<br />
<br />
* Hillestad et al., estimated that at 90 percent adoption, the potential efficiency savings of the EMR for both inpatient and outpatient care could average more than $77 billion per year. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117 <br />
<br />
*Sixty-six percent of adverse drug events might be preventable with the use of ambulatory CPOE. Each avoided event saves $1,000–$2,000 because of avoided office visits, hospitalizations, and other care. Ref: D. Johnston et al., Patient Safety in the Physician’s Office: Assessing the Value of Ambulatory CPOE, April 2004, www.chcf.org/topics/view.cfm?itemID=101965.<br />
<br />
* Even though some research have shown considerable savings, up to billions of dollar after EMR adoption and implementation, the heavy initial investment and long term ROI still constitute one of the main barriers for implementing such systems for small size hospitals and physician offices. Thakkar and Davis suggest that specialized software systems such as EHR need to come with "one size fits all" version of the product to be massively adopted. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2047303&blobtype=pdf)<br />
<br />
* Can improve billing by allowing improved medical staff documentation and lack of lost or misplaced charts.<br />
<br />
* A study done by Hillestad et al explains that the cumulative potential net efficiency and safety savings from hospital systems could be nearly $371 billion while potential cumulative savings from physician practice EMR systems could be $142 billion. Both savings are calculated upon a course of 15 years. This potential net financial benefit could double if the health savings produced by chronic disease prevention and management were included. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117. http://content.healthaffairs.org/cgi/content/full/24/5/1103<br />
<br />
* With the use of the Eclipsys system, Lucile Packard Children’s Hospital identified $49 million in underpayments, collected $27 million of that amount, and saved $6.5 million in outsourcing costs. This was in between August 2002 and April 2006. Ref: http://www.eclipsys.com/ourclients/success_stories_details_LucilePackardChildrensHospital.asp<br />
<br />
* The estimated net benefit from using an EMR in promary care for a 5 year period was $86,400 per provider [Wang et al. A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine (2003)]<br />
<br />
== '''Clinical''' ==<br />
* EMR systems have been proven to decrease the amount of time nursing staff spends on documentation. Reference: A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database. Journal of Healthcare Information Management- Vol. 21, No. 1 p 67.<br />
<br />
* Alert and reminder programs in EMR's increase physician attentiveness to certain areas such as preventive medicine or more specifically drug level monitoring. Reference: Computer Physician Order EntryL Benefits, Costs, and Issues. Gilad Kuperman, M.D., P.h.D., Richard Gibson, M.D., P.h.D. Ann Intern Med. 2003; 139:31-39. <br />
<br />
* Interfacing EMR with hospital paging system allows critical laboratory results to be communicated to responsible physician timely. The system reduces the time between a critical result arises and the corresponding physician's responses. Ref: Kuperman GJ, Teich JM, Tanasijevic MJ, Luf NM, Rittenberg E, Jha A, Fiskio J, Winkelman J, Bates DW. Improving response to critical laboratory results with automation. J Am Med Inform Assoc. 1999;6(6):512-22.<br />
<br />
* Information on patient allergies and other medications, in combination with alerts and reminders, can decrease the number of medication-related adverse events and improve presribing practices of physicians and nurse practioners. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* Increased ordering rates for pneumococcal and influenza vaccine, prophylactic heparin, and aspirin at discharge. from: Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med. 2001;345:965-70.<br />
<br />
* With the quality EMR, quick access to patients records can be lifesaving during the emergency situation by helping emergency decision-making process.<br />
<br />
* EMR can help making medical history more efficient and accurate by providing templates that can decrease the time spent in documentation.<br />
<br />
* EMR can reduce the number of errors associated with transcription.<br />
<br />
* EMR will provide the integrated view of patient to clinician so that they can spent less time for getting patients’ history, lab and radiology results and medication information so that clinicians can make diagnosis more accurately and faster.<br />
<br />
* EMRs have the capability to dislay previous laboratory test results can significantly reduce the number of redundant tests ordered, not only saving money, but also the preventing the patient from undergoing unnecessary tests.[http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* By integrating guidelines and clinical information tools, EMRs improve the quality of outpatient care and safety of drug administration. Reference: Crane RM, Raymond B. Fulfilling the Potential of Clinical Information System. The Permanente Journal. 7.1 (2003). PP 63-64.<br />
<br />
* An effective EMR system helps clinical nurse specialists notify patients with pressure ulcers or risk for developing pressure ulcers in time and therefore improve quality of care. Timm JA, Chick KL, Peterson JA, Epps SI, Bleimeyer RR, Harris M. Using expert rules to automate pressure ulcer alerts for the clinical nurse specialist. AMIA Annu Symp Proc. 2008 Nov 6:1154.<br />
<br />
*Improved patient education through use of patient portal<br />
<br />
*Streamline communication both between patient and provider, and between clinicians<br />
<br />
*Process Improvement. EMR implementations allows to review the clinical processes management, customizing it for a better quality and delivered health care. University of Illinois Chicago Medical Center has published 75% reduction in chart pull requests, expected to increase, 12 paper forms eliminated and 100% availability patient records (previously 40%). The Gemini Project http://www.himss.org/content/files/davies_2001_uiccmc.pdf<br />
<br />
*EMR improves the patient safety by reducing medication discrepancies. Maimonides Medical Center, Brooklyn, New York, has published 58% decrease in medication orders and 55% decrease in medication discrepancies after EMR implementation. http://www.himss.org/content/files/davies_2002_maimonides.pdf<br />
<br />
*Overhage and colleagues demonstrated that compliance with the monitoring of drug levels doubled when automated ordering reminders were implemented. Ref: Overhage JM, Tierney WM, Zhou XH, McDonald CJ. A randomized trial of “corollary orders” to prevent errors of omission. J Am Med Inform Assoc.1997;4:364-75. [PMID: 9292842]<br />
<br />
*Teich et al found that CPOE with reminder feature increases the providers' compliance rate in using formulary and prophylactic heparin according to clinical guidelines and improves the appropriateness of dosage. Ref: Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of computerized physician order entry on prescribing practices. Arch Intern Med. 2000;160:2741-7.<br />
<br />
* EMR can be instrumental in the connection to national disease registries allowing practices to compare their performance with that of others, which in turn, might improve the quality of care and facilitate research. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117.<br />
<br />
*Health information exchange can be easily and safely achieved for patients with multiple chronic illnesses who receive care from multiple providers in many settings. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117.<br />
<br />
* Features such as remote access and electronic messaging were shown very usefull and successfull for primary care practice. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1839545&blobtype=pdf)<br />
<br />
* Secondary use of health data stored in EMR has potentials to protect and enhance public health, and facilitate health science research. Ref: American Medical Information Association. Secondary uses and re-uses of healthcare data: taxonomy and policy formulation and planning. 2007. http://www.amia.org/files/amiataxonomyncvhs.pdf<br />
<br />
* Can improve critical medical decisions by providing the most up-to-date clinical information at point-of-care.<br />
<br />
* According to a study performed by Work, the use of bedside medication scanning with EMRs decreased medication administration error rates by 67% at a pilot unit in Beloit Memorial Hospital. BCMA was then implemented to other units and measured to have decreased error rates to an average of 93% in the first four months of study and not counting the first month. Work M. Improving Medication Safety with a Wireless, Mobile Barcode System in a Community Hospital. Patient Safety & Quality Healthcare. 2005. http://www.psqh.com/mayjun05/casestudy.html<br />
<br />
* According to an article by the president of the University of Texas M.D. Anderson Cancer Center in Houston, a standardized nation-wide electronic medical record will ensure quality care for patients who see multiple providers at multiple sites. A national EMR could provide enormous opportunities for reducing overhead costs, identifying factors contributing to many illnesses (including cancer), determining optimal treatment, and detecting uncommon side effects of treatment. Mendelsohn J. Ten pieces to the cancer puzzle. Jan 24, 2009. http://www.chron.com/disp/story.mpl/editorial/outlook/6228636.html<br />
<br />
* Genome-enabled EMR can integrate resources such as OMIM and PharmGKB to facilitate the diagnosis, long-term and family member management of molecular and cytogenetic diseases. [Hoffman. The genome-enabled electronic medical record. Journal of Biomedical Informatics (2007)]<br />
<br />
* Electronic order sets, as part of CPOE, will improve compliance with nationally reported quality indicators e.g. core measures.<br />
<br />
* Clinical decision support regarding culture results can improve antibiotic utilization, reduce costs of unnecessary medications, reduce bacterial resistance rates and lessen the incidence of Clostridium difficile and fungal infections.<br />
<br />
* Studies have documented that CPOE can decrease costs, shorten length of stay, decrease medical errors, and improve compliance with several types of guidelines. [Kuperman, et.al., Computer Physician Order Entry: Benefits, Costs, and Issues, 2003]<br />
<br />
* An effective EHR/CPOE can prompt providers to prescribe generic medicine instead of more costly brand-name drugs. [Hagen, et.al., Evidence on the Costs and Benefits of Health Information Technology, Congressional Budget Office report, May 2008]<br />
<br />
* Health care practitioners are bombarded with changing clinical decision factors and are challenged to stay abreast of an ever-increasing knowledge base in specific ares of expertise. Current medical practice relies heavily on the unaided mind to recall a great amount of detailed knowledge - a process which, to the detriment of all stakeholders, has repeatedly been shown unreliable. CPOE systems maintained with current information and processes will help eliminate this problem. McDonald, CJ. Protocol-based computer reminder, the quality of care and the non-perfectibility of man, New England Journal of Medicine, 1976]<br />
<br />
== '''Operational''' ==<br />
<br />
* Overall, 6.2% increase in time spent ordering (not statistically significant); experienced users were time neutral with paperbased ordering. from: Overhage JM, Perkins S, Tierney WM, McDonald CJ. Controlled trial of direct physician order entry: effects on physicians’ time utilization in ambulatory primary care internal medicine practices. J Am Med Inform Assoc. 2001;8:361-71.<br />
<br />
* EMRs allow a physician to access multiple records at the touch of a button. Whether he or she is at a computer or in an exam room with a patient, the workflow is enhanced as less effort is required to retrieve information.<br />
<br />
* Protects patient data by preventing unauthorized individuals from accessing the clinical record. <br />
<br />
* Integrated communication and reporting support. EMR can facilitate the efficient creation and transmission of reports that relate to health care operations such as billing and charge information. Coiera, E (2003) Guide to Health Informatics (2nd Edition), Arnold Publishers Shortliffe, EH (ed) (2006) Biomedical Informatics (3rd Edition), Springer. pg. 119.<br />
<br />
* EMRs improve interdisciplinary collaborations and efficent communications between physicians and nurses via nursing documentation with greater clarity and additional information. Green SD, Thomas JD. Interdisciplinary collaboration and the electronic medical record. PMID: 18649812 [PubMed - indexed for MEDLINE]<br />
<br />
*documentation completed at conclusion of encounter.<br />
<br />
*Preventing the missing patient paper medical recodrs. Every time a paper chart gets stored, there is the chance it will be misplaced or maybe filed in a wrong place. This is very frequently is many hospitals, specially in those of the limited resources countries without EMR systems in where all paper medical records are located in a central repository room. EMR allows to prevents it by an unique electronic record and patient chart available in all time and stored into one central data repository server.<br />
<br />
* Eliminates lost orders and ambiguities caused by illegible handwriting, generating realated orders automatically, monitoring for duplicate orders and reducing time to o fill orders. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* EMR is time savings for physicians and staffs by reducing in documenting the chart. According to the statistics, the average saving time is 5 minutes which can be done in real-time, point of encounter and no need for longer appointments. The total ROI per physician per year approximately is $78,000. [Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]<br />
<br />
* EMR is improvements in medical coding. The approximately annual loss per physician is $40,000 - $50,000 by under coding due to fear of audit and lack of time to sufficiently document the level of care. The ROI of improvement in coding per year is approximately $54,000. <br />
[Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]<br />
<br />
* The benefit of an electronic medical record can increase the numerators and decrease the denominators. In addition, efficiency takes all of the duties involved in medical record medical office management divided by time and money. [Douglas. Thompson, Neil Fleming. Finding the ROI in EMRs. http://www.hfma.org]<br />
<br />
* Part of the money-saving nature of electronic medical record technology is the elimination of IT infrastructure and the streamlining of multiple databases. The infrastructure is simplified into one online database, even for multiple offices.[Douglas. Thompson, Neil Fleming. Finding the ROI in EMRs. http://www.hfma.org]<br />
<br />
* During the implementation phase of the EMR, was noted a closer cooperation between the clinical, and administrative setvices of hospitals. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2245928&blobtype=pdf)<br />
<br />
* Can allow for better appreciation of clinician performance for which can be used for employee bonuses.<br />
<br />
* The benefit of electronic medical record primarily accrued from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors. [Wang et al. A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine (2003)]<br />
<br />
* CPOE will automatically date and time physician orders, as recommended by regulatory organizations.</div>Akaplanhttp://clinfowiki.org/wiki/index.php/EMR_Benefits_and_Return_on_Investment_CategoriesEMR Benefits and Return on Investment Categories2009-09-11T13:58:55Z<p>Akaplan: </p>
<hr />
<div>The following EMR-related benefits have been identified within various health care organizations. Before one assumes that just because some other organization was able to realize a specific benefit that they will be able to achieve the same thing, one must ensure that they have the same EMR features and functions available AND the clinicians are, or will, use them at their organization. See related [[EMR Cost Categories]] page...<br />
<br />
== '''Common EMR Benefit Categories''' ==<br />
<br />
<br />
== '''Financial''' ==<br />
* EMR can prevent unnecessary duplication of diagnostic tests that might occur when a patient sees multiple healthcare providers. Reference: Evidence on the Costs and Benefits of Health Information Technology. http://www.cbo.gov/ftpdocs/91xx/doc9168/MainText.3.1.shtml#1096012<br />
<br />
* Charges for laboratory tests were 8.8% lower in the intervention group (P < 0.05) from: Tierney WM, McDonald CJ, Hui SL, Martin DK. Computer predictions of abnormal test results. Effects on outpatient testing. JAMA. 1988;259:1194-8.<br />
<br />
* With the use of EMR, record handling will be conducted in the office, records will not have to be sent to an outsource provider or to a transcriber for handling. This will ultimately help saving transcription cost. Reference: http://www.allscripts.com/casestudies/nffm.pdf<br />
<br />
* EMR can facilitate the efficient creation and transmission of reports that support patient safety, quality improvement, public health, research, and other health care operations. All of those will reduce the cost of healthcare.<br />
<br />
* EMRs can remove the middle man in different instances, cutting cost by eliminating the need for the middle man. For instance, automated dictation replaces the person that would type the dictation, thus reducing total cost.<br />
<br />
* Financial benefits under pay for performance (P4P) accrue to the highest quality providers, both hospitals and physicians. EMR's which allow for real-time quality data can enable organizations to better meet targets to earn quality bonuses on Medicare and private insurance reimbursement.<br />
<br />
* Many ambulatory EMR systems are integrated with e-Prescribing. For physicians who use this technology in 2009 and 2010 for at least 50% of their eligible patients, an addtional 2% will be added to their Medicare reimbursement. The amount drops to 1% for 2011 and 2012, and thereafter, non-use becomes a penalty. [http://www.cms.hhs.gov/PQRI/Downloads/PQRIEPrescribingFactSheet.pdf] <br />
<br />
* A major component of all hospital operating budgets is the purchase of drugs with IV and IM doses generally being considerably more costly per dose versus oral. EMR's can support early transition from parenteral medications to oral, thus decreasing costs per admission and length of stay (LOS).[Reference: Fischer MA et al.Conversion from intravenous to oral medications. Arch Int Med 163(2003):2585-2589.]<br />
<br />
*In a paper record, clinicians are not always thinking about optimizing charges. Omission of essential information makes it difficult to justify the charges. An EMR can help reduce billing errors and help prompt users to document fields that will be essential for billing. Wang et al, A Cost-Benefit Analysis of Electronic Medical Record.<br />
<br />
* Effective EMRs and clinical decision support systems help notify clinical nurse specialists of patients with pressure ulcers or risk for developing pressure ulcers and avoid unnecessary costs for hospitals. Timm JA, Chick KL, Peterson JA, Epps SI, Bleimeyer RR, Harris M. Using expert rules to automate pressure ulcer alerts for the clinical nurse specialist. AMIA Annu Symp Proc. 2008 Nov 6:1154.<br />
<br />
* Physicians alerted on computer-screen displays to the charges for each test, and the total charges for tests ordered that day, ordered fewer tests. "In the intervention group, physicians ordered 14% fewer tests (P < 0.005) and charges for tests were 13% lower (both P < 0.05)." Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl JMed. 1990;322:1499-504. [PMID: 2186274]<br />
<br />
* Showing doctors the results of previous tests on computer-screen displays, including the test dates, reduced the rate of ordering new tests. "The number of tests decreased significantly in both groups, but more in the intervention group (16.8% in the intervention group and 10.9% in the control group)." Tierney WM, McDonald CJ, Martin DK, Rogers MP. Computerized display of past test results. Effect on outpatient testing. Ann Intern Med. 1987;107:569-74. [PMID: 3631792]<br />
<br />
* Using a CPOE system reduced total hospital charges by $887, or 12.7%, compared to the control group. The average stay was 0.89 day shorter (P = 0.11). Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA. 1993;269:379-83. [PMID: 8418345]<br />
<br />
*Eliminating paper chart supplies and copying expense as well as costs associated with storing paper charts.<br />
<br />
* On average charts are pulled approximately 600 times a year. With an average cost of $5 to pull and re-file a chart, this is a savings of approximately $3000. Ref: A Cost-Benefit Analysis of Electronic Medical Records/Wang et al<br />
<br />
* Using an EMR can lead to reduced malpractice insurance rates for hospitals and clinical practices. Some insurance companies offer lower rates when clinicians use EMRs. Ref: http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm<br />
<br />
* EMR can reduce staff time used in preparing paper records. Brigham and Women's Hospital reported a cumulative saving of $0.6 million by automatically generating medication lists at patients' discharges using their EMR. Ref: Kaushal R et al. Return on investment for a computerized physician order entry system. J Am Med Inform Assoc. 2006;13(3):261-66.<br />
<br />
* Hillestad et al., estimated that at 90 percent adoption, the potential efficiency savings of the EMR for both inpatient and outpatient care could average more than $77 billion per year. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117 <br />
<br />
*Sixty-six percent of adverse drug events might be preventable with the use of ambulatory CPOE. Each avoided event saves $1,000–$2,000 because of avoided office visits, hospitalizations, and other care. Ref: D. Johnston et al., Patient Safety in the Physician’s Office: Assessing the Value of Ambulatory CPOE, April 2004, www.chcf.org/topics/view.cfm?itemID=101965.<br />
<br />
* Even though some research have shown considerable savings, up to billions of dollar after EMR adoption and implementation, the heavy initial investment and long term ROI still constitute one of the main barriers for implementing such systems for small size hospitals and physician offices. Thakkar and Davis suggest that specialized software systems such as EHR need to come with "one size fits all" version of the product to be massively adopted. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2047303&blobtype=pdf)<br />
<br />
* Can improve billing by allowing improved medical staff documentation and lack of lost or misplaced charts.<br />
<br />
* A study done by Hillestad et al explains that the cumulative potential net efficiency and safety savings from hospital systems could be nearly $371 billion while potential cumulative savings from physician practice EMR systems could be $142 billion. Both savings are calculated upon a course of 15 years. This potential net financial benefit could double if the health savings produced by chronic disease prevention and management were included. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117. http://content.healthaffairs.org/cgi/content/full/24/5/1103<br />
<br />
* With the use of the Eclipsys system, Lucile Packard Children’s Hospital identified $49 million in underpayments, collected $27 million of that amount, and saved $6.5 million in outsourcing costs. This was in between August 2002 and April 2006. Ref: http://www.eclipsys.com/ourclients/success_stories_details_LucilePackardChildrensHospital.asp<br />
<br />
* The estimated net benefit from using an EMR in promary care for a 5 year period was $86,400 per provider [Wang et al. A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine (2003)]<br />
<br />
== '''Clinical''' ==<br />
* EMR systems have been proven to decrease the amount of time nursing staff spends on documentation. Reference: A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database. Journal of Healthcare Information Management- Vol. 21, No. 1 p 67.<br />
<br />
* Alert and reminder programs in EMR's increase physician attentiveness to certain areas such as preventive medicine or more specifically drug level monitoring. Reference: Computer Physician Order EntryL Benefits, Costs, and Issues. Gilad Kuperman, M.D., P.h.D., Richard Gibson, M.D., P.h.D. Ann Intern Med. 2003; 139:31-39. <br />
<br />
* Interfacing EMR with hospital paging system allows critical laboratory results to be communicated to responsible physician timely. The system reduces the time between a critical result arises and the corresponding physician's responses. Ref: Kuperman GJ, Teich JM, Tanasijevic MJ, Luf NM, Rittenberg E, Jha A, Fiskio J, Winkelman J, Bates DW. Improving response to critical laboratory results with automation. J Am Med Inform Assoc. 1999;6(6):512-22.<br />
<br />
* Information on patient allergies and other medications, in combination with alerts and reminders, can decrease the number of medication-related adverse events and improve presribing practices of physicians and nurse practioners. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* Increased ordering rates for pneumococcal and influenza vaccine, prophylactic heparin, and aspirin at discharge. from: Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med. 2001;345:965-70.<br />
<br />
* With the quality EMR, quick access to patients records can be lifesaving during the emergency situation by helping emergency decision-making process.<br />
<br />
* EMR can help making medical history more efficient and accurate by providing templates that can decrease the time spent in documentation.<br />
<br />
* EMR can reduce the number of errors associated with transcription.<br />
<br />
* EMR will provide the integrated view of patient to clinician so that they can spent less time for getting patients’ history, lab and radiology results and medication information so that clinicians can make diagnosis more accurately and faster.<br />
<br />
* EMRs have the capability to dislay previous laboratory test results can significantly reduce the number of redundant tests ordered, not only saving money, but also the preventing the patient from undergoing unnecessary tests.[http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* By integrating guidelines and clinical information tools, EMRs improve the quality of outpatient care and safety of drug administration. Reference: Crane RM, Raymond B. Fulfilling the Potential of Clinical Information System. The Permanente Journal. 7.1 (2003). PP 63-64.<br />
<br />
* An effective EMR system helps clinical nurse specialists notify patients with pressure ulcers or risk for developing pressure ulcers in time and therefore improve quality of care. Timm JA, Chick KL, Peterson JA, Epps SI, Bleimeyer RR, Harris M. Using expert rules to automate pressure ulcer alerts for the clinical nurse specialist. AMIA Annu Symp Proc. 2008 Nov 6:1154.<br />
<br />
*Improved patient education through use of patient portal<br />
<br />
*Streamline communication both between patient and provider, and between clinicians<br />
<br />
*Process Improvement. EMR implementations allows to review the clinical processes management, customizing it for a better quality and delivered health care. University of Illinois Chicago Medical Center has published 75% reduction in chart pull requests, expected to increase, 12 paper forms eliminated and 100% availability patient records (previously 40%). The Gemini Project http://www.himss.org/content/files/davies_2001_uiccmc.pdf<br />
<br />
*EMR improves the patient safety by reducing medication discrepancies. Maimonides Medical Center, Brooklyn, New York, has published 58% decrease in medication orders and 55% decrease in medication discrepancies after EMR implementation. http://www.himss.org/content/files/davies_2002_maimonides.pdf<br />
<br />
*Overhage and colleagues demonstrated that compliance with the monitoring of drug levels doubled when automated ordering reminders were implemented. Ref: Overhage JM, Tierney WM, Zhou XH, McDonald CJ. A randomized trial of “corollary orders” to prevent errors of omission. J Am Med Inform Assoc.1997;4:364-75. [PMID: 9292842]<br />
<br />
*Teich et al found that CPOE with reminder feature increases the providers' compliance rate in using formulary and prophylactic heparin according to clinical guidelines and improves the appropriateness of dosage. Ref: Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of computerized physician order entry on prescribing practices. Arch Intern Med. 2000;160:2741-7.<br />
<br />
* EMR can be instrumental in the connection to national disease registries allowing practices to compare their performance with that of others, which in turn, might improve the quality of care and facilitate research. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117.<br />
<br />
*Health information exchange can be easily and safely achieved for patients with multiple chronic illnesses who receive care from multiple providers in many settings. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117.<br />
<br />
* Features such as remote access and electronic messaging were shown very usefull and successfull for primary care practice. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1839545&blobtype=pdf)<br />
<br />
* Secondary use of health data stored in EMR has potentials to protect and enhance public health, and facilitate health science research. Ref: American Medical Information Association. Secondary uses and re-uses of healthcare data: taxonomy and policy formulation and planning. 2007. http://www.amia.org/files/amiataxonomyncvhs.pdf<br />
<br />
* Can improve critical medical decisions by providing the most up-to-date clinical information at point-of-care.<br />
<br />
* According to a study performed by Work, the use of bedside medication scanning with EMRs decreased medication administration error rates by 67% at a pilot unit in Beloit Memorial Hospital. BCMA was then implemented to other units and measured to have decreased error rates to an average of 93% in the first four months of study and not counting the first month. Work M. Improving Medication Safety with a Wireless, Mobile Barcode System in a Community Hospital. Patient Safety & Quality Healthcare. 2005. http://www.psqh.com/mayjun05/casestudy.html<br />
<br />
* According to an article by the president of the University of Texas M.D. Anderson Cancer Center in Houston, a standardized nation-wide electronic medical record will ensure quality care for patients who see multiple providers at multiple sites. A national EMR could provide enormous opportunities for reducing overhead costs, identifying factors contributing to many illnesses (including cancer), determining optimal treatment, and detecting uncommon side effects of treatment. Mendelsohn J. Ten pieces to the cancer puzzle. Jan 24, 2009. http://www.chron.com/disp/story.mpl/editorial/outlook/6228636.html<br />
<br />
* Genome-enabled EMR can integrate resources such as OMIM and PharmGKB to facilitate the diagnosis, long-term and family member management of molecular and cytogenetic diseases. [Hoffman. The genome-enabled electronic medical record. Journal of Biomedical Informatics (2007)]<br />
<br />
* Electronic order sets, as part of CPOE, will improve compliance with nationally reported quality indicators e.g. core measures.<br />
<br />
* Clinical decision support regarding culture results can improve antibiotic utilization, reduce costs of unnecessary medications, reduce bacterial resistance rates and lessen the incidence of Clostridium difficile and fungal infections.<br />
<br />
* Studies have documented that CPOE can decrease costs, shorten length of stay, decrease medical errors, and improve compliance with several types of guidelines. [Kuperman, et.al., Computer Physician Order Entry: Benefits, Costs, and Issues, 2003]<br />
<br />
* An effective EHR/CPOE can prompt providers to prescribe generic medicine instead of more costly brand-name drugs. [Hagen, et.al., Evidence on the Costs and Benefits of Health Information Technology, Congressional Budget Office report, May 2008]<br />
<br />
* Health care practitioners are bombarded with changing clincal decision factors and are challenged to stay abreat of an ever-increasing knowledge base in specific ares of expertise. Current medical practice relies heavily on the unaided maind to recall a great amount of detailed knowledge - a process which, to the detriment of all stakeholders, has repeatedly been shown unreliable. CPOE systems maintained with current information and processes will help eliminate this problem. McDonald, CJ. Protocol-based computer reminder, the quality of care and the non-perfectibility of man, New England Journal of Medicine, 1976]<br />
<br />
== '''Operational''' ==<br />
<br />
* Overall, 6.2% increase in time spent ordering (not statistically significant); experienced users were time neutral with paperbased ordering. from: Overhage JM, Perkins S, Tierney WM, McDonald CJ. Controlled trial of direct physician order entry: effects on physicians’ time utilization in ambulatory primary care internal medicine practices. J Am Med Inform Assoc. 2001;8:361-71.<br />
<br />
* EMRs allow a physician to access multiple records at the touch of a button. Whether he or she is at a computer or in an exam room with a patient, the workflow is enhanced as less effort is required to retrieve information.<br />
<br />
* Protects patient data by preventing unauthorized individuals from accessing the clinical record. <br />
<br />
* Integrated communication and reporting support. EMR can facilitate the efficient creation and transmission of reports that relate to health care operations such as billing and charge information. Coiera, E (2003) Guide to Health Informatics (2nd Edition), Arnold Publishers Shortliffe, EH (ed) (2006) Biomedical Informatics (3rd Edition), Springer. pg. 119.<br />
<br />
* EMRs improve interdisciplinary collaborations and efficent communications between physicians and nurses via nursing documentation with greater clarity and additional information. Green SD, Thomas JD. Interdisciplinary collaboration and the electronic medical record. PMID: 18649812 [PubMed - indexed for MEDLINE]<br />
<br />
*documentation completed at conclusion of encounter.<br />
<br />
*Preventing the missing patient paper medical recodrs. Every time a paper chart gets stored, there is the chance it will be misplaced or maybe filed in a wrong place. This is very frequently is many hospitals, specially in those of the limited resources countries without EMR systems in where all paper medical records are located in a central repository room. EMR allows to prevents it by an unique electronic record and patient chart available in all time and stored into one central data repository server.<br />
<br />
* Eliminates lost orders and ambiguities caused by illegible handwriting, generating realated orders automatically, monitoring for duplicate orders and reducing time to o fill orders. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* EMR is time savings for physicians and staffs by reducing in documenting the chart. According to the statistics, the average saving time is 5 minutes which can be done in real-time, point of encounter and no need for longer appointments. The total ROI per physician per year approximately is $78,000. [Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]<br />
<br />
* EMR is improvements in medical coding. The approximately annual loss per physician is $40,000 - $50,000 by under coding due to fear of audit and lack of time to sufficiently document the level of care. The ROI of improvement in coding per year is approximately $54,000. <br />
[Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]<br />
<br />
* The benefit of an electronic medical record can increase the numerators and decrease the denominators. In addition, efficiency takes all of the duties involved in medical record medical office management divided by time and money. [Douglas. Thompson, Neil Fleming. Finding the ROI in EMRs. http://www.hfma.org]<br />
<br />
* Part of the money-saving nature of electronic medical record technology is the elimination of IT infrastructure and the streamlining of multiple databases. The infrastructure is simplified into one online database, even for multiple offices.[Douglas. Thompson, Neil Fleming. Finding the ROI in EMRs. http://www.hfma.org]<br />
<br />
* During the implementation phase of the EMR, was noted a closer cooperation between the clinical, and administrative setvices of hospitals. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2245928&blobtype=pdf)<br />
<br />
* Can allow for better appreciation of clinician performance for which can be used for employee bonuses.<br />
<br />
* The benefit of electronic medical record primarily accrued from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors. [Wang et al. A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine (2003)]<br />
<br />
* CPOE will automatically date and time physician orders, as recommended by regulatory organizations.</div>Akaplanhttp://clinfowiki.org/wiki/index.php/EMR_Benefits_and_Return_on_Investment_CategoriesEMR Benefits and Return on Investment Categories2009-09-11T13:35:57Z<p>Akaplan: </p>
<hr />
<div>The following EMR-related benefits have been identified within various health care organizations. Before one assumes that just because some other organization was able to realize a specific benefit that they will be able to achieve the same thing, one must ensure that they have the same EMR features and functions available AND the clinicians are, or will, use them at their organization. See related [[EMR Cost Categories]] page...<br />
<br />
== '''Common EMR Benefit Categories''' ==<br />
<br />
<br />
== '''Financial''' ==<br />
* EMR can prevent unnecessary duplication of diagnostic tests that might occur when a patient sees multiple healthcare providers. Reference: Evidence on the Costs and Benefits of Health Information Technology. http://www.cbo.gov/ftpdocs/91xx/doc9168/MainText.3.1.shtml#1096012<br />
<br />
* Charges for laboratory tests were 8.8% lower in the intervention group (P < 0.05) from: Tierney WM, McDonald CJ, Hui SL, Martin DK. Computer predictions of abnormal test results. Effects on outpatient testing. JAMA. 1988;259:1194-8.<br />
<br />
* With the use of EMR, record handling will be conducted in the office, records will not have to be sent to an outsource provider or to a transcriber for handling. This will ultimately help saving transcription cost. Reference: http://www.allscripts.com/casestudies/nffm.pdf<br />
<br />
* EMR can facilitate the efficient creation and transmission of reports that support patient safety, quality improvement, public health, research, and other health care operations. All of those will reduce the cost of healthcare.<br />
<br />
* EMRs can remove the middle man in different instances, cutting cost by eliminating the need for the middle man. For instance, automated dictation replaces the person that would type the dictation, thus reducing total cost.<br />
<br />
* Financial benefits under pay for performance (P4P) accrue to the highest quality providers, both hospitals and physicians. EMR's which allow for real-time quality data can enable organizations to better meet targets to earn quality bonuses on Medicare and private insurance reimbursement.<br />
<br />
* Many ambulatory EMR systems are integrated with e-Prescribing. For physicians who use this technology in 2009 and 2010 for at least 50% of their eligible patients, an addtional 2% will be added to their Medicare reimbursement. The amount drops to 1% for 2011 and 2012, and thereafter, non-use becomes a penalty. [http://www.cms.hhs.gov/PQRI/Downloads/PQRIEPrescribingFactSheet.pdf] <br />
<br />
* A major component of all hospital operating budgets is the purchase of drugs with IV and IM doses generally being considerably more costly per dose versus oral. EMR's can support early transition from parenteral medications to oral, thus decreasing costs per admission and length of stay (LOS).[Reference: Fischer MA et al.Conversion from intravenous to oral medications. Arch Int Med 163(2003):2585-2589.]<br />
<br />
*In a paper record, clinicians are not always thinking about optimizing charges. Omission of essential information makes it difficult to justify the charges. An EMR can help reduce billing errors and help prompt users to document fields that will be essential for billing. Wang et al, A Cost-Benefit Analysis of Electronic Medical Record.<br />
<br />
* Effective EMRs and clinical decision support systems help notify clinical nurse specialists of patients with pressure ulcers or risk for developing pressure ulcers and avoid unnecessary costs for hospitals. Timm JA, Chick KL, Peterson JA, Epps SI, Bleimeyer RR, Harris M. Using expert rules to automate pressure ulcer alerts for the clinical nurse specialist. AMIA Annu Symp Proc. 2008 Nov 6:1154.<br />
<br />
* Physicians alerted on computer-screen displays to the charges for each test, and the total charges for tests ordered that day, ordered fewer tests. "In the intervention group, physicians ordered 14% fewer tests (P < 0.005) and charges for tests were 13% lower (both P < 0.05)." Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl JMed. 1990;322:1499-504. [PMID: 2186274]<br />
<br />
* Showing doctors the results of previous tests on computer-screen displays, including the test dates, reduced the rate of ordering new tests. "The number of tests decreased significantly in both groups, but more in the intervention group (16.8% in the intervention group and 10.9% in the control group)." Tierney WM, McDonald CJ, Martin DK, Rogers MP. Computerized display of past test results. Effect on outpatient testing. Ann Intern Med. 1987;107:569-74. [PMID: 3631792]<br />
<br />
* Using a CPOE system reduced total hospital charges by $887, or 12.7%, compared to the control group. The average stay was 0.89 day shorter (P = 0.11). Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA. 1993;269:379-83. [PMID: 8418345]<br />
<br />
*Eliminating paper chart supplies and copying expense as well as costs associated with storing paper charts.<br />
<br />
* On average charts are pulled approximately 600 times a year. With an average cost of $5 to pull and re-file a chart, this is a savings of approximately $3000. Ref: A Cost-Benefit Analysis of Electronic Medical Records/Wang et al<br />
<br />
* Using an EMR can lead to reduced malpractice insurance rates for hospitals and clinical practices. Some insurance companies offer lower rates when clinicians use EMRs. Ref: http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm<br />
<br />
* EMR can reduce staff time used in preparing paper records. Brigham and Women's Hospital reported a cumulative saving of $0.6 million by automatically generating medication lists at patients' discharges using their EMR. Ref: Kaushal R et al. Return on investment for a computerized physician order entry system. J Am Med Inform Assoc. 2006;13(3):261-66.<br />
<br />
* Hillestad et al., estimated that at 90 percent adoption, the potential efficiency savings of the EMR for both inpatient and outpatient care could average more than $77 billion per year. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117 <br />
<br />
*Sixty-six percent of adverse drug events might be preventable with the use of ambulatory CPOE. Each avoided event saves $1,000–$2,000 because of avoided office visits, hospitalizations, and other care. Ref: D. Johnston et al., Patient Safety in the Physician’s Office: Assessing the Value of Ambulatory CPOE, April 2004, www.chcf.org/topics/view.cfm?itemID=101965.<br />
<br />
* Even though some research have shown considerable savings, up to billions of dollar after EMR adoption and implementation, the heavy initial investment and long term ROI still constitute one of the main barriers for implementing such systems for small size hospitals and physician offices. Thakkar and Davis suggest that specialized software systems such as EHR need to come with "one size fits all" version of the product to be massively adopted. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2047303&blobtype=pdf)<br />
<br />
* Can improve billing by allowing improved medical staff documentation and lack of lost or misplaced charts.<br />
<br />
* A study done by Hillestad et al explains that the cumulative potential net efficiency and safety savings from hospital systems could be nearly $371 billion while potential cumulative savings from physician practice EMR systems could be $142 billion. Both savings are calculated upon a course of 15 years. This potential net financial benefit could double if the health savings produced by chronic disease prevention and management were included. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117. http://content.healthaffairs.org/cgi/content/full/24/5/1103<br />
<br />
* With the use of the Eclipsys system, Lucile Packard Children’s Hospital identified $49 million in underpayments, collected $27 million of that amount, and saved $6.5 million in outsourcing costs. This was in between August 2002 and April 2006. Ref: http://www.eclipsys.com/ourclients/success_stories_details_LucilePackardChildrensHospital.asp<br />
<br />
* The estimated net benefit from using an EMR in promary care for a 5 year period was $86,400 per provider [Wang et al. A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine (2003)]<br />
<br />
== '''Clinical''' ==<br />
* EMR systems have been proven to decrease the amount of time nursing staff spends on documentation. Reference: A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database. Journal of Healthcare Information Management- Vol. 21, No. 1 p 67.<br />
<br />
* Alert and reminder programs in EMR's increase physician attentiveness to certain areas such as preventive medicine or more specifically drug level monitoring. Reference: Computer Physician Order EntryL Benefits, Costs, and Issues. Gilad Kuperman, M.D., P.h.D., Richard Gibson, M.D., P.h.D. Ann Intern Med. 2003; 139:31-39. <br />
<br />
* Interfacing EMR with hospital paging system allows critical laboratory results to be communicated to responsible physician timely. The system reduces the time between a critical result arises and the corresponding physician's responses. Ref: Kuperman GJ, Teich JM, Tanasijevic MJ, Luf NM, Rittenberg E, Jha A, Fiskio J, Winkelman J, Bates DW. Improving response to critical laboratory results with automation. J Am Med Inform Assoc. 1999;6(6):512-22.<br />
<br />
* Information on patient allergies and other medications, in combination with alerts and reminders, can decrease the number of medication-related adverse events and improve presribing practices of physicians and nurse practioners. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* Increased ordering rates for pneumococcal and influenza vaccine, prophylactic heparin, and aspirin at discharge. from: Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med. 2001;345:965-70.<br />
<br />
* With the quality EMR, quick access to patients records can be lifesaving during the emergency situation by helping emergency decision-making process.<br />
<br />
* EMR can help making medical history more efficient and accurate by providing templates that can decrease the time spent in documentation.<br />
<br />
* EMR can reduce the number of errors associated with transcription.<br />
<br />
* EMR will provide the integrated view of patient to clinician so that they can spent less time for getting patients’ history, lab and radiology results and medication information so that clinicians can make diagnosis more accurately and faster.<br />
<br />
* EMRs have the capability to dislay previous laboratory test results can significantly reduce the number of redundant tests ordered, not only saving money, but also the preventing the patient from undergoing unnecessary tests.[http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* By integrating guidelines and clinical information tools, EMRs improve the quality of outpatient care and safety of drug administration. Reference: Crane RM, Raymond B. Fulfilling the Potential of Clinical Information System. The Permanente Journal. 7.1 (2003). PP 63-64.<br />
<br />
* An effective EMR system helps clinical nurse specialists notify patients with pressure ulcers or risk for developing pressure ulcers in time and therefore improve quality of care. Timm JA, Chick KL, Peterson JA, Epps SI, Bleimeyer RR, Harris M. Using expert rules to automate pressure ulcer alerts for the clinical nurse specialist. AMIA Annu Symp Proc. 2008 Nov 6:1154.<br />
<br />
*Improved patient education through use of patient portal<br />
<br />
*Streamline communication both between patient and provider, and between clinicians<br />
<br />
*Process Improvement. EMR implementations allows to review the clinical processes management, customizing it for a better quality and delivered health care. University of Illinois Chicago Medical Center has published 75% reduction in chart pull requests, expected to increase, 12 paper forms eliminated and 100% availability patient records (previously 40%). The Gemini Project http://www.himss.org/content/files/davies_2001_uiccmc.pdf<br />
<br />
*EMR improves the patient safety by reducing medication discrepancies. Maimonides Medical Center, Brooklyn, New York, has published 58% decrease in medication orders and 55% decrease in medication discrepancies after EMR implementation. http://www.himss.org/content/files/davies_2002_maimonides.pdf<br />
<br />
*Overhage and colleagues demonstrated that compliance with the monitoring of drug levels doubled when automated ordering reminders were implemented. Ref: Overhage JM, Tierney WM, Zhou XH, McDonald CJ. A randomized trial of “corollary orders” to prevent errors of omission. J Am Med Inform Assoc.1997;4:364-75. [PMID: 9292842]<br />
<br />
*Teich et al found that CPOE with reminder feature increases the providers' compliance rate in using formulary and prophylactic heparin according to clinical guidelines and improves the appropriateness of dosage. Ref: Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of computerized physician order entry on prescribing practices. Arch Intern Med. 2000;160:2741-7.<br />
<br />
* EMR can be instrumental in the connection to national disease registries allowing practices to compare their performance with that of others, which in turn, might improve the quality of care and facilitate research. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117.<br />
<br />
*Health information exchange can be easily and safely achieved for patients with multiple chronic illnesses who receive care from multiple providers in many settings. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117.<br />
<br />
* Features such as remote access and electronic messaging were shown very usefull and successfull for primary care practice. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1839545&blobtype=pdf)<br />
<br />
* Secondary use of health data stored in EMR has potentials to protect and enhance public health, and facilitate health science research. Ref: American Medical Information Association. Secondary uses and re-uses of healthcare data: taxonomy and policy formulation and planning. 2007. http://www.amia.org/files/amiataxonomyncvhs.pdf<br />
<br />
* Can improve critical medical decisions by providing the most up-to-date clinical information at point-of-care.<br />
<br />
* According to a study performed by Work, the use of bedside medication scanning with EMRs decreased medication administration error rates by 67% at a pilot unit in Beloit Memorial Hospital. BCMA was then implemented to other units and measured to have decreased error rates to an average of 93% in the first four months of study and not counting the first month. Work M. Improving Medication Safety with a Wireless, Mobile Barcode System in a Community Hospital. Patient Safety & Quality Healthcare. 2005. http://www.psqh.com/mayjun05/casestudy.html<br />
<br />
* According to an article by the president of the University of Texas M.D. Anderson Cancer Center in Houston, a standardized nation-wide electronic medical record will ensure quality care for patients who see multiple providers at multiple sites. A national EMR could provide enormous opportunities for reducing overhead costs, identifying factors contributing to many illnesses (including cancer), determining optimal treatment, and detecting uncommon side effects of treatment. Mendelsohn J. Ten pieces to the cancer puzzle. Jan 24, 2009. http://www.chron.com/disp/story.mpl/editorial/outlook/6228636.html<br />
<br />
* Genome-enabled EMR can integrate resources such as OMIM and PharmGKB to facilitate the diagnosis, long-term and family member management of molecular and cytogenetic diseases. [Hoffman. The genome-enabled electronic medical record. Journal of Biomedical Informatics (2007)]<br />
<br />
* Electronic order sets, as part of CPOE, will improve compliance with nationally reported quality indicators e.g. core measures.<br />
<br />
* Clinical decision support regarding culture results can improve antibiotic utilization, reduce costs of unnecessary medications, reduce bacterial resistance rates and lessen the incidence of Clostridium difficile and fungal infections.<br />
<br />
* Studies have documented that CPOE can decrease costs, shorten length of stay, decrease medical errors, and improve compliance with several types of guidelines. [Kuperman, et.al., Computer Physician Order Entry: Benefits, Costs, and Issues, 2003]<br />
<br />
== '''Operational''' ==<br />
<br />
* Overall, 6.2% increase in time spent ordering (not statistically significant); experienced users were time neutral with paperbased ordering. from: Overhage JM, Perkins S, Tierney WM, McDonald CJ. Controlled trial of direct physician order entry: effects on physicians’ time utilization in ambulatory primary care internal medicine practices. J Am Med Inform Assoc. 2001;8:361-71.<br />
<br />
* EMRs allow a physician to access multiple records at the touch of a button. Whether he or she is at a computer or in an exam room with a patient, the workflow is enhanced as less effort is required to retrieve information.<br />
<br />
* Protects patient data by preventing unauthorized individuals from accessing the clinical record. <br />
<br />
* Integrated communication and reporting support. EMR can facilitate the efficient creation and transmission of reports that relate to health care operations such as billing and charge information. Coiera, E (2003) Guide to Health Informatics (2nd Edition), Arnold Publishers Shortliffe, EH (ed) (2006) Biomedical Informatics (3rd Edition), Springer. pg. 119.<br />
<br />
* EMRs improve interdisciplinary collaborations and efficent communications between physicians and nurses via nursing documentation with greater clarity and additional information. Green SD, Thomas JD. Interdisciplinary collaboration and the electronic medical record. PMID: 18649812 [PubMed - indexed for MEDLINE]<br />
<br />
*documentation completed at conclusion of encounter.<br />
<br />
*Preventing the missing patient paper medical recodrs. Every time a paper chart gets stored, there is the chance it will be misplaced or maybe filed in a wrong place. This is very frequently is many hospitals, specially in those of the limited resources countries without EMR systems in where all paper medical records are located in a central repository room. EMR allows to prevents it by an unique electronic record and patient chart available in all time and stored into one central data repository server.<br />
<br />
* Eliminates lost orders and ambiguities caused by illegible handwriting, generating realated orders automatically, monitoring for duplicate orders and reducing time to o fill orders. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* EMR is time savings for physicians and staffs by reducing in documenting the chart. According to the statistics, the average saving time is 5 minutes which can be done in real-time, point of encounter and no need for longer appointments. The total ROI per physician per year approximately is $78,000. [Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]<br />
<br />
* EMR is improvements in medical coding. The approximately annual loss per physician is $40,000 - $50,000 by under coding due to fear of audit and lack of time to sufficiently document the level of care. The ROI of improvement in coding per year is approximately $54,000. <br />
[Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]<br />
<br />
* The benefit of an electronic medical record can increase the numerators and decrease the denominators. In addition, efficiency takes all of the duties involved in medical record medical office management divided by time and money. [Douglas. Thompson, Neil Fleming. Finding the ROI in EMRs. http://www.hfma.org]<br />
<br />
* Part of the money-saving nature of electronic medical record technology is the elimination of IT infrastructure and the streamlining of multiple databases. The infrastructure is simplified into one online database, even for multiple offices.[Douglas. Thompson, Neil Fleming. Finding the ROI in EMRs. http://www.hfma.org]<br />
<br />
* During the implementation phase of the EMR, was noted a closer cooperation between the clinical, and administrative setvices of hospitals. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2245928&blobtype=pdf)<br />
<br />
* Can allow for better appreciation of clinician performance for which can be used for employee bonuses.<br />
<br />
* The benefit of electronic medical record primarily accrued from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors. [Wang et al. A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine (2003)]<br />
<br />
* CPOE will automatically date and time physician orders, as recommended by regulatory organizations.</div>Akaplanhttp://clinfowiki.org/wiki/index.php/E-MDsE-MDs2009-09-10T14:39:16Z<p>Akaplan: </p>
<hr />
<div>Developed in 1996 by a group of Family Practice Physicians in Austin, TX, this electronic EMR/EHR was created to fill a void in EMRs for small practices that was not cost-prohibitive. Dr. David Winn, MD., and his colleagues who had been using an older EMR system, developed the e-MDs for an ambulatory office, and this system was one of the first six ambulatory EMR systems to receive the Certification Commission for Healthcare Information Technology's 2007 criteria for functionality, interoperability and security.<br />
<br />
Source: <br />
www.e-mds.com</div>Akaplanhttp://clinfowiki.org/wiki/index.php/MEDHOST_EDISMEDHOST EDIS2009-09-10T13:48:56Z<p>Akaplan: </p>
<hr />
<div>MEDHOST, Inc. is the provider of the Emergency Department Information System (EDIS) that is used by many ER departments. It consists of Patient Tracking, Nurse Charting, Physician Documentation, Order Entry and comprehensive reporting.<br />
<br />
MEDHOST was formed in 1997 to provide the healthcare industry with management applications that are easy to learn, use and implement. Until that time, EDIS technologies were a rarity, as ED doctors and nurses generally recorded charges and important information by hand, spending more time on paperwork than with patients.<br />
<br />
MEDHOST currently serves more than 160 facilities, including the Baylor Healthcare System in Texas, Catholic Healthcare West in California, Catholic Health System in New York and Tenet Healthcare Corporation. MEDHOST is the preferred EDIS provider of VHA Inc., a national cooperative serving more than 2,400 not-for-profit healthcare organizations. MEDHOST easily integrates with leading hospital information systems, including MEDITECH, Cerner, Siemens and McKesson.<br />
<br />
MEDHOST EDIS version 4.2 is a CCHIT Certified® 08 Emergency Department Electronic Health Record.<br />
<br />
<br />
<br />
Sources:<br />
<br />
www.medhost.com<br />
<br />
www.biohealthmatics.com</div>Akaplanhttp://clinfowiki.org/wiki/index.php/MEDHOST_EDISMEDHOST EDIS2009-09-10T13:48:47Z<p>Akaplan: </p>
<hr />
<div>MEDHOST, Inc. is the provider of the Emergency Department Information System (EDIS) that is used by many ER departments. It consists of Patient Tracking, Nurse Charting, Physician Documentation, Order Entry and comprehensive reporting.<br />
<br />
MEDHOST was formed in 1997 to provide the healthcare industry with management applications that are easy to learn, use and implement. Until that time, EDIS technologies were a rarity, as ED doctors and nurses generally recorded charges and important information by hand, spending more time on paperwork than with patients.<br />
<br />
MEDHOST currently serves more than 160 facilities, including the Baylor Healthcare System in Texas, Catholic Healthcare West in California, Catholic Health System in New York and Tenet Healthcare Corporation. MEDHOST is the preferred EDIS provider of VHA Inc., a national cooperative serving more than 2,400 not-for-profit healthcare organizations. MEDHOST easily integrates with leading hospital information systems, including MEDITECH, Cerner, Siemens and McKesson.<br />
<br />
MEDHOST EDIS version 4.2 is a CCHIT Certified® 08 Emergency Department Electronic Health Record.<br />
<br />
<br />
<br />
Sources:<br />
<br />
www.medhost.com<br />
www.biohealthmatics.com</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Historically_Important_Electronic_Medical_Record_SystemsHistorically Important Electronic Medical Record Systems2009-09-10T13:39:28Z<p>Akaplan: </p>
<hr />
<div>The following Electronic Medical Record (EMR) systems were among the first of their kind ever developed. Each of the following systems added key information to our current understanding of how EMRs can improve the cost, quality, or efficiency of the care delivered within the modern health care system.<br />
<br />
* [[COmputer STored Ambulatory Record (COSTAR)]] - Harvard Pilgrim Health Plan, Boston, MA<br />
* [[Health Evaluation through Logical Programming (HELP)]] - LDS Hospital, Salt Lake City, UT<br />
* [[The Medical Record (TMR)]] - Duke University, Durham, NC<br />
* [[Lockheed-Martin / Technicon Data Systems (TDS)]] - El Camino Hospital, Mountain View, CA<br />
* [[Regenstrief Medical Record System (RMRS)]] - Wishard Memorial Hospital, Indianapolis, IN<br />
* [[Brigham Integrated Computing System (BICS)]] - Brigham & Women's Hospital, Boston, MA<br />
* [[Out-patient Medical Record (OMR)]] - Beth Israel Deaconess Medical Center, Boston, MA<br />
* [[Diogene]] - University Hospital, Geneva, Switzerland<br />
* [[Akron General Hospital and IBM]] - Akron, Ohio<br />
* [[Problem-Oriented Medical Information System (PROMIS)]] - Burlington, VT<br />
* [[Veterans Health Information Systems and Technology Architecture (VistA)]] - Department of Veterans Affairs (VA)<br />
* [[Armed Forces Health Longitudinal Technology Application (AHLTA)]] - US Department of Defense (DoD)<br />
* [[Janus Health - JanusOSSM]] - San Diego, CA<br />
* [[Revised Three-layer Graph-based Meta Model]] (3GLM2) - University of Leipzig, Leipzig, Germany<br />
* [[Junzi No.1 Hospital Information System]] - PLA General Hospital, Beijing, China<br />
* [[EcMR]]<br />
* [[Hospital Italiano EHR System]] - Buenos Aires, Argentina<br />
* [[Buenos Aires Hospital Network EHR System]]<br />
* [[Alberta Netcare]] - Alberta, Canada<br />
* [[Center for Clinical Computing (CCC)]] - Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA<br />
* [[Epic Systems]] - Madison, WI<br />
* [[Technicon Medical Information System (TMIS)]] - Eclipsys Corporatons, Atlanta, GA <br />
* [[Distributed Hospital Computer Program (DHCP)]] - Veterans Administration hospitals<br />
* [[Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) ]] - Stanford University Department of Medicine, Stanford, California.<br />
* [[Maine General Health (MGH) EMR]] - One Patient, one chart to achieve interoperability standard<br />
* [[Cerner Millennium]] - Cerner Corporation, Kansas City, MO<br />
* [[ISABEL]] - Paddington, London<br />
* [[Care2x Integrated Healthcare Open Source Environment]]<br />
* [[Comprehensive Health Enhancement Support System - CHESS]] - developed at the University of Wisconsin-Madison<br />
* [[OpenMRS]]<br />
* [[Itoiz Clinic EMR]]<br />
* [[OpenSDE]]<br />
* [[ELIAS]]<br />
* [[Liang Zhang Han Expert System]]<br />
* [[Problem-Knowledge Couplers]]<br />
* [[Structured Data Entry]]<br />
* [[THERESA CPR]] - Computer-based patient record system at Emory University<br />
* [[Composite Health Care System (CHCS)]] - Original DoD EHR<br />
* [[Patient Care Information System (PCIS)]] - Indian Health Service CIS system<br />
* [[MEDITECH (MIIS)]] <br />
* [[e-MDs]]<br />
* [[ChartLogic EHR]]<br />
* [[MEDHOST EDIS]]<br />
<br />
[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>Akaplanhttp://clinfowiki.org/wiki/index.php/ChartLogic_EHRChartLogic EHR2009-09-10T13:13:25Z<p>Akaplan: </p>
<hr />
<div>ChartLogic EHR is an ambulatory EHR system designed to work in physicians offices or clinics.<br />
<br />
ChartLogic EHR was established in 1994 by Brad Melis, under the name of Task Technologies. Melis teamed up with pediatrician Dr Bruce Jorgenson who wanted a technology that would not slow down his practice. Task Technologies/ChartLogic was born by incorporating a sophisicated voice recognition software that has "voice driven commands, dictation, specialty specific vocabulary, microphones, hardware and training - all optimized to achieve highly accurate voice recognition and time saving shortcuts from the start."<br />
<br />
"The ChartLogic EMR product made it possible for physicians to complete a patient chart electronically with ease, in less time, and at a fraction of the cost of conventional paper charts while utilizing the same technique that physicians have used for years - their voice!"<br />
<br />
Currently, this system is running in "thousands" of offices and clinics in the U.S.<br />
<br />
Source:<br />
ChartLogic, Inc. www.chartlogic.com</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Historically_Important_Electronic_Medical_Record_SystemsHistorically Important Electronic Medical Record Systems2009-09-10T12:55:28Z<p>Akaplan: </p>
<hr />
<div>The following Electronic Medical Record (EMR) systems were among the first of their kind ever developed. Each of the following systems added key information to our current understanding of how EMRs can improve the cost, quality, or efficiency of the care delivered within the modern health care system.<br />
<br />
* [[COmputer STored Ambulatory Record (COSTAR)]] - Harvard Pilgrim Health Plan, Boston, MA<br />
* [[Health Evaluation through Logical Programming (HELP)]] - LDS Hospital, Salt Lake City, UT<br />
* [[The Medical Record (TMR)]] - Duke University, Durham, NC<br />
* [[Lockheed-Martin / Technicon Data Systems (TDS)]] - El Camino Hospital, Mountain View, CA<br />
* [[Regenstrief Medical Record System (RMRS)]] - Wishard Memorial Hospital, Indianapolis, IN<br />
* [[Brigham Integrated Computing System (BICS)]] - Brigham & Women's Hospital, Boston, MA<br />
* [[Out-patient Medical Record (OMR)]] - Beth Israel Deaconess Medical Center, Boston, MA<br />
* [[Diogene]] - University Hospital, Geneva, Switzerland<br />
* [[Akron General Hospital and IBM]] - Akron, Ohio<br />
* [[Problem-Oriented Medical Information System (PROMIS)]] - Burlington, VT<br />
* [[Veterans Health Information Systems and Technology Architecture (VistA)]] - Department of Veterans Affairs (VA)<br />
* [[Armed Forces Health Longitudinal Technology Application (AHLTA)]] - US Department of Defense (DoD)<br />
* [[Janus Health - JanusOSSM]] - San Diego, CA<br />
* [[Revised Three-layer Graph-based Meta Model]] (3GLM2) - University of Leipzig, Leipzig, Germany<br />
* [[Junzi No.1 Hospital Information System]] - PLA General Hospital, Beijing, China<br />
* [[EcMR]]<br />
* [[Hospital Italiano EHR System]] - Buenos Aires, Argentina<br />
* [[Buenos Aires Hospital Network EHR System]]<br />
* [[Alberta Netcare]] - Alberta, Canada<br />
* [[Center for Clinical Computing (CCC)]] - Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA<br />
* [[Epic Systems]] - Madison, WI<br />
* [[Technicon Medical Information System (TMIS)]] - Eclipsys Corporatons, Atlanta, GA <br />
* [[Distributed Hospital Computer Program (DHCP)]] - Veterans Administration hospitals<br />
* [[Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) ]] - Stanford University Department of Medicine, Stanford, California.<br />
* [[Maine General Health (MGH) EMR]] - One Patient, one chart to achieve interoperability standard<br />
* [[Cerner Millennium]] - Cerner Corporation, Kansas City, MO<br />
* [[ISABEL]] - Paddington, London<br />
* [[Care2x Integrated Healthcare Open Source Environment]]<br />
* [[Comprehensive Health Enhancement Support System - CHESS]] - developed at the University of Wisconsin-Madison<br />
* [[OpenMRS]]<br />
* [[Itoiz Clinic EMR]]<br />
* [[OpenSDE]]<br />
* [[ELIAS]]<br />
* [[Liang Zhang Han Expert System]]<br />
* [[Problem-Knowledge Couplers]]<br />
* [[Structured Data Entry]]<br />
* [[THERESA CPR]] - Computer-based patient record system at Emory University<br />
* [[Composite Health Care System (CHCS)]] - Original DoD EHR<br />
* [[Patient Care Information System (PCIS)]] - Indian Health Service CIS system<br />
* [[MEDITECH (MIIS)]] <br />
* [[e-MDs]]<br />
* [[ChartLogic EHR]]<br />
<br />
[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>Akaplanhttp://clinfowiki.org/wiki/index.php/E-MDsE-MDs2009-09-09T18:08:42Z<p>Akaplan: </p>
<hr />
<div>Developed in 1996 by a group of Family Practice Physicians in Austin, TX, this electronic EMR/EHR was created to fill a void in EMRs for small practices that was not cost-prohibitive. Dr. David Winn, MD., and his colleagues who had been using an older EMR system, developed the e-MDs for an ambulatory office, and this system was one of the first six ambulatory EMR systems to receive the Certification Commission for Healthcare Information Technology's 2007 criteria for functionality, interoperability and security.</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Historically_Important_Electronic_Medical_Record_SystemsHistorically Important Electronic Medical Record Systems2009-09-09T18:02:06Z<p>Akaplan: </p>
<hr />
<div>The following Electronic Medical Record (EMR) systems were among the first of their kind ever developed. Each of the following systems added key information to our current understanding of how EMRs can improve the cost, quality, or efficiency of the care delivered within the modern health care system.<br />
<br />
* [[COmputer STored Ambulatory Record (COSTAR)]] - Harvard Pilgrim Health Plan, Boston, MA<br />
* [[Health Evaluation through Logical Programming (HELP)]] - LDS Hospital, Salt Lake City, UT<br />
* [[The Medical Record (TMR)]] - Duke University, Durham, NC<br />
* [[Lockheed-Martin / Technicon Data Systems (TDS)]] - El Camino Hospital, Mountain View, CA<br />
* [[Regenstrief Medical Record System (RMRS)]] - Wishard Memorial Hospital, Indianapolis, IN<br />
* [[Brigham Integrated Computing System (BICS)]] - Brigham & Women's Hospital, Boston, MA<br />
* [[Out-patient Medical Record (OMR)]] - Beth Israel Deaconess Medical Center, Boston, MA<br />
* [[Diogene]] - University Hospital, Geneva, Switzerland<br />
* [[Akron General Hospital and IBM]] - Akron, Ohio<br />
* [[Problem-Oriented Medical Information System (PROMIS)]] - Burlington, VT<br />
* [[Veterans Health Information Systems and Technology Architecture (VistA)]] - Department of Veterans Affairs (VA)<br />
* [[Armed Forces Health Longitudinal Technology Application (AHLTA)]] - US Department of Defense (DoD)<br />
* [[Janus Health - JanusOSSM]] - San Diego, CA<br />
* [[Revised Three-layer Graph-based Meta Model]] (3GLM2) - University of Leipzig, Leipzig, Germany<br />
* [[Junzi No.1 Hospital Information System]] - PLA General Hospital, Beijing, China<br />
* [[EcMR]]<br />
* [[Hospital Italiano EHR System]] - Buenos Aires, Argentina<br />
* [[Buenos Aires Hospital Network EHR System]]<br />
* [[Alberta Netcare]] - Alberta, Canada<br />
* [[Center for Clinical Computing (CCC)]] - Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA<br />
* [[Epic Systems]] - Madison, WI<br />
* [[Technicon Medical Information System (TMIS)]] - Eclipsys Corporatons, Atlanta, GA <br />
* [[Distributed Hospital Computer Program (DHCP)]] - Veterans Administration hospitals<br />
* [[Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) ]] - Stanford University Department of Medicine, Stanford, California.<br />
* [[Maine General Health (MGH) EMR]] - One Patient, one chart to achieve interoperability standard<br />
* [[Cerner Millennium]] - Cerner Corporation, Kansas City, MO<br />
* [[ISABEL]] - Paddington, London<br />
* [[Care2x Integrated Healthcare Open Source Environment]]<br />
* [[Comprehensive Health Enhancement Support System - CHESS]] - developed at the University of Wisconsin-Madison<br />
* [[OpenMRS]]<br />
* [[Itoiz Clinic EMR]]<br />
* [[OpenSDE]]<br />
* [[ELIAS]]<br />
* [[Liang Zhang Han Expert System]]<br />
* [[Problem-Knowledge Couplers]]<br />
* [[Structured Data Entry]]<br />
* [[THERESA CPR]] - Computer-based patient record system at Emory University<br />
* [[Composite Health Care System (CHCS)]] - Original DoD EHR<br />
* [[Patient Care Information System (PCIS)]] - Indian Health Service CIS system<br />
* [[MEDITECH (MIIS)]] <br />
* [[e-MDs]]<br />
<br />
[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>Akaplanhttp://clinfowiki.org/wiki/index.php/MEDITECH_(MIIS)MEDITECH (MIIS)2009-09-09T01:03:38Z<p>Akaplan: </p>
<hr />
<div>MEDITECH was founded by A. Neil Pappalardo and Curt W. Marble who are best known as the developers of the MUMPS software at Mass General Hospital from 1964 thru 1968. Their work at Mass General was funded by the National Institute of health, making all products they developed public domain. In 1968, Pappalardo and Marble took their MUMPS software and started MEDITECH. <br />
<br />
In 1971, they introduced MIIS (MEDITECH Interpretive Information System) Language and started developing various modules of software for the health industry. In 1975, they released a pharmacy system, followed in the next 10 years by modules for payroll, radiology, account payable, blood bank, nursing, and materials management. Many other subsystems for the health care industry followed. MEDITECH started using a DEC mainframe computer, and changing with technology to a distributed system with mobile and hand-held devices. <br />
<br />
MEDITECH provides: <br />
<br />
Health care Information System<br />
Practice Management Solution<br />
Home Care Solution<br />
Long Term Care System<br />
Behavioral Health System<br />
Today, MEDITECH has 40 years of experience in health care data automation and IT, more than 2500 employees. MEDITECH software has over 2,200 customers worldwide at hospitals and clinics in the United States, Canada, United Kingdom, reland, South Africa, Latin America, Mexico, and Spain <br />
<br />
<br />
Reference: ___________________________________________________________________________________________________________________________ <br />
<br />
1] MEDITECH, www.meditech.com</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Historically_Important_Electronic_Medical_Record_SystemsHistorically Important Electronic Medical Record Systems2009-09-09T01:00:48Z<p>Akaplan: </p>
<hr />
<div>The following Electronic Medical Record (EMR) systems were among the first of their kind ever developed. Each of the following systems added key information to our current understanding of how EMRs can improve the cost, quality, or efficiency of the care delivered within the modern health care system.<br />
<br />
* [[COmputer STored Ambulatory Record (COSTAR)]] - Harvard Pilgrim Health Plan, Boston, MA<br />
* [[Health Evaluation through Logical Programming (HELP)]] - LDS Hospital, Salt Lake City, UT<br />
* [[The Medical Record (TMR)]] - Duke University, Durham, NC<br />
* [[Lockheed-Martin / Technicon Data Systems (TDS)]] - El Camino Hospital, Mountain View, CA<br />
* [[Regenstrief Medical Record System (RMRS)]] - Wishard Memorial Hospital, Indianapolis, IN<br />
* [[Brigham Integrated Computing System (BICS)]] - Brigham & Women's Hospital, Boston, MA<br />
* [[Out-patient Medical Record (OMR)]] - Beth Israel Deaconess Medical Center, Boston, MA<br />
* [[Diogene]] - University Hospital, Geneva, Switzerland<br />
* [[Akron General Hospital and IBM]] - Akron, Ohio<br />
* [[Problem-Oriented Medical Information System (PROMIS)]] - Burlington, VT<br />
* [[Veterans Health Information Systems and Technology Architecture (VistA)]] - Department of Veterans Affairs (VA)<br />
* [[Armed Forces Health Longitudinal Technology Application (AHLTA)]] - US Department of Defense (DoD)<br />
* [[Janus Health - JanusOSSM]] - San Diego, CA<br />
* [[Revised Three-layer Graph-based Meta Model]] (3GLM2) - University of Leipzig, Leipzig, Germany<br />
* [[Junzi No.1 Hospital Information System]] - PLA General Hospital, Beijing, China<br />
* [[EcMR]]<br />
* [[Hospital Italiano EHR System]] - Buenos Aires, Argentina<br />
* [[Buenos Aires Hospital Network EHR System]]<br />
* [[Alberta Netcare]] - Alberta, Canada<br />
* [[Center for Clinical Computing (CCC)]] - Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA<br />
* [[Epic Systems]] - Madison, WI<br />
* [[Technicon Medical Information System (TMIS)]] - Eclipsys Corporatons, Atlanta, GA <br />
* [[Distributed Hospital Computer Program (DHCP)]] - Veterans Administration hospitals<br />
* [[Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) ]] - Stanford University Department of Medicine, Stanford, California.<br />
* [[Maine General Health (MGH) EMR]] - One Patient, one chart to achieve interoperability standard<br />
* [[Cerner Millennium]] - Cerner Corporation, Kansas City, MO<br />
* [[ISABEL]] - Paddington, London<br />
* [[Care2x Integrated Healthcare Open Source Environment]]<br />
* [[Comprehensive Health Enhancement Support System - CHESS]] - developed at the University of Wisconsin-Madison<br />
* [[OpenMRS]]<br />
* [[Itoiz Clinic EMR]]<br />
* [[OpenSDE]]<br />
* [[ELIAS]]<br />
* [[Liang Zhang Han Expert System]]<br />
* [[Problem-Knowledge Couplers]]<br />
* [[Structured Data Entry]]<br />
* [[THERESA CPR]] - Computer-based patient record system at Emory University<br />
* [[Composite Health Care System (CHCS)]] - Original DoD EHR<br />
* [[Patient Care Information System (PCIS)]] - Indian Health Service CIS system<br />
* [[MEDITECH (MIIS)]] <br />
<br />
[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>Akaplanhttp://clinfowiki.org/wiki/index.php/MeditechMeditech2009-09-09T00:57:24Z<p>Akaplan: </p>
<hr />
<div>MEDITECH was founded by A. Neil Pappalardo and Curt W. Marble who are best known as the developers of the MUMPS software at Mass General Hospital from 1964 thru 1968. Their work at Mass General was funded by the National Institute of health, making all products they developed public domain. In 1968, Pappalardo and Marble took their MUMPS software and started MEDITECH.<br />
<br />
In 1971, they introduced MIIS (MEDITECH Interpretive Information System) Language and started developing various modules of software for the health industry. In 1975, they released a pharmacy system, followed in the next 10 years by modules for payroll, radiology, account payable, blood bank, nursing, and materials management. Many other subsystems for the health care industry followed. MEDITECH started using a DEC mainframe computer, and changing with technology to a distributed system with mobile and hand-held devices.<br />
<br />
MEDITECH provides:<br />
Health care Information System<br />
Practice Management Solution<br />
Home Care Solution<br />
Long Term Care System<br />
Behavioral Health System<br />
<br />
Today, MEDITECH has 40 years of experience in health care data automation and IT, more than 2500 employees. MEDITECH software has over 2,200 customers worldwide at hospitals and clinics in the United States, Canada, United Kingdom, reland, South Africa, Latin America, Mexico, and Spain<br />
<br />
<br />
Reference:<br />
___________________________________________________________________________________________________________________________<br />
1] MEDITECH, www.meditech.com</div>Akaplanhttp://clinfowiki.org/wiki/index.php/MeditechMeditech2009-09-09T00:56:53Z<p>Akaplan: </p>
<hr />
<div>MEDITECH was founded by A. Neil Pappalardo and Curt W. Marble who are best known as the developers of the MUMPS software at Mass General Hospital from 1964 thru 1968. Their work at Mass General was funded by the National Institute of health, making all products they developed public domain. In 1968, Pappalardo and Marble took their MUMPS software and started MEDITECH.<br />
<br />
In 1971, they introduced MIIS (MEDITECH Interpretive Information System) Language and started developing various modules of software for the health industry. In 1975, they released a pharmacy system, followed in the next 10 years by modules for payroll, radiology, account payable, blood bank, nursing, and materials management. Many other subsystems for the health care industry followed. MEDITECH started using a DEC mainframe computer, and changing with technology to a distributed system with mobile and hand-held devices.<br />
<br />
MEDITECH provides:<br />
Health care Information System<br />
Practice Management Solution<br />
Home Care Solution<br />
Long Term Care System<br />
Behavioral Health System<br />
<br />
Today, MEDITECH has 40 years of experience in health care data automation and IT, more than 2500 employees. MEDITECH software has over 2,200 customers worldwide at hospitals and clinics in the United States, Canada, United Kingdom, reland, South Africa, Latin America, Mexico, and Spain<br />
<br />
<br />
Reference:<br />
___________________________________________________________________________________________________________________________<br />
1] MEDITECH, www.meditech.com</div>Akaplanhttp://clinfowiki.org/wiki/index.php/MeditechMeditech2009-09-08T21:04:22Z<p>Akaplan: </p>
<hr />
<div>Meditech was founded by A. Neil Pappalardo and Curt W. Marble</div>Akaplanhttp://clinfowiki.org/wiki/index.php/MeditechMeditech2009-09-08T19:01:25Z<p>Akaplan: </p>
<hr />
<div>Meditech was founded by</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Historically_Important_Electronic_Medical_Record_SystemsHistorically Important Electronic Medical Record Systems2009-09-08T19:00:49Z<p>Akaplan: </p>
<hr />
<div>The following Electronic Medical Record (EMR) systems were among the first of their kind ever developed. Each of the following systems added key information to our current understanding of how EMRs can improve the cost, quality, or efficiency of the care delivered within the modern health care system.<br />
<br />
* [[COmputer STored Ambulatory Record (COSTAR)]] - Harvard Pilgrim Health Plan, Boston, MA<br />
* [[Health Evaluation through Logical Programming (HELP)]] - LDS Hospital, Salt Lake City, UT<br />
* [[The Medical Record (TMR)]] - Duke University, Durham, NC<br />
* [[Lockheed-Martin / Technicon Data Systems (TDS)]] - El Camino Hospital, Mountain View, CA<br />
* [[Regenstrief Medical Record System (RMRS)]] - Wishard Memorial Hospital, Indianapolis, IN<br />
* [[Brigham Integrated Computing System (BICS)]] - Brigham & Women's Hospital, Boston, MA<br />
* [[Out-patient Medical Record (OMR)]] - Beth Israel Deaconess Medical Center, Boston, MA<br />
* [[Diogene]] - University Hospital, Geneva, Switzerland<br />
* [[Akron General Hospital and IBM]] - Akron, Ohio<br />
* [[Problem-Oriented Medical Information System (PROMIS)]] - Burlington, VT<br />
* [[Veterans Health Information Systems and Technology Architecture (VistA)]] - Department of Veterans Affairs (VA)<br />
* [[Armed Forces Health Longitudinal Technology Application (AHLTA)]] - US Department of Defense (DoD)<br />
* [[Janus Health - JanusOSSM]] - San Diego, CA<br />
* [[Revised Three-layer Graph-based Meta Model]] (3GLM2) - University of Leipzig, Leipzig, Germany<br />
* [[Junzi No.1 Hospital Information System]] - PLA General Hospital, Beijing, China<br />
* [[EcMR]]<br />
* [[Hospital Italiano EHR System]] - Buenos Aires, Argentina<br />
* [[Buenos Aires Hospital Network EHR System]]<br />
* [[Alberta Netcare]] - Alberta, Canada<br />
* [[Center for Clinical Computing (CCC)]] - Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA<br />
* [[Epic Systems]] - Madison, WI<br />
* [[Technicon Medical Information System (TMIS)]] - Eclipsys Corporatons, Atlanta, GA <br />
* [[Distributed Hospital Computer Program (DHCP)]] - Veterans Administration hospitals<br />
* [[Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) ]] - Stanford University Department of Medicine, Stanford, California.<br />
* [[Maine General Health (MGH) EMR]] - One Patient, one chart to achieve interoperability standard<br />
* [[Cerner Millennium]] - Cerner Corporation, Kansas City, MO<br />
* [[ISABEL]] - Paddington, London<br />
* [[Care2x Integrated Healthcare Open Source Environment]]<br />
* [[Comprehensive Health Enhancement Support System - CHESS]] - developed at the University of Wisconsin-Madison<br />
* [[OpenMRS]]<br />
* [[Itoiz Clinic EMR]]<br />
* [[OpenSDE]]<br />
* [[ELIAS]]<br />
* [[Liang Zhang Han Expert System]]<br />
* [[Problem-Knowledge Couplers]]<br />
* [[Structured Data Entry]]<br />
* [[THERESA CPR]] - Computer-based patient record system at Emory University<br />
* [[Composite Health Care System (CHCS)]] - Original DoD EHR<br />
* [[Patient Care Information System (PCIS)]] - Indian Health Service CIS system<br />
* [[Meditech 6.0 - Meditech]] <br />
<br />
[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Problem-Knowledge_CouplersProblem-Knowledge Couplers2009-09-05T20:22:44Z<p>Akaplan: </p>
<hr />
<div>''' Introduction'''<br />
<br />
Problem-Knowledge Couplers (PKC) is founded by Dr. Lawrence L. Weed, the father of problem-oriented medical record (POMR). POMR generally includes four parts: Subjective, Objective, Analytical and Planning(SOAP) progress notes. Dr Weed developed SOAP and POMR in the early 1960s, and still continues to work on and advocate it's use. SOAP is commonly used today by all physicians in medical records, but not necessarily as a problem-oriented structure.<br />
<br />
PKC right now provides software tools that help both healthcare consumers and providers make well informed medical decisions. Take their Headache Diaggnosis Coupler as an example, it is web-based platform with four steps<br />
* Step 1 Enter data<br />
* Step 2 Review Data<br />
* Step 3 Review guidance<br />
* Step 4 Finish<br />
<br />
<br />
<br />
The coupler design is based on two premises, that the human mind cannot process large amounts of data, and creating arobust decision making system requires consistant data gathering from many patients and doctors.1 PKC collects data <br />
from a variety of patients and providers and can find consistencies with diagnostic hypotheses for both common and <br />
uncommon diagnoses. It can provide alternative treatments if necessary, or provide evidence of disease progression.<br />
<br />
"Problem Knowledge Couplers are built on the premise that no single clinician can remember all of the numerous possible causes of any symptom and that clinicians tend to focus on the one or few medical problems that fall within their recent experiences rather than the hundreds that may or may not be pertinent to the patient with the problem. The couplers, therefore, take the recall variable out of the equation of diagnostic or management problem solving, and give clinicians a set of possible solutions based on the patient responses to the questions linked to the facts in the knowledge net. From this set of solutions, clinicians are then able to rule out the impossible, review the improbable, and select the most logical solution to<br />
the medical problem as determined by the patient and the knowledgebase with little or no reliance on personal biases."2<br />
<br />
'''Reference'''<br />
* PKC(http://www.pkc.com)<br />
1 PKC www.pkc.com Introduction to Problem-Knowledge Couplers, PCK Corporation<br />
<br />
2 McGoaan, Julie J., Ph.D., AHIP, Winstead-Fry, Patricia, Ph.D. Problem Knowledge Couplers: reengineering evidenced based medicine through interdisciplinary development,decision support, and research, Bulletin of the Medical Library Association, Oct 1999</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Problem-Knowledge_CouplersProblem-Knowledge Couplers2009-09-05T20:22:20Z<p>Akaplan: </p>
<hr />
<div>''' Introduction'''<br />
<br />
Problem-Knowledge Couplers (PKC) is founded by Dr. Lawrence L. Weed, the father of problem-oriented medical record (POMR). POMR generally includes four parts: Subjective, Objective, Analytical and Planning(SOAP) progress notes. Dr Weed developed SOAP and POMR in the early 1960s, and still continues to work on and advocate it's use. SOAP is commonly used today by all physicians in medical records, but not necessarily as a problem-oriented structure.<br />
<br />
PKC right now provides software tools that help both healthcare consumers and providers make well informed medical decisions. Take their Headache Diaggnosis Coupler as an example, it is web-based platform with four steps<br />
* Step 1 Enter data<br />
* Step 2 Review Data<br />
* Step 3 Review guidance<br />
* Step 4 Finish<br />
<br />
<br />
<br />
The coupler design is based on two premises, that the human mind cannot process large amounts of data, and creating arobust decision making system requires consistant data gathering from many patients and doctors.1 PKC collects data <br />
from a variety of patients and providers and can find consistencies with diagnostic hypotheses for both common and <br />
uncommon diagnoses. It can provide alternative treatments if necessary, or provide evidence of disease progression.<br />
<br />
"Problem Knowledge Couplers are built on the premise that no single clinician can remember all of the numerous possible causes of any symptom and that clinicians tend to focus on the one or few medical problems that fall within their recent experiences rather than the hundreds that may or may not be pertinent to the patient with the problem. The couplers, therefore, take the recall variable out of the equation of diagnostic or management problem solving, and give clinicians a set of possible solutions based on the patient responses to the questions linked to the facts in the knowledge net. From this set of solutions, clinicians are then able to rule out the impossible, review the improbable, and select the most logical solution to<br />
the medical problem as determined by the patient and the knowledgebase with little or no reliance on personal biases."2<br />
<br />
'''Reference'''<br />
* PKC(http://www.pkc.com)<br />
1 PKC www.pkc.com Introduction to Problem-Knowledge Couplers, PCK Corporation<br />
2 McGoaan, Julie J., Ph.D., AHIP, Winstead-Fry, Patricia, Ph.D. Problem Knowledge Couplers: reengineering evidenced based medicine through interdisciplinary development,decision support, and research, Bulletin of the Medical Library Association, Oct 1999</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Problem-Knowledge_CouplersProblem-Knowledge Couplers2009-09-05T20:10:25Z<p>Akaplan: </p>
<hr />
<div>''' Introduction'''<br />
<br />
Problem-Knowledge Couplers (PKC) is founded by Dr. Lawrence L. Weed, the father of problem-oriented medical record (POMR). POMR generally includes four parts: Subjective, Objective, Analytical and Planning(SOAP) progress notes. Dr Weed developed SOAP and POMR in the early 1960s, and still continues to work on and advocate it's use. SOAP is commonly used today by all physicians in medical records, but not necessarily as a problem-oriented structure.<br />
<br />
PKC right now provides software tools that help both healthcare consumers and providers make well informed medical decisions. Take their Headache Diaggnosis Coupler as an example, it is web-based platform with four steps<br />
* Step 1 Enter data<br />
* Step 2 Review Data<br />
* Step 3 Review guidance<br />
* Step 4 Finish<br />
<br />
<br />
<br />
The coupler design is based on two premises, that the human mind cannot process large amounts of data, and creating arobust decision making system requires consistant data gathering from many patients and doctors.1 PKC collects data <br />
from a variety of patients and providers and can find consistencies with diagnostic hypotheses for both common and <br />
uncommon diagnoses. It can provide alternative treatments if necessary, or provide evidence of disease progression.<br />
<br />
<br />
'''Reference'''<br />
* PKC(http://www.pkc.com)<br />
1 PKC www.pkc.com Introduction to Problem-Knowledge Couplers, PCK Corporation</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Problem-Knowledge_CouplersProblem-Knowledge Couplers2009-09-05T20:09:20Z<p>Akaplan: </p>
<hr />
<div>''' Introduction'''<br />
<br />
Problem-Knowledge Couplers (PKC) is founded by Dr. Lawrence L. Weed, the father of problem-oriented medical record (POMR). POMR generally includes four parts: Subjective, Objective, Analytical and Planning(SOAP) progress notes. Dr Weed developed SOAP and POMR in the early 1960s, and still continues to work on and advocate it's use. SOAP is commonly used today by all physicians in medical records, but not necessarily as a problem-oriented structure.<br />
<br />
PKC right now provides software tools that help both healthcare consumers and providers make well informed medical decisions. Take their Headache Diaggnosis Coupler as an example, it is web-based platform with four steps<br />
* Step 1 Enter data<br />
* Step 2 Review Data<br />
* Step 3 Review guidance<br />
* Step 4 Finish<br />
<br />
<br />
The coupler design is based on two premises, that the human mind cannot process large amounts of data, and creating a <br />
robust decision making system requires consistant data gathering from many patients and doctors.1 PKC collects data <br />
from a variety of patients and providers and can find consistencies with diagnostic hypotheses for both common and <br />
uncommon diagnoses. It can provide alternative treatments if necessary, or provide evidence of disease progression.<br />
<br />
<br />
'''Reference'''<br />
* PKC(http://www.pkc.com)<br />
1 PKC www.pkc.com Introduction to Problem-Knowledge Couplers, PCK Corporation</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Problem-Knowledge_CouplersProblem-Knowledge Couplers2009-09-05T20:08:44Z<p>Akaplan: </p>
<hr />
<div>''' Introduction'''<br />
<br />
Problem-Knowledge Couplers (PKC) is founded by Dr. Lawrence L. Weed, the father of problem-oriented medical record (POMR). POMR generally includes four parts: Subjective, Objective, Analytical and Planning(SOAP) progress notes. Dr Weed developed SOAP and POMR in the early 1960s, and still continues to work on and advocate it's use. SOAP is commonly used today by all physicians in medical records, but not necessarily as a problem-oriented structure.<br />
<br />
PKC right now provides software tools that help both healthcare consumers and providers make well informed medical decisions. Take their Headache Diaggnosis Coupler as an example, it is web-based platform with four steps<br />
* Step 1 Enter data<br />
* Step 2 Review Data<br />
* Step 3 Review guidance<br />
* Step 4 Finish<br />
<br />
<br />
The coupler design is based on two premises, that the human mind cannot process large amounts of data, and creating a robust decision making system requires consistant data gathering from many patients and doctors.1 PKC collects data from a variety of patients and providers and can find consistencies with diagnostic hypotheses for both common and uncommon diagnoses. It can provide alternative treatments if necessary, or provide evidence of disease progression.<br />
<br />
<br />
'''Reference'''<br />
* PKC(http://www.pkc.com)<br />
1 PKC www.pkc.com Introduction to Problem-Knowledge Couplers, PCK Corporation</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Problem-Knowledge_CouplersProblem-Knowledge Couplers2009-09-03T15:32:13Z<p>Akaplan: </p>
<hr />
<div>''' Introduction'''<br />
<br />
Problem-Knowledge Couplers (PKC) is founded by Dr. Lawrence L. Weed, the father of problem-oriented medical record (POMR). POMR generally includes four parts: Subjective, Objective, Analytical and Planning(SOAP) progress notes. Dr Weed developed SOAP and POMR in the early 1960s, and still continues to work on and advocate it's use. SOAP is commonly used today by all physicians in medical records, but not necessarily as a problem-oriented structure.<br />
<br />
PKC right now provides software tools that help both healthcare consumers and providers make well informed medical decisions. Take their Headache Diaggnosis Coupler as an example, it is web-based platform with four steps<br />
* Step 1 Enter data<br />
* Step 2 Review Data<br />
* Step 3 Review guidance<br />
* Step 4 Finish<br />
<br />
<br />
The coupler<br />
'''Reference'''<br />
* PKC(http://www.pkc.com)</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Problem-Knowledge_CouplersProblem-Knowledge Couplers2009-09-03T15:18:07Z<p>Akaplan: </p>
<hr />
<div>''' Introduction'''<br />
<br />
Problem-Knowledge Couplers (PKC) is founded by Dr. Lawrence L. Weed, the father of problem-oriented medical record(POMR). POMR generally includes four parts: Subjective, Objective, Analytical and Planning(SOAP) progress notes. Dr Weed developed SOAP and POMR in the early 1960s, and still continues to work on and advocate it's use. SOAP is commonly used today by all physicians in medical records, but not necessarily as a problem-oriented structure.<br />
<br />
PKC right now provides software tools that help both healthcare consumers and providers make well informed medical decisions. Take their Headache Diaggnosis Coupler as an example, it is web-based platform with four steps<br />
* Step 1 Enter data<br />
* Step 2 Review Data<br />
* Step 3 Review guidance<br />
* Step 4 Finish<br />
<br />
<br />
The coupler<br />
'''Reference'''<br />
* PKC(http://www.pkc.com)</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Problem-Knowledge_CouplersProblem-Knowledge Couplers2009-09-03T15:16:25Z<p>Akaplan: </p>
<hr />
<div>''' Introduction'''<br />
<br />
Problem-Knowledge Couplers (PKC) is founded by Dr. Lawrence L. Weed, the father of problem-oriented medical record(POMR). POMR generally includes four parts: Subjective, Objective, Analytical and Planning(SOAP) progress notes. SOAP is commonly used today by all physicians in medical records.<br />
<br />
PKC right now provides software tools that help both healthcare consumers and providers make well informed medical decisions. Take their Headache Diaggnosis Coupler as an example, it is web-based platform with four steps<br />
* Step 1 Enter data<br />
* Step 2 Review Data<br />
* Step 3 Review guidance<br />
* Step 4 Finish<br />
<br />
<br />
The coupler<br />
'''Reference'''<br />
* PKC(http://www.pkc.com)</div>Akaplanhttp://clinfowiki.org/wiki/index.php/Problem-Knowledge_CouplersProblem-Knowledge Couplers2009-09-02T22:16:11Z<p>Akaplan: </p>
<hr />
<div>''' Introduction'''<br />
<br />
Problem-Knowledge Couplers (PKC) is founded by Dr. Lawrence L.Weed, the father of problem-oriented medical record(POMR). POMR generally includes four parts: Subjective, Objective, Analytical and Planning(SOAP) progress notes.<br />
<br />
PKC right now provides software tools that help both healthcare consumers and providers make well informed medical decisions. Take their Headache Diaggnosis Coupler as an example, it is web-based platform with four steps<br />
* Step 1 Enter data<br />
* Step 2 Review Data<br />
* Step 3 Review guidance<br />
* Step 4 Finish<br />
<br />
<br />
The coupler<br />
'''Reference'''<br />
* PKC(http://www.pkc.com)</div>Akaplan