EMR Benefits: Informational
The informational benefits of EMRs are vast.
- 1 Anticipated and Realized EMR Benefits
- 2 Insurance
- 3 Storage and retrieval
- 4 Administrative and Management Benefits
- 5 Workflow
- 6 Integrated View of Patient Data
- 7 Integration within hospital
- 7.1 Integration with pharmacy
- 7.2 Integration with long-Term facilities/rehabilitation centers
- 7.3 Integration with imaging
- 7.4 Facilitated referral for multidisciplinary care
- 7.5 Establishing a learning chance to improve healthcare system
- 7.6 Improved Documentation and Coding
- 8 Increase in Revenue
- 9 System Selection
- 10 Misc, to sort later
- 11 Informational
Anticipated and Realized EMR Benefits
Leadership at 15 Critical Access Hospitals in rural Iowa generated their own reasons for acquiring an Electronic Medical Records (EMR) system that is not supported with official documents or from documents to support their informal observations but will benefit their operations. According to Mills et al. 2010, "Interviews with CEOs and CIO at selected rural Critical Access Hospitals suggest that the actual benefits realized from EMRs are at best limited in comparison to anticipated benefits." "... despite the lack of official measurement and documentation of these effects, they believed that their CAH had realized improvements in documentation, medical reconciliation, patient safety, efficiency (process of care), access to utilization of patient information, capturing and processing of changes and patient numbers or revenues.” Other tangible benefits generated from “informal observations consisted of improved standardization of communication, patient monitoring and staff accountability.” 
- Reduced payment denials 
- Improved reimbursement inpatient or outpatient
- The records provide proof to insurance companies that a patient was seen
Storage and retrieval
EMRs improve the storage and retrieval of patient information in the following ways:
- Retrieval of prior encounters and medication history 
- Decreased cost of paper forms
- Reduces the amount of physical storage space required to house charts.
- Protected from fire, natural disaster, or theft.
- Records can be backed up to off-site facilities
- Instant access to records.
- More controlled access, including a record of who accessed the record.
- Eliminates “lost” or incomplete charts.
- More than one provider can access the record at one time. Ability to identify who modified the record.
- Ensures business continuity and uninterrupted medical service.
- EMRs store patient 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 eliminates time and cost from paper chart pulls and transcription and re-file of paper charts 
- They reduce 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.
- EMRs can promote early intervention in disease processes because all the health data- vital signs, lab results, imaging, physician notes, nursing notes, etc.- of a patient are accessible in the same record (6).
- They are vital to improved quality of care at the bedside or point of care because less time is spent doing non-caring activities and more time spent actually caring for the patient (6).
- EMRs reduce the number of lost or missing reports.
- They reduce variability of care.
- Timely delivery of critical services
- Ensures business continuity and uninterrupted medical service.
- Ensures accurate patient identification: For example, there can be multiple Jon Does in the hospital even with same age. EMR ensure that they are uniquely identified with medical record numbers and also additional features like photograph etc.
- Up to date information about patient at point of care 
Respondents from the 2011 U.S. Physician Workflow study of office-based physicians reported that the Electronic Health Record (EHR) helped them access patient records remotely (81%) and enhanced patient care overall (78%).
Administrative and Management Benefits
By moving beyond the paper records, EMR can help Heath Care Providers do a better job at managing patient care. A vast amount of information can be easily used and shared. When fully functional and interoperable, EMRs can provide far more benefits than paper records such as "help providers improve productivity and work life balance."  At a higher level of EMR implementation and functionality, Computerized Provider Order Entry (CPOE) can help standardize the clinical practice and eliminate variation. Some benefits of CPOE are:
- The records can be used in court in the event of a malpractice claim
- Help improve communication amongst care givers
- Expedite patient transfer to other levels of care
- Capture data for quality assurance and administrative purposes
- Aid practice and care in a complex care environment through the use of alerts and reminders
- Provides some level of assurance to patients that technology is being applied to their safety .
- Better strategic planning - The data generated from using electronic medical records can be used for strategic management by the administration. EMRs can help identify trends in utilization, identify bottlenecks in productivity for staff, and monitor patient needs and satisfaction. This would allow the management team to make better decisions on capital investments, staffing levels and workforce redeployment. They can use this data to implement process improvement projects. EMRs have the potential to help medical facilities design and reach their strategic vision.
EMRs have also eliminated the physical transporting, sifting and filing of charts, making data available at all times. Additionally, for systems that allow remote access to charts, clinicians can even be off site and still securely access patient files. Storage and inventory is also reduced, freeing up physical space within the hospital or office, and allowing the redeployment of human resources. Unnecessary movement is eliminated, ultimately eliminating batch delivery and improving the flow of patients and information.
Legal and regulatory compliance
- Enforces data confidentiality and improves compliance.
- Improve legal and regulatory compliance 
In the event of a medical malpractice suit, EMRs can serve as evidence in the courtroom. Unlike paper records, that can be changed, lost, stolen, or destroyed intentionally, EMRs in this case, are more beneficial. 
Legibility is very important to reduce medical errors. For instance, patient information presented as typed text is much easier to read compared to human writings. They are also unified in structures and standards to prevent confusion. Misspelled words can be corrected with spell checks or autocorrect function. Clinicians will be required by computers to enter complete patient notes to avoid missing information.
When physicians use Computer Provider Order Entry (CPOE) systems within the EMR, fewer medication errors also occur because there are fewer legibility issues. Proper dosages are clearly entered into the computer by the ordering physician, thus reducing the need for nurses or other staff to “second guess” or question the order. 
In addition, with the use of electronic prescribing, the hand-written prescription is no longer applicable as a physician can electronically send a prescription directly to the pharmacy of the patient’s choice. This means there’s no question regarding which medication/dosage the provider prescribed and there are no complications with the physical prescription potentially being lost in transition .
- Data accessibility by multiple users 
- Increased ability to sanitize data for use in research studies
- Increased access for researchers both in-house and external
- Advances in medical research 
EMR has tremendous effects on changing workflow by several ways such as reducing time spent in getting medical histories, ease of data retrieval, greater remote access, and providing auto-produced sign-out documents to support handoff workflow. According to a study performed by Julia Driessen and ects. They estimated EMR assist an employee to reduce about 17 min per working day (28%) in transcription time. Although the volume of work initially required to achieve the goal of digitizing a healthcare office may seem overwhelming, the end result is well worth the effort.
Every medical office has its own "system" for organizing patient data, the majority of these facilities could use a little help in improving their processes. Searching through physical file folders for a specific patient's medical record and then being required to sift through paperwork to find the document(s) necessary for a certain task are time-consuming tasks that could be eliminated through the implementation of electronic medical records. A digitized records database can solve problems associated with human filing errors and misplaced documentation. Instead, all authorized medical staff will have immediate and accurate access to the exact information needed through just a few clicks of a mouse.
An EMR service that fully analyzes and streamlines the patient workflow, and works to support a lean practice operation, can actually improve efficiency, such as integrated billing. Providers can be more productive, spend more time with patients, and even enjoy increased patient visits.
EMRs can decrease the fragmentation of care by improving care co-ordination among clinical and administrative staff. Better care coordination can improve transparency among overall processes. EMRs have the potential to integrate and organize patient health information and communicate this information accurately among everyone that is involved in a patient's care. Better availability of patient information can reduce medical errors and redundancy in health care.
Improved care coordination increases with EHRs. Care coordination can be seen when every provider has the same access to a patients health information. This is important with patients who are receiving emergency setting treatment, seeing a few or many specialists and when transitioning care settings. EHRs can even provide the ability to set off alerts in a patients charts when they have been in the hospital. This allows providers to proactively follow up.
With the ability of the coordination between clinical and administrative staff, information such as up-to-date medication and allergy lists, order sets, and care plans allow for a common treatment of patients across an entire hospital stay no matter where the patient is located. This gives the patient better care and the possibility of a better outcome. 
With the increased implementation of EMRs, usability is a highly beneficial feature. Usability is described as how useful and satisfying a system is for the user. The usability of an EMR depends on the software design. With an interactive software design and fewer keystrokes for the end-user of the system there are reduced medical errors. Another benefit of a well designed and usable EMR is less time away from patient care and increased patient satisfaction. 
Integrated View of Patient Data
EHR systems can provide integrated access to all data about a patient from many visits and facilities such as laboratory tests, problems, diagnoses, medications, etc. from the database. This retrieval is made easy by data standards like HL7, LOINC, and SNOMED. Practitioners can also have multiple views of data through links provided in the user interfaces.
The capacity to integrate the way patient data can be viewed is one of the most important benefits of the EMR to healthcare providers. Being able to see flowcharts of a patients vital signs, lab results, intake and output, and medication administration, provide physicians a faster and better way to visualize and make decisions on the patient’s current condition without spending a considerable amount of time leafing through a patient’s paper chart searching for disjointed documentation. 
Tracking Patients’ Medical Data
By having the EMR save patient data (such as heart rate, blood pressure, eating habits, etc.) over, healthcare providers – or even the patients – can check parameters during a specific time frame when certain symptoms occur and correlate any relation. Having the constant patient data, allows the healthcare professional to go back in time and see any relationship to specific parameters and patient illness symptoms. 
Data Accessibility by Multiple Users
Electronic health records are accessible to multiple healthcare workers at the same time , at multiple locations such as remote access from the office, hospital or home. . While a billing clerk is looking at the electronic chart, the primary care physician and a specialist can be analyzing clinical information simultaneously .
Electronic Health Records (EHRs) can improve health care quality. As opposed to paper record, it can also make health care more convenient for providers and patients. Below are some instances showing improved Health Care Quality and Convenience:
Quick access to patient records from inpatient and remote locations for more coordinated, efficient care, enhanced decision support, clinical alerts, reminders, and medical information performance-improving tools, real-time quality reporting. Legible, complete documentation that facilitates accurate coding and billing Interfaces with labs, registries, and other EHRs safer, more reliable prescribing.
Reduced need to fill out the same forms at each office visit, reliable point-of-care information and reminders notifying providers of important health interventions, convenience of e-prescriptions electronically sent to pharmacy, patient portals with online interaction for providers and electronic referrals allowing easier access to follow-up care with specialists 
- Facilitates patient self-service and increases patient's engagement with the help of Patient portal which is a secure online website that patients can access anywhere and anytime to view their medications, immunizations, lab reports, request prescription refills, schedule appointments, make payments and much more.
Retrieval of Prior Encounters and Medication History
One of the most attractive features of EMR is the ability to create and store a patient encounter electronically. In seconds one can view the last encounter and determine what treatment was rendered .
Primary Care Clinic's Ability to Prepare Patient's Encounter
EHR has a positive operational impact to prepare patient encounter consisting of "Review of patient information prior to encounter is greatly facilitated."; "Easier to prepare for encounter, maintenance of problem list/summary is much easier."; and "Immediate access to patient information-no lost files." 
Integration within hospital
Integration with pharmacy
EHRs are able to instantly look up the patient's pharmacy and send refill requests reducing the chances of a patient losing a paper prescription. Clinicians can also search for a patient's past and current medication, communicate with the pharmacy staff, and determine if there are any contraindications.
E-prescribing systems enable electronic transmissions of prescriptions to pharmacies from the provider's office. The promise of e-prescribing in regard to patient safety is reduction in the time gap between point of care and point of service, reduction in medication errors, and improved quality of care. There are 2 types of e-prescribing systems: stand alone e-prescribing systems and EHR (electronic health record) integrated e-prescribing systems.
Records such as in-pharmacy immunizations in the past were sent to physicians by fax or traditional mail. By using EHRs, pharmacists and pharmacy healthcare providers contribute to the compilation of more complete medical histories for their patients. 
Integration with long-Term facilities/rehabilitation centers
EHR plays an important role in improving the health care quality and safety; thus reducing the costs of providing care in long-term care facilities.  The relationship-building between the hospitals and long-term facilities is essential in reducing readmissions and improving patient satisfaction. EHR helps in improving the transition from one care setting to next and hence prevents any gaps in care provided to the patient.
According to Jenq (Program Director for the Greater New Haven Coalition for Safe Transitions and Readmission Reductions, or GNH CoSTARR)"Nursing facilities frequently do not receive the information they need to properly care for patients discharged from the hospital. From the hospital side, we presume that our paperwork makes it to the skilled-nursing facility and that they have all the material necessary," Jenq says. "But we're finding that our paperwork actually doesn't make it in a timely, efficient manner." Hospital clerical workers often do not recognize all the components of the discharge paperwork; historically, there has been no protocol for laboratory results, such as urine cultures, to be sent to nursing facilities. 
Skilled nursing facilities (SNF) nurses do not know how to get information from the hospital. "Sometimes the nursing facility will call back to the hospital, but the hospital RN they reach will say, 'I don't know the patient,' and essentially end the conversation there," Jenq says. "We are going to have to lay out roles and responsibilities for all the people involved in the transition of care to make sure they are held accountable for this type of communication." When a problem arises, nursing facilities may not share the hospital's goal of keeping patients out of the hospital. "Right now, the skilled-nursing facilities don't get penalized for the readmission, so they are not affected if the patient goes to the emergency department and gets admitted," Jenq says. "In the future, when penalties apply to them as well, both the SNF and the emergency department will be forced to develop care plans that can work at an SNF." 
EHR also helps in Improving the communication between the hospital staff and assisted living or the long-term care facility staff when the patient is transferred from one setting to other. 
Integration with imaging
With an EHR imaging can be integrated into the patient's chart electronically allowing for quick access to multiple imaging studies in high definition native formats rather than having to view them from film or on a printout. Having the studies in the EHR allows the provider to pull up the imaging with the patient quickly and easily. This improves patient communication and understanding. On top of improved efficiency and communication from having the right information at the right time almost instantly, integrating imaging in EHRs can reduce costs as well. By no longer needed to store and archive imaging there are no more expenses for labels, jackets, or storage. It also reduces the workload of the staff since filing and retrieval is no longer necessary. 
Minimize Repeating Diagnostic Imaging Studies
HIE can potentially eliminate unnecessary repetition of diagnostic testing, especially in the Emergency Department. Indeed as study found that HIE reduced imaging studies order by Emergency Department physicians for patients presenting with back pain, this is not only decrease the cost of expensive imaging studies but also decrease risk of unnecessary patients exposure to radiation. This illustrate the importance of HIE and the potentially huge impact it will have on reducing cost and delivery an optimal health care.
Nitros et al reported that that a hospital that installed Picture Archiving and Communication System (PACS) as a part of EMR implementation has increased quality and efficiency of patient care in Radiology department. The article listed the benefits of installing PACS as follows.
- Hospital’s Radiology department productivity increased by 12%
- Department’s turnaround time improved above 60%
- Patient’s length of wait time reduced and workflow improved substantially.
- And, finally the article reported that there was $1.9 millions cost savings as a result of the implementation.
- Improved utilization of radiology tests 
Facilitated referral for multidisciplinary care
Electronic medical record (EMR) systems have the potential to facilitate referral of patients from one physician to another physician for provision of well-integrated multidisciplinary care . Such an advantage of EMRs is best served when the referring physician and the physician(s) to whom the patient is referred have direct and full access to the EMR system containing the patient’s file. In such a scenario, viewing and modification of the patient’s EMR file by the physician to whom the patient is referred is immediate and secure . In the absence of direct and full access, referral to other physicians can still be facilitated by EMRs if the relevant data contained within the patient’s EMR file can be transferred electronically, securely, and rapidly between physicians .
Establishing a learning chance to improve healthcare system
EMR can assist people to review the outcomes of populations under care. Managers can find a more Meaningful Use criteria applied on quality improvement, research, outreach, and reduction of disparities.
Improved Documentation and Coding
- With an EHR system a record can be captured within 12 to 24 after discharge, which can provide an accurate coding in a decreasing amount of time. Healthcare organizations are no longer limited to local coding resources and now healthcare facilities can provide coders with better expertise.
- Nielsen, Thomson, Kiley, Kosman and Jackson(2000) reported that the implementation of the Standard Obstetric Record Charting system (STORC) led to completeness and accuracy of charting 
Increase in Revenue
The implementation of electronic health record (EHR) systems is generally believed to help avert operational costs and increase revenue for healthcare providers. Improved and more efficient financial records management with improved efficiency and more accurate coding functionality resulting from better capture of charges and decreased billing errors help providers with EHR systems more likely to realize increases in annual billable gains. Financial benefits will also occur as a result of improved care delivery from more efficient clinical decision support capabilities, increased patient flow and staff productivity. With the integration of efficient pharmacy systems, the use of EHRs also ensures that providers realize more savings and increased revenues from better controlled and well monitored drug inventory and utilization.
Some EHR provide help and support in the form of a medical billing specialist. This specialist gives both practices and patients customer support. The specialist also has access to medical codes (ICD-9), CPT code books and practice-related HIPAA information. Other EHRs provide onsite training and on-the-phone consulting for software and billing questions. http://www.advancedmd.com/medical-billing-services
Improved Risk Management
- Prevention of adverse drug events
- Public health outcome improvements
- Prevention of liability actions
- Improvement with complete and legible health records
Predicting Risk of Falling in Nursing Home Residents
Because EMRs are more frequently updated, it has been found that using data from EMRs to predict fall risk for residents of nursing homes is more accurate than using data from the Minimum Data Set (MDS), which is a screening from the Centers for Medicare and Medicaid Services (CMS). In the long term, this increases revenue by preventing the high costs associated with falls. 
Remodeling of Paper-chart Storage Areas
By adding an EMR system, Samsung Medical Center (SMC)was able to obtain additional revenue by converting "5 paper-chart temporary storage rooms on the outpatient care floors" to clinical rooms by 4.02%. 
Based on the application the type of system selected will vary based on current research, size of practice, institution, academic affiliation, vendors and their ability to demonstrate compliance with current research “by identifying funded and published research(Kannry Mukani& Myers , 2006)” and ultimately the assessment and analysis of the total cost of ownership.
ONE CONSISTENT THEME emerges from EHR implementations in physician practices: almost everyone underestimates the complexity, time, and effort required. 
According to Kannry Mukani& Myers in their 2006 article Using an Evidence-based Approach for System Selection at a Large Academic Medical Center: Lessons Learned in Selecting an Ambulatory EMR at Mount Sinai Hospital . The authors note the technology requirements of educational institutions vary greatly from the needs of the private sector. Although both the private sector and academia have concerns with accurate documentation, patient safety and patient care, educational institutions focus on “education, training and research, (Kannry Mukani& Myers, 2006). The need of residents and compliance with regulatory requirements is significant and cannot be minimized.  According to Ajami and Chadegani, despite of the potential benefits of electronic health records, implement of this project facing with barriers and restriction, that the most of these limitations are cost constraints, technical limitations, standardization limits, attitudinal constraints–behavior of individuals and organizational constraints.
The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of time and workload. Each user group also identified factors specific to their professional and individual priorities .
- 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 use of EMR and the afforded efficiencies may not provide immediate cost savings to some office-based physicians. These physicians may not be able to reduce their office expenses sufficiently to offset the revenue decreases they may see as a result of increasing efficiency. For example, a physician who is paid, as many laboratory or treatment centers are, per service rendered would see a direct decrease in revenue were they to reduce the number of duplicated diagnostic tests.
- The reported barriers to adoption and MU of EHRs were not associated with serving a predominately Medicaid-insured population, and were consistent with barriers that health care professionals in other studies had previously reported. In fact, barriers to adopting and using EHRs that could be associated with Medicaid providers were issues specific to provider types who were eligible for the Medicaid EHR Incentive Program but not the Medicare EHR Incentive Program, specifically, dentists and pediatricians. However, all findings were useful in generating a set of recommendations that are specific to promoting MU of EHRs among health care professionals eligible for the Medicaid EHR Incentive Program. 
- 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.
- The high cost of basic infrastructure of clinical information technology is a substantial hurdle for many health care organizations, many of whose income margins have deteriorated after years of decreasing reimbursement (from Medicare and other sources) and whose access to capital for new medical technology is extremely scarce. Financial instability and scarce capital resources for IT infrastructure similarly affect small to mid-sized independent practice associations (IPAs) and independent physician offices, the practice venues for most physicians in the United States.
- Diversity of products as well as lack of standards for common architecture of basic infrastructure of clinical information technology constitutes a barrier and further complicates EMR Implementation.
Misc, to sort later
- E-prescribing will reduce number of physician office visit and phone call. phone calls and visits, Test results and appointments alert will be implemented and patients are automatically notified of test results and appointment times.   
- Updates are done faster and files can be synchronized.
- Duplicate orders and illegible handwriting will no longer be an issue is less of a problem 
- Hard drives take up less space. Shared databases reduces the need for paper 
- Billing is easier as the formatted documentation may improve the accuracy of charge capture.
- Billing edits, including National and Local Coverage Determinations, can be alerted in real-time.
- Patients arecan be informed of generic drugs, doctors can know if insurances do not cover patients, and formulary requirements can be identified.
- Insurance and malpractice premiums can also be lowered. ) 
- Different drugs can save hospitals money Hospitals will save money over various drugs .
- Dictation is automatic
- HIM staff may be reduced or staffing requirements changed 
- Nurses will be more productive and more efficient 
- Reduces medication errors and checks for drug-drug interactionsAdverse drug event (ADE), drug-drug interactions(DDI)will be detected thereby reducing errors in medication.    
- Reduces redundant lab tests  
- Reminders increase underused preventative measures 
- deduce infections from a list of symptoms and help make doctors make good clinical decisions.     The patient internet portal allows patients to know the most up to date information about healthcare. 
- Large scale data exchange and information integration  
- Surveillance and reporting of diseases 
- Research information in the database 
Academic EHRs are functional systems that makes training for nursing staff more efficient. Student nurses apply their learnt skills to plan patient care in a simulated setup. This allows student nurses to develop their acquired knowledge in a practical setting and transition into a familiar working environment after their academic careers.(.
Prior to the implementation of Meaningful Use (MU) incentives, EHR adoption was held back due cost of EHR systems. With incentives given to those who meet the different stage requirements in the implementation of an EHR, implementation is being seen across the country. The data being leveraged from EHRs are allowing for clinicians to review data in real time, communicate effectively with one another, and automate processes, reducing time and cost amongst staff. In addition to improving healthcare processes and procedures, EHR’s are also contributing to overall public health in communities to help identify and monitor rising health issues in the community. 
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