EMR Benefits and Return on Investment Categories

From Clinfowiki
Revision as of 15:27, 16 September 2012 by Adaofoegbu (Talk | contribs)

Jump to: navigation, search

The Electronic Medical Record may consist of computer order entry, decision support, electronic medication administration, documentation, and so much more. When compared to paper charts, Electronic Medical Records (EMRs) have many benefits and return on investments (ROIs). Following is a brief discussion of some of those benefits and ROIs.



Efficiency

EMRs improve clinical efficiency in multiple ways. First and foremost, it stores all the patient’s data, including but not limited to, patient medical history, medication history, vital signs, lab tests results, as well as other pertinent information in a single location, and is readily available to anyone directly involved in the patient’s care, regardless of location. It reduces the likelihood that tests will be unnecessarily duplicated. Coordination of care is easier to achieve and eliminates steps that may lead to discrepancies in the sharing of data. EMRs can promote early intervention in disease processes because all the health data- vital signs, lab results, imaging, physician notes, nursing notes, etc.- of a patient are accessible in the same record (6). EMRs are vital to improved quality of care at the bedside or point of care because less time is spent doing non-caring activities and more time spent actually caring for the patient (6).

Storage and Retrieval

Paper charts take up large amounts of physical space. As organizations run out of storage space, they may be forced to rent space outside of the facilities where they see their patients. As a result they incur additional expenses and face the risk of losing the records to a fire, natural disaster, or theft. With the EMR, less physical storage space is required; they can be backed up and a copy kept at a separate location in case of a disasater or loss; and access to the records can be controlled. The EMRs are also a lot easier to retrieve and/or access for patient encounters. EMRs are legible, somewhat complete [more than paper records], easy to access in more than one place, and secure from unauthorized uses and users (7).

Lower costs and better management of risks

By consolidating information across the entire spectrum of clinical operations, from admission to treatment to labs and beyond, EMR allows for:

1.Increase in the pace of information flow including service delivery 2.Coding/billing accuracy 3.Better documentation of patient encounters 4.Reduction in operating costs of the healthcare institution 5.Reduction in costs for the patient.

Furthermore, the integration of EMR systems enables for a more consistent application of medical protocols. As a result, the availability of information 24 hours a day, 7 days a week, helps to contribute significantly to reduced errors, better decision-making, improved outcomes, and lower malpractice risk. In a study done by Harvard researchers, 6.1% of physicians with electronic records had malpractice settlements, compared to 10.8% without electronic records [3].

Better Sharing of integrated information

With better information integration capability, it allows for healthcare institutions to facilitate better quality care, contain costs, and better manage risks. Thus, by having healthcare organizations that incorporate an EMR, it enables for both clinical and business advantages by in turn creating a clinical healthcare system that helps to unite crucial patient information with various departments. As a result, this helps to create a central clinical information repository and resource used throughout the integrated delivery network of the institution. This in the long run allows for the different information of patients to be coalesced together in a timelier manner, which can reduce errors in diagnosis. EMRs allow for interoperability such that multiple clinicians and facilities may use or add to a patient’s record, even at the same time.


Patient Safety

EMRs help to increase patient safety in a number of ways. Evidence-based clinical reminders as well as reminders based on Good Clinical Practice guidelines can be prompted during the patient encounter . Also, medical errors due to illegible handwritings is drastically reduced. Alerts can be posted on the screen for the provider in instances where a drug that the patient is allergic to may be ordered, or in a situation where the drug(s) being ordered are incompatible with medications the patient is currently taking. Also, alerts may be posted for adverse effects for medications based on the patient’s profile and medical history.

EMRs have tremendous potential for improving medication safety by implementing computerized provider entry forms (CPOE). Medication errors are common and are mainly attributed to illegible handwritten orders, incomplete information about the patient or communication breakdowns between clinicians. EHRs can greatly reduce such errors when clinicians would enter medical orders directly into the system. While the clinicians are entering the orders, the system allows automated checks for allergies and other drug-to drug interaction.

In other words, EMRs allow for Decision Support Systems (DSS) to be utilized. DSS detect critical values or errors in care and notify the clinician immediately. DSS may provide knowledge-based information and/or reminders to support or aid in finding a solution to a clinical problem (7).

Investment Flexibility

How much investment is available over a certain period of time? For example if a hospital considering to install a nursing system may conduct a pre- and post-implementation analysis of investment including maintenance cost, operating cost, nursing time and activities, determining the exact time spent on each patient activity.

Management Risk Disposition

Willingness to invest in experimental efforts.

Provide users with real time knowledge

Reduce non-clinical time

Increase patient doctor time

Investment Motivation

To reduce cost, position for capitation/managed care, and gain market share.

To enable providers to take advantage of financial incentives under the HITECH Act related to "Meaningful Use". https://www.cms.gov/EHRIncentivePrograms/01_Overview.asp#TopOfPage

--Sfjafari 22:21, 10 September 2011 (CDT)

--Sfjafari 22:29, 10 September 2011 (CDT)

Administrative and Management Benefits

By moving beyond the paper records, EMR can help Heath Care Providers do a better job at managing patient care. A vast amount of information can be easily used and shared. When fully functional and exchangeable, EMRs can offer far more benefits than managing paper records can.

Improved quality and convenience of patient care

With the implementation of EMRs, patients' health information is available in one place and can be accessed when and where it is needed. Complete access to health information is essential for safe and effective care of patients which can lead to better patient outcomes and high quality care. Health care providers with busy practices and patients with busy lives can conveniently manage their health care transactions with EMRs.

Increased patient participation in their care

EMRs can give full and accurate information to patients about all of their medical evaluations and follow up information such as an office visit or a hospital stay, self-care instructions, reminders and other helpful information. Effective communication with patients can enhance informed decision making and high quality care.

Improved accuracy of diagnoses and health outcomes

EMR provide reliable access to a patient's comprehensive health information which in turn helps diagnose patients' problems efficiently. EMRs can improve the ability to diagnose diseases and reduce, even prevent medical errors, improve patient safety, and support better patient outcomes. EMRs can also have beneficial effects on the public health by identifying and working with patients to manage specific risk factors or combinations of risk factors to improve patient outcomes.

Improved care coordination

EMRs can decrease the fragmentation of care by improving care co-ordination among clinical and administrative staff. Better care coordination can improve transparency among overall processes. EMRs have the potential to integrate and organize patient health information and communicate this information accurately among everyone that is involved in a patient's care. Better availability of patient information can reduce medical errors and redundancy in health care.

Increased practice efficiencies and cost savings

EMRs help improve medical practice management by increasing practice efficiencies and cost savings. A practice can be made more efficient by using integrated EMR systems that can be used for scheduling, automated coding, and managing claims which save time as well. Communication is enhanced among clinicians, labs and health plans as information can be accessed from anywhere. EMRs save money by reducing redundancies in medical care, by eliminating costly tasks of creating paper charts and labor intensive management of paper charts.

There is significant evidence to show that while initial costs remain an issue, switching from paper records to EHR systems will ultimately reduce overall health care expenses. Research indicates that Medicare and private payers could save tens of billions of dollars every year. To incentivize EMR adoption, the federal government has established a plan to provide $44.7 billion during 2010-2019 to financially assist health care providers in the EMR implementation process [4].

Return on Investment (ROI)

Quality Care

One could approach the ROI from the perspective of the Institute of Medicine Report, Crossing the Quality Chasm

  1. Safe: Reducing adverse drug events, inappropriate testing
  2. Effective: Reducing drug costs through appropriate prescribing
  3. Efficient: Reducing drug, laborotory, or radiologic utilization
  4. Timely: Reducing wait times
  5. Patient-centered: Reducing length-of-stay while hospitalized
  6. Equitable: Provides data to demonstrate equal delivery

Quantitative Benefits:

These are financial benefits that are clearly measurable and are attributable to the use of a particular technology. E.g. the use of EMR technology to submit claims has resulted in widely quantified cost savings for provider and payer organizations.

Qualitative Benefits:

The EMR will improve patient care by reducing medication error and wait time. Clinical processes will be standardized and there will be less variation in clinical care provided at one place from another. Records would be easily shared among the providers, which will reduce the process time and over all improve disease management. It will also improve the communication among the care providers and the administrative staff and administrative activities.

These are directly and indirectly attributed to the technology but are more difficult to quantify. E.g. implementation of a clinical nursing system may lead to increased case in recruiting efforts, better nurse retention, more rapid access to clinical nursing data, and decreased charting time. Quantification and measurement – of benefits usually is difficult because of the task complexity of the nursing function.

Strategic Benefits:

These offer substantial benefits to the organization, but at some future date. E.g. investments in networking and telecommunications offer significant future strategic benefits, positioning organizations to utilize enterprise-wide patient indexing and EMR or distributed case management technologies as they emerge.

--Sfjafari 22:29, 10 September 2011 (CDT)

Sources of Funding

  1. Organizational Reserves – provider organization make investments in affiliated organizations
  2. Bank and other financial service – short term loans
  3. Capital leases – used for large equipment acquisitions but can be negotiated for a major IT investment
  4. Vendor discounts and incentives – requires something in return
  5. Joint venture or partnership – tighter relationship
  6. Health plans and plan sponsors – contractual arrangement
  7. Private philanthropy – fellowships or university chairs
  8. Pharmaceutical companies – willing to conduct clinical trials
  9. Public grants – government initiatives
  10. State legislative initiatives – local and state initiatives

Costs

The Medical Group Management Association (MGMA) says the average cost of an EMR per physician is $33,000. (http://www.physicianspractice.com/display/article/1462168/1591117)

Software License:: EMR license prices can easily range from $1,000 – $25,000. The average license for a FULL/TRUE EMR usually starts at $10,000, while a light/entry EMR usually starts at around $1,000, and these costs tend to recur. (http://www.phyaura.com/resources-2/open_source/)

Implementation: Implementation costs are usually billed hourly at a rate of $75-$150 per hour. Average implementation time per provider is 35 hours. Where 10 hours are used for customization, 25 hours for training and 10 hours for computer/network setup. This becomes exponentially lower as more physicians are added. (http://www.emrexperts.com/emr-roi/index.php)

Hardware: Network hardware and configuration, number and type of servers/workstations, hand-held devices, etc. is driven by the vendor's requirements and recommendations, as well as your organization's needs. Costs depend on quantity of equipment purchased or leased. For example, a tablet PC could cost $2,000, a workstation $1,500 and a server $5,000. (http://www.emrapproved.com/emr-hardware.php)

Support & Maintenance: Ongoing support costs will be incurred from both an annual support contract with the software vendor for updates and technical support and the increased need of hardware/network support through a local IT representative. (http://www.emrexperts.com/emr-roi/index.php)

Research

The EMR allows researchers to efficiently search patient medical information by medical condition, date of treatment, physician name and test category. Researchers can quickly focus their attention on medical information that will support their research efforts, develop databases to study patient outcomes, and cross-check complex medical information.

Researchers can use the EMR to analyze large amounts of patient data more efficiently, quickening the use of new research findings to improve patient care [5].

Barriers of EMR Implementation

  • In order for an EMR to be truly successful, proper and timely training must be administered to all who will interact with the system.
  • Conflicting research findings on the cost and efficiency benefits of EMR implementations will make it difficult, if not impossible, for administration staff to be confident in choosing an EMR for their facility. Until there is adequate research on multitudes of EMR systems that shows causal relationships between facility characteristics and the related EMR components there will not be a sufficient method of EMR selection and implantation.
  • If it is true that implementations of EMRs cause a decrease in efficiency and an increase in quality of medical care then further research must take both of these repercussions into account and determine if there is an overall net benefit of EMR implementation.
  • The variability of results of similar studies on the monetary and efficiency benefits of EHRs indicates that there is no single approach to EMR implementation that will fit all settings. Variables such as hospital size, setting, specialty, prior computer integration, etc will determine the effectiveness of an EMR dramatically and must be considered in all cases.

EMR Cost Categories


References

Committee on Quality of Health Care in America, Institute of Medicine. "Front Matter." Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press, 2001. Full text

1. http://www.msdc.com/EMR_Benefits.htm

2. http://patients.about.com/od/electronicpatientrecords/a/EMRbenefits.htm

3. http://www.eurekalert.org/pub_releases/2008-11/hms-ehr112508.php

4. http://www.cdc.gov/about/grand-rounds/archives/2011/july2011.htm

5. http://www.mayoclinic.org/emr/benefits.html

6. Crane, R. M., Raymond, B., (Winter 2003). Fulfilling the Potential of Clinical Information Systems. The Permanente Journal. 7 (1), pp.62-67

7. Hersh, W. R., (2002). Medical Informatics: Improving Health Care Through Information. Journal of American Medical Association. 288 (16), pp.1955-1958

Retrieved from "http://clinfowiki.org/wiki/index.php?title=EMR_Benefits_and_Return_on_Investment_Categories&oldid=15593"