Difference between revisions of "EMR Benefits and Return on Investment Categories"

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−	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...	+	The sections below detail the benefits, costs, and barriers in evaluating EMR implementations. Selecting, financing, and launching an EHR system is difficult.
−	= '''Common EMR Benefit Categories''' =	+	== Informational ==
		+	[[EMR Benefits: Informational]]
−	== '''Security and Privacy''' ==	+	== Security ==
		+	[[EMR Benefits: Security]] is an advantageous attribute which comes with EMR systems. Centers for Medicare and Medicaid Services (CMS) published a privacy, security & [[Meaningful Use|meaningful use]] guidelines which computer systems that store patient information need to conform to imply to [[Health Insurance Portability and Accountability Act (HIPAA)|HIPAA]] privacy guidelines. <ref name="Privacy-Standards-CMS">Centers for Medicare & Medicaid Services. Privacy and Security Standards. http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/HIPAAGenInfo/PrivacyandSecurityStandards.html</ref>
−	* Though electronic systems facilitate audit trails, they are not immune to breaches. In just about any information system designed with commercial or security concerns, there are a handful of provisions that provide tracking and trending, tagging for storage (ex. CAS), history, billing (which is a form of data tagging for billing purposes, essentially providing financial audit trail), and numerous other forms and systematic ways of enhancing security by making it possible to trace back actions on important and private data.	+	== Environmental ==
		+	[[EMR Benefits: Environmental]] positive impact through Electronic Health Records has the potential to improve the environmental footprint left by the health care industry. <ref name="turley 2011">Turley, M., Porter, C., Garrido, T., Gerwig, K., Young, S., Radler, L., & Shaber, R. (2011). Use of electronic health records can improve the health care industry’s environmental footprint. Health affairs, 30(5), 938-946.</ref>
−	* Electronic objects can easily be tagged for conditional processing. This enhances privacy by providing different levels of security tags based on group policies, access control policies, government policies and other regulatory body public or private. However, it also lends itself to some false sense of security in that it doesn’t prevent humans from mislabeling, incorrectly tagging objects, or malicious tampering.	+	== Quality Outcomes ==
−	* Digital data is, for better or for worse, immortal: once electronic data is created, it can be argued that it can never be destroyed providing everlasting durability and consistency.	+	EHR’s can be utilized to generate reports on quality measures in the effort to improve quality and patient satisfaction. With the ability to produce reports from EHR’s, clinicians can easily compare data to baseline data and quickly identify areas in need of improvement. Once areas in need of improvement have been identified, clinicians can compare data to manual reports and similar data to validate the reported information.  Once an area of improvement has been identified it can be delivered to the performance improvement department where informatics professionals can perform gap analysis and identify methods to improve overall quality. , <ref name="Stefan 2011">Stefan, Susan (2011). Using clinical EHR metrics to demonstrate quality outcomes.http://ovidsp.tx.ovid.com.ezproxyhost.library.tmc.edu/sp-3.16.0b/ovidweb.cgi?QS2=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
−	* Privacy and confidentiality remains a patient right! As digital data is permanent so are the trails of access to such data. There are news reports of staff being fired due to accessing 'celebrity-status' patient medical records. (http://www.nydailynews.com/news/national/2011/01/13/2011-01-13_staffers_at_tucson_university_medical_center_fired_after_staffers_violated_feder.html).	+	== Medical Education ==
		+	[[EMR Benefits: Medical education]]
−	* The privacy threat posed by the interoperability of a national network is a key concern. One of the most vocal critics of EMRs, New York University Professor Jacob M. Appel, has claimed that the number of people who will need to have access to such a truly interoperable national system, which he estimates to be 12 million, will inevitable lead to breaches of privacy on a massive scale. Appel has written that while "hospitals keep careful tabs on who accesses the charts of VIP patients," they are powerless to act against "a meddlesome pharmacist in Alaska" who "looks up the urine toxicology on his daughter's fiance in Florida, to check if the fellow has a cocaine habit."(30.^ JM Appel. Why shared medical database is wrong prescription. Orlando Sentinel, December 30, 2008. http://www.orlandosentinel.com/news/opinion/views/orl-opappel3008dec30,0,4065787.story)	+	In a teaching facility EMRs can be a very useful tool for medical education and training. EMRs can be used to monitor how much time each trainee spends with patients and therefore their clinical experience in terms of patient diagnosis and procedures can be tracked and reported to enable optimization of workflow for both trainee and training programs. <ref name= "Tierney 2013">Tierney et al, Medical Education in the Electronic Medical Record (EMR) Era: Benefits, Challenges, and Future Directions http://tmclibrary.summon.serialssolutions.com/search?s.q=tierney+m+j#!/search?ho=t&l=en&q=Medical%20education%20in%20the%20electronic%20medical%20record%20(EMR)%20era:%20Benefits,%20challenges,%20and%20future%20directions.%20Academic%20Medicine</ref>
−	* This is a significant barrier for the adoption of an EHR. Accountability among all the parties that are involved in the processing of electronic transactions including the patient, physician office staff, and insurance companies, is the key to successful advancement of the EHR in the U.S. Supporters of EHRs have argued that there needs to be a fundamental shift in “attitudes, awareness, habits, and capabilities in the areas of privacy and security” of individual’s health records if adoption of an EHR is to occur.(31.^ a b Nulan C (2001). "HIPAA--a real world perspective". Radiol Manage 23 (2): 29–37; quiz 38–40. PMID 11302064.)	+	In addition the use of EMRs in a teaching environment allows trainees access to the most up to date information. “Point-of-care education accessed via CDS allows for easy access to relevant and up-to-date medical literature from which students and residents can draw to formulate diagnosis and management plans".<ref name= "Tierney 2013">Tierney et al, Medical Education in the Electronic Medical Record (EMR) Era: Benefits, Challenges, and Future Directions http://tmclibrary.summon.serialssolutions.com/search?s.q=tierney+m+j#!/search?ho=t&l=en&q=Medical%20education%20in%20the%20electronic%20medical%20record%20(EMR)%20era:%20Benefits,%20challenges,%20and%20future%20directions.%20Academic%20Medicine</ref>
−	* EMR's add an important layer of security by restricting unlimited access to confidential sections of a patient file to all healthcare works and support staff.  By simply adding user name and password codes, access for employees is restricted to only the portions of the record needed to complete their work tasks.	+	== Financial ==
		+	[[EMR Benefits: Financial]]
−	* While paper medical records simply required physical proximity to be accessed, EMRs have the capability of requiring physical proximity to the computer system as well as a username and password.	+	"Implementing an EMR system could cost a single physician approximately $163,765. As of May
		+	2015, the Centers for Medicare and Medicaid Services (CMS) had paid more than $30 billion in
		+	financial incentives to more than 468,000 Medicare and Medicaid providers for implementing
		+	EMR systems. With a majority of Americans now having at least one if not multiple EMRs
		+	generated on their behalf, data breaches and security threats are becoming more common and are
		+	estimated by the American Action Forum (AAF) to have cost the health care industry as much as
		+	$50.6 billion since 2009." <ref name="O'Neill"> O'Neill, T. (2015, August). Are Electronic Medical Records Worth the Cost of Implementation.</ref>
−	== '''Financial''' ==	+	Some of the ways that EMR systems can cut healthcare costs are due to savings based on "time-consuming paper-driven and labor-intensive tasks":<ref name="Medical Cost"> Kumar, S., & Bauer, K. (2011). Medical Practice Efficiencies & Cost Savings.http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings</ref>
−	*e-MD, a leading EHR software company, reports that use of their software in small 3-4 physician primary care groups gain an average net profit of $50,000 per provider per year. (Dr. Michael Stearns, CEO of e-MD, “EMR update” presentation, Texas Healthcare Information Technology Forum at the Texas State Capitol, January 26, 2011).	+	* Reduced transcription costs<ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
		+	* Reduced chart pull, storage, and re-filing costs <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
		+	* Improved and more accurate reimbursement coding with improved documentation for highly compensated codes <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
		+	* Reduced medical errors through better access to patient data and error prevention alerts <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
		+	* Improved patient health/quality of care through better disease management and patient education <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
		+	There are few comprehensive estimates of savings from Health Information Technology (HIT) at the national level. At 90 percent adoption, it is estimated that the potential HIT – enabled efficiency savings for both inpatient and outpatient care could average more than 77 billion per year.<ref name=”Hillestad 2005”> </ref> <ref name=”Hillestad 2005”> Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. Health Affairs, 24(5), 1103-1117.</ref>
−	* 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	+	Although the full extent of EMR advantages may not become apparent until further implementation and research is carried out, a clear benefit is the reduction of cost. Major administrative costs can be eliminated or reduced. Providers can do away with the costs of “chart pulls,” while substantially reducing dictation costs through the use of EMRs. Healthcare providers can also receive decision support regarding selection and costs of medications, radiographic studies, and laboratory tests.<ref name="Bates 2003"> Bates, D. W., Ebell, M., Gotlieb, E., Zapp, J., & Mullins, H. C. (2003). A proposal for electronic medical records in US primary care. Journal of the American Medical Informatics Association, 10(1), 1-10.</ref>
−	* 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.	+	===Billing Accuracy===
−	* Most EMR’s will automatically prompt the user with the appropriate level of service allowed based on the documentation entered during the patient encounter. Using the 1997 Coding Guidelines, the EMR will determine whether the visit is coded at a level 1,2,3,4, or 5 by and provide visual queues to remind providers to complete appropriate documentation(http://www.urologypracticetoday.com/index.php?option=com_content&task=view&id=206).	+	The benefits for small to medium private practices that have implemented EMR systems integrated with the practices' billing and prescription systems, can be increased efficiency and accuracy thanks to automatic coding leading to improved profitability. "Since installing the EMR, Medicare has audited only one of my charts. I had billed out as a level four and Medicare said it should have been billed as a level five, which, in essence, said that we should have been paid more. My EMR system gave the chart a level four and I believe it was right.” "Since adopting an EMR system, my practice receipts have increased about $4,000 per month."<ref name="Sonnenberg 2007">EMR ROI: A Pennsylvania family practice's investment in an EMR pays off three-fold.  http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?p=HRCA&u=txshracd2509&id=GALE|A163469720&v=2.1&it=r&sid=summon&userGroup=txshracd2509</ref>
−	* This reduces the regular occurrence of physician down-coding visits for fear of over-coding due to lack of supporting documentation. By coding appropriately the practice will see an increase in revenues and reduced risk of non-compliance. National studies have shown that, on average, physician under-coding results in a 7% to 9% loss of revenue. A conservative estimate of an increase of 3.5% of revenue should be expected after implementing an EMR. One practice found that they increased a least one coding level for every seventh encounter, which resulted in a 4% increase in coding revenue. An example from my practice is shown in Figure 1 where the typical bell-shaped curve of mostly level 3, shifted to the right once an EMR was implemented in my practice((http://www.urologypracticetoday.com/index.php?option=com_content&task=view&id=206).	+	A nuanced view is appropriate here, however; improved billing can coincide with fewer patients seen. "EHR implementation ... increased reimbursements but reduced long-term practice productivity across all specialties"<ref name="Howley 2015">Howley et al, 2015. "The long-term financial impact of electronic health record implementation" http://jamia.oxfordjournals.org/content/22/2/443</ref> according to one study. This may be a net financial positive for the practice: "an EHR should greatly enhance physician effectiveness even if fewer patients are seen by the physician"<ref name="Howley 2015"></ref> due to gains in billing efficiency, but this also represents an artificial reduction in the supply of services.
−	* Documents can be customized by provider and document type. Referral letters can be generated automatically and faxed directly to the referring physician before the patient leaves the office. This enhances physician patient relations, minimizes paper, labor and postage costs.(http://www.urologypracticetoday.com/index.php?option=com_content&task=view&id=206).	+	=== An EMR Cost Benefit Analysis ===
−	* 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	+	Samsung Medical Center (SMC) performed a cost benefit analysis (CBA) on the cost benefits of implementing an electronic medical record (EMR) system.  Costs of implementing the EMR system involved both '''direct costs''' to build the system infrastructure and '''induced costs''' to make a smooth transition to the new system. Benefits of implementing the EMR system include both cost reductions and increased revenue. Five types of cost reductions, mentioned by the authors, include:
−	* 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.	+	# Reduction of supplies for paper charts
		+	# Disposal of storage facilities used for paper chart storage
		+	# Reduction of full-time equivalent (FTE) employees for the paper chart management
		+	# Reduction in staff for outpatient clinics
		+	# Decreased supplies for medical devices
−	*  Studies performed by the RAND Corporation and the Center for Information Technology Leadership both estimated savings of $80 billion annually from the widespread adoption of Healthcare Information Technology.  This is approximately 4 percent of the $2 trillion spent annually on health care, measured in 2005 dollars.  While many observers have expressed concern about the manner in which these studies were conducted, it is nonetheless very likely that society as a whole will greatly benefit from the adoption of these systems.  [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]	+	The FTE's responsible for paper management were greatly reduced from 28 FTE's (2007) to 1 FTE (2009).
−	* 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.	+	This CBA was based on an eight year period post EMR implementation.  SMC determined the EMR system became cost effective shortly after 6 years.  The outcomes of the CBA were calculated using the following formulas:
−	* 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.	+	* The primary outcome is the Net Present Value (NPV)
		+	** '''NPV = Present Value (PV) of benefit for the eight year period - PV of cost'''
		+	* The second outcome is the Benefit Cost Ratio (BCR)
		+	** '''BCR = PV of the benefit / PV of the cost'''
		+	* The third outcome is the Discounted Payback Period (DPP).
		+	**'''This is the time to reach the breakeven point'''.
−	* Many ambulatory EMR systems are integrated with [http://www.drfirst.com/e-prescribing.jsp 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]	+	This CBA does not include clinical benefits of the EMR implementation such as decreased medication errors, improved workflow, and reduced length of stay.<ref name="Choi 2013">Choi, J., Lee, W., Rhee, P. (2013). Cost-Benefit Analysis of Electronic Medical Record System at a Tertiary Care Hospital, Health Informatics Research;19(3):205-214. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3810528/</ref>
−	* 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.]	+	== Improving Patient Care ==
		+	[[EMR Benefits: Healthcare quality]]
−	*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.	+	Many EMRs have alert systems that ensure physicians do not forget to request important tests.  As well as the legal benefits that this provides, EMR alerts remind physicians of the "preventive care needs for patients, which helps improve quality of care and office income by reminding us to do appropriate testing and provide vaccinations" recommended for some patient conditions e.g. asthma, emphysema or diabetes. <ref name= Block 2008">How We Improved Our Practice and Our Bottom Line With a New EMR System.Fam Pract Manag, 15(7), 25. http://www.aafp.org/fpm/2008/0700/p25.html</ref>
−	* EMR systems can minimize coding errors, time delays in filing the claims and filing of an incomplete claim resulting in claim delay or denial.
−	* 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.	+	[[EMR Benefits: Reduction in no shows]]
−	* 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]	+	EMR system was used to improve on automated calls made to patients to remind them of their appointment which reduced the number of no call shows and improved patient satisfaction.
		+	<ref name= Block 2008">How We Improved Our Practice and Our Bottom Line With a New EMR System.Fam Pract Manag, 15(7), 25. http://www.aafp.org/fpm/2008/0700/p25.html</ref>
−	* 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]	+	[[EMR Benefits: Medication Management]]
−		+
−	* 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]	+
−	*Eliminating paper chart supplies and copying expense as well as costs associated with storing paper charts.	+	"Rational antibiotic use resulted in a lower mortality of 0.0644 % during the post-implementation period compared to 0.179 % during the pre-implementation period (p = 0.018). The comprehensive EMR system contributed to a significant reduction in antibiotic consumption and an improvement in rational antibiotic use."<ref name= journal of medical systems">The Meaningful Use of EMR in Chinese Hospitals: A Case Study on Curbing Antibiotic Abuse 15(7),</ref>
−	* 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	+	EMR systems have the ability to make evidence-based suggestions regarding patient care. With these suggestions, EMRs are able to use a patient’s information to identify preventative services that specific patient may need. The system is able to remind doctors that the patient is due for certain screening exams or other services which allows the doctor to discuss it with the patient and also allows the patient to decide whether or not they would like to schedule an appointment for that specific exam. This reminder has proven to benefit patient care by increasing compliance with preventative care.
−	* 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	+	EMRs also benefit patient care by assisting in long-term chronic disease prevention and management. Case management systems in EMRs allow patients to communicate with a variety of specialists, which better enables them to manage their care. This system also allows healthcare providers to keep track of patient data, such as vital signs, and allows case management nurses to quickly respond to any issues that may occur. The system benefits the patient because it allows the patient’s acute issues to be handled promptly before they become bigger issues that may lead to a hospital admission.
−	* After implementing an $11.8 million dollar CPOE system, the Brigham and Women’s Hospital (BWH) gained a net savings of $16.7 million and $9.7 million in their operating budget over a ten-year period. The most significant benefits emerged during the latter years when a Clinical Decision Support System (CDSS) was implemented resulting in a huge financial gain from improved renal dosing, nurse time utilization, and expensive drug guidance. [Kaushal R et al. Return on investment for a computerized physician order entry system. J Am Med Inform Assoc. 2006;13(3):261-66.]	+	EMRs have the ability to eliminate up to 200,000 adverse drug events with the use of CPOE. Using reminders and alerts CPOEs are able to notify physicians about possible drug interactions that may occur when a new medication order is placed.
−	* 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	+	EMRs have a direct correlation with the quality of healthcare offered to a patient. Problems in healthcare quality fell into three categories as stipulated by the National Roundtable on Health Care Quality. These three categories are the underuse, overuse, and misuse of healthcare services. Reducing overuse and misuse of healthcare services, as noted by the Roundtable, leads to an increase in health care quality while simultaneously lowering costs. In addition, reducing the underuse of healthcare services increases quality, but may in turn increase costs. “Computerized physician order [CPOE] entry may affect all three categories of health care quality problems, as well as inefficiencies in the health care system.” <ref name="Kuperman 2003">Kuperman, G. J., & Gibson, R. F. (2003). Computer physician order entry: benefits, costs, and issues. Annals of internal medicine, 139(1), 31-39.</ref>
−	*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.	+	== Research ==
		+	[[EMR Benefits: Research]]
−	* 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)	+	Researchers can use EHRs to retrieve up-to-date data from various sources around the country to advance their studies. EHRs can compute a report to show researchers certain trends in the population or common side effects of medications. <ref name="Enormous Benefits"></ref>
−	* Can improve billing by allowing improved medical staff documentation and lack of lost or misplaced charts.	+	== Health Information Exchange (HIE) ==
		+	[[EMR Benefits: HIE]]
−	* 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	+	== Personal Health Records ==
		+	[[EMR Benefits: PHR]]
−	* 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	+	===Patient Participation===
		+	Patients can use personal health record (PHR) to keep track of information from doctor visits, record health-related information, and link to health-related resources. PHR, is an electronic application used by patients to maintain and manage their own health information.  Connected PHRs are linked to a specific health care organization's EMR system that can increase patient and family participation in their own care.               <ref name="PHR">http://www.healthit.gov/providers-professionals/patient-participation</ref>
−	* The estimated net benefit from using an EMR in primary care over a 5 year period ranged anywhere from $8400 to $140,100 (with an average of $86,400 per provider), where financial gains were most sensitive to the proportion of capitated patients. [Wang et al. A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine (2003)]	+	== Electronic Dental Records ==
		+	[[EMR Benefits: EDR]]
−	* EMR can track patients medications and notified them when a drug manufacturer recalls a medication. Since these recalls are not FDA class I recalls, pharmacies are not mandated to notify these patients.Corley, S. Electronic prescribing: a review of costs and benefits.(electronic prescribing software is found to be cost effective for all size practices). Topics in Health Information Management 24.1,2003: 29.	+	==Telehealth==
		+	[[EMR Benefits: Telehealth]]
−	* One-third of the physicians/ nurses time is being spent responding to phone calls from pharmacies regarding prescriptions. Because of EMR system's features like e-prescribing and having potential implementation of interagency interoperability with pharmacy systems, clinics can save time, increase productivity (due to less interruptions in the workflow) and reduce the number of call backs from the pharmacies regarding wrong medicines prescribed, wrong dosages and illegibility of the prescription. Reference: http://www.emrconsultant.com/education/e-prescribing	+	== E-Prescribing ==
		+	[[EMR Benefits: E-Prescribing]]
−	* Electronic "triggers" can be implemented to generate notifications to physicians and pharmacists when less costly but equally efficacious drugs can be substituted for the prescribed medication.	+	E-Prescribing has many benefits, some of them include: <ref name="E-Prescribing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
		+	* reduce illegibility <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
		+	* providing warning and alert systems, which reduce medication errors  <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
		+	* access to patient's medical history  <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
		+	* reduces or eliminates phone calls and call-backs to pharmacies  <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
		+	*eliminates faxes to pharmacies  <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
		+	*streamlines the refill and authorization processess  <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
		+	* increases patient compliance  <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
−	* The application of EMR can help ICUs to identify missed billing opportunities, which occur more often in busy ICU environments. Consequently, this can improve billing efficiency. http://www.ncbi.nlm.nih.gov/pubmed/19590335	+	== Mobile EMRs ==
		+	[[EMR Benefits: mHealth]]
−	*  One group showed a 50% reduction in pharmacy call backs.  Theoretically this should mean decreased near-misses and decreased office time used answering these calls.  Ref: Allscripts.  Joliet Medical Group E-Prescribing Triples Performance Payment over Prior Year.  2002.  (http://www.allscripts.com)	+	== Physicians ==
		+	[[EMR Benefits: Physicians]]
−	*  EMR can provide guidance to physicians at the time of order entry for drug-dosing adjustement according to the patient's renal function. These ajustments have shown significant annual cost savings. Chertow GM, Lee J, Kuperman GJ, et al. Guided medication dosing for inpatients with renal insufficiency. JAMA. 2001;286:2839–44.	+	===Physicians Benefit===
−	* EMR can provide clinicians information about a patient's financial status. Examples include:	+	EMRs can greatly improve communication between physicians by allowing each full access to the patient’s medical record and by making it easier for physicians to follow up with patients. The electronic record provides up to the minute information on the patient allowing more efficient collaboration between disciplines. EMRs allow multiple providers to simultaneously access a patient’s record from any authorized computer.<ref name="MD">http://www.usfhealthonline.com/resources/healthcare/benefits-of-ehr/#.VfjJDXktDmQ
−	** EMR can initiate a conversation between a physician and patient about making a drug selection, such as a drug on the patient's insurance formulary or a generic drug.	+	</ref>
−	** EMR can indicate to a physician that Medicare does not cover a particular usage of a drug.	+
−	*  Hospital Managers can use historic information regarding trends in patient census to make better decisions about staffing levels and bulk purchasing opportunities for supplies which will save the facility money.	+	== Nurses ==
		+	[[EMR Benefits: Nurses]]
−	*  According to a 2004 report by the California Healthcare Foundation for the CITL (EXTRA: Patient Safety in the Physician’s Office: Assessing the Value of Ambulatory CPOE) [[http://www.chcf.org/documents/ihealth/PatientSafetyInPhysiciansOfficeACPOE.pdf]]	+	Nurses use the EMR to identify newly admitted patients, track their location, and document admission information. The nursing SWAT team harnessed the power of EMR technology, and successfully re-organized nursing workflow to expedite the admission process, while maintaining patient and family centered care.<ref name="Journal of pediatric nursing ">http://www.sciencedirect.com.ezproxyhost.library.tmc.edu/science/article/pii/S0882596314002413
−	Providers with a higher capitation percentage reap more financial benefits from ACPOE than those whose practices use a fee-for-service model. This is a barrier for most practices to adopt ACPOE, based on the national average of 11.6% capitation.	+	</ref>
−	[[User:MikeField|MikeField]] 15:59, 23 January 2010 (CST)	+
−	*  According to the same 2004 ACPOE report by the California Healthcare Foundation, advanced ACPOE systems for 50 providers with 14.4% capitation net return is $108,000 per provider in 5 years, or an average of $21,000/provider/year. Since two-thirds of practices have 3 or fewer physicians, and capitation is not typical, both of which the model shows leads to net cost after 5 years, other than financial are needed to encourage widespread adoption of ACPOE.	+	== Versatile capabilities of EHRs in healthcare settings ==
−	[[User:MikeField|MikeField]] 20:11, 23 January 2010 (CST)	+	There are many studies showed that EHRs are capable to integrate with various standards systems such as billing codes, clinical notes, ICD diagnose codes, and medications, which essentially enhances effectiveness and efficiency of care and results in superior phenotyping performance compared with paper-based medical record systems. <ref name=" Wei 2015"> Wei, W.Q., Teixeira, P. L., Mo, H., Cronin, R. M., Warner, J. L., & Denny, J. C. Combining billing codes, clinical notes, and medications from electronic health records provides superior phenotyping performance. Journal of the American Medical Informatics Association: JAMIA. http://doi.org/10.1093/jamia/ocv130 </ref>.
−	*  Studies show that the use of clinical information tools produce cost savings due to improved prescription drug administration and patient safety. Electronic medical records help to reduce the number of adverse drug interactions, to improve drug dosing, and promote more effective utilization of pharmaceuticals. Crane, R.M. & Raymond, B. (2003). Fulfilling the Potential of Clinical Information Systems. ''The Permanente Journal'', 7(1), 62-67.	+	==  Improvement of Spontaneous Reporting System for drug post-marketing safety surveillance ==
		+	In the healthcare settings, Spontaneous Reporting Systems (SRSs) are critical systems for monitoring drug post-marking safety and adverse drug reactions (ADRs).  Although widespread utilization of SRSs has played a fundamental role in drug safety monitoring, there are certain limitations that hinder their efficacy and accuracy in practices. For example, multiple sources of data are needed for confirmation and validation; the nature of passive reactions to ADR events makes SRSs perform poorly in terms of pharmacovigilance. The integration of an SRS system into EHRs could have potential to improve efficiency and effectiveness of detection for ADR events. The combination of an SRS with EHRs could help collect data and information related to ADRs dynamically while avoiding the need of data validation from multiple sources and potentially reducing the costs. <ref name=" Pacurariu  2015"> Pacurariu, A. C. Useful Interplay Between Spontaneous ADR Reports and Electronic Healthcare Records in Signal Detection. Drug Safety. http://doi.org/10.1007/s40264-015-0341-5. </ref>
−	*   The article in Health Management Technology  (4/2002) highlighted the considerable savings of an electronic medical record (EMR) system versus manual methods at the California Pacific Medical Center (CPMC) in San Francisco, CA. Using EMR saves 90-135 mins in Complex NICU Patient discharge summary an 75% time Improvement.	+	==  Improvement of healthcare outcomes through interactive collaboration among stakeholders ==
		+	It has been reported that the integration of a Network-Based Learning Health System with EHRs can potentially improve a variety of healthcare outcomes. For example, integrating chronical care management, quality improvement, patients and their family engagement, and comparative research.   <ref name=" Marsolo  2015"> Marsolo, K., Margolis, P. A., Forrest, C. B., Colletti, R. B., & Hutton, J. J.  A Digital Architecture for a Network-Based Learning Health System: Integrating Chronic Care Management, Quality Improvement, and Research. EGEMS (Washington, DC), 3(1), 1168. </ref>.  Therefore, EHRs can serve as an effective platform and infrastructure that fascinates online learning for all stakeholders, and patient-centered quality care and evidence-based medical research.
−	*  A technology evaluation study published in JAMIA in 2006 by Kaushal et al reported cumulative benefits for some clinical decision support systems' (CDSS) elements at Brigham’s and Women’s Hospital. The largest savings were from renal dosing guidance. Other savings were related to improvements in nursing time utilization, specific or expensive drug guidance, adverse drug event (ADE) prevention, laboratory charge display and redundant lab warnings. Some CDSS features were added to the system at a later time and were therefore not included in the analyses. The pilot studies related to these other features were also indicative of associated savings. These features included a transfusion guidance system, the appropriate ordering of Cl. Difficile toxin assays, and ordering of digoxin levels.
−	*  More complete records helps clinicians and staff to avoid mistakes and to manage the cost of malpractice insurance.	+	== Costs ==
−	[http://www.msdc.com/EMR_Benefits.htm]	+
−	* As a tried and proven EMR system, the VistA system offers a low-cost, low-risk EMR option.  The system that has become VistA was initiated and planned at the beginning of the 1970s by the National Center for Health Services Research and Development of the U.S. Public Health Service (NCHSR&D/PHS). (The NCHSR&D is now known as the Agency for Healthcare Research and Quality (AHRQ).)[http://en.wikipedia.org/wiki/VistA]  Cost has been cited as the primary reason healthcare facilities have not implemented EMR systems.[Jha, et. al.,  “Use of Electronic Health Records in U.S. Hospitals”, http://www.nejm.org/doi/pdf/10.1056/NEJMsa0900592] Under the US Freedom of Information Act, the VistA software is available free of charge, bypassing one of the major costs of an implementation.	+	[[Return on investment]]
−	* Decrease patient’s flow through time, attributed to the use of EMR, can also increase revenue generated by the clinic or organization.  The faster a patient moves through the institution, the more patients that can be seen on a given day. The more patients seen, the more revenue generated.	+	It is estimated that purchasing and installing an EMR can cost a provider anywhere from $15,000 to $70,000.  There are several things to consider when looking for an EMR for your organization or practice.  The prices vary based on number of providers using the EMR and whether it is a select on-site EHR deployment or web-based EHR deployment. Other factors to take into consideration of what costs you will incur include these 5 components of implementation: <ref name="How much is this going to cost me?">HealthcareIT.gov http://www.healthit.gov/providers-professionals/faqs/how-much-going-cost-me http://www.healthit.gov/providers-professionals/faqs/how-much-going-cost-me </ref>
−	*Cost associated with incorrect exams being ordered, performed and billed as well as incorrect diagnosis and treatment due to putting information belonging to Patient A into Patient B’s file is, significantly reduced by the use of unique patient barcodes. Medical record numbers alone cannot adequately reduce cost due to the human error factor.	+	*Hardware: Hardware costs may include database servers, desktop computers, tablets/laptops, printers, and scanners. <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
−	* EHR has the potential to reduce expensive and unnecessary radiology tests use thus decreasing the cost to facilities and the exposure to the patient. (Kaushal, Ashih et. al. 2006)	+	*EHR Software: Potential software costs include an EHR application, interface modules and upgrades to your EHR application. Remember, software costs vary depending on whether you select an on-site EHR deployment or a SaaS EHR deployment. <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
−	* An EHR eliminates the need for space for bulky paper records allowing more space for patient care and other revenue generating functions. In 2007 the Michael E DeBakey VA Medical Center in Houston, TX moved its paper medical records off site and used the vacated space (over 1000 square feet) of space to expand the nuclear medicine department.	+	*Implementation Assistance: Potential implementation assistance costs include IT contractor, attorney, electrician, and/or consultant support; chart conversion; hardware/network installation; and workflow redesign support. <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
−	* Automatic notifications can reduce the need for clerical staff that personally need to contact each patient with test results, appointment times, errors etc.	+	*Training: Your organization will need to train your physicians, nurses, and office staff before and during EHR implementation.  <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
−	==  '''Clinical''' ==	+	*Ongoing Network Fees and Maintenance: Potential ongoing costs include hardware and software license maintenance agreements, ongoing staff education, telecom fees, and IT support fees. <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
−	* Improving the Productivity of Nurses and Physicians:  A 2005 summary of research by Poissant and others suggests that when health IT systems were in use, nurses in hospitals saw drops in the time required to document the delivery of care but physicians saw increases in documentation time. That finding implies that hospitals might be able to reduce their spending on nurses but not necessarily on physicians. Those studies, however, may have identified a short-term effect among physicians—that is, before providers had become accustomed to the new system and incorporated the new methods into their daily routine. In addition, most studies have examined health IT in teaching hospitals, and the generalizability of their results to more typical community hospitals may be limited.  The measures of productivity that researchers have used in such studies are relatively narrow and do not exhaust the ways in which the use of health IT might affect health care workers’ productivity. For example, the improvements in documentation that EHRs provide might help physicians improve their caregiving: If such systems led providers to spend more time documenting the care they delivered, the end result might be higher-quality care. Health IT systems might also enable a physician to provide other services for patients, such as helping them get appropriate preventive care, providing better education about their health, and assisting them in making choices from among an array of treatment options.   Reference: Evidence on the Costs and Benefits of Health Information Technology, Stuart Hagen and Peter Richmond, Congressional Budget Office, May 2008.	+	*Although the initial cost of an EMR may (and typically does) result in an immediate increase in administrative cost, through the reduction of other “removable and or defunct items or process the implementation of the EMR showed a positive improvement in the BCR and NPV. <ref name= "Removable or defunct"> Removable or Defunct http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810528/ </ref>
		+	examples: remodeling of paper-chart storage areas, medical transcriptions, shorter chain of communication, reduction of administrative material
−	* Joan Breuer, Ph.D. 01/22/2010 20:00 Clinicians can view all angles of radiology pictures, and turn each of them around up to 360 degrees for clearer sights of potential tumor(s). The patient can be present at that time, so that he/she will be up-to-date on the status of his disease.	+	==Cost vs Time == (A reduction of time spent on a common process can lead to reduced cost and better efficiency)
		+	*EMRs can greatly reduce or make more efficient use of time.
		+	A recent study (July-2015)EMR decision support systems where proven to have reduced and or made more efficient use of the time needed for “Colorectal cancer screening where the immediate harms are balanced with longer-term benefits.” By providing a “personalized benefit/harm assessment”. <ref name="Cost vs Time"> Cost vs Time http://www.ajmc.com/journals/issue/2015/2015-vol21-n7/Pilot-of-Decision-Support-to-Individualize-Colorectal-Cancer-Screening-Recommendations/</ref>
−	* Electronic clinical documentation systems enhance the value of EHRs by providing electronic capture of clinical notes; patient assessments; and clinical reports, such as medication administration records (MAR)(http://www.ncrr.nih.gov/publications/informatics/ehr.pdf).
−	* Joan Breuer, Ph.D. 01/22/2010 20:00 When observing laboratory results via an EMR, a graph can be shown of values over time (e.g., glucose levels over one week or month or year).  The advantage of a graph compared to a list of values, is that one can immediately see changes very clearly, and it is much more appealing visually.
−	* According to Sanders and Miller, "decision support ordering screen helps to improve physician compliance with guidelines for use of brain MRI". Sanders D.L, Miller R.A, The effects on clinician ordering patterns of a computerized decision support system for neuroradiology imaging studies. Proc AMIA Symp, 2001:583-7. [PMID: 11825254]
−	* The realities of a typical hospital to accurately evaluate implementation of an EMR system are difficult, time consuming, and expensive.  This is mostly due to the fact that methods to evaluate EMRs that provide the most useful information (e.g. focused studies and site visits) require more effort and expertise. A solution proposed to overcome these barriers is a comprehensive national database of real results from actual EMR implementations. [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.]	+	==Implementaion==
		+	For a proper return on investment a proper implementation of EHR is needed.
		+	lots of things have to be kept in mind for a successful implementation of an EHR.
−	* 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.	+	*Benefits and risks of the EHR.
		+	*cost
		+	*specifications of our needs and what we want and what the EHR have.
		+	*vendor certifications.
		+	*preparations for implementation and after.
		+	The journal of Emergency medicine titled with "computers in Emergency medicine" talks about all aspects of EHR implementation. <ref name="implementation"> IMPLEMENTING ELECTRONIC HEALTH RECORDS IN THE
		+	EMERGENCY DEPARTMENT. http://www.jem-journal.com/article/S0736-4679(08)00321-1.</ref>
−	* 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.
−	* 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]
−	* 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.
		+	=== Neonatal Informatics and CPOE ===
		+
		+	Computerized physician order entry (CPOE) can be considered one of the major contributions to patient safety and health care quality from an EMR system implementation. CPOE and clinical decision support (CDS) systems have the potential to impact care of the critically ill neonatal patients to an even greater extent than other patient groups.  Implementation of CPOE with CDS has been shown to specifically benefit Neonatal care intensive care units (NICU) with improved medication turnaround times, decreased medication errors, reduced adverse drug effects, and improved radiology turnaround times.<ref>Corder, L., Kuehn, L., Kumar R.R., Mekhjian, H.S. Impact of computerized physican order entry on clinical practice in a newborn intensive care unit. J Perinatol. 2004;24:88-93. [Pubmed: 14872207].</ref>
		+
		+	While studies have shown these benefits to be consistent with CPOE and CDS equipped institutions, the effects of these systems on morbidity and mortality have been ambiguous.  A 2005 article reported an increase in mortality rate with the implementation of an EMR system with CPOE in a pediatric intensive care unit (PICU).<ref>Han, Y.Y., Carcillo, J.A., Venkataraman, S.T., et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system.  Pediatrics. 2005;116:1506-1512. [PubMed: 16322178].</ref>  The informaticists and hospital administration, determined that errors with the implementation process of the CPOE system resulted in these negative results.  They stressed that a change in the workflow design was essential for a safer CPOE implementation.  A more recent 2010 article reported a decrease in neonatal mortality rate using the exact same CPOE system.<ref>Longhurst, C.A., Parast, L., Sandborg, C.I. et al. Decrease in hospital-wide mortality rate after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2010;126:14-21. [PubMed: 20439590].</ref>These findings indicate that the implementation of the CPOE system needs to include careful consideration of workflow analysis.  However, even with the utmost attention being given to ensure the safety of a new CPOE system, inadvertent issues may still arise with human error. An example of such would be a physician order entry on the wrong patient.<ref name="Palma 2011">Palma, J.P., Sharek, P.J., Classen, D.C., & Longhurst, C.A. (2011). Neonatal Informatics: Computerized Physician Order Entry. Neoreviews. 12:393-396. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3146345/</ref>
−	* 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]
−	* 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.	+	== Specialty clinics ==
−	* 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.	+	EHR’s can significantly improve the productivity for specialty physician clinics such as for ophthalmology. Incorporating an EHR, a clinic can reduce process and time spent on recording patient data, as most diagnostic equipment can communicate with EHR’s.  With medical and diagnostic equipment communicating with EHR’s, staff and technicians can focus more on the patient.  <Ref name== "Misch, 2012"> Misch, D.M. Specialty-specific EHR system benefits both practice, patients: technologic innovation: how using EHR, practice management platform can improve standard of care and efficiency. http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?p=HRCA&u=txshracd2509&id=GALE|A312290264&v=2.1&it=r&sid=summon&userGroup=txshracd2509</ref>
−	*Improved patient education through use of patient portal	+	== Benefits Database ==
		+	[[EMR Benefits: Benefits Database]]
−	* EMR data can be accessed by patients via web portals. Web portal usage increases patient satisfaction overall and increases patient communication with informational and psychosocial content. [http://www.pubmedcentral.nih.gov/articlerender.fcgi?pmid=16236699 Lin et al. An Internet-Based Patient-Provider Communication System: Randomized Controlled Trial. J Med Internet Res. 2005 Jul–Sep; 7(4): e47.]	+	A national repository of EMR benefits data is needed to help stakeholders make more informed decisions about EMR implementation and to facilitate monitoring and corrective redesign of existing EMR implementations. A framework for reporting data should be developed that will enable meaningful comparisons, provide uniform benefit categories and standardized methods of measurement and evaluation.<ref name=”Thompson 2006”>Thompson, D. I., Osheroff, J., Classen, D., & Sittig, D. F. (2006). 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: JHIM, 21(1), 62-68.</ref>
−	*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	+	==Compliance==
		+	[[EMR Benefits: Compliance]]
−	*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
−	*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]	+	18. Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings,      And Costs. Health Affairs, 1103-1117. doi:10.1377/hlthaff.24.5.1103 Health Aff September 2005 vol. 24 no. 5 1103-1117
−	*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.
−	* 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.
−	PHR has appeal as it eliminates collaborative governance challenges, trades providers' high cost technology for patient managed lower cost technology, and places information of educational value directly in the hands patients.
−	Ref: Tang PC, Ash JS, Bates DW, et al. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc 2006;13:121–6.
−	*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.	+	== References ==
		+	<references/>
−	* 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)	+	[[Category: EHR]]
−		+	[[Category: EMR]]
−	* 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	+
−		+
−	* Can improve critical medical decisions by providing the most up-to-date clinical information at point-of-care.	+
−		+
−	* 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	+
−		+
−	* 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	+
−		+
−	* 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)]	+
−		+
−	* Electronic order sets, as part of CPOE, will improve compliance with nationally reported quality indicators e.g. core measures.	+
−		+
−	* 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.	+
−		+
−	* EMRs systems generates reports like flowsheets, a specialty snap shot about progression of a patient status which are very useful in management of chronic illnesses like diabetes.	+
−		+
−	* Lists of patients receiving vesicant drugs can be generated and used to contact the appropriate physicians for those patients needing special IV access to decrease incidence of phlebitis.	+
−		+
−	* EHRs also provide important information for purposes such as health policy planning. (Definition, structure, content, use and impacts of electronic health records: a review of the research literature. Häyrinen K, Saranto K, Nykänen P.Int J Med Inform. 2008 May;77(5):291-304. Epub 2007 Oct 22.)	+
−		+
−	* EHRs integration to personal health records may improve home telehealth management of chronic illness. (Home telehealth electronic health information lessons learned. Charters K. Stud Health Technol Inform. 2009;146:719.)	+
−		+
−	*EHR’s prescription profiles may facilitate resident education and improve resident competency in practice based learning, by enabling educators to determine the range of  medications residents prescribe. (Utilizing VA information technology to develop psychiatric resident prescription profiles; Rohrbaugh R, Federman DG, Borysiuk L, Sernyak M; Acad Psychiatry. 2009 Jan-Feb;33(1):27-30.)	+
−		+
−	*The EHR will reduce the costs incurred by storing and keeping patient medical records.  It also will ensure billing to patients.	+
−	http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art	+
−		+
−	*Integrating digital radiology studies into the EHR allows physicians to view images from their offices, homes, and multiple sites throughout the facility.  Digital studies allow small rural hospitals access to prompt 24/7 radiology reading services through telemedicine contracts.  Diagonosis can occur as soon as the image is captured.	+
−		+
−	* By integrating decision support tools and standardized patient care letters, the EMR system can link patient care with an educational program. From a pediatric respiratory department’s experiences, more asthmatic patients (58%) received an asthma action plan upon discharge in an EMR system (as opposed to 4% before the EMR). http://www.ncbi.nlm.nih.gov/pubmed/18972308	+
−		+
−	* Some EMR systems allow patients to access their own health records. This can strengthen the connectivity between doctors and patients. Also this can help patients to figure out their health condition. http://www.ncbi.nlm.nih.gov/pubmed/17901601	+
−		+
−	*  Planning programs allow physicians to make and modify detailed treatment plans which can then be viewed by any other physician caring for the patient.	+
−		+
−	* EMR can be integrated with computer-based monitoring to store and display information gathered from a patient automatically, such as vital signs or ECG.	+
−		+
−	* EMRs that incorporate dynamic knowledge bases will allow Clinicians to incorporate new research and new medical knowledge and developments into their practice faster than the traditional methods self study and reading journals. New research and new medical developments are happening at such a rapid rate that it has become challenging for practitioners to respond to the new information.	+
−		+
−	*  Patient waiting time and Triage times are significantly reduced with nurse-driven template charts and a vital sign interface that automatically drops the vital signs into the nursing note once the measurements are taken. The Financial Impact of an Emergency Department Information System - Michael Hocker, Health Care Technology Volume 2.	+
−		+
−	*  EHR system with its Clinical Decision Support system brings about a change in the decision making behavior of the clinicians, increasing their confidence, ability to identify solutions, increased interpretation accuracy and thereby, more efficient decision making.	+
−		+
−	* An EMR can help optimize the choice of individual tests based on additional considerations. This includes considering cost-effectiveness and giving additional information to help clinicians make the best choice for the patient. Osheroff J, Pifer, E, Teich J, Sittig D, Jenders R. Improving outcomes with clinical decision support: An implementer’s guide. HIMSS: Chicago. 2005 (p. 48)	+
−		+
−	* An EMR can help improve compliance with care guidelines. The compliance can help to improve a hospital’s scores in Core Measure guidelines. Osheroff J, Pifer, E, Teich J, Sittig D, Jenders R. Improving outcomes with clinical decision support: An implementer’s guide. HIMSS: Chicago. 2005 (p. 49)	+
−		+
−	* An EMR can improve communication among caregivers. Automatic notifications and instant messaging can improve communications between caregivers and improve patient care. Osheroff J, Pifer, E, Teich J, Sittig D, Jenders R. Improving outcomes with clinical decision support: An implementer’s guide. HIMSS: Chicago. 2005 (p. 56)	+
−		+
−	*  Joan Breuer, Ph.D. 02/03/2010 An EMR can mitigate risks such as medication administration, can improve health care process by having an expert engine, and, reduce response time for finding items in a patient medical record.  This implies saving money for the Health Care Facility (ROI).	+
−		+
−	*  Facilitates research by creating an enormous source of medical data that can be standardized and aggregated.  Once analyze, this information can be used to:  (1) Improve treatment methods, (2) Lower the cost of health care, and (3) Support the development of public health policies. [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]	+
−		+
−	*  EHRs can help providers be more effective by:  (1) reminding physicans about preventive care, (2) identifying allergic reactions to prescribed drugs and highlighting potentially harmful drug interactions, and (3) providing doctors with appropriate and timely information to support decision making.  Ref: [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]	+
−		+
−	* EMR systems can integrate evidence-based recommendations for preventive services (such as screening exams) with patient data (such as age, sex, and family history) to identify patients needing specific services. The system can remind providers to offer the service during routine visits and remind patients to schedule care. Reminders to patients generated by EMR systems have been shown to increase patients’ compliance with preventive care recommendations when the reminders are merely interjected into traditional outpatient workflows. Ref:"Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs" - Richard Hillestad et al.	+
−	*	+
−	* Automated upload of vital signs directly into an EMR reduced the documentation error rate to less than 1%. Additional safety benefits may include improved timeliness to vital sign data and clinical work-flow processes. Ref: "Connected care: reducing errors through automated vital signs data upload. -" Smith LB, Banner L, Lozano D, Olney CM, Friedman B.	+
−		+
−	* Mobile EMR can contribute to out patient follow-up for chronic conditions that require day to day monitoring for years and provide feedback for physicians and also for patients to avoid constly life-threating situations.  Peter Boland, "Better Health Well in Hand"	+
−		+
−	* With Mobile EMR medication levels can be adjusted based on the monitoring of patient physiological conditions, which some can be time sensitive, like distant monitoring of maternal contractions, fetal heart-rate, on high risk pregnancies.	+
−		+
−	* EMRs can be integrated with any existing or future clinical information systems, which adhere to HL7 compatibility standards, thus enabling easy connection, communication,and collaboration of medical data of every patient.	+
−		+
−	* EMRs can be used to ascertain phenocopies, phenotype heterogeneity, and relevant covariates to enable Genome Wide Association Studies (GWAS) of Peripherial Arterial Disease.Biorepositories linked to EMRs may provide a relatively efficient means of conducting GWAS. 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.Journal of American Medical Informatics Association.(2010);17(5):568-74.	+
−		+
−	* Tragic events like 9/11, Hurricane Katrina, and the California fires have showcased the benefits of electronic record keeping. For those who had medical records available were easily treated then those whose medical records are not available. Large scale EMR systems replicate their stored records in several places across the country so that one tragic event won't destroy them.	+
−	http://patients.about.com/od/electronicpatientrecords/a/EMRbenefits.htm	+
−		+
−	*  Significant positive associations between specific objective quality indicators and CPOE implementation have been have been found.  After controlling for confounders, CPOE hospitals outperformed comparison hospitals on 5 of 11 measures related to ordering medications and on 1 of 9 nonmedication-related quality measures.  [http://ajm.sagepub.com/content/24/4/278.abstract (American Journal of Medical Quality 2009;24:278-286)]	+
−		+
−	* Regarding abnormal cervical cytology results and follow-up care, in an at-risk urban population, an automated, EMR-based tracking system has been shown to reduce the time to resolution and increase the number of women who achieved diagnostic resolution.  [http://www.springerlink.com/content/7t116l968n5u5167/ (Journal of General Internal Medicine 2010;25(6):575-580)]	+
−		+
−		+
−	* The May 2008 Congressional Budget Office report - ‘Evidence on the Costs and Benefits of Health Information Technology’ discusses evidence related to a multi-functional EHR (Jha and colleagues, 2006). The report discusses electronic referral communication between providers, among other EHR functions, that could have a significant impact on medical practice.	+
−		+
−	* Use of Computerized physician order entry (CPOE) with clinical decision support (CDS) has been shown to decrease Adverse Drug Events (ADE’s) in 5 studies.  Wolfstadt JI, Gurwitz JH, Field TS, et al. The effect of computerized physician order entry with clinical decision support on the rates of adverse drug events: a systematic review. J Gen Intern Med. 2008;23:451-8.	+
−		+
−	* Electronic prescribing of chemotherapy medications has been shown to ensure that safe chemotherapy practices were followed.  Huertas, M. J., Baena-Cañada, J. M., Martínez, M. J., Arriola, E. & García, M. V. The impact of computerised chemotherapy prescriptions on the prevention of medication errors. Clin. Transl. Oncol. 8, 821–825 (2006).	+
−		+
−	* Prescribing accuracy has been shown to be greatly increased as the occurrence of missing or incomplete data in prescriptions dropped by a factor of 10 by implementing a CPOE.  C Mir, A Gadri, GL Zelger, et al. Impact of a computerized physician order entry system on compliance with prescription accuracy requirements. Pharmacy World and Science, Oct 2009, vol. 31, no. 5, p. 596-602	+
−		+
−	* Reminders indicating that patient is eligible for preventive care measures. Dexter et al.	+
−		+
−	* On-screen display of the charges for laboratory and radiologic tests at the time of computer ordering led to 4.5% fewer laboratory tests ordered in the intervention group (not statistically significant); minimal difference for radiologic tests. Bates et al.	+
−		+
−	* A study performed by Bates et al., 55% reduction in serious medication errors (P = 0.01); decrease in preventable adverse drug events of 17% (P > 0.2). Bates et al.	+
−		+
−	* Compliance with drug monitoring and preventive care guidelines. Overhage et al.	+
−		+
−	* A CPOE system and an electronic medication administration record led to significant decreases in turnaround times, elimination of transcription errors, improvements in order countersignature, and decrease in length of stay. Mekhjian et al.	+
−		+
−	* EMR helps healthcare providers to target patients with specific needs like immunization.	+
−		+
−	* EMR allows various views of patient data to physicians. i.e, In a chronological order by report date- which helps the physicians to find the newest test results, they can highlight the changes etc. Edward H. Shortliffe, James J. Cimino. Biomedical Informatics Computer Applications in Health Care and Biomedicine. 3rd edition.	+
−		+
−	* EMR is capable of generating reports. By generating reports healthcare providers can know the amount of vaccines used in the previous year and with that number they can plan for the coming years. Also they can know which patients are due for shots.(http://www.ama-assn.org/amednews/2008/05/05/bisa0505.html)	+
−		+
−	* An EMR Can Assist In Providing Preventive Care. Preventive care is important for patienars both on an individual level and a community level.  On an individual patient level, the EMR can "enable a physician to provide other services for patients, such as helping them get appropriate preventive care, providing better education about their health, and assisting them in making choices from among an array of treatment options." This can be accoplished through physician reminders (for tests such as mammograms), and links to portals with patient information on diseases and teatments.  On the community level, the information captured by the EMR could "help target public health effort." Public health agencies would be able to use the information not only for surveillance, but to determine if any the public health interventions are effective.  REF: Evidence on the Costs and Benefits of Health Information Technology (http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm)	+
−		+
−	* EMRS can provide clinicians answers to their information needs.  "Studies of clinicians' information needs reveal that common questions that physicians ask concerning patient information (e.g., Is there evidence to support a specific patient diagnosis? Has a patient ever had a specific test? Has there been any follow up because of a particular laboratory test result?) are difficult to answer from the perusal of the paper-based chart (Tang et al., 1994b)." The EMR can assist the clinician by display the relevant contents of the patient's record in a useful format.  REF: Edward H.  Shortliffe Editor, James J.  Cimino Associate Editor, Biomedical Informatics Computer Applications in Health Care and Biomedicine, Third Edition 471 pp..	+
−		+
−	* The EMR can calculate intake and output, cardiac outputs, body mass index, and other complex values that nurses used to calculate themselves. Robles, Jane. (2009) The effect of the electronic medical record on nurses' work. Creative Nursing Retrieved from http://findarticles.com/p/articles/mi_7514/is_200901/ai_n32316746/	+
−		+
−	* Ready access to data helps nurses feel empowered in decision making. Robles, Jane (2009)	+
−		+
−	* Computerized Provider Order Entry - Nurses spend less time tracking down providers, playing telephone tag, and performing actions that are outside their scope of practice. Robles, Jane (2009)	+
−		+
−	* Patient care handoffs are times of high risk, when breakdowns in communication can cause significant harm to the patient. An EMR provides detailed patient information, easily accessible to everyone, in a consistent format. SBAR (Situation, Background, Assessment, Recommendation) offers a standardized approach for handoff communication, such as reporting at shift changes and during patient transfers.  Robles, Jane (2009)	+
−		+
−	* With the use of unique barcodes on patient information scanned into an EMR, the possibility of putting information belonging to one patient in another patient’s file is almost completely reduced. Providing savings cost associated in ADEs, patient safety and malpractice.(http://www.pdcorp.com/en-001/healthcare/case-study-danbury-hospital.html )	+
−		+
−	* The use of EMRs allows more than one person in an organization to access a given patient’s data at one time. This increases productivity for everyone. The person performing a test does not have to wait on the physical chart to be available from the ordering doctor to load images from the exam. Just as the billing department does not need to wait for the radiologist to add exam reports before the patient is billed. This decreases the patient’s flow through time. REF: Osheroff Jerome, Pifer E, Telch J, Sittig D, Jenders R, Improving Outcomes with Clinical Decision Support: An implementers Guide. Chicago: Healthcare Information Systems Society; 2005.	+
−		+
−	Use of Electronic Medical Records (EMRs) as part of Immunization database and tracking systems or registries allows timely recall of patients for updates or missed immunizations. When used in conjunction with citywide or statewide systems such as the State of Texas' ImmTrac system, EMR allows the immunization records of participating families (which hopefully will reach 100% participation some day) who move frequently between practices, and who sometimes do not carry up to date immunization records, to be accessed and readily updated, thus avoiding duplications and omissions.	+
−	There's a great potential in a national and ultimately, global immunzation registry when this can be attained. Combined with a standardized and well- laid out continuity of care record included as a module in the EMR, access to the data globally for immunization updates wii help maintain the gains in control of infectious diseases especially in an era of frequent global travel.	+
−		+
−	Intregration of available community referral resources and support into the EMR of na out-patient communiity health facility will allow timely access to these resources for patient care co-ordination and quality care.	+
−		+
−	*Providers that have integrated a comprehensive Clinical Decision Support Systems (CDSS) into their EHR typically see a greater improvement in the quality of care of their patients. The most common of these improvements is the decrease in Adverse Drug Events (ADE). Incorporating CDSS into EHR can reduce these potential fatal errors up to 90% (Potts and others, 2004; Bates and others, 1999a, 1998a; Evans and others, 1998).	+
−		+
−	== '''Operational''' ==	+
−		+
−	* Promoting the Cost-Effective Use of Prescription Drugs: Evidence suggests that in hospitals, features of EHRs—specifically, clinical decision support (CDS) and computerized physician order entry—could help reduce the cost of prescription drugs by prompting providers to use generic alternatives, lower-cost therapies, and, for more complex drug regimens, cost-effective drug management programs. In outpatient settings such as clinics and physicians’ offices, health IT—specifically, e-prescribing—could alter prescribing practices in the direction of lower-cost drugs.  References:  Mullett CJ et al:  Development and Impact of a Computerized Pediatric Antiinfective Decision Support Program.  PEDIATRICS Vol. 108 No. 4 October 2001, p. 75;  Wang SJ et a; A Cost-Benefit Analysis of Electronic Medical Records in Primary Care.  Am J Med. 2003;114:397– 403.	+
−		+
−	* With back-office management software packages integrated with the EMR software, it is easier than the paper record systems to produce statistical analysis reports for administrative purposes like scorecard reports for clinic performance, or individual physician contributions.	+
−		+
−	* Joan Breuer, Ph.D. 01/22/2010 20:00 By building an EMR, there are opportunities for the IT staff to gain clinical knowledge.	+
−		+
−	* 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.	+
−		+
−	* 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.	+
−		+
−	* Protects patient data by preventing unauthorized individuals from accessing the clinical record.	+
−		+
−	* From an operational standpoint, EMR improve patient quality of care as well as operational excellence by providing an electronic method of capturing national quality indicators such as the Core Measures.	+
−	* The EMR trigger the completion of certain forms, alert for antibiotics, vaccines and or discharge medications for patient such as heart failure patients. By doing so, facilities will receive optimum quality awards and financial rewards which will impact the facility in a positive manner.	+
−	* EMR will improve the technology needed in order to provide patient with optimal care due to an increase in obtaining their medical information which will decrease unnecessary tests thus increase the flow of patients in the facility.  Patients will spend less time in the hospital which will decrease their length of stay and eventually decrease the overall cost of care.	+
−		+
−	* 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.	+
−		+
−	* 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]	+
−		+
−	* Documentation completed at conclusion of encounter.	+
−		+
−	* Preventing the missing patient paper medical records. 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.	+
−		+
−	* 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]	+
−		+
−	* 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]	+
−		+
−	* 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.	+
−	[Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]	+
−		+
−	* 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]	+
−		+
−	* 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]	+
−		+
−	* 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)	+
−		+
−	* Can allow for better appreciation of clinician performance for which can be used for employee bonuses.	+
−		+
−	* 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)]	+
−		+
−	* CPOE will automatically date and time physician orders, as recommended by regulatory organizations.	+
−		+
−	* EMR user authentication can protect patient records from unauthorized access.	+
−		+
−	* EMR user logging and auditing can provide assurance to patients that only authorized personnel have accessed their record (or proof that unauthorized personnel have accessed it).	+
−		+
−	*'''It reduces redundancy by eliminating duplicate testing'''.--[[User:Kjbracey|Kjbracey]] 15:10, 23 January 2011 (CST) http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art	+
−		+
−	*It increases patient privacy, by requiring secure login access.  It also gives patients access to their records at any time. http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art	+
−		+
−	* BCMA enhances tracking and understanding of medication delivery processes which can pinpoint opportunities for improvement in safety and efficiency.	+
−		+
−	* With EMR, disaster planning and recovery should be easier with today technologies, and should be similar to that of any organization with electronic systems.  It’s almost not possible to move all paper-based data and patients’ records to another site when nature hits the current site.	+
−		+
−	* With correctly designed EMR, an update should only need to be done in one place and will automatically synchronize with the rest of the system where the same data may resign.  With paper-based system, same data can be in multiple places and updating can be much more challenging with making sure all places are updated accordingly.	+
−		+
−	* Better, more efficient systems can be built only on top of an EMR.  Not much improvement can be made to a paper-based system.	+
−		+
−	* There are significant time gains that can be accomplished using an EMR.  A study done shows that a 75% improvement was achieved in complex NICU discharges.  [http://www.msdc.com/EMR_Benefits.htm]	+
−		+
−	* ''Data recovery becomes more manageable using a digital system versus a paper system''.--[[User:Kjbracey|Kjbracey]] 15:10, 23 January 2011 (CST)  Backups can be maintained for an EMR where as there are no disaster options for paper based systems.	+
−		+
−	* Automation of billing charges are typically included.  This reduces error in submitting codes to insurance companies.	+
−		+
−	* With anytime, anywhere access to their own EMR, patients can edit their medical history from the comfort of their home, and whenever they have time. Quickly editing a medical history in a waiting room is too error-prone. Additionally, it needs to be created only one time and could easily be corrected.	+
−		+
−	* Patient information cannot get lost or become inaccessible. This may happen with conventional records, for example when a practice is closed, or bad materials were used for paper or film material. The loss of electronic data is less probable due to highly evolved techniques for secure data storage.	+
−		+
−	* An EMR is almost essential in a telehealth-like setting, where a practitioner would like to ask a colleague for advice about a specific case. Through an EMR, the other side could easily access all the patient information. Besides saving time, efficiency is improved since the other side gets all information - or just part of it for privacy protection - and can decide what information is most relevant for the specific case.	+
−		+
−	* The use of a CPOE system in an ICU setting can cut down on errors [Potts AL, Barr FE, Gregory DF, Wright L, Patel NR. Computerized physician order entry and medication errors in a pediatric critical care unit. Pediatrics. 2004;113 :59 –63]	+
−		+
−	* The use of CPOE systems can improve the turnaround time of laboratory and radiology test results. [Thompson, Willie B, Dodek PM, Norena M, Dodek, Jordana BSc. Computerized physician order entry of diagnostic tests in an intensive care unit is associated with improved timeliness of service. Crit Care Med. 2004;32 :1306 –1309]	+
−		+
−	* Studies on "multifunctional systems" of HIT,  found evidence that implementing a multifunctional EHR system could increase the delivery of care that would adhere to guidelines and protocols, enhance the capacity of the providers of health care to perform surveillance and monitoring for disease conditions and care delivery, reduce rates of medication errors, and decrease utilization of care.  [B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006;144:742-752.]	+
−		+
−	*  Increased enrollment on clinical trials by using CDS to identify eligible patients.  Ref:  Embi PJ, Jain A, Clark J, Harris CM.  Development of an electronic health record-based Clinical Trial Alert system to enhance recruitment at the point of care.  AMIA Annual Symposium Proceedings, 2005:  231-5.	+
−		+
−	*  The ability to support patient mobility.  When a patient moves, is on vacation, or simply seeing a specialist; it is currently very difficult to transfer the Medical Records between hospitals.  With paper the records need to be pulled, faxed, and sent.  Then they need to be retrieved, processed, and then read.  With Integrated EMR, these steps can occur instantly.	+
−		+
−	*  Support of Bio-Surveillance.  We live in a time when man made (terrorists) and natural (epidemics) are all around us.  The advantage of the EMR is to eventually automatically, track outbreaks and health issues across regions, the country, or the world.  This will enable rapid detection and prevention of wide-spread out break.  The H1N1 outbreak is a prime example of how even a day or a few more hours of advanced notice could have helped contain the spread.	+
−		+
−	*  Re-purposing of data.  There is a push these days to do more with less.  Access to a hospital's patients data enables retrospective studies and data mining.  It is a ready and accessible source (assuming proper anonymity can be obtained when required).  Instead of spending millions of dollars to track how infusions affect patient outcome in the ER, that data could be mined from decades of patient information.	+
−		+
−	*  Helps in better adapting to HIPAA standards. HIPAA now requires stricter control over patients data, with better audit in general. EMR are better equipped to provide the combination of security from unauthorized access and the ease of access for authorized users. Moreover, an EMR is better suited to adapt to changes that might be enforced in the future.	+
−		+
−	*  Among the problems commonly faced in all clinical settings, is the problem of conflicting prescriptions. The inability of physician to account for other prescriptions by other physicians even within the same hospital leads to over-medicating, or conflicting medications.	+
−		+
−	*  Better supervision from physicians in charge. Within academic hospital, physicians may find it impossible to maintain a high standard of care along with all the responsibilities of teaching and supervising medical students. Physicians may find it much easier to follow students' notes across all the different records to grade and suggest any changes.	+
−		+
−	*  Facilitates the communication of patients' data and needs among different hospitals. With today's videoconferencing technologies, many hospitals opted to schedule weekly meetings to discuss difficult or interesting cases with other more specialized hospitals. EMRs allow both the ease of release/communication of data as required for these cases with the retention of unnecessary/private information about the patients.	+
−		+
−	* EMRs allow better integration to other operations such as billing, external departments and patient portals to manage, share, collect and protect the critical medical information.    Many EMRs are offered as services hosted over the Internet.  This allows clinicians to access them from any location worldwide using cell phone technology or laptops with cellular connectivity. In an implementation like this, patient information can be accessed literally anywhere without having any kind of network connection to the medical facility.	+
−		+
−	*  EMR systems facilitate the automation of records necessary for audit compliance with federal, state, and accreditation organization regulations. See “EXTRA: Patient Safety in the Physician’s Office: Assessing the Value of Ambulatory CPOE” [[http://www.chcf.org/documents/ihealth/PatientSafetyInPhysiciansOfficeACPOE.pdf]]	+
−	[[User:MikeField|MikeField]] 17:54, 23 January 2010 (CST)	+
−		+
−	*  EHR System provides valuable administrative tools wherein daily reports can be generated. Also, data collected can be sent to a spreadsheet where further analysis, data manipulation, and interpretation can occur. The Financial Impact of an Emergency Department Information System - Michael Hocker, Health Care Technology Volume 2.	+
−		+
−	*  An 11 study meta-analysis comparing paper vs. electronic demonstrated nurses saved 24 percent of their documenting time when using electronic systems.  The studies time savings ranged from 28 to 36 minutes per nurse per eight hour shift.  For a 32 bed unit with 1:8 patient to nurse ratio, 36 minutes per shift saves 2 hours 24 minutes.  This does not allow for savings by changes in staffing with 1 less nurse. Studies with a more broad perspective suggest savings ranging from 95 to 260 minutes per 12-hour shift for each nurse.  This does allow for the possibility of staffing changes, only if nursing operations and cultures can adapt. “Incremental” overtime (OT) costs are incurred when nurses complete documentation at the end of their shifts.  Work compiled from 8 hospitals found a range of incremental OT to be from 96 cents to $3.23 per admission (excluding newborns).  Nursing leaders estimate potential OT cost reduction of 80 percent, or 77 cents to $2.30 to be expected for a typical 300 bed hospital per non-newborn admissions or a savings of $11,000 to $33,000 per year.  A 28 to 38 minute reduction per nurse per shift could reduce or eliminate “incremental” overtime costs. [Thompson MBA, Douglas I, Osheroff MC, Jerry, Classen, MD, David, and Sittig PhD, Dean F.  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.1:67-68]	+
−		+
−	* CPOE implementation reduced the mean pharmacy order processing time from composition to verification by 97%. After CPOE implementation, a new medication order was verified as appropriate by a pharmacist in three minutes, on average. Ref: "Effects of computerized prescriber order entry on pharmacy order-processing time" - Jon Wietholter, Susan Sitterson, and Steven Allison	+
−		+
−	*Implementing an EHR can increase reuse of data that is collected at point of care for many groups downstream in the health system.  Many times data is recollected and re entered in to various systems which increases time and costs.	+
−		+
−	*Having an EHR can facilitate the need for a national person identification number that can be used to identify individuals when seen at various locations.  The national person identification number will promote the ability to integrate records from various institutions to give a complete picture of the person by providers.''Diabetes information systems: a rapidly emerging support for diabetes surveillance and care. Joshy G, Simmons D.Waikato Clinical School, University of Auckland, Hamilton, New Zealand. joshyg@waikatodhb.govt.nz	+
−	''	+
−		+
−	* Pay for performance linked to patient health outcomes are now a real possibility with electronic medical records, which integrate a patient’s medical history, health status and other health indicators in addition to medical visit encounters. Crane, R.M. & Raymond, B. (2003). Fulfilling the Potential of Clinical Information Systems. ''The Permanente Journal'', 7(1), 62-67.	+
−	* Patient portals integrated in electronic medical records, which offer appointment scheduling, retrieval of test results, and other services, make it possible for patients to participate in their health care with their providers. Most savvy healthcare consumers know that they must be active in their own care if they want to obtain the highest quality. Crane, R.M. & Raymond, B. (2003). Fulfilling the Potential of Clinical Information Systems. ''The Permanente Journal'', 7(1), 62-67.	+
−		+
−	* EMRs have significant potential to address impending workforce shortage in health care[http://www.hemonctoday.com/article.aspx?rid=67420 1][http://www.asco.org/ASCO/Downloads/Research%20Policy/Workforce%20Presentation%20at%202007%20Annual%20Meeting.pdf 2]	+
−		+
−	* Greater EMR sophistication may be associated with emergency department (ED) efficiency.  Relative to EDs with minimal or no EMR, fully functional EMR was associated with 22.4% lower ED length of stay and 13.1% lower diagnosis/treatment time. However, relationships varied by patient acuity level and diagnostic services provided.  [http://mcr.sagepub.com/content/early/2010/06/07/1077558710372108.abstract (Medical Care and Research Review, 2010 Jun 16; Epub 2010 Jun 16)]	+
−		+
−		+
−	* A 2007 article by Liang, titled ‘The Gap Between Evidence and Practice’, in Health Affairs, discusses the opportunities to improve healthcare by learning from the data available in electronic health record databases in order to bridge the gap between evidence and practice. The paper emphasizes the importance of the use of EHR data for comparative clinical effectiveness research. This potential benefit of EHRs is also addressed by the May 2008 Congressional Budget Office report - ‘Evidence on the Costs and Benefits of Health Information Technology’.	+
−		+
−	* Software and hardware vendors are making things easier for doctors with cloud computing and secure web-based computing. These applications let doctors use the same laptops they’ve always used, but it gives them access to large volumes of clinical data, patient history and even 3D avatars that help doctors visualize medical records. The use of EMR as a standard way to exchange healthcare information will lower the costs of healthcare delivery and let physicians get back to the basics — thoughtful, holistic patient care. And it won’t stop there. Doctors will be able to take a proactive role in patient care, anticipating potential problems and dealing with them before they even arise, because they will have visibility into their patients’ complete medical records across the full range of doctors and healthcare providers.[http://classic.cnbc.com/id/38973121]	+
−		+
−	* Software like Medical Dragon NaturallySpeaking with its ability to produce real-time language as enriched the lives of medical practitioners and their patients. It allows direct data entry by clinicians and staff by voice eliminates the need for transcription. Voice recognition software helps “voice writing” to document a verbatim record of medical examinations and surgeries saving approximately $10,000 per year. Dragon Naturally Speaking costs 80% less than manual medical transcription.[http://www.ehrdoctors.com/page/2/],[http://www.dragon-medical-transcription.com/]	+
−		+
−	* Electronic claims processing is one of the many benefits of EMR software and service packages. With EMRs, electronic claims processing makes receiving payments faster, billing easier and more accurate.(http://hubpages.com/hub/The-Benefits-of-Electronic-Claims-Processing-with-EMR)	+
−		+
−	* EMR allows fast access to patient’s medical record, update the record with changes in address  or insurance carrier.(http://www.mayoclinic.org/emr/benefits.html)	+
−		+
−	*EMR enables generation of report easily and instantly. Reports can be conveniently generated and programmed to automatic settings. Such reports can be used for assessment of various variables of performance, analysis, compliance and for research studies.	+
−		+
−	Regionally integrated EMRs can help improve the safety of ar-risk patients, or narcotic addicted patients who may visit several emergency departments seeking treatment and medications for their habit. This can save time and cost since these patients may not have health insurance, and time that would have been spent on these patients can be extended to the care of emergency patients.	+
−		+
−	'''EMRs can have a significant effect on patient care when successfully integrated with a fully featured Laboratory Information System (LIS) including:'''	+
−		+
−	*Decrease in patient stays - a delay of a few hours through inefficient ordering processes can increase length-of-stay by up to 24 hours for some tests	+
−	*Results in fewer diagnostic duplications, especially when coupled with a CDSS (which otherwise must be monitored by specially trained nursing or lab personnel	+
−	*Can greatly reduce patient morbidity and mortality (once again especially when coupled with a CDSS) by quick reporting of critical values directly to involved providers	+
−		+
−	== '''National''' ==	+
−		+
−	* The American healthcare industry needs a national database of actual EMR implementation results to meet the absence of a low-cost, easy-to-use method for a typical hospital to reasonably estimate the potential benefits of an EMR purchase.  This database should include EMR implementation results using 1.common or standardized terms, 2.definitions, and 3.calculation metrics,4.--[[User:Kjbracey|Kjbracey]] 14:50, 23 January 2011 (CST) as well as information about the actual EMR implementation environment for truer apples to apples comparison.  HIMSS CIS Benefits Taskforce has an initial framework to begin addressing this need.  The framework consists of: 1.  Hospital Demographic Information 2.  Measures to describe the technology infrastructure of the organization 3.  Descriptive measures of how the technology is being used by clinicians 4.  Benefit categories that are defined 5.  System components defined and associated with each benefit 6.  Quantitative metrics for each benefit category 7.  Entry of above framework data into a web-based data collection tool by hospitals  expanding the database and allowing others to find similar hospitals to estimate their own costs  [Thompson MBA, Douglas I, Osheroff MC, Jerry, Classen, MD, David, and Sittig PhD, Dean F.  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: 66-67]	+
−		+
−	* To broadly examine the potential health and financial benefits of health information technology (HIT), this paper compares health care with the use of IT in other industries. It estimates potential savings and costs of widespread adoption of electronic medical record (EMR) systems, models important health and safety benefits, and concludes that effective EMR implementation and networking could eventually save more than $81 billion annually—by improving health care efficiency and safety—and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits(http://content.healthaffairs.org/content/24/5/1103.full)	+
−		+
−	* Sound public policy recommendations worthy of serious consideration have been identified by Crane, Raymond [1] to enable widespread clinical IT systems implementation.  1.  Leadership in the development of standard clinical vocabulary, standards for exchange of clinical information, and interoperability standards.  2.  Barriers to legitimate development and use of clinical information supporting a balance between public privacy right’s and a clinician’s ability, within an uncoordinated delivery system, to manage care and perform research that benefits society.  3. Costs of health information technology (HIT) should be shared among those that benefit.  4.  Promotion of and focused study on research and development focused on HIT implementations.  The Stimulus Act of 2009 is providing clear movement in this direction[2].  The American Recovery and Reinvestment Act (ARRA), has many implications on health information issues.  AHIMA is actively monitoring, participating and developing resources to assist in understanding the key components of this law and the impact on the industry and practice. Information on healthcare reform will be continually evolving.  Important HIM issues include:  1.  Incentives for adoption of EHRs,  2.  Health information exchange (HIE),  3.  New privacy regulations for both HIPAA and non-HIPAA entities, and  4. HIM workforce opportunities.  [1] Crane MPA, Robert; Raymond MPH, Brian.  Fulfilling the Potential of Clinical Information Systems.  The Permanente Journal Winter 2003, Vol. 7, No. 1: 66    [2] http://www.ahima.org/arra/	+
−		+
−	*With the public and government demand for healthcare reform it is critical that health care technology structure be improved.  Implementing EMR will help achieve that success but uptake by the US has been slow with only 7% of the providers using them. Taking the Pulse: Physicians and the Internet(1). (1) New York:Deloitte and Touche 2000. Other industries have improvement in quality, security and productivity using IT infrastructure and it seems this could also translate to the healthcare Industry to slow down the rising healthcare costs while improving quality.(2)  A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database.  (2)Thompson, MBA; Osheroff, MD; Classen, MD; Sittig, PhD. Journal of Healthcare Information Management Vol 21.1 pp 63''	+
−		+
−	* To realize the plan to create a National Health Information Network for providers, hospitals and public health systems an EHR system is needed to facilitate data exchange. The implementation of an EHR system for national use will improve the health of the population which is a goal of the Department of Health and Human Services. An Electronic Health Record - Public Health (EHR-PH) System Prototype for Interoperability in 21st Century Healthcare Systems Anna O. Orlova, PhD,Mark Dunnagan, Terese Finitzo, PhD, Michael Higgins, PhD, Todd Watkins, Allen Tien, MD, MHS, and Steven Beales AMIA Annu Symp Proc. 2005; 2005: 575–579.	+
−		+
−	* Regional Health Information Organizations have the potential to revolutionize health care delivery. By connecting disparate providers, payers and other stakeholders, RHIOs are supposed to streamline and accelerate the flow of patient data. Medical records will move seamlessly from doctors’ offices to hospital to outpatient clinic. The ultimate goal is better care for patients, and billions of dollars in savings for the industry as a whole.  But RHIOs are still very much in their infancy and are plagued by many unresolved issues, including a clear definition of what they are.  [www.hhnmag.com, "A Primer for Building RHIOs", By Dagmara Scalise] [EarnValle9_11_10]	+
−		+
−	* HIE and RHIO benefits can be measured along following key axis:	+
−	•Quality of care improvement by way of greater access to data, newer data sources and technologies	+
−	•Reduction in costs achieved either through efficiency and productivity gains or avoidance of redundant provider services	+
−	•Improved patient experience with the system resulting in higher “customer satisfaction”	+
−	•Compliance with legal, accreditation and standards of care practices	+
−	•Ability to add new revenue stream due to new business opportunity the network creates [http://www.healthunity.com/handbook_hie_benefits.aspx] [EarnValle_9_12_10]	+
−		+
−	* One feature of health IT that may qualify as a public good is the wealth of information that can be captured through EHR systems. (As discussed earlier, if researchers	+
−	combined data from the EHRs of the population, they might be able to understand the spread and prevention of various diseases and injuries—and eventually develop cures and treatments; assess the effectiveness of various treatments; and more readily detect potential treatment hazards.) [http://www.cbo.gov/ftpdocs/91xx/doc9168/05-20-HealthIT.pdf] [EarnValle_9_12_10]	+
−		+
−	* EMRs can support federal and state mandatory reporting requirements. Electronic data storage that employs uniform data standards will enable health care organizations to respond more quickly, thus improving disease surveillance and there by promoting early detection of fatal infectious diseases [http://www.openclinical.org/emr.html 1], [http://www.bt.cdc.gov/episurv/ 2].	+
−		+
−	• Provides complete and accurate access to patient information for providers and demonstrates time saved over paper record.	+
−	• Expedites results reporting through customizable displays	+
−	• Supports a common user interface for accessing patient information, usually through a workstation.	+
−	• Supports monitoring and analysis of patient care outcomes	+
−		+
−	* On a national and even international level, one benefit of EMR’s is to have potential research information readily available for multiple studies. The result would be not only more data but more immediate data.  This allows for more studies to validate or eliminate new approved therapies and medications resulting in improved health care.	+
−		+
−	* EMR’s systems that are linked nationally would allow for healthcare workers to identify and treat new outbreaks in infectious/communicable diseases in a specified region. Faster identification of the cause would allow for faster treatment and a decrease in illness and death.	+
−		+
−	* Federal government agencies such as the CDC, FDA, VA, HHS will better be able to allocate resources around the country based on data that is collected from an EHR. Such data will allow for improved risk management and planning for disasters such as an epidemic or biological attack.	+
−		+
−	== Health Record Banking ==	+
−	One benefit of EMR's is that they enable the implementation of health record banks.  A health record bank is a centralized location for storage of an individual's EMRs.  Whenever care is provided the records generated can be added to the individual's banked personal health record (PHR).  At any time an individual can access their own medical records and review them for accuracy.  [Ref: Health Record Banking Alliance, http://www.healthbanking.org]	+
−		+
−	When a person with banked health records seeks medical care, they can give their care provider access to all or part of their PHR that has been stored in the bank up to that point.  Over time a person who uses a health record bank could collect all their relevant medical history and have it accessible in one location.	+
−		+
−	The concept of the health record bank was first introduced in an article in the July/August 2000 issue of MD Computing.  [Ramsaroop P & Ball J. The "Bank of Health" - A Model for More Useful Patient Health Records. MD Computing. Vol. 17, No. 4, July/August 2000:45-48.]* [http://www.gadgetsdotcom.com ]	+
−		+
−		+
−	== Health Research==	+
−		+
−	* EMR allows researchers to efficiently search patient medical information by medical condition, date of treatment, physician name and test category. Researchers can use the EMR to analyze large amounts of patient information more efficiently, speeding the application of new research findings to improving patient care.  (http://www.mayoclinic.org/emr/benefits.html)	+
−		+
−	* We will look at four specific categories within a medical office where an EMR can make a significant difference, and within each category we will provide concrete examples of benefits realized by clinics across the country. Each example has either top line (=increased revenue) or bottom line (=increased profitability) implications for the clinic. Keep in mind that the EMR is a tool with a broad set of features and capabilities that are optimized when the clinic is able to fully transition to the electronic chart (as opposed to running dual paper and electronic systems)(http://emrresource.com/)	+
−		+
−	The categories are as follows:	+
−		+
−	- Cost Reduction	+
−	- Revenue Enhancement	+
−	- Improved Administrative Efficiency	+
−	- Improved Clinical Efficiency, Patient Care, and Service(http://emrresource.com/)	+
−		+
−		+
−		+
−	* Generating Data for Research on Comparative Effectiveness and Cost-Effectiveness of Treatments:  Proponents of the adoption of health IT note its potential to provide a massive source of new health care data—once patients’ identifying information has been removed and the data have been standardized and assembled in a repository—for research on the comparative effectiveness and cost-effectiveness of medical treatments. The data could provide more-comprehensive information about the health histories of different patients and about the outcomes of their treatments than has previously been available. And the depth and breadth of the data would make it easier to take into account the differences among patients who receive different treatments and allow researchers to assess a broad set of outcomes.	+
−		+
−	The knowledge gained from such studies could:	+
−		+
−	Improve treatment protocols and methods,	+
−		+
−	Lead to better outcomes for patients,	+
−		+
−	Lower costs for health care,	+
−		+
−	Improve postmarketing surveillance of pharmaceuticals (to ensure that a drug is effective and has no unexpectedly harmful side effects) that have been approved by the Food and Drug Administration,	+
−		+
−	Help target public health efforts, and	+
−		+
−	Support early detection of outbreaks of diseases.	+
−		+
−	Reference:  HMO Research Network, Agency for Healthcare Research and Quality (Congressional Budget Office, 2007b).	+
−		+
−	* EMR can assist the FDA in postmarketing surveillance of drugs to ensure that they are effective and there are no unexpected harmful side effects. (http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm)	+
−		+
−		+
−	* Wikipedia--JM Appel. Why shared medical database is wrong prescription. Orlando Sentinel, December 30, 2008. http://www.orlandosentinel.com/news/opinion/views/orl-opappel3008dec30,0,4065787.story	+
−		+
−	Research	+
−	EMRs can facilitate research collaboration by allowing movement of large amounts of data between and across computers for viewing and analysis without the usually large cost associated with moving, sorting and and storing paper data.	+
−		+
−	* EMRs allow for de-identified patient information to be consolidated and analyzed for trends in populations.	+

---

Latest revision as of 18:33, 22 September 2015

The sections below detail the benefits, costs, and barriers in evaluating EMR implementations. Selecting, financing, and launching an EHR system is difficult.

Informational

EMR Benefits: Informational

Security

EMR Benefits: Security is an advantageous attribute which comes with EMR systems. Centers for Medicare and Medicaid Services (CMS) published a privacy, security & meaningful use guidelines which computer systems that store patient information need to conform to imply to HIPAA privacy guidelines. ^[1]

Environmental

EMR Benefits: Environmental positive impact through Electronic Health Records has the potential to improve the environmental footprint left by the health care industry. ^[2]

Quality Outcomes

EHR’s can be utilized to generate reports on quality measures in the effort to improve quality and patient satisfaction. With the ability to produce reports from EHR’s, clinicians can easily compare data to baseline data and quickly identify areas in need of improvement. Once areas in need of improvement have been identified, clinicians can compare data to manual reports and similar data to validate the reported information. Once an area of improvement has been identified it can be delivered to the performance improvement department where informatics professionals can perform gap analysis and identify methods to improve overall quality. , Cite error: Closing </ref> missing for <ref> tag

In addition the use of EMRs in a teaching environment allows trainees access to the most up to date information. “Point-of-care education accessed via CDS allows for easy access to relevant and up-to-date medical literature from which students and residents can draw to formulate diagnosis and management plans".^[3]

Financial

EMR Benefits: Financial

"Implementing an EMR system could cost a single physician approximately $163,765. As of May 2015, the Centers for Medicare and Medicaid Services (CMS) had paid more than $30 billion in financial incentives to more than 468,000 Medicare and Medicaid providers for implementing EMR systems. With a majority of Americans now having at least one if not multiple EMRs generated on their behalf, data breaches and security threats are becoming more common and are estimated by the American Action Forum (AAF) to have cost the health care industry as much as $50.6 billion since 2009." ^[4]

Some of the ways that EMR systems can cut healthcare costs are due to savings based on "time-consuming paper-driven and labor-intensive tasks":^[5]

• Reduced transcription costs^[5]
• Reduced chart pull, storage, and re-filing costs ^[5]
• Improved and more accurate reimbursement coding with improved documentation for highly compensated codes ^[5]
• Reduced medical errors through better access to patient data and error prevention alerts ^[5]
• Improved patient health/quality of care through better disease management and patient education ^[5]

There are few comprehensive estimates of savings from Health Information Technology (HIT) at the national level. At 90 percent adoption, it is estimated that the potential HIT – enabled efficiency savings for both inpatient and outpatient care could average more than 77 billion per year.^{[6] [7]}

Although the full extent of EMR advantages may not become apparent until further implementation and research is carried out, a clear benefit is the reduction of cost. Major administrative costs can be eliminated or reduced. Providers can do away with the costs of “chart pulls,” while substantially reducing dictation costs through the use of EMRs. Healthcare providers can also receive decision support regarding selection and costs of medications, radiographic studies, and laboratory tests.^[8]

Billing Accuracy

The benefits for small to medium private practices that have implemented EMR systems integrated with the practices' billing and prescription systems, can be increased efficiency and accuracy thanks to automatic coding leading to improved profitability. "Since installing the EMR, Medicare has audited only one of my charts. I had billed out as a level four and Medicare said it should have been billed as a level five, which, in essence, said that we should have been paid more. My EMR system gave the chart a level four and I believe it was right.” "Since adopting an EMR system, my practice receipts have increased about $4,000 per month."^[9]

A nuanced view is appropriate here, however; improved billing can coincide with fewer patients seen. "EHR implementation ... increased reimbursements but reduced long-term practice productivity across all specialties"^[10] according to one study. This may be a net financial positive for the practice: "an EHR should greatly enhance physician effectiveness even if fewer patients are seen by the physician"^[10] due to gains in billing efficiency, but this also represents an artificial reduction in the supply of services.

An EMR Cost Benefit Analysis

Samsung Medical Center (SMC) performed a cost benefit analysis (CBA) on the cost benefits of implementing an electronic medical record (EMR) system. Costs of implementing the EMR system involved both direct costs to build the system infrastructure and induced costs to make a smooth transition to the new system. Benefits of implementing the EMR system include both cost reductions and increased revenue. Five types of cost reductions, mentioned by the authors, include:

1. Reduction of supplies for paper charts
2. Disposal of storage facilities used for paper chart storage
3. Reduction of full-time equivalent (FTE) employees for the paper chart management
4. Reduction in staff for outpatient clinics
5. Decreased supplies for medical devices

The FTE's responsible for paper management were greatly reduced from 28 FTE's (2007) to 1 FTE (2009).

This CBA was based on an eight year period post EMR implementation. SMC determined the EMR system became cost effective shortly after 6 years. The outcomes of the CBA were calculated using the following formulas:

• The primary outcome is the Net Present Value (NPV)
  • NPV = Present Value (PV) of benefit for the eight year period - PV of cost
• The second outcome is the Benefit Cost Ratio (BCR)
  • BCR = PV of the benefit / PV of the cost
• The third outcome is the Discounted Payback Period (DPP).
  • This is the time to reach the breakeven point.

This CBA does not include clinical benefits of the EMR implementation such as decreased medication errors, improved workflow, and reduced length of stay.^[11]

Improving Patient Care

EMR Benefits: Healthcare quality

Many EMRs have alert systems that ensure physicians do not forget to request important tests. As well as the legal benefits that this provides, EMR alerts remind physicians of the "preventive care needs for patients, which helps improve quality of care and office income by reminding us to do appropriate testing and provide vaccinations" recommended for some patient conditions e.g. asthma, emphysema or diabetes. ^[12]

EMR Benefits: Reduction in no shows

EMR system was used to improve on automated calls made to patients to remind them of their appointment which reduced the number of no call shows and improved patient satisfaction. ^[12]

EMR Benefits: Medication Management

"Rational antibiotic use resulted in a lower mortality of 0.0644 % during the post-implementation period compared to 0.179 % during the pre-implementation period (p = 0.018). The comprehensive EMR system contributed to a significant reduction in antibiotic consumption and an improvement in rational antibiotic use."^[13]

EMR systems have the ability to make evidence-based suggestions regarding patient care. With these suggestions, EMRs are able to use a patient’s information to identify preventative services that specific patient may need. The system is able to remind doctors that the patient is due for certain screening exams or other services which allows the doctor to discuss it with the patient and also allows the patient to decide whether or not they would like to schedule an appointment for that specific exam. This reminder has proven to benefit patient care by increasing compliance with preventative care.

EMRs also benefit patient care by assisting in long-term chronic disease prevention and management. Case management systems in EMRs allow patients to communicate with a variety of specialists, which better enables them to manage their care. This system also allows healthcare providers to keep track of patient data, such as vital signs, and allows case management nurses to quickly respond to any issues that may occur. The system benefits the patient because it allows the patient’s acute issues to be handled promptly before they become bigger issues that may lead to a hospital admission.

EMRs have the ability to eliminate up to 200,000 adverse drug events with the use of CPOE. Using reminders and alerts CPOEs are able to notify physicians about possible drug interactions that may occur when a new medication order is placed.

EMRs have a direct correlation with the quality of healthcare offered to a patient. Problems in healthcare quality fell into three categories as stipulated by the National Roundtable on Health Care Quality. These three categories are the underuse, overuse, and misuse of healthcare services. Reducing overuse and misuse of healthcare services, as noted by the Roundtable, leads to an increase in health care quality while simultaneously lowering costs. In addition, reducing the underuse of healthcare services increases quality, but may in turn increase costs. “Computerized physician order [CPOE] entry may affect all three categories of health care quality problems, as well as inefficiencies in the health care system.” ^[14]

Research

EMR Benefits: Research

Researchers can use EHRs to retrieve up-to-date data from various sources around the country to advance their studies. EHRs can compute a report to show researchers certain trends in the population or common side effects of medications. ^[15]

Health Information Exchange (HIE)

EMR Benefits: HIE

Personal Health Records

EMR Benefits: PHR

Patient Participation

Patients can use personal health record (PHR) to keep track of information from doctor visits, record health-related information, and link to health-related resources. PHR, is an electronic application used by patients to maintain and manage their own health information. Connected PHRs are linked to a specific health care organization's EMR system that can increase patient and family participation in their own care. ^[16]

Electronic Dental Records

EMR Benefits: EDR

Telehealth

EMR Benefits: Telehealth

E-Prescribing

EMR Benefits: E-Prescribing

E-Prescribing has many benefits, some of them include: ^[17]

• reduce illegibility ^[18]
• providing warning and alert systems, which reduce medication errors ^[18]
• access to patient's medical history ^[18]
• reduces or eliminates phone calls and call-backs to pharmacies ^[18]
• eliminates faxes to pharmacies ^[18]
• streamlines the refill and authorization processess ^[18]
• increases patient compliance ^[18]

Mobile EMRs

EMR Benefits: mHealth

Physicians

EMR Benefits: Physicians

Physicians Benefit

EMRs can greatly improve communication between physicians by allowing each full access to the patient’s medical record and by making it easier for physicians to follow up with patients. The electronic record provides up to the minute information on the patient allowing more efficient collaboration between disciplines. EMRs allow multiple providers to simultaneously access a patient’s record from any authorized computer.^[19]

Nurses

EMR Benefits: Nurses

Nurses use the EMR to identify newly admitted patients, track their location, and document admission information. The nursing SWAT team harnessed the power of EMR technology, and successfully re-organized nursing workflow to expedite the admission process, while maintaining patient and family centered care.^[20]

Versatile capabilities of EHRs in healthcare settings

There are many studies showed that EHRs are capable to integrate with various standards systems such as billing codes, clinical notes, ICD diagnose codes, and medications, which essentially enhances effectiveness and efficiency of care and results in superior phenotyping performance compared with paper-based medical record systems. ^[21].

Improvement of Spontaneous Reporting System for drug post-marketing safety surveillance

In the healthcare settings, Spontaneous Reporting Systems (SRSs) are critical systems for monitoring drug post-marking safety and adverse drug reactions (ADRs). Although widespread utilization of SRSs has played a fundamental role in drug safety monitoring, there are certain limitations that hinder their efficacy and accuracy in practices. For example, multiple sources of data are needed for confirmation and validation; the nature of passive reactions to ADR events makes SRSs perform poorly in terms of pharmacovigilance. The integration of an SRS system into EHRs could have potential to improve efficiency and effectiveness of detection for ADR events. The combination of an SRS with EHRs could help collect data and information related to ADRs dynamically while avoiding the need of data validation from multiple sources and potentially reducing the costs. ^[22]

Improvement of healthcare outcomes through interactive collaboration among stakeholders

It has been reported that the integration of a Network-Based Learning Health System with EHRs can potentially improve a variety of healthcare outcomes. For example, integrating chronical care management, quality improvement, patients and their family engagement, and comparative research. ^[23]. Therefore, EHRs can serve as an effective platform and infrastructure that fascinates online learning for all stakeholders, and patient-centered quality care and evidence-based medical research.

Costs

Return on investment

It is estimated that purchasing and installing an EMR can cost a provider anywhere from $15,000 to $70,000. There are several things to consider when looking for an EMR for your organization or practice. The prices vary based on number of providers using the EMR and whether it is a select on-site EHR deployment or web-based EHR deployment. Other factors to take into consideration of what costs you will incur include these 5 components of implementation: ^[24]

• Hardware: Hardware costs may include database servers, desktop computers, tablets/laptops, printers, and scanners. ^[5]

• EHR Software: Potential software costs include an EHR application, interface modules and upgrades to your EHR application. Remember, software costs vary depending on whether you select an on-site EHR deployment or a SaaS EHR deployment. ^[5]

• Implementation Assistance: Potential implementation assistance costs include IT contractor, attorney, electrician, and/or consultant support; chart conversion; hardware/network installation; and workflow redesign support. ^[5]

• Training: Your organization will need to train your physicians, nurses, and office staff before and during EHR implementation. ^[5]

• Ongoing Network Fees and Maintenance: Potential ongoing costs include hardware and software license maintenance agreements, ongoing staff education, telecom fees, and IT support fees. ^[5]

• Although the initial cost of an EMR may (and typically does) result in an immediate increase in administrative cost, through the reduction of other “removable and or defunct items or process the implementation of the EMR showed a positive improvement in the BCR and NPV. ^[25]

   examples: remodeling of paper-chart storage areas, medical transcriptions, shorter chain of communication, reduction of administrative material

==Cost vs Time == (A reduction of time spent on a common process can lead to reduced cost and better efficiency)

• EMRs can greatly reduce or make more efficient use of time.

A recent study (July-2015)EMR decision support systems where proven to have reduced and or made more efficient use of the time needed for “Colorectal cancer screening where the immediate harms are balanced with longer-term benefits.” By providing a “personalized benefit/harm assessment”. ^[26]

Implementaion

For a proper return on investment a proper implementation of EHR is needed. lots of things have to be kept in mind for a successful implementation of an EHR.

• Benefits and risks of the EHR.
• cost
• specifications of our needs and what we want and what the EHR have.
• vendor certifications.
• preparations for implementation and after.

The journal of Emergency medicine titled with "computers in Emergency medicine" talks about all aspects of EHR implementation. ^[27]

Neonatal Informatics and CPOE

Computerized physician order entry (CPOE) can be considered one of the major contributions to patient safety and health care quality from an EMR system implementation. CPOE and clinical decision support (CDS) systems have the potential to impact care of the critically ill neonatal patients to an even greater extent than other patient groups. Implementation of CPOE with CDS has been shown to specifically benefit Neonatal care intensive care units (NICU) with improved medication turnaround times, decreased medication errors, reduced adverse drug effects, and improved radiology turnaround times.^[28]

While studies have shown these benefits to be consistent with CPOE and CDS equipped institutions, the effects of these systems on morbidity and mortality have been ambiguous. A 2005 article reported an increase in mortality rate with the implementation of an EMR system with CPOE in a pediatric intensive care unit (PICU).^[29] The informaticists and hospital administration, determined that errors with the implementation process of the CPOE system resulted in these negative results. They stressed that a change in the workflow design was essential for a safer CPOE implementation. A more recent 2010 article reported a decrease in neonatal mortality rate using the exact same CPOE system.^[30]These findings indicate that the implementation of the CPOE system needs to include careful consideration of workflow analysis. However, even with the utmost attention being given to ensure the safety of a new CPOE system, inadvertent issues may still arise with human error. An example of such would be a physician order entry on the wrong patient.^[31]

Specialty clinics

EHR’s can significantly improve the productivity for specialty physician clinics such as for ophthalmology. Incorporating an EHR, a clinic can reduce process and time spent on recording patient data, as most diagnostic equipment can communicate with EHR’s. With medical and diagnostic equipment communicating with EHR’s, staff and technicians can focus more on the patient. ^[32]

Benefits Database

EMR Benefits: Benefits Database

A national repository of EMR benefits data is needed to help stakeholders make more informed decisions about EMR implementation and to facilitate monitoring and corrective redesign of existing EMR implementations. A framework for reporting data should be developed that will enable meaningful comparisons, provide uniform benefit categories and standardized methods of measurement and evaluation.^[33]

Compliance

EMR Benefits: Compliance

18. Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs. Health Affairs, 1103-1117. doi:10.1377/hlthaff.24.5.1103 Health Aff September 2005 vol. 24 no. 5 1103-1117

References

1. ↑ Centers for Medicare & Medicaid Services. Privacy and Security Standards. http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/HIPAAGenInfo/PrivacyandSecurityStandards.html
2. ↑ Turley, M., Porter, C., Garrido, T., Gerwig, K., Young, S., Radler, L., & Shaber, R. (2011). Use of electronic health records can improve the health care industry’s environmental footprint. Health affairs, 30(5), 938-946.
3. ↑ Tierney et al, Medical Education in the Electronic Medical Record (EMR) Era: Benefits, Challenges, and Future Directions http://tmclibrary.summon.serialssolutions.com/search?s.q=tierney+m+j#!/search?ho=t&l=en&q=Medical%20education%20in%20the%20electronic%20medical%20record%20(EMR)%20era:%20Benefits,%20challenges,%20and%20future%20directions.%20Academic%20Medicine
4. ↑ O'Neill, T. (2015, August). Are Electronic Medical Records Worth the Cost of Implementation.
5. ↑ ^{5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10} Kumar, S., & Bauer, K. (2011). Medical Practice Efficiencies & Cost Savings.http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings
6. ↑
7. ↑ Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. Health Affairs, 24(5), 1103-1117.
8. ↑ Bates, D. W., Ebell, M., Gotlieb, E., Zapp, J., & Mullins, H. C. (2003). A proposal for electronic medical records in US primary care. Journal of the American Medical Informatics Association, 10(1), 1-10.
9. ↑ EMR ROI: A Pennsylvania family practice's investment in an EMR pays off three-fold. http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?p=HRCA&u=txshracd2509&id=GALE%7CA163469720&v=2.1&it=r&sid=summon&userGroup=txshracd2509
10. ↑ ^{10.0 10.1} Howley et al, 2015. "The long-term financial impact of electronic health record implementation" http://jamia.oxfordjournals.org/content/22/2/443
11. ↑ Choi, J., Lee, W., Rhee, P. (2013). Cost-Benefit Analysis of Electronic Medical Record System at a Tertiary Care Hospital, Health Informatics Research;19(3):205-214. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3810528/
12. ↑ ^{12.0 12.1} How We Improved Our Practice and Our Bottom Line With a New EMR System.Fam Pract Manag, 15(7), 25. http://www.aafp.org/fpm/2008/0700/p25.html
13. ↑ The Meaningful Use of EMR in Chinese Hospitals: A Case Study on Curbing Antibiotic Abuse 15(7),
14. ↑ Kuperman, G. J., & Gibson, R. F. (2003). Computer physician order entry: benefits, costs, and issues. Annals of internal medicine, 139(1), 31-39.
15. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Enormous_Benefits
16. ↑ http://www.healthit.gov/providers-professionals/patient-participation
17. ↑ Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing
18. ↑ ^{18.0 18.1 18.2 18.3 18.4 18.5 18.6} Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing
19. ↑ http://www.usfhealthonline.com/resources/healthcare/benefits-of-ehr/#.VfjJDXktDmQ
20. ↑ http://www.sciencedirect.com.ezproxyhost.library.tmc.edu/science/article/pii/S0882596314002413
21. ↑ Wei, W.Q., Teixeira, P. L., Mo, H., Cronin, R. M., Warner, J. L., & Denny, J. C. Combining billing codes, clinical notes, and medications from electronic health records provides superior phenotyping performance. Journal of the American Medical Informatics Association: JAMIA. http://doi.org/10.1093/jamia/ocv130
22. ↑ Pacurariu, A. C. Useful Interplay Between Spontaneous ADR Reports and Electronic Healthcare Records in Signal Detection. Drug Safety. http://doi.org/10.1007/s40264-015-0341-5.
23. ↑ Marsolo, K., Margolis, P. A., Forrest, C. B., Colletti, R. B., & Hutton, J. J. A Digital Architecture for a Network-Based Learning Health System: Integrating Chronic Care Management, Quality Improvement, and Research. EGEMS (Washington, DC), 3(1), 1168.
24. ↑ HealthcareIT.gov http://www.healthit.gov/providers-professionals/faqs/how-much-going-cost-me http://www.healthit.gov/providers-professionals/faqs/how-much-going-cost-me
25. ↑ Removable or Defunct http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810528/
26. ↑ Cost vs Time http://www.ajmc.com/journals/issue/2015/2015-vol21-n7/Pilot-of-Decision-Support-to-Individualize-Colorectal-Cancer-Screening-Recommendations/
27. ↑ IMPLEMENTING ELECTRONIC HEALTH RECORDS IN THE EMERGENCY DEPARTMENT. http://www.jem-journal.com/article/S0736-4679(08)00321-1.
28. ↑ Corder, L., Kuehn, L., Kumar R.R., Mekhjian, H.S. Impact of computerized physican order entry on clinical practice in a newborn intensive care unit. J Perinatol. 2004;24:88-93. [Pubmed: 14872207].
29. ↑ Han, Y.Y., Carcillo, J.A., Venkataraman, S.T., et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2005;116:1506-1512. [PubMed: 16322178].
30. ↑ Longhurst, C.A., Parast, L., Sandborg, C.I. et al. Decrease in hospital-wide mortality rate after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2010;126:14-21. [PubMed: 20439590].
31. ↑ Palma, J.P., Sharek, P.J., Classen, D.C., & Longhurst, C.A. (2011). Neonatal Informatics: Computerized Physician Order Entry. Neoreviews. 12:393-396. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3146345/
32. ↑ Misch, D.M. Specialty-specific EHR system benefits both practice, patients: technologic innovation: how using EHR, practice management platform can improve standard of care and efficiency. http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?p=HRCA&u=txshracd2509&id=GALE%7CA312290264&v=2.1&it=r&sid=summon&userGroup=txshracd2509
33. ↑ Thompson, D. I., Osheroff, J., Classen, D., & Sittig, D. F. (2006). 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: JHIM, 21(1), 62-68.