EMR Benefits and Return on Investment Categories
When compared to paper charts, Electronic Medical Records (EMRs) have many benefits and return on investments (ROIs). Following is a brief discussion of some of those benefits and ROIs.
Contents
- 1 Efficiency
- 2 Storage and Retrieval
- 3 Lower costs and better management of risks
- 4 Better Sharing of integrated information
- 5 Patient Safety
- 6 Investment Flexibility:
- 7 Management Risk Disposition
- 8 Administrative and management benefits
- 9 Return on Investment (ROI)
- 10 Costs
- 11 Research
- 12 Barriers of EMR Implementation
- 13 References
Efficiency
EMRs improve clinical efficiency in multiple ways. First and foremost, it stores all the patient’s data, including but not limited to, patient medical history, medication history, vital signs, lab tests results, as well as other pertinent information in a single location, and is readily available to anyone directly involved in the patient’s care, regardless of location. It reduces the likelihood that tests will be unnecessarily duplicated. Coordination of care is easier to achieve and eliminates steps that may lead to discrepancies in the sharing of data.
Storage and Retrieval
Paper charts take up large amounts of physical space. As organizations run out of storage space, they may be forced to rent space outside of the facilities where they see their patients. As a result they incur additional expenses and face the risk of losing the records to a fire, natural disaster, or theft. With the EMR, less physical storage space is required; they can be backed up and a copy kept at a separate location in case of a disasater or loss; and access to the records can be controlled. The EMRs are also a lot easier to retrieve and/or access for patient encounters.
Lower costs and better management of risks
By consolidating information across the entire spectrum of clinical operations, from admission to treatment to labs and beyond, EMR allows for:
1.Increase in the pace of information flow including service delivery 2.Coding/billing accuracy 3.Better documentation of patient encounters 4.Reduction in operating costs of the healthcare institution 5.Reduction in costs for the patient.
Furthermore, the integration of EMR systems enables for a more consistent application of medical protocols. As a result, the availability of information 24 hours a day, 7 days a week, helps to contribute significantly to reduced errors, better decision-making, lower malpractice risk and improved outcomes.
Better Sharing of integrated information
With better information integration capability, it allows for healthcare institutions to facilitate better quality care, contain costs, and better manage risks. Thus, by having healthcare organizations that incorporate an EMR, it enables for both clinical and business advantages by in turn creating a clinical healthcare system that helps to unite crucial patient information with various departments. As a result, this helps to create a central clinical information repository and resource used throughout the integrated delivery network of the institution. This in the long run allows for the different information of patients to be coalesced together in a timelier manner, which can reduce errors in diagnosis.
Patient Safety
EMRs help to increase patient safety in a number of ways. Evidence-based clinical reminders as well as reminders based on Good Clinical Practice guidelines can be prompted during the patient encounter . Also,medical errors due to illegible handwritings is drastically reduced. Alerts can be posted on the screen for the provider in instances where a drug that the patient is allergic to may be ordered, or in a situation where the drug(s) being ordered are incompatible with medications the patient is currently taking. Also, alerts may be posted for adverse effects for medications based on the patient’s profile and medical history.
EMRs have tremendous potential for improving medication safety by implementing computerized provider entry forms (CPOE). Medication errors are common and are mainly attributed to illegible handwritten orders, incomplete information about the patient or communication breakdowns between clinicians. EHRs can greatly reduce such errors when clinicians would enter medical orders directly into the system. While the clinicians are entering the orders, the system allows automated checks for allergies and other drug-to drug interaction.
Investment Flexibility:
How much investment is available over a certain period of time? For example if a hospital considering to install a nursing system may conduct a pre- and post-implementation analysis of investment including maintenance cost, operating cost, nursing time and activities, determining the exact time spent on each patient activity.
Management Risk Disposition
Willingness to invest in experimental efforts.
Provide users with real time knowledge
Reducing non-clinical time
Increase patient doctor time:
Investment Motivation:
To reduce cost, position for capitation/managed care, and gain market share.
To enable providers to take advantage of financial incentives under the HITECH Act related to "Meaningful Use". https://www.cms.gov/EHRIncentivePrograms/01_Overview.asp#TopOfPage
--Sfjafari 22:21, 10 September 2011 (CDT)
--Sfjafari 22:29, 10 September 2011 (CDT)
Administrative and management benefits
- Overall transparency among the processes
- Improved communication among the clinical to clinical and clinical to administrative staff
- Reduction in drug and radiology usage in the outpatient setting
Return on Investment (ROI)
Quality Care
One could approach the ROI from the perspective of the Institute of Medicine Report, Crossing the Quality Chasm
- Safe: Reducing adverse drug events, inappropriate testing
- Effective: Reducing drug costs through appropriate prescribing
- Efficient: Reducing drug, laborotory, or radiologic utilization
- Timely: Reducing wait times
- Patient-centered: Reducing length-of-stay while hospitalized
- Equitable: Provides data to demonstrate equal delivery
Quantitative Benefits:
These are financial benefits that are clearly measurable and are attributable to the use of a particular technology. E.g., the use of EMR technology to submit claims has resulted in widely quantified cost savings for provider and payer organizations.
Qualitative Benefits:
The EMR will improve patient care by reducing medication error and wait time. Clinical processes will be standardized and there will be less variation in clinical care provided at place from another. Records would be easily shared among the providers, which will reduce the process time and over all improve the disease management.It will also improve the communication among the care providers and the administrative staff and administrative activities.
These are directly and indirectly attributed to the technology but are more difficult to quantify. E.g., implementation of a clinical nursing system may lead to increased case in recruiting efforts, better nurse retention, more rapid access to clinical nursing data, and decreased charting time. Quantification and measurement – of benefits usually is difficult because of the task complexity of the nursing function.
Strategic Benefits:
These offer substantial benefits to the organization, but at some future date. E.g., investments in networking and telecommunications offer significant future strategic benefits, positioning organizations to utilize enterprise-wide patient indexing and EMR or distributed case management technologies as they emerge.
--Sfjafari 22:29, 10 September 2011 (CDT)
Sources of Funding
- Organizational Reserves – provider organization make investments in affiliated organizations
- Bank and other financial service – short term loans
- Capital leases – used for large equipment acquisitions but can be negotiated for a major IT investment
- Vendor discounts and incentives – requires something in return
- Joint venture or partnership – tighter relationship
- Health plans and plan sponsors – contractual arrangement
- Private philanthropy – fellowships or university chairs
- Pharmaceutical companies – willing to conduct clinical trials
- Public grants – government initiatives
- State legislative initiatives – local and state initiatives
Costs
The Medical Group Management Association (MGMA) says the average cost of an EMR per physician is $33,000. (http://www.physicianspractice.com/display/article/1462168/1591117)
Software License:: EMR license prices can easily range from $1,000 – $25,000. The average license for a FULL/TRUE EMR usually starts at $10,000, while a light/entry EMR usually starts at around $1,000, and these costs tend to recur. (http://www.phyaura.com/resources-2/open_source/)
Implementation: Implementation costs are usually billed hourly at a rate of $75-$150 per hour. Average implementation time per provider is 35 hours. Where 10 hours are used for customization, 25 hours for training and 10 hours for computer/network setup. This becomes exponentially lower as more physicians are added. (http://www.emrexperts.com/emr-roi/index.php)
Hardware: Network hardware and configuration, number and type of servers/workstations, hand-held devices, etc. is driven by the vendor's requirements and recommendations, as well as your organization's needs. Costs depend on quantity of equipment purchased or leased. For example, a tablet PC could cost $2,000, a workstation $1,500 and a server $5,000. (http://www.emrapproved.com/emr-hardware.php)
Support & Maintenance: Ongoing support costs will be incurred from both an annual support contract with the software vendor for updates and technical support and the increased need of hardware/network support through a local IT representative. (http://www.emrexperts.com/emr-roi/index.php)
Research
- EMR's increase the quality of medical data by recording coded rather than textual data. This, alongside the application of UMLS coding, will facilitate processes like data mining, data warehousing, in silico clinical trials, predictive modeling and any other mainstream research which requires data analysis. Also, by paving the way for automating data acquisition from other systems (like lab machines, imaging devices, barcode/RFID readers, bio-data sensors) error resulting from duplicate data entry procedures, manual file search and patient identification will decrease.
- While EMRs have shown an increase in the quality of medical data, research is still conflicting on the cost benefits and efficiency gains of EHRs. A study of HIMSS Analytics Database data from California medical-surgical units showed a decrease in cost efficiency for Stage 1 and Stage 2 EMR implementation, and no efficiency correlation for State 3 EMR implementations (http://www.ncbi.nlm.nih.gov/pubmed/20812460).
- EMRs contain large amounts of structured and free-text data which can be de-identified and used for research without disclosing patient information. Pantazos, K., Lauesen, S., Lippert, S. 2011. De-identifying an EHR Database - Anonymity, Correctness and Readability of the Medical Record. Stud Health Technol Inform. 2011, 169, 862-866.
- In addition to structured vocabulary searches of EMR databases, free-text search algorithms within and EMR can generate additional information critical to the identification of epidemics. Often, critical information is omitted by the clinical team when only structured vocabulary is analyzed. DeLisle S, South B, Anthony JA, Kalp E, Gundlapalli A, Curriero FC, Glass GE, Samore M, Perl TM. Combining Free Text and Structured Electronic Medical Record Entries to Detect Acute Respiratory Infections. PLoS One. 2010 Oct 14, 5(10):e13377
- Genome-wide association studies have become commonplace for the identification of risk and causative genetic variants. The power of these studies is highly dependent on accurate phenotypic classification of both control and test populations. Application of natural language processing algorithms to free-text clinical narrative, in addition to structured data, can significantly benefit these studies. Kullo IJ, Fan J, Pathak J, Savova GK, Ali Z, Chute CG. Leveraging informatics for genetic studies: use of the electronic medical record to enable a genome-wide association study of peripheral arterial disease. J Am Med Inform Assoc. 2010 September, 17(5): 568-574.
Barriers of EMR Implementation
- In order for an EMR to be truly successful, proper and timely training must be administered to all who will interact with the system.
- Conflicting research findings on the cost and efficiency benefits of EMR implementations will make it difficult, if not impossible, for administration staff to be confident in choosing an EMR for their facility. Until there is adequate research on multitudes of EMR systems that shows causal relationships between facility characteristics and the related EMR components there will not be a sufficient method of EMR selection and implantation.
- If it is true that implementations of EMRs cause a decrease in efficiency and an increase in quality of medical care then further research must take both of these repercussions into account and determine if there is an overall net benefit of EMR implementation.
- The variability of results of similar studies on the monetary and efficiency benefits of EHRs indicates that there is no single approach to EMR implementation that will fit all settings. Variables such as hospital size, setting, specialty, prior computer integration, etc will determine the effectiveness of an EMR dramatically and must be considered in all cases.
References
Committee on Quality of Health Care in America, Institute of Medicine. "Front Matter." Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press, 2001. Full text
http://www.msdc.com/EMR_Benefits.htm
http://patients.about.com/od/electronicpatientrecords/a/EMRbenefits.htm