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 ==
		+	[[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>
−	== '''Financial''' ==	+	== Environmental ==
−	* 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	+	[[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>
−	* 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.	+	== Quality Outcomes ==
−	* 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	+	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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
−	* 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.	+	== Medical Education ==
		+	[[EMR Benefits: Medical education]]
−	* 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.	+	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>
−	* 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.	+	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>
−	* Many ambulatory EMR systems are integrated with e-Prescribing. For physicians who use this technology in 2009 and 2010 for at least 50% of their eligible patients, an addtional 2% will be added to their Medicare reimbursement.  The amount drops to 1% for 2011 and 2012, and thereafter, non-use becomes a penalty. [http://www.cms.hhs.gov/PQRI/Downloads/PQRIEPrescribingFactSheet.pdf]	+	== Financial ==
		+	[[EMR Benefits: Financial]]
−	* 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.]	+	"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>
−	*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.	+	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>
−	* 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.	+	* 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>
−	* 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]	+	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>
−	* 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]	+	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>
−		+
−	* 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.	+	===Billing Accuracy===
−	* 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	+	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>
−	* 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	+	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.
−	* EMR can reduce staff time used in preparing paper records. Brigham and Women's Hospital reported a cumulative saving of $0.6 million by automatically generating medication lists at patients' discharges using their EMR. Ref: Kaushal R et al. Return on investment for a computerized physician order entry system. J Am Med Inform Assoc. 2006;13(3):261-66.	+	=== An EMR Cost Benefit Analysis ===
−	* 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	+	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:
−	*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.	+	# 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
−	* 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)	+	The FTE's responsible for paper management were greatly reduced from 28 FTE's (2007) to 1 FTE (2009).
−	* Can improve billing by allowing improved medical staff documentation and lack of lost or misplaced charts.	+	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:
−	* 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	+	* 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'''.
−	* 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	+	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>
−	* The estimated net benefit from using an EMR in promary care for a 5 year period was $86,400 per provider [Wang et al. A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine (2003)]	+	== Improving Patient Care ==
		+	[[EMR Benefits: Healthcare quality]]
−	* 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.	+	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>
−	==  '''Clinical''' ==
−	* EMR systems have been proven to decrease the amount of time nursing staff spends on documentation.  Reference: A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database.  Journal of Healthcare Information Management- Vol. 21, No. 1 p 67.
−	* 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.	+	[[EMR Benefits: Reduction in no shows]]
−	* 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.	+	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>
−	* 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]	+	[[EMR Benefits: Medication Management]]
−	* 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.	+	"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>
−	* With the quality EMR, quick access to patients records can be lifesaving during the emergency situation by helping emergency decision-making process.	+	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.
−	*  EMR can help making medical history more efficient and accurate by providing templates that can decrease the time spent in documentation.	+	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.
−	*  EMR can reduce the number of errors associated with transcription.	+	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.
−	* EMR will provide the integrated view of patient to clinician so that they can spent less time for getting patients’ history, lab and radiology results and medication information so that clinicians can make diagnosis more accurately and faster.	+	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>
−	* 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]	+	== Research ==
		+	[[EMR Benefits: Research]]
−	* 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.	+	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>
−	* 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.	+	== Health Information Exchange (HIE) ==
		+	[[EMR Benefits: HIE]]
−	*Improved patient education through use of patient portal	+	== Personal Health Records ==
		+	[[EMR Benefits: PHR]]
−	* 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. [Lin et al. An Internet-Based Patient-Provider Communication System: Randomized Controlled Trial,	+	===Patient Participation===
−	J Med Internet Res. 2005 Jul–Sep; 7(4): e47.|http://www.pubmedcentral.nih.gov/articlerender.fcgi?pmid=16236699]	+	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>
−	*Streamline communication both between patient and provider, and between clinicians	+	== Electronic Dental Records ==
		+	[[EMR Benefits: EDR]]
−	*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	+	==Telehealth==
		+	[[EMR Benefits: Telehealth]]
−	*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	+	== E-Prescribing ==
		+	[[EMR Benefits: E-Prescribing]]
−	*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]	+	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>
−	*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.	+	== Mobile EMRs ==
		+	[[EMR Benefits: mHealth]]
−	* 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.	+	== Physicians ==
		+	[[EMR Benefits: Physicians]]
−	*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.	+	===Physicians Benefit===
−	* 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)	+	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
		+	</ref>
−	* 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	+	== Nurses ==
		+	[[EMR Benefits: Nurses]]
−	* Can improve critical medical decisions by providing the most up-to-date clinical information at point-of-care.	+	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
		+	</ref>
−	* 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	+	== 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.  <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>.
−	* 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	+	==  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>
−	* 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)]	+	==  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.
−	* 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.	+	== Costs ==
−	* 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.	+	[[Return on investment]]
−	== '''Operational''' ==	+	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>
−	* 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.	+	*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>
−	* 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.	+	*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>
−	* Protects patient data by preventing unauthorized individuals from accessing the clinical record.	+	*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>
−	* 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.	+	*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>
−	* 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]	+	*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>
−	* Documentation completed at conclusion of encounter.	+	*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
−	* 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.	+	==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>
−	* 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]	+	==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.
−	* 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]	+	*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>
−	* 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.	+	=== 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>
−	* 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).	+	== 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.  <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>
		+
		+	== 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.<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>
		+
		+	==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 ==
		+	<references/>
		+
		+	[[Category: EHR]]
		+	[[Category: EMR]]

---

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.