EMR Benefits and Return on Investment Categories

From Clinfowiki
Revision as of 05:53, 18 February 2015 by Annathehybrid (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. [1]

The sections below detail the benefits, costs, and barriers in evaluating EMR implementations. Selecting, financing, and launching an EHR system is difficult. Product certification seeks to make the first step a little easier. [2]


Contents

Informational

EMR Benefits: Informational

Security

EMR Benefits: Security

Mobile EMRs

The present day physician is always busy and on the go between hospitals.clinics and own practice.[3] There will be better workflow, improved communications, cost containment, and most importantly enhanced patient care.[3] Ease of access to EMRs using mobile technologies such as iPad and smartphones has decreased resistance to EMR use and implementation in busy settings such as Emergency Departments (EDs). A recent study has shown that use of iPads in EDs presents the following advantages in addition to those observed for EMRs in general (29).

  1. Enhanced patient education and satisfaction
  2. Increased mobility of the device provides a better fit of technology to the application setting
  3. The iPad touch screen enables easy use even without excessive knowledge of computers
  4. Mobile devices was similar to paper charts in that they are extremely portable allowing physicians to carry it around in EDs easily
  5. Remote patient monitoring and diagnosis
  6. Remote ordering capability for physicians [78]
  7. Ability to cross-reference medical terminology and provide multi-language support.
  8. Supports globalization of medical care.
  9. Ability to send health data directly from wearable devices to medical records [1]
  10. Link daily activities of living (e.g. fitness, nutrition data) to health data [1]
  11. Dictate on the iOS device, e-Prescribe, and perform real-time eligibility checks [74].

In addition to voice and text, new mobile device models offer more advanced features, such as web searching, global positioning systems (GPS), high-quality cameras, and sound recorders.[4] The June 2012 Manhattan Research/Physician Channel Adoption Study found that doctors’ ownership and use of mobile devices is pervasive, with 87% using a smartphone or tablet device in their workplace, compared to 99% who use a computer.[5] 13 Surveys have shown that around 80% of physicians use an iPhone, while most of the remainder opt for Android smartphones. [6] [7]

The March 16, 2012, Letter to Us at Kaiser Permanente reported that Kaiser Permanente members can use mobile smartphones (Android, iPhones, or Blackberrys) to access their medical records, lab results, and all other aspects of kp.org. Kaiser Permanente members accessed the smartphone application over 1,000,000 times during the first month of use. In 2011, KP patients participated in more than 12,000,000 e-visits with their health care providers.

Another form of mobile technology that can ease access to EMRs are wearables such as Google Glass, Moto 360, and the Apple Watch [8]. [9]There also other wearables on the market such as BodyMedia Fit system that is FDA approved. These products can collect basic biometrics such as number of steps taken, hours slept, calories burned, etc., and when synced to a smartphone or computer, track your progress over time [10]. Patients with chronic illnesses can wear these devices that can collect continuous data that can be automatically be updated to an EMR. This will allow clinicians to see more accurate trends of a patient's vitals that could not be achieved with regular appointment visits[8].

Architecture of Mobile EMRs

Severence Hospital started developing mobile EMR applications in 2005. In 2010, a mobile solutions for healthcare professionals for IOS based iPhones. In 2012, this application was redesinged to be platform independent, encryption policy was added to ensure data security and provided integrated management of Legacy EMR and a mobile solution. The patient list was organized by themes and its main feature was EMR history retrieval. The new architecture design process had four steps: Server and its architecture, Screen layout and story board making, Screen UI design and development, Pilot test and step by step by step deployment.

The Mobile architecture: consists of Mobile server and Mobile device.The server receives information from the EMR system matched with search parameters which is then converted into information to be displayed on specific mobile device. This mobiles solution was first pilot tested for two month and later deployed in four Severence Hospitals[69]

Cloud Based EHRs: Cloud based EHRs are on the rise in todays health care world. Even though there is still uncertainty and resistance towards cloud services, many small physician practices are leaning towards the cloud. Some important considerations to note when moving towards a cloud based EHR are hardware, usability and cost of ownership. This type of EHR is easier to update than onsite EHRs. [11]

In January 2015, due to a recent KLAS study, ZH Healthcare (ZH), a leading provider of open source Health IT solutions, announced the release of BlueEHS, the first Electronic Health Solution (EHS). BlueEHS will provide a “customizable on the cloud” design that allows users to enable or disable modules that may not fit the provider’s need. The basic system will be offered to providers at no cost.[12]

Entrada health

There is availability of high quality speech-to-text services with efficiency and intelligence tools “in the cloud.[13] Also, there is maturation of connectivity technologies, such as HL7 and integration engines. [13]

Entrada Health of Nashville, TN (www.entradahealth.com) has developed a mobile-enabled Smart System powered by SayIt™ voice recognition technology from nVoq (www.nvoq.com) of Boulder, Colorado. This smart system has been flexibly built to work with the leading smartphone platforms. The system uses the highly accurate voice recording capabilities available within mobile devices as a “virtual keyboard” and then builds an intelligent workflow around the data management process. Instead of attempting to replicate the entire user interface for a given application, such as an EMR, the system minimizes the amount of device keystrokes required for data capture by focusing primarily on clinical narrative unique to each patient such as SOAP notes. Voice data is captured, converted to text and then synchronized with the appropriate business application, which typically resides either on a client’s desktop or in the cloud. [13]

drchrono

With technology pushing us into a new era of healthcare, it appears that many hospitals and privately owned physician institutions are switching to EHRs. This has been a breakthrough from previous years, but the change is still happening. Now, programs such as drchrono take the EHR and make it accessible through a mobile device such as iPhone or iPad through a specific tailored app. The remarkable functionality of drchrono is that it provides benefits not only for physicians, but also for patients. [14]

Physician Benefits

In present time, it seems as if physicians always give the five-minute consultation when evaluating a patient. They come in, introduce themselves, go over the patient's problem briefly, give a diagnosis and prescription if necessary, and then move on to the next patient. It can be concluded that time is a very key aspect of a physician's daily practice. Therefore, it is logical to hypothesize that a physician needs to find ways to cut time in any scenario so that he/she may spend more time with a patient. This is where the benefits of drchrono play a key role.

The first benefit implemented by drchrono is the ability to have speech-to-text support. Essentially, a physician is able to tap on the screen and begin to speak; the program will then analyze the audio sample and turn it into text. [15] With specific M*Modal technology implemented into the application, medical language is easily turned into accurate text. [16] A functional tool like this eliminates the barrier between older physicians who struggle with using physical or electronic keyboards.

Another benefit directly derived from drchrono is the ability of customizing templates on the system. [17] Many traditional EHRs used in hospital settings are inundated with extra material which is irrelevant to many physicians. With template customization, a physician who specializes in neurology can specifically set forms that are only relevant to his practice. Other material such as cardiovascular, pulmonary, etc. can be removed completely from the application in order to have better user-interface functionality.

Patient Benefits

One of the most frustrating things for a physician can be when a patient either arrives late or completely misses a scheduled consultation. One of the main reasons this tends to happen is simply because the patient forgot. With the drchrono application, patients can also benefit from the software. The application has the capability of allowing a patient to receive automated patient reminders. [18]

When a patient arrives at the clinic, logging on to their personal drchrono account will speed up the visit. Once logged in, a patient is able to check-in and fill out any necessary forms online. These forms will then be stored directly on the patient’s account for future use. [19] Tools like this make a patient’s visit more friendly and provide a reason for greater patient satisfaction.

Future trends

Apps that help in the management of chronic health conditions,such as diabetes,obesity,&heart disease, are needed and are eagerly awaited.[20] Mobile device hardware and apps are expected to continue to improve, bringing additional and enhanced benefits to clinical practice.[21] Future mobile apps are expected to include even larger databases, as well as CDSS prompts that will aid in the clinical decision making. There is also need to develop standards for mobile apps so that they can integrate seamlessly with H.I.S capabilities,such as EMRs and patient monitoring systems.[22] [23] As the use of medical devices and apps expands, more educational health care programs are expected to incorporate them into medical curricula. At the same time, establishing standards and policies within health care institutions will be necessary to ensure ethical and transparent conduct.[24]

In September 2013, the FDA released long-awaited guidelines concerning regulation of mobile device apps, announcing that the agency will evaluate apps that are “used as an accessory to a regulated medical device; or transform a mobile platform into a regulated medical device.” The FDA has chosen to exercise only enforcement discretion for apps that are deemed to pose less risk, such as those that inform or assist patients in managing their disease without providing treatment suggestions, or simple tools that allow patients to track or organize health information or interact with their EHRs.[20] [25]

Health Information Exchange (HIE)

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.

The advent of the Health Information Exchange (HIE) allows for sharing of patient information electronically within an organization, system, community, region or state. This helps in monitoring not just a patient's health but health in certain subsets of populations, whether for a certain diagnosis group or within a social demographic or a geographic region. Stratifying the data to look for trends over areas, ethnicities or over time has helped in development of software models which help in predicting the health of not only a patient but also patient populations over time. Metrics such as 30 day readmission are used commonly in healthcare to gauge the quality of care of a patient and is an example of where predictive modeling is being used. EMR has allowed for transparency, and the analysis of data has helped to establish trends and patterns. Big Data is another commonly used term in healthcare and refers to the availability of large amounts of data available from the collection of patient EMR records.

Health information exchange (HIE) is the electronic transfer of healthcare information between various organizations. This has become an important topic because it improves the quality, safety and efficiency of healthcare. Electronic health records (EHR) helps to facilitate the electronic exchange between hospitals, clinics, and patients much more possible. According to the Department of Health and Human Services, 84% of hospitals that adopted EHR and participated in regional HIO exchanged information w/ providers outside organization. HIEs also assist with provider/patient interactions regarding chronic disease management. One example of this looks at Western New York (WNY) Beacon Community and the regional health information exchange (HIE) HealtheLink. The two organizations teamed up to help diabetic patients in upstate New York with disease management. The cost of diabetes management has risen from $174 billion in 2007 to $245 billion in 2012; that is a 41% increase over five years (American Diabetes Association, 2014). These figures address an increased in financial burden, use of health resources and lost productivity associated with diabetes (American Diabetes Association, 2014). In response to this rise in cost, WNY Beacon has shared strategies not only improving the health of diabetic patients, but cutting costs for such management as well. Their strategies cover three primary topics: 1) expanding research for better analytics, 2) improving real-time care coordination and communication and 3) patient education, telehealth and population management.

Aside from the Kaiser HMO and the VA system, considered the nation's best examples of Health Information Exchange (HIE), there are two other such HIEs, Indiana Health Information Exchange (IHIE) and Rhode Island Quality Institute (riqi.orrg) worth mentioning. They're mentioned here to introduce the idea of federated data management (as against the traditional centralized data management approach) by keeping ownership of data at source (Physician Practices) and introducing data lockers to get access to data for Analytics & Reporting purposes, thus minimizing data aggregation, normalization and security expenses. [26]

Virtual Lifetime Electronic Record (VLER), a program initiated in April 2009 by President Obama designed for the VA and DoD to lead the efforts in creating VLER (Virtual Lifetime Electronic Record), which would “ultimately contain administrative and medical information from the day an individual enters military service throughout their military career and after they leave the military.” VLER avails the eHealth Exchange to share prescribed patient information via this protected network environment with participating private health care providers, with exception of ‘scanned’ patient information. [27]


The Direct Project

Standards of information exchange are beginning to take hold for purposes of summarizing a patient record or event or allowing a provider to query for records across a community. The Direct Project aims to utilize these standards as well to replace methods of information exchange such as fax, courier, postal mail, and patients themselves that continue to slow down and predominate the health care field for transferring lab results, x-ray results, reminders for Dr. visits, etc. [61]

The project is sponsored by the Office of the National Coordinator for Health IT (ONC) but led by volunteers in the industry. The Direct Project offers a simple, non-proprietary solution for direct information exchange between two healthcare entities. [51]

It is important to note here another emerging standard called Fast Healthcare Interoperability Resource (FHIR), also referred to as fire, that is expected to meet the standards of the market needs in the areas of Mobile HC apps, Medical devices and Custom workflows and also drive new efficiency in terms of care coordination, cost of care optimization, patient engagement and behavior influence of both care delivery folks as well as patients. [28]

Environmental

Electronic Health Records have the potential to improve the environmental footprint left by the health care industry. [29]

Decreased Paper Consumption

Using EHRs can greatly reduce the need for paper in an office setting. Instead of throwing away and shredding old paper records or documents and destroying trees, digital documents can be erased without another tree being cut down to make another sheet of paper. [30] As an eco-friendly software application, it reduces need for reams of paper and the environmental costs associated with it. [31]

Avoided Transportation

EHRs also reduce the gasoline consumption by patients by avoiding non-urgent medical office visits and instead using it’s services to securely message requests for prescription refills, ask clinicians questions, and conduct other virtual activities. [29]

Avoided Plastic Waste From X-Rays

X-ray film is composed of at least 57 percent plastic. EHRs ability to digitize and archive x-ray images avoids the waste of printing x-rays on plastic film. [29]

Medical Education

While clinical and operational benefits of EMRs are obvious, their effect on medical education and trainees are not well documented. The few studies that have analyzed such effects have shown that there are advantages inherent in EMRs that can be leveraged and disadvantages in the current EMRs to education that need to be addressed in the future [22]. Implementation of EMRs in academic environments can benefit education of trainees by:

  1. Increased accessibility to relevant and up-to-date literature for diagnosis and management plans via clinical decision support (CDS) systems within the EMR
  2. Training the students to follow accepted clinical guidelines (best practices) using CDS
  3. Monitoring clinical experience of trainees more efficiently in real time to optimize workflow for trainees and training programs. Use of EMRs to track patient care milestones achieved by trainees will identify that can be then addressed more efficiently in a prospective manner.
  4. EMRs have been used to help physicians improve the quality of their clinical skills. An example of this has been in Radiology. Radiologists do not routinely receive information on clinical outcomes of patients for whom they provide radio-diagnoses. Alkasab et.al created an automated outcome tracking system for radiologists which allows them to review clinical outcomes of the patients whose images they reported on. Such a system can allow radiologists to improve self-assessment, accuracy and relevance of their reporting, and study interventions in their processes to improve outcomes [47].

The disadvantages of EMRs to education were noted by the following issues:

  1. Problems with student access into the facilities systems such as obtaining log-ins and passwords
  2. Concern that students will not learn skills of independently recognizing items that need to be documented, but rather the students would only choose from drop down boxes and pick lists.
  3. Instructor's concern that EMRs allow portions or entire sections of notes to be copied and pasted, which in turn leads to ethical concerns with plagiarism and documenting procedures that were never performed.
  4. Trainees overly attentive to patient’s EMR data versus gaining information from physical examination and patient interactions
  5. Focus on engagement with computer terminal disrupts patient-physician relationship in exam room
  6. Automation bias - too much trust in decision support systems without consideration of their limitations

As EMR use becomes standard fare in medical practice, the benefits of using EMR need to be harnessed by adapting the training curriculum of medical students and graduate medical education trainees to incorporate EMR-related sub-competencies [32] [33]

Improving interpersonal and communication skills

EMR can reduce time of getting information and trainees can spend more time on synthesizing and demonstrating clinical reasoning in real time.

Enhancing professionalism

Detailed data provided by EMR can help doctors or other medical workers to convince patients more easily. EMR documentation can enhance professionalism among medical personnel by increasing accountability on the part of the healthcare provider to offer quality healthcare to patients.

Access to knowledge resource

Today, clinicians can get access to medical literature on the internet while making clinical decisions or reviewing patient charts. EHRs can provide links in a patient record to internet resources like PubMed, NLM, and OVID to show clinicians the most up-to-dated information and knowledge in medicine.

Financial

EMR Benefits: Financial


Personal Health Records

Personal Health Records - A personal health record, or PHR, is an electronic application used by patients to maintain and manage their own health information (or that of others for whom they are authorized to do so). Patients can use a PHR to keep track of information from doctor visits, record other health-related information, and link to health-related resources. PHRs can increase patient participation in their own care. They can also help families become more engaged in the health care of family members.

With standalone PHRs, patients fill in the information from their own records and memories, and the information is stored on patients' computers or the Internet. Tethered or connected PHRs are linked to a specific health care organization's EHR system or to a health plan's information system. The patient accesses the information through a secure portal. With tethered/connected PHRs, patients can log on to their own records and see, for example, the trend of their lab results over the last year. That kind of information can motivate patients to take medications and keep up with lifestyle changes that have improved their health. Products such as FitBit allow consumers to record changes and sync the data to a smartphone to track changes. [8][10]

Ideally, patients will be able to link their PHRs with their doctors' EHRs, creating their own health care "hubs." Most doctors are not ready for that kind of change quite yet, but it is a worthy goal. A study has show that allowing patients to see their medical record, called OpenNotes, showed that patients 77 to 87 percent of patients felt they were more in control of their health when they could see their medical records. [34]

Although expectations for EMRs in the areas of data exchange typically span Provider to Provider data exchange for better care coordination at transitions of care, it is important to point out here emergence of another standard called, "Human API" which enables users (patients) to share their personal health records (PHR) with the EMR systems bi-directionally, regardless of how they're recorded, processed or stored.

Over a decade, VA has emphasized patient-centered innovations including MyHealtheVet (www.myhealth.va.gov), an e-portal suite of tools for Veterans and Caregivers that provides a secure web-based Personal Health Record (PHR), patient access to personal health information from the VA Electronic Health Record, the ability to download and share personal health information using the VA Blue Button, online services such as e-prescription refills, trusted health education resources, and Secure Messaging between patients and their VA health care teams.

A VA patient with an upgraded account has following benefits:

  • Engage in Secure Messaging with your participating VA health care team members
  • Request prescription refills
  • Access to key portions of your Department of Defense (DOD) Military Service Information , VA Wellness Reminders ,VA Appointments, VA Lab Results, VA Allergies and Adverse Reactions and other key portions of their VA electronic record ,VA Comprehensive Care Document (CCD) and involve in future features as they become available.[35]

Patient Participation

Providers and patients who share access to electronic health information can collaborate in informed decision making. Patient participation is especially important in managing and treating chronic conditions such as asthma, diabetes, and obesity.

Electronic health records (EHRs) can help providers:

  • Ensure high-quality care. With EHRs, providers can give patients full and accurate information about all of their medical evaluations. Providers can also offer follow-up information after an office visit or a hospital stay, such as self-care instructions, reminders for other follow-up care, and links to web resources.
  • Create an avenue for communication with their patients. With EHRs, providers can manage appointment schedules electronically and exchange e-mail with their patients. Quick and easy communication between patients and providers may help providers identify symptoms earlier. And it can position providers to be more proactive by reaching out to patients. [36] [37]

As patient participation increases with EHR usage. The participants are able to increase their knowledge and become more proactive with their medical record. This will intern improve the service of care when a patient is admitted to a facility with an installed EHR and PHR integration. "Patients indicated they were interested in EHRs as a means of gaining more one-to-one physician access: 55% said they would like to use EHRs to ask doctors questions, 56% wanted to use them for refill requests, and 36% said it would be a valuable way to request referrals."[38] EHRs empower the patient increasing patient participation and improved overall health of the patient.

Snapshot of Improved Health Care Quality and Convenience for Patients

  • Reduced need to fill out the same forms at each office visit
  • Reliable point-of-care information and reminders notifying providers of important health interventions
  • Convenience of e-prescriptions electronically sent to pharmacy
  • Patient portals with online interaction for providers
  • Electronic referrals allowing easier access to follow-up care with specialists

http://www.healthit.gov/providers-professionals/health-care-quality-convenience

Patient Safety Outcomes

EMRs increase patient safety and improve patient quality care by:

  1. Insuring practice of better evidence-based medicine
  2. Allowing flawless health information exchange between health care providers
  3. Decreasing cost due to changes in drug frequency, dose or route administration [39]
  4. Improving communication and engagement with patients and their health care providers
  5. Increasing patient medication compliance leading to improved overall health outcomes
  6. Promoting higher rates of reporting incidents and near incidents, ensuring greater numbers of completed reports and resulting in a more diverse pool of healthcare staff who report. [40]

EMRs insure the practice of better evidence-based medicine by developing evidence-based clinical and Good Clinical Practice guideline reminders that are prompted to health care providers during patient encounters.

The exchange of health information is greatly improved with EMRs because it can be delivered instantly and securely. Since the health care provider is entering the data into an EMR, medical errors are reduced from illegible handwriting.

The impact of computerized provider order entry (CPOE) on medication errors with the use of a basic CPOE system in an ambulatory setting was associated with a significant reduction in medication errors of most types and severity levels. [41]

EMRs help health care providers by alerting them to potential adverse drug events when entering new prescribed medications in the computerized provider entry forms (CPOE) for patients with allergies, incompatible medication interactions, and delivering medications to verified patients. CPOE systems address these problems, ensure patient safety and save associated costs and injuries. CPOE features that help to achieve this are patient-specific dosage suggestions, reminder to monitor drug levels, reminders to choose an appropriate drugs, checking for drug allergy and drug-drug interactions, standardized order sets, increased legibility, automated communication to ancillary departments and ease of access to patient data.[17]

EMRs allow pharmacists access to patient histories, past medication therapies, and current lab values. Clinical pharmacists have the responsibility of medication reconciliation, medication dose adjustments due to changes in liver/kidney function, transition of IV to oral therapies (in order to discharge the patient) and establishment of outpatient therapies. These areas of focus have shown to dramatically decrease length of hospital stay, increase beneficial patient outcomes, and decrease overall healthcare cost.

Use of traditional peer-reviewed approaches as a model for developing standardizations could serve as models for a foundation for new CPOE tools and as a benchmark for existing CPOE tools. For practically all major disease states, there are publicly accessible treatment guidelines that have been established by experts, undergone peer review, and are updated on a periodic basis. Using these review standards for development of protocols for drug-drug interactions, etc. improved accuracy and up-to-date information would be available and utilized to assist in protecting patients. [54]

Participants in the U.S. 2011 Physician Workflow study of office-based physicians responded that use of the EHR alerted them to potential medication errors (65%) and critical lab values (75%). This type of notification is a clinical decision support tool that many hospitals and providers use in their EHR. Clinical Decision Support is not limited to just alerts but can also inform a physician of immunizations needed for a certain age group or clinical guidelines. [42]

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). [41].

Improving patient care

EMR Benefits: Healthcare quality

Research

EMR Benefits: Research


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. The EMR can help the provider deliver the best quality of care because the EMR contains the complete patient‘s health history. In a crisis, the EMR provides immediate access to a patient's medical history, allergies, and medications. The retrieved information enables providers to make decisions sooner which otherwise they would have to wait for, like information from test results or other resources. This feature is very critical when a patient has a serious or chronic medical condition, such as diabetes. Also, the EMR information can be shared with patients and their family, so they can more fully take part in decisions about their health care. In addition, using decision support tools in EMRs help the provider to make efficient and effective decisions about patient care through clinical alerts and reminders.

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.

Pinsonneault and associates found that data from before and after EHR integration, from a matched set of 15,626 patients with electronic integration and 15, 626 patients in a control group, who visited over 95 physicians in a large North American health network, show that patients treated through the electronically integrated system had better quality of care in the follow-up period and a higher continuity of care, compared to the control group [29].

Another overview of an attempt to quantify quality outcomes and cost reporting measures benefits of EHRs was published by the Healthcare Information and Management Systems Society in 2010 and can be found here: http://www.himss.org/content/files/QPRWhitePaper.pdf

Improve Legal and Regulatory Compliance

EMRs can facilitate and improve legal and regulatory compliance in terms of increased security of data and enhanced patient confidentiality through controlled and auditable provider access [43]. In a study by Bhattacherjee et al, Florida hospitals with a greater adoption of health information technology had higher operational performance, as measured by outcomes of Joint Commission on Accreditation of Healthcare Organizations (JCAHO) site visits [43]

Up To Date Information About Patient at Point of Care

EMR can provide health information that is up-to-date with clinical information [44]. With an EMR, lab or radiology results can be retrieved much more rapidly. Test results and medical history are recorded directly into the EMR [45].

Increased Accuracy in Medication Administration

EMAR can help increase accuracy in Medication Administration. There are about 700,000 reasons annually—the estimated U.S. number of adverse drug events—for the increasing use of the electronic medication administration record (EMAR) to support inpatient care. With paper and other non-digital records prone to being incomplete, misread, or even misplaced, nurses need a way to help ensure that medications are properly administered and tracked. With the help of EMAR functionality and bar coding/electronic verification during medication administration along with real-time alerts, there is very little room for errors thus accuracy in Medication Administration most like happen at all times.

[46]

Personalizing Healthcare

After Visit summaries (AVS)

Stage 3 meaningful use recommends that patients or their authorized representative receive a clinical summary after each visit that is not just an abstract from the medical records, Most EHRs enable clinicians to supply patients with such information in the form of an After Visit Summary (AVS) that is generated from data entered into their medical records. The AVS should have relevant clinical information and instructions pertinent to the office visit. It should also be provided in a language other than English, when needed, within 3 business days of the clinic visit, and should contain more than 50% of the office visit clinical summary. Provision of the AVS is important, as physicians usually overestimate patient understanding of the treatment plan. Therefore, the AVS has the potential to improve patient engagement in their care and contribute to more personalized healthcare and share medical decisions.

Improved Documentation of Advanced Care Planning

EMR can be utilized to screen patients in an outpatient setting and prompt the physician to have a discussion about Advanced Directives. A study conducted as a QI improvement project showed that EMR-based reminders on counseling were effective in improving documentation rates of Advanced Directives.[59]

Targeted cancer therapy

EHR with clinical decision support help process the genomic data in the context of individual patient and provide dosing recommendation in a timely manner.

EHR when intergrated into work flow can help realize personalized cancer treatment at the point of care. [www.ncbi.nlm.nih.gov/pubmed/21568680]

Enhanced Patient Access

Some EHR systems provide functionality e.g. MyChart [10] for patients to access portions of their medical record, view test results, renew prescriptions, schedule appointments etc. These convenience features enable patients to engage in and take ownership of their own health care.

[1]

Integrated Imaging

With an EHR imaging can be integrated into the patient's chart electronically allowing for quick access to multiple imaging studies in high definition native formats rather than having to view them from film or on a printout. Having the studies in the EHR allows the provider to pull up the imaging with the patient quickly and easily. This improves patient communication and understanding.[47] On top of improved efficiency and communication from having the right information at the right time almost instantly, integrating imaging in EHRs can reduce costs as well. By no longer needed to store and archive imaging there are no more expenses for labels, jackets, or storage. It also reduces the workload of the staff since filing and retrieval is no longer necessary. [48]

Telehealth

Integrating EMRs with telehealth can improve the scope of telehealth and boost its benefits. Some benefits are:

  1. It can increase the access of healthcare to remote, underserved and rural areas
  2. It can address the shortage of healthcare providers. Primary care physicians and specialist consultants can serve patients remotely
  3. It can ensure continuity of care without increasing number of hospital visits.

For example, Texas prison system successfully combined a statewide EMR system with Telemedicine system of UTMB, which resulted in improved healthcare delivery for the inmates as well as huge savings for the state. [2]

Telehealth has become very popular due to the rural patients that can start receiving specialty services at their local communities. Some of the services rural hospitals can provide are trauma, stroke and intensive care. The adoption of Telehealth also supports clinical education programs. It allows easy communication between rural clinicians and specialists. Continuing education will also be easily accessed by rural healthcare providers. [49]

In one paper Telehealthcare showed to improve blood glucose checking by individuals with diabetes and resulted in the study participants to have tighter glycemic control, this may result in more widespread adoption of such technology for diabetes management. [50]

Special Care Access Network - Extension for Community Healthcare Outcomes (SCAN-ECHO):Through VA’s SCAN-ECHO initiative, Veterans and their primary care team can videoconference to seek expertise advice from specialists within 100-500 miles away. In 2013, SCAN ECHO spread to 46 rural sites of care with more than 100 participating rural primary care physicians, nurse practitioners, and physician assistants. [51]

Increased practice efficiencies, cost savings, and reimbursement

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. As one example, a clinic or physician practice can expect to increase revenue and decrease costs by converting the encounter form to digital format to reduce billing errors and revenue loss. Prompts for fields that need to be completed will reduce errors by an average of 78% according to one study [40]. 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. Very simply, the EHR eliminates paper chart pulls and staffing expenses can be reduced as a result. One study estimated that an average of $5 per pull would be saved considering the time and cost of medical records staff to retrieve and then re-file the paper chart. The clinic studied expected it would reduce paper chart pulls by approximately 600 annually and transcription costs would be reduced by 28% [41].

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. Documenting electronically is much less time consuming than documenting on paper allowing physicians more time with their patients and the ability to see more patients. [52] Historically, it has been difficult to identify and achieve a solid, measurable Return on Investment (ROI) following Electronic Health Records (EHR) or other clinical system implementation initiatives. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 has motivated system implementations, and the associated incentive dollars have offered a simple measure of ROI on the revenue side of the ledger, but this represents only one aspect of the substantial benefits clinical systems can yield. A proper optimization program, with broader consideration for the projects comprising it, can bring a truly positive ROI to healthcare organizations over a 10-15 year period if properly considered and executed. (Cumberland Consulting Group, 2013) 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]. However according to Himmelstein, Wright & Woolhandler, as currently implemented, the use of Electronic Medical Records could moderately advance metrics related to quality measures, it does however not reduce the cost of administration of ‘overall’ costs. “Hospitals on the ‘Most Wired’ list performed no better than others on quality, costs, or administrative costs” (Himmelstein, Wright & Woolhandler, 2009). Forecasts of potential improvements in efficiency and cost-savings from implementation of computerized health care and the use of Electronic Medical Records seem premature at the time the authors published their data in 2009 [12]. According to DRCRHONO, physicians qualify to get $24,000 or more as part of the economic stimulus incentive offered by the HITECH act if they adopt a certified EMR. Incentives are given to providers who qualify. The stimulus includes $24,000 in Medicare Incentives or $63,750 in Medicaid Incentives. The government is putting in $19.2 billion dollars to help move all doctors off paper records onto electronic systems [62].

EMR implementations could affect physician and health system reimbursement in a number of ways. Some have argued that increased clinical documentation as a result of using an EMR will lead to increased billing and therefore reimbursement. Having an electronic health record can mean less time with filing claims or searching for documentation. If a physician works in many different locations accessing a patients electronic record from a different location is very easy. [52] An increase in emergency department billing among Medicare patients has been attributed to more complete documentation that allows for higher levels of billing [43]. However, given the pay-for-service model present in many facets of the American healthcare system, some of the cost savings possibly generated by the introduction of an EMR – such as eliminating unnecessary and duplicated tests and ineffective procedures – could lead to decreased reimbursement for the physicians and health systems.

According to a survey performed by the National Center for Health Statistics, in collaboration with the Office of the National Coordinator for HIT, it was found that 82% of providers report time savings when sending prescriptions electronically and that 79% of providers see increased efficiency when using an electronic health record. [53]

EMRs Help Manage Transactions

EMRs help better manage the “large number of transactions and handoffs” which can include: billing, physicians’ orders, prescriptions, nurses’ orders insurance information, and more. Having this information all in one place makes it easier for any staff member – from administrators/front office to pharmacists to physical therapists – to gain access to the patient’s records and read and notes that may apply to them. [6]

Physician Recruitment

68% of physicians surveyed by the National Center for Health Statistics report that the implementation and use of electronic health records is seen as an asset when recruiting physicians to their practice.[53]

Physician Satisfaction

An association has been shown to exist between EMR use and physician satisfaction with their current practice[76], as well as with their career satisfaction [77].

Patient Handoff

Patients can be safely handed off from one caregiver to the other. Especially CPOE reduces errors due to bad handwriting, verbal miscommunication etc. Implementing standardized, electronic patient hand off communication tools is known to have a positive effect on provider satisfaction and potentially patient safety. [54] Also, integrating sign off notes into EHR was found to improve physician workflow and improve physician satisfaction. [55]

Patient portals

Electronic health records can improve the relationship between healthcare providers and their patients. EHR systems make it easier for patients to access their medical records as opposed to the time consuming and expensive way of copying stacks of paper health records. Patients appreciated the ability to review their patient files which allowed them to be more comfortable and knowledgeable about their own health [25].

With the increase in use of patient portals, more patients and physicians are communicating via secure online messaging. Patients can request appointments, refills, review lab results, pay bills or ask general questions about their health via online portals. Online appointment scheduling is one of the most desired features of the patient portal followed by reviewing test results. In fact, Kaiser Permanente experienced a jump from 9% to 27% in patient registration once they added the feature to review test results [72].

Patients are more likely to ask questions via the portal because it offers private and direct communication with the physician. This enables the patient to feel comfortable to ask difficult -- and sometimes embarrassing -- questions, whereas the patient may refrain if he or she has to go through a nurse first. These candid questions offer better insight into the patient’s concerns, allowing the provider to be more responsive to the patient’s individual needs.[56]

Engagement of patients with their care is a benefit of these portals and the education they receive due to this engagement is also profound [55].

But first we must look at changing the behavior of both the physician and patient. Patients have always relied on their physicians as having all their healthcare information. Patients need to be educated on the importance of their involvement in their own healthcare. Physicians need to be shown how this will improve their quality of care to the care and what it will mean to their workflow. [57]

Patient Education Through PHRs

PHRs and patient portals can provide patients with vetted, high-quality information specific to their disease, condition, or health. Patient education, improved health literacy, and more patient engagement are seen as key factors in improving healthcare outcomes.[58]


Improve efficiency and patient throughput

The Institute of Medicine estimates that $17-29 billion is spent annually on unnecessary or inaccurate patient care due to misdiagnosis. If clinicians can rapidly determine the correct dose, calculation or diagnosis, they can order relevant tests and make appropriate referrals, saving time and eliminating unnecessary costs for the patients and the ED. Of course, CDS is most effective when it is built into the clinician’s workflow, which minimizes interruptions and dangerous distractions. It is also important for CDS to be incorporated into providers’ workflow in such a way that minimizes alert fatigue.[59].

Standardization of Practice

Although publication of evidence-based medicine abounds, it has been noted that physicians do not practice according to proven guidelines.[60] The reasons are numerous. One of them is that busy physicians do not have the time to read publications that have increased exponentially. [61] Another is the innate human limitation in the capacity to integrate information during decision-making.[60] This has led to a decline in patient care standards.[61] CDDS can increase compliance with evidence-based practice by presenting the needed information to the clinician at the point of care.[60] And while there is resistance to its use from physicians who view CDSS as an out of the box practice that is not tailored to their clinical workflow, it has been noted that incorporating factors such as patient-specific information, consideration of comorbid conditions, and organized and explicit presentation, might result in increased CDSS utilization. [62]

Universal Protocol

Universal protocols are developed by various disease monitoring agencies for accurate diagnosis, management and prevention of health related problems.For instance the universal protocol created by the joint commission to prevent wrong site,wrong procedure,and wrong surgery. [63].This ensures the same standard of care everywhere.


Barriers to EMR Implementation

System Selection

Based on the application the type of system selected will vary based on current research, size of practice, institution, academic affiliation, vendors and their ability to demonstrate compliance with current research “by identifying funded and published research(Kannry Mukani& Myers , 2006)” and ultimately the assessment and analysis of the total cost of ownership.

ONE CONSISTENT THEME emerges from EHR implementations in physician practices: almost everyone underestimates the complexity, time, and effort required. [64]

According to Kannry Mukani& Myers in their 2006 article Using an Evidence-based Approach for System Selection at a Large Academic Medical Center: Lessons Learned in Selecting an Ambulatory EMR at Mount Sinai Hospital . The authors note the technology requirements of educational institutions vary greatly from the needs of the private sector. Although both the private sector and academia have concerns with accurate documentation, patient safety and patient care, educational institutions focus on “education, training and research, (Kannry Mukani& Myers, 2006). The need of residents and compliance with regulatory requirements is significant and cannot be minimized. [13] According to Ajami and Chadegani, despite of the potential benefits of electronic health records, implement of this project facing with barriers and restriction, that the most of these limitations are cost constraints, technical limitations, standardization limits, attitudinal constraints–behavior of individuals and organizational constraints.[71] The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of time and workload. Each user group also identified factors specific to their professional and individual priorities [30].

  • In order for an EMR to be truly successful, proper and timely training must be administered to all who will interact with the system.
  • Conflicting research findings on the cost and efficiency benefits of EMR implementations will make it difficult, if not impossible, for administration staff to be confident in choosing an EMR for their facility. Until there is adequate research on multitudes of EMR systems that shows causal relationships between facility characteristics and the related EMR components there will not be a sufficient method of EMR selection and implantation.
  • If it is true that implementations of EMRs cause a decrease in efficiency and an increase in quality of medical care then further research must take both of these repercussions into account and determine if there is an overall net benefit of EMR implementation.
  • The use of EMR and the afforded efficiencies may not provide immediate cost savings to some office-based physicians. These physicians may not be able to reduce their office expenses sufficiently to offset the revenue decreases they may see as a result of increasing efficiency. For example, a physician who is paid, as many laboratory or treatment centers are, per service rendered would see a direct decrease in revenue were they to reduce the number of duplicated diagnostic tests.[3]
  • The reported barriers to adoption and MU of EHRs were not associated with serving a predominately Medicaid-insured population, and were consistent with barriers that health care professionals in other studies had previously reported. In fact, barriers to adopting and using EHRs that could be associated with Medicaid providers were issues specific to provider types who were eligible for the Medicaid EHR Incentive Program but not the Medicare EHR Incentive Program, specifically, dentists and pediatricians. However, all findings were useful in generating a set of recommendations that are specific to promoting MU of EHRs among health care professionals eligible for the Medicaid EHR Incentive Program. [4]
  • The variability of results of similar studies on the monetary and efficiency benefits of EHRs indicates that there is no single approach to EMR implementation that will fit all settings. Variables such as hospital size, setting, specialty, prior computer integration, etc will determine the effectiveness of an EMR dramatically and must be considered in all cases.
  • The high cost of basic infrastructure of clinical information technology is a substantial hurdle for many health care organizations, many of whose income margins have deteriorated after years of decreasing reimbursement (from Medicare and other sources) and whose access to capital for new medical technology is extremely scarce. Financial instability and scarce capital resources for IT infrastructure similarly affect small to mid-sized independent practice associations (IPAs) and independent physician offices, the practice venues for most physicians in the United States.
  • Diversity of products as well as lack of standards for common architecture of basic infrastructure of clinical information technology constitutes a barrier and further complicates EMR Implementation.

Costs

Cost benefit analysis is categorized into 3 fields [70]:

  1. Direct, one-time costs
    1. Hardware & Peripherals
    2. Packaged and customized software
    3. Network, peripherals, supplies, equipment
    4. Initial data collection and conversion of archival data
    5. Facilities upgrades, including site preparation and renovation
    6. End-user project management
    7. Project planning, contract negotiation, procurement
    8. Application development and deployment
    9. Configuration management
    10. Office accommodations, furniture, related items
    11. Initial user training
    12. Workforce adjustment for affected employees
    13. Transition costs (parallel systems, converting legacy systems)
    14. Quality assurance and post implementation reviews
  1. Direct, ongoing costs
    1. Salaries for IT and assigned end user staff
    2. Software maintenance, subscriptions, upgrades,
    3. Equipment leases
    4. Facilities rental and utilities
    5. Professional services, Ongoing training and
    6. Reviews and audits
  1. Indirect, ongoing costs.
    1. Data integrity
    2. Security
    3. Privacy
    4. IT policy management
    5. Help Desk

The financial commitment of implementing a CPOE system varies amongst facilities and depends on the facility's current hardware and software systems. The institution's current system needs to have a strong infrastructure in order to be able to enhance it's capabilities. The license for the software is but a small portion of the total cost. The larger expenses incurred will be a result of training healthcare professionals and support activities. Customer service and technical support should be available everyday 24 hours a day.

For more information, see EMR Cost Categories.

Challenges to Identifying a Return on Investment (ROI)

Evidence of a strong ROI business case for EHR implementation is confounded by anecdotal evidence in peer reviewed research and trade journals. Furthermore, environmental differences across provider settings make it challenging to replicate information system strategies and dependence on disparate legacy applications [48]. For organizational stakeholders to embrace EHR adoption, they need assurance that adopting an EHR system would positively impact business performance [58].

Additional barriers include:

  • Vendor supplied benefits data may not be objective
  • Few vendors maintain a structured database of benefits information
  • Peer reviewed studies are difficult to compare due to the complexity of health services delivery and variety of provider settings.
  • Differences in system architecture
  • Trade journals tend to focus on anecdotal evidence rather then empirical evidence
  • No standardized domain method exists to measure the ROI of electronic health records
  • Lack of information regarding maintenance and optimization costs [48]

Consequently, providers frequently lack the necessary information to make sound financial decisions regarding Health IT capital investments. Uncovering the true cost and benefit of EHR adoption will require a national effort to standardize and centralize evidence in a national database. [48]

EMR and Providers’ Productivity

Health care providers are adopting electronic medical records, but some doctors report a disturbing side effect. Instead of becoming more efficient, some practices, especially smaller ones are becoming less. As with all new systems, there will be a temporary reduction in productivity as the healthcare staff become familiar with the new system. A study by Menachemi and Brooks (2006) estimated a 20% loss of productivity for the first month, 10% loss in the second month, and 5% loss in the third month and finally productivity returning to baseline in the subsequent months. [65]. Several studies indicated that when physicians spent extra time entering data themselves, it cut down time spent with patients and stretched out their workday. [70]

In a study by Bhargava et al. which examines productivity impacts of electronic medical records (EMR) implementation in a large academic hospital in California. Bhargava et al. also investigate the dynamics through which EMRs may impact productivity. The study employ random effects model on panel data comprising 3,189 physician-month observations for productivity data collected on 87 physicians specializing in internal medicine, pediatrics and family practice. The total duration of data collection was 39 months. Bhargava et al. find that the productivity of physicians dropped immediately after EMR implementation, but began to recover in a few months and finally leveled-off. Additionally, Bhargava et al. find that productivity impacts of EMR are contingent upon physician specialty. Bhargava et al postulate that the fit provided by an EMR to the task requirements of physicians of various specialties is key to entangling the productivity dynamics. [71]

Return on Investment (ROI) Estimates

While barriers of determining actual ROI for EMR implementations exist, companies such as Dr. Cloud EMR are providing EMR and EHR ROI estimates based on each practice's details. This however does not suggest that it is entirely accurate and is only an estimate. DrCloudEMR is built by DrCloud Healthcare Solutions Inc, a wholly owned EnSoftek, Inc. subsidiary. [65] There are 2 main postulates for ROI which KOSH’s postulate and Sir Austin Bradford Hill’s criteria for Causation. Kosh’s postulate for CIS is i. The system or feature must be present in every case in which the benefit is observed. ii. The system must be isolated from the organization. iii. The benefit must be reproduced when the system is implemented in a new organization. iv. We must demonstrate that the system was used in the new organization. Hill’s Criteria for Causation includes (a) Strength of Association (b) Consistency of findings (c) Specificity of Association (d) Temporality (e) Dose-response (f) Plausibility (g) Coherence (h) Experimental Evidence and Analogy.

(a) Strength of Association tells us that the greater the change observed, the more likely the association is to be causal (e.g. If a EHR system is implemented and the CPOE feature greatly reduces medication errors, we could say that the implementation of the system had a causal effect on the reduction of medication errors and the strength of association is great).

(b) Consistency of Findings explains that if a change has been observed by different groups in different places with different circumstances and systems, the change is valid, so to speak. For example, if Company A (London, England, UK) implements System A , Company B (Houston, TX, USA) implements System B, and Company C (Guadalajara, Jalisco, Mexico) implements System C, and all three companies reduce medication errors using their respective systems, we can, again say that the CPOE feature of EHR systems can help reduce medication errors. It is important to note that the more consistent findings amongst different groups in different places, the better.

(c) Specificity of Association requires us to ask if there are any other factors which may have affected the change that we've observed. In regards to medication errors being reduced, one would have to ask if CPOE was the only factor involved. If errors could have been reduced due to other mechanisms in place besides CPOE alerts (e.g. better workflow in departments, new policies, etc.), the specificity of association could be considered weak. Weak does not imply wrong, but it does mean that more research has to be initiated.

(d) Temporality addresses the evaluation after an EHR system is implemented. Temporality asks us "were there any changes AFTER the system was implemented?" Usually this is harder to prove due to lack of data prior to EHR implementation, however, Sittig rates temporality as "strong."

(e) Dose-Response asks if the size of changes are directly correlated with the increase of system use (e.g. were medication errors greatly reduced due to the use of many medication alerts in the EHR system?). Usually, there is a strong and direct correlation between system use and the reduction of medication errors, as one example of a dose response in an EHR system.

(f) Plausibility must be shown; There must be some way to demonstrate that the EHR system was used the way it was intended to deliver certain results (e.g. Physicians must have used clinical support decisions the way the EHR system intended to reduce medication errors, in order to demonstrate plausibility.)

(g) Coherence simply states that changes caused by EHR systems should be caused by other EHR systems elsewhere. So, if medication errors are reduced by the use of one EHR system and that happens with the use of many other EHR systems, coherence exists.

(h) Experimental Evidence and Analogy is proving that when the system is not used properly or at all, that certain changes stop. So, if an EHR system is not being used properly or at all (after initial proper use), does a rise in medication errors resume? Experimental evidence is hard to obtain after EHR implementation because it requires not using the system for quite some time (which many would view as wasted money).



Reference Laboratories

Reference Labs benefit greatly from interfacing with the various EMR's of the Hospitals, Clinics, and Physician Practices which utilize their services. Benefits include, but are not limited to: [66]

  • Decreased costs as a result of transitioning to a paperless system.
  • Decreased order entry time.
  • Decreased lab result response time.

Through the use of EMRs a physician is able to place a lab order for their patients in their EMR and have that information be conveyed electronically through the use of Health Level 7 (HL7)[67] messages to the system utilized by the reference lab. This saves time as the order will automatically populate within the reference lab's system and will not have to be manually entered.

Once the lab work is complete the results can be transmitted in a similar manner as the initial order to have the results populate in the ordering provider's EMR. This increases the precision of the results, and decreases the time required for the patient and physician to receive the results as the result would no longer require to wait until someone in the physician's office manually enters the results into the EMR (risking the possibility of errors).

Educational Benefits

Patients also are not left out of potential benefits of an Electronic Medical Record (EMR), as providers can provide patients with educational materials relative to patient condition and diagnosis. (Marshall, 1998). [68]


Misc, to sort later

  • E-prescribing will reduce number of physician office visit and phone call. phone calls and visits, Test results and appointments alert will be implemented and patients are automatically notified of test results and appointment times. [5] [6] [7]
  • Updates are done faster and files can be synchronized.
  • Duplicate orders and illegible handwriting will no longer be an issue is less of a problem [69]
  • Hard drives take up less space. Shared databases reduces the need for paper [8]
  • Billing is easier as the formatted documentation may improve the accuracy of charge capture.
  • Billing edits, including National and Local Coverage Determinations, can be alerted in real-time.
  • Patients arecan be informed of generic drugs, doctors can know if insurances do not cover patients, and formulary requirements can be identified.
  • Insurance and malpractice premiums can also be lowered. [9]) [10]
  • Different drugs can save hospitals money Hospitals will save money over various drugs [11].
  • Dictation is automatic
  • HIM staff may be reduced or staffing requirements changed [12]
  • Nurses will be more productive and more efficient [13]
  • Reduces medication errors and checks for drug-drug interactionsAdverse drug event (ADE), drug-drug interactions(DDI)will be detected thereby reducing errors in medication. [14] [15] [16] [17]
  • Reduces redundant lab tests [18] [19]
  • Reminders increase underused preventative measures [20]
  • deduce infections from a list of symptoms and help make doctors make good clinical decisions. [21] [22] [23] [24] The patient internet portal allows patients to know the most up to date information about healthcare. [25]
  • Telemedicine
  • Large scale data exchange and information integration [26] [27]
  • Surveillance and reporting of diseases [28]
  • Research information in the database [29]

Academic EHRs are functional systems that makes training for nursing staff more efficient. Student nurses apply their learnt skills to plan patient care in a simulated setup. This allows student nurses to develop their acquired knowledge in a practical setting and transition into a familiar working environment after their academic careers.([70].

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
60. Interviews with John Kansky, Laura Adams (2014, 8) by Mark Braunstein, GA Tech.
61. What is the DIRECT project (2010, 10) by The Direct Project. http://wiki.directproject.org/file/view/DirectProjectOverview.pdf

References (old, to edit)

  1. What Is an Electronic Medical Record (EMR)? http://www.healthit.gov/providers-professionals/electronic-medical-records-emr
  2. Heubusch, K. (2008). Certified EHRs. Journal of AHIMA, 79(8), 34-36. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/212569443?accountid=7034
  3. 3.0 3.1 http://intecit.com/industry-solutions/healthcare-it/mobile-devices-and-electronic-medical-records-emrs-anytime-access-and-convenience-for-patients-and-doctors/
  4. Boulos MN, Wheeler S, Tavares C, Jones R. How smartphones are changing the face of mobile and participatory health care; an overview, with example from eCAALYX. Biomed Eng Online. 2011 Apr;10:24.
  5. Chase J. IPads and other drugs. Medical Marketing & Media: The Interactive Guide.
  6. Moodley A, Mangino J, Goff D. Review of infectious diseases applications for iPhone/iPad and Android: from pocket to patient. Clin Infect Dis. 2013 Oct;57:1145–1154.
  7. Wallace S, Clark M, White J. ‘It’s on my iPhone’: attitudes to the use of mobile computing devices in medical education, a mixed-methods study. BMJ Open. 2012 Aug;2:e001099.
  8. 8.0 8.1 8.2 Davies, Michael A.M. "Wearable Tech Can Extend Clinical Analytics." InformationWeek. N.p., 12 Aug. 2014. Web. 19 Sept. 2014 http://www.informationweek.com/healthcare/mobile-and-wireless/wearable-tech-can-extend-clinical-analytics/a/d-id/1297924
  9. Will Apple Watch revolutionize health care? Three reasons to be cautious. http://www.advisory.com/daily-briefing/blog/2014/09/will-apple-iwatch-revolutionize-health-care
  10. 10.0 10.1 BodyMedia FitBit Official Website http://www.fitbit.com/story
  11. Physicians Divided on Cloudbased EHRs http://www.ihealthbeat.org/insight/2013/physicians-divided-on-cloudbased-ehrs
  12. ZH Healthcare (ZH) Releases New Electronic Health Solution (EHS), Becomes Provider’s Answer to Health IT. http://www.prweb.com/releases/2015/01/prweb12444585.htm
  13. 13.0 13.1 13.2 http://entradahealth.com/resources/case-studies/voice-enabled-mobile-workflow/
  14. drchrono https://www.drchrono.com/about_us/
  15. drchrono products https://www.drchrono.com/products/ehr/
  16. mmodal http://mmodal.com/products-and-services/speech/
  17. drchrono clinical forms https://www.drchrono.com/features/clinical-forms/
  18. drchrono patient benefits https://www.drchrono.com/
  19. drchrono onpatient https://www.drchrono.com/products/onpatient/
  20. 20.0 20.1 Tam C, Sharma A. Mobile medical apps: to regulate or not to regulate? American Pharmacists Association. Available at: http://www.pharmacist.com/mobile-medical-apps-regulate-or-not-regulate.
  21. Mickan S, Tilson JK, Atherton H, et al. Evidence of effectiveness of health care professionals using handheld computers; a scoping review of systematic reviews. J Med Internet Res. 2013;15(10):e212.
  22. Mosa AS, Yoo I, Sheets L. A systematic review of health care apps for smartphones. BMC Med Inform Dec Mak. 2012 Jul;12:67.
  23. Divali P, Camosso-Stefinovic J, Baker R. Use of personal digital assistants in clinical decision making by health care professionals: a systematic review. Health Informatics J. 2013;19(1):16–28.
  24. Misra S, Lewis TL, Aungst TD. Medical application use and the need for further research and assessment for clinical practice: creation and integration of standards for best practice to alleviate poor application design. JAMA Dermatol. 2013;149(6):661–662.
  25. Mobile Medical Applications. FDA. Available at http://www.fda.gov/medicaldevices/productsandmedicalprocedures/connectedhealth/mobilemedicalapplications/default.htm
  26. Braunstein, Mark (08/2014) Excerpts from Interviews with John Kansky Interim President, CEO, IHIE, Laura Adams, CEO Rhode Island Quality Institute
  27. Health benefits. http://www.va.gov/healthbenefits/resources/publications/IB10185_Health_Care_Overview_2014_Eng_V6_web.pdf
  28. Muir, E. (2013, March 3). What is 'FHIR' and why should you care? Retrieved January 26, 2015, from http://www.interfaceware.com/blog/what-is-fhir-and-why-should-you-care/
  29. 29.0 29.1 29.2 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.
  30. Benefits of EMR or EHR Over Paper Charts http://www.emrandhipaa.com/benefits-of-emr-or-ehr-over-paper-charts/
  31. Electronic Medical Records and the Environment http://www.healthynumbers.co.za/index.php?page=electronic_medical_records_environment
  32. Medical Education in the Electronic Medical Record (EMR) Era: Benefits, Challenges, and Future DirectionsMichael J. Tierney, MD, Natalie M. Pageler, MD, Madelyn Kahana, MD, Julie L. Pantaleoni, MD, and Christopher A. Longhurst, MD, MS Acad Med. 2013 Jun;88(6):748-52. http://www.ncbi.nlm.nih.gov/pubmed/23619078
  33. Refocusing Medical Education in the EMR Era. Natalie M. Pageler; Charles P. Friedman; Christopher A. Longhurst. JAMA. 2013;310(21):2249-2250. http://jama.jamanetwork.com/article.aspx?articleid=1787416
  34. Delbanco T, Walker J, Bell SK, Darer JD, Elmore JG, Farag N, et al. Inviting Patients to Read Their Doctors' Notes: A Quasi-experimental Study and a Look Ahead. Ann Intern Med. 2012;157:461-470. http://annals.org/article.aspx?articleid=1363511
  35. Health Benefits. http://www.va.gov/healthbenefits/resources/publications/IB10185_Health_Care_Overview_2014_Eng_V6_web.pdf
  36. Cite error: Invalid <ref> tag; no text was provided for refs named Patient_Participation
  37. About: The Benefits of Electronic Health Records (EHRs) http://patients.about.com/od/electronicpatientrecords/a/EMRbenefits.htm
  38. Weinstein, D. Patient survey indicates promise of EHR (2015)http://www.mmm-online.com/patient-survey-indicates-promise-of-ehr/article/391473/
  39. Wang, S. J., Middleton, B., A. Prosser, L., G. Bardon, C., D. Spurr, C., J. Carchidi, P. A cost-benefit analysis of electronic medical records in primary care. http://www.ncbi.nlm.nih.gov/pubmed/12714130
  40. Elliott, P., Martin, D. & Neville, D. (2014). Electronic Clinical Safety Reporting System: A Benefits Evaluation. JMIR MEDICAL INFORMATICS; 2(1):e12. http://www.ncbi.nlm.nih.gov/pubmed/25600569
  41. 41.0 41.1 The impact of computerized provider order entry on medication errors in a multispecialty group practice. http://www.ncbi.nlm.nih.gov/pubmed/20064806/
  42. Clinical Decision Support more than just alerts tipsheet. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/ClinicalDecisionSupport_Tipsheet-.pdf
  43. Cite error: Invalid <ref> tag; no text was provided for refs named benefits_.26_drawbacks
  44. The Era of Electronic Medical Records. http://health.usnews.com/health-news/most-connected-hospitals/articles/2011/07/18/most-connected-hospitals
  45. Cite error: Invalid <ref> tag; no text was provided for refs named practical_guide
  46. Electronic Mediation Administration. http://www.fdbhealth.com/solutions/emar/
  47. Berdy, Gregg J. "EHR brings tangible benefits: how it's possible to operate an ophthalmology practice electronically and efficiently." Ophthalmology Times 1 Oct. 2013: 48. Health Reference Center Academic. Web. 12 Sept. 2014. Accessed at: http://go.galegroup.com/ps/i.do?id=GALE%7CA350575449&v=2.1&u=txshracd2509&it=r&p=HRCA&sw=w&asid=4392d00f96857d4f275dd1ab337a1958
  48. http://srssoft.com/srs-pacs
  49. Benefits of Telehealth / Telemedicine? http://www.setrc.us/index.php/what-is-telehealth/benefits-of-telehealth-telemedicine/
  50. Chen, L., Chuang, L.M., Chang, C.H., Wang, C.S., Wang, I.C., Chung, Y., Peng, H.Y., Chen, H.C., Hsu, Y.L., Lin, Y.S., Chen, H.J., Chang, T.C., Jiang, Y.D., Lee, H.C., Tan, C.T., Chang, H.L. & Lai, F. (2013). Evaluating Self-Management Behaviors of Diabetic Patients in a Telehealthcare Program: Longitudinal Study Over 18 Months. Journal of Medical Internet Research; 15(12):e266. http://www.jmir.org/2013/12/e266/
  51. http://www.va.gov/healthbenefits/resources/publications/IB10185_Health_Care_Overview_2014_Eng_V6_web.pdf
  52. 52.0 52.1 5 simple ways to realize ROI from your EHR.http://www.healthcareitnews.com/news/5-simple-ways-realize-roi-your-ehr/
  53. 53.0 53.1 Jamoom, E., Patel, V., King, J., & Furukawa, M. (2012, August). National perceptions of ehr adoption: Barriers, impacts, and federal policies. National conference on health statistics.
  54. Implementation of a Standardized, Electronic Patient Hand Off Communication Tool in a Level III NICU. Source: OJNI Volume 18, Number 2 June 1, 2014
  55. Bernstein, Jonathan A.; Imler, Daniel L.; Sharek, Paul; Longhurst, Christopher A. Improved Physician Work Flow After Integrating Sign-out Notes into the Electronic Medical Record Source: Joint Commission Journal on Quality and Patient Safety, Volume 36, Number 2, February 2010, pp. 72-78(7)
  56. J.Morrow How a patient portal can benefit your practice.http://www.medicalpracticeinsider.com/best-practices/how-patient-portal-can-benefit-your-practice
  57. Patient engagement means attitude adjustments on both sides. http://www.healthcareitnews.com/news/patient-engagement-means-attitude-adjustments-both-sides
  58. http://www.healthit.gov/providers-professionals/faqs/what-are-advantages-electronic-health-records
  59. Top 5 Benefits of Clinical Decision Support in the ED http://www.govhealthit.com/blog/top-5-benefits-clinical-decision-support-ed
  60. 60.0 60.1 60.2 Morris, A. H. (2000). Developing and implementing computerized protocols for standardization of clinical decisions. Retrieved from http://www.sciencedirect.com/science/article/pii/S1532046407001049
  61. 61.0 61.1 Sackett, D. L., & Rosenberg, W. M. (1995). The need for evidence-based medicine. J R Soc Med, 88(11), 620-624. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1295384/?tool=pmcentrez
  62. Sittig, D. F., Wright, A., Osheroff, J. A., Middleton, B., Teich, J. M., Ash, J. S., . . . Bates, D. W. (2008). Grand challenges in clinical decision support. J Biomed Inform, 41(2), 387-392. doi: 10.1016/j.jbi.2007.09.003. Retrieved from http://www.sciencedirect.com/science/article/pii/S1532046407001049
  63. Chapter 4. Determining the Target Patient Safety Practices.http://archive.ahrq.gov/research/findings/finalreports/contextsensitive/context4.html
  64. Gaudreau, E., & Palermo, D. (2009). EHR fast track. Journal of AHIMA, 80(8), 40-43. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/212610540?accountid=703
  65. Menachemi, N. & Brooksm R. (2006). Reviewing the Benefits and Costs of Electronic Health Records and Associated Patient Safety Technologies.http://download.springer.com.ezproxyhost.library.tmc.edu/static/pdf/470/art%253A10.1007%252Fs10916-005-7988-x.pdf?auth66=1411967145_1fbceb4fa2c5cea1c67867e88dd78695&ext=.pdf
  66. Making Reference Labs More Competitive and Profitable with an HL7 Interface Engine, http://www.corepointhealth.com/sites/default/files/whitepapers/reference-labs-hl7-engine-advantages.pdf
  67. Health Level 7, http://www.hl7.org/about/index.cfm?ref=nav
  68. Marshall, P. D., & Chin, H. L. (1998). The Effects of an Electronic Medical Record on Patient Care: Clinician Attitudes in a Large HMO. In Proceedings of the AMIA Symposium (p. 150). American Medical Informatics Association.
  69. IOM Key Capabilities of an Electronic Health Record System http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf
  70. Gardner, C. and Jones, S. (June 2012). Utilization of academic electronic medical records in undergraduate nursing education. Online Journal of Nursing Informatics (OJNI), vol. 16 (2)


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. msdc benefits of emr
  2. about ehrs
  3. malpractice 2008
  4. http://www.cdc.gov/about/grand-rounds/archives/2011/july2011.htm
  5. http://www.mayoclinic.org/emr/benefits.html
  6. Integrated Centre for Care Advancement through Research (iCARE); Canada Health Infoway (Infoway); Canadian Patient Safety Institute (CPSI). (2007). The Relationship Between Electronic Health Records and Patient Safety: A Joint Report On Future Directions For Canada. 1-31.
  7. Crane, R. M., Raymond, B., (Winter 2003). Fulfilling the Potential of Clinical Information Systems. The Permanente Journal. 7 (1), pp.62-67
  8. Hersh, W. R., (2002). Medical Informatics: Improving Health Care Through Information. Journal of American Medical Association. 288 (16), pp.1955-1958
  9. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_046429.hcsp?dDocName=bok1_046429
  10. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/56_DataAndReports.asp
  11. http://www.ischool.drexel.edu/faculty/ssilverstein/AJM-Himmelstein-Hospital-Computing.pdf
  12. http://www.himss.org/content/files/jhim/20-2/16_original_evidence.pdf
  13. http://www.markle.org/publications/403-achieving-health-it-objectives-american-recovery-and-reinvestment-act
  14. http://www.cdc.gov/ehrmeaningfuluse/
  15. http://healthit.ahrq.gov/portal/server.pt/document/958478/barriers_to_meaningful_use_in_medicaid_final_report_pdf?qid=82968838&rank=5
  16. Evidence on the Costs and Benefits of Health Information Technology. A Congressional Budget Office Paper. Congress of the United States. Congressional Budget Office. Available at: http://www.cbo.gov/publication/41690. Acessed September 30, 2013.
  17. Kuperman GJ, Gibson RF. Computer Physician Order Entry: Benefits, Costs and Issues. Ann Intern Med. 2003;139:31-39.
  18. Shapiro JS, Kannry J, et al. Approaches to patient health information exchange and their impact on emergency medicine. Ann Emerg Med. 2006 Oct;48(4):426-432.
  19. Kaushal R, Jha AK, Franz C, Glaser J, Shetty KD, Jaggi T, Middleton B, Kuperman GJ, Khorasani R, Tanasijevic M, Bates DW; Brigham and Women's Hospital CPOE Working Group. (2006). Return on investment for a computerized physician order entry system. J Am Med Inform Assoc. 13(3):261-6.
  20. tierney 2013
  21. http://www.hhs.gov/news/press/2013pres/08/20130805a.html
  22. http://www.fierceemr.com/story/new-york-looks-ehrs-enhance-public-health-surveillance/2013-08-27
  23. http://ehrintelligence.com/2012/12/10/engaging-patients-through-ehr-access-open-notes/
  24. The effect of electronic medical record-based clinical decision support on HIV care in resource-constrained settings: A systematic review Tom Oluocha,*,Xenophon Santasb, Daniel Kwaroc, Martin Wered, Paul Biondichd,
  25. Driessen J,CioffiM, Alide N,et al. J Am Med Inform Assoc 2013;20:743–748.
  26. Overcoming barriers to electronic medical record (EMR) implementation in the US healthcare system: A comparative study Sameer Kumar, Krista Aldrich
  27. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Basics.html
  28. http://www.ncbi.nlm.nih.gov/pubmed/9576410
  29. Study of the factors that promoted the implementation of electronic medical record on iPads at two emergency departments. Rao AS, Adam TJ, Gensinger R, Westra BL. AMIA Annu Symp Proc. 2012;2012:744-52. Epub 2012 Nov 3.
  30. Connelly, D. P., Park, Y. T., Du, J., Theera-Ampornpunt, N., Gordon,B. D., Bershow, B. A., ... & Speedie, S. M. (2012). The impact of electronic health records on care of heart failure patients in the emergency room. Journal of the American Medical Informatics Association, 19(3), 334-340.
  31. Pinsonneault, A., Dakshinamoorthy, V., Reidel, K., & Tamblyn, R. (2012, January). The impact of IT on quality of care: Evaluation of an integrated chronic disease management system. In System Science (HICSS), 2012 45th Hawaii International Conference on (pp. 2947-2956). IEEE.
  32. McGinn, C. A., Grenier, S., Duplantie, J., Shaw, N., Sicotte, C., Mathieu, L., ... & Gagnon, M. P. (2011). Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC medicine, 9(1), 46.
  33. Mintz, MD, M., Narvarte, MD, H. J., OBrien, MD, K. E., Papp, PhD, K. K., Thomas, MD, M., & Durning, MD, S. J. (2009). Use of electronic medical records by physicians and students in academic internal medicine settings. Academic Medicine, 84(12), 1698-1704.
  34. http://www.practicefusion.com/ehrbloggers/2010/10/return-on-investment-for-emrs.html
  35. http://jama.jamanetwork.com/article.aspx?articleid=1737043#ArticleInformation
  36. Kuperman, G.J. and Gibson, R.F. (2003) “Computer Physician Order Entry: Benefits, Costs & Issues” Am Intern Med 2003; 139:31-39
  37. Crane, R.M. and Raymond, B. (2003) “Fulfilling the Potential of Clinical Information Systems: The Permanente Journal Winter/2003/Vol.7No1
  38. Kaushal, R.; Jha, A.K.; Franz, C. et al. (2006) J Am Med Inform Assoc 2006;13:261-266 doi 10.1197/jamia.J1984
  39. http://www.nejm.org/doi/full/10.1056/NEJMp1211315#t=article
  40. Menachemi N, Collum H.T. Benefits and drawbacks of electronic health record systems.Risk Manag Healthc Policy. 2011; 4: 47–55.
  41. http://www.healthit.gov/sites/default/files/pdf/privacy/privacy-and-security-guide-chapter-2.pdf
  42. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978883/
  43. Thompson, D., Osheroff, J., Classen, D., & Sittig, D. (2007). 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, 21 (1), 62-68.
  44. Butcher L. Hospitals strengthen bonds with post-acute providers. http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/01JAN2013/0113HHN_Feature_strategy&domain=HHNMAG
  45. Voigt, C. & Torzewski, S. (2011). Direct results: An HIE simple information exchange using the direct project. Journal of AHIMA, 38-41.
  46. Kohn, L. T., Corrigan, J. M., & Donaldson, M. S., eds. (2000). To err is human. Institute of Medicine Committee on Quality of Health Care in America. Washington, DC: National Academic Press.
  47. McGeath, J. (2012). The Team Dynamics of Connecting Medical Devices with EMR Systems. 24X7, 17(10), 34-41
  48. Mulherin, D. P., Zimmerman, C. R., & Chaffee, B. W. (2013). National standards for computerized prescriber order entry and clinical decision support: The case of drug interactions. American Journal Of Health-System Pharmacy, 70(1), 59-64. doi:10.2146/ajhp120217
  49. Otte-Trojel, T., de Bont, A., Rundall, T. G., & van de Klundert, J. (2014). How outcomes are achieved through patient portals: a realist review. Journal of the American Medical Informatics Association, amiajnl-2013.
  50. http://www.healthit.gov/providers-professionals/2-install-and-enable-encryption
  51. http://www.dialogmedical.com/informed-consent-2-3/
  52. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047866.hcsp?dDocName=bok1_047866
  53. Hayek S1 et al. End-of-Life Care Planning: Improving Documentation of Advance Directives in the Outpatient Clinic using Electronic Medical Records. J Palliat Med. 2014 Jul 2.
  54. Gummadi S1. Electronic medical record: a balancing act of patient safety, privacy and health care delivery. Am J Med Sci. 2014 Sep;348(3):238-43.
  55. Ojeleye O1 et al. The evidence for the effectiveness of safety alerts in electronic patient medication record systems at the point of pharmacy order entry: a systematic review. BMC Med Inform Decis Mak. 2013 Jul 1;13:69.
  56. https://www.drchrono.com/meaningful-use-ehr/
  57. EMR Effectiveness: The Positive Benefit Electronic Medical Record Adoption has on Mortality Rates. http://apps.himss.org/content/files/HAHealthgradesEMRStudyWhitePaper.pdf
  58. Integrating Clinical Practice and Public Health Surveillance Using Electronic Medical Record Systems. http://www.ajpmonline.org/article/S0749-3797(12)00249-8/fulltext
  59. EMR ROI / EHR ROI Calculator. http://www.drcloudemr.com/roi/
  60. http://www.academia.edu/4083826/An_Adaptive_Evidence_Based_Medicine_System_Based_on_a_Clinical_Decision_Support_System
  61. http://www.cdc.gov/ehrmeaningfuluse/introduction.html
  62. http://www.healthit.gov/providers-professionals/faqs/how-can-electronic-health-records-improve-public-and-population-health-
  63. http://www.esi-bethesda.com/ncrrworkshops/clinicalresearch/pdf/MichaelKahnPaper.pdf
  64. http://www.forbes.com/sites/hbsworkingknowledge/2014/03/26/how-electronic-patient-records-can-slow-doctor-productivity/
  65. Bhargava, Hemant K., and Abhay Mishra. "Electronic Medical Records and Physicians Productivity: Insights from Panel Data Analysis and Design Implications." 2nd round at Management Science (2011).
  66. http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1855&pageaction=displayproduct
  67. Shortliffe, E. H., & Cimino, J. J. (2006). Biomedical informatics. Springer Science+ Business Media, LLC.
  68. http://www.healthit.gov/providers-professionals/faqs/what-are-advantages-electronic-health-records
  69. Kim, Y., Kim, S. S., Kang, S., Kim, K., & Jun Kim. (2014). Development of Mobile Platform Integrated with Existing Electronic Medical Records. Health Infrormatics Research.
  70. Zaroukian, M. (n.d.). EMR Cost-Benefit Analysis: Managing ROI into Reality. Retrieved from http://www.himss.org/files/HIMSSorg/content/files/EMRCost-BenefitReality.pdf
  71. Ajami, S., & Arabchadegani, R. (n.d.). Barriers to implement Electronic Health Records (EHRs). Materia Socio Medica, 213-213. Retrieved September 10, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3804410/
  72. http://hitconsultant.net/2014/08/19/patient-portal-features-which-is-the-most-beneficial-frustrating/
  73. http://www.cms.gov/Medicare/E-Health/Eprescribing/index.html?redirect=/EPrescribing
  74. https://www.drchrono.com
  75. turley 2011
  76. Menachemi N, Powers TL, Brooks RG. The role of information technology usage in physician practice satisfaction. Health Care Manage Rev. 2009;34(4):364–371.
  77. Elder KT, Wiltshire JC, Rooks RN, et al. Health information technology and physician career satisfaction. Perspect Health Inf Manag. 2010;7:1d.
  78. http://www.himss.org/ResourceLibrary/ResourceDetail.aspx?ItemNumber=17246
  79. http://www.ihealthbeat.org/insight/2013/physicians-divided-on-cloudbased-ehrs




6. Harrington, L., Porch, L., Acosta, K., & Wilkens, K. (2011). Realizing electronic medical record benefits: an easy-to-do usability study. The Journal of Nursing Administration, 41(7-8), 331–5. doi:10.1097/NNA.0b013e3182250b23

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 (Project Hope), 24(5), 1103–17. doi:10.1377/hlthaff.24.5.1103

References

  1. Bailey JE, Pope RA, Elliott EC, Wan JY, Waters TM, Frisse ME. Health Information Exchange Reduces Repeated Diagnostic Imaging for Back Pain. Annals of Emergency Medicine 2013 Jul;62(1):16-24.
  2. bates 1997
  3. Johnston D, Pan E, Walker J. The value of CPOE in ambulatory settings. J Healthc Inf Manag 2004;18(1):5-8.
  4. Berger RG, Kichak JP. Computerized physician order entry: helpful or harmful? J Am Med Inform Assoc 2004 Mar;11(2):100-3.
  5. Stage DRMU. 3; Meaningful Use Work Group; Paul Tang, chair and George Hripcsak, co-chair. 2013. August.
  6. Singh H. Editorial: Helping Health Care Organizations to Define Diagnostic Errors as Missed Opportunities in Diagnosis. Joint Commission Journal on Quality and Patient Safety 2014 Mar;40(3):99-101.
  7. Bogua¡eviaius A, Maleckas A, Pundzius J, Skaudickas D. Prospective randomised trial of computer‐aided diagnosis and contrast radiography in acute small bowel obstruction. European Journal of Surgery 2002;168(2):78-83.
  8. Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 2005;293(10):1223-38.
  9. McDonald KM, Matesic B, Contopoulos-Ioannidis DG, Lonhart J, Schmidt E, Pineda N, et al. Patient safety strategies targeted at diagnostic errors: a systematic review. Ann Intern Med 2013 Mar 5;158(5 Pt 2):381-9.
  10. Radley, D. C., Wasserman, M. R., Olsho, L. E., Shoemaker, S. J., Spranca, M. D., & Bradshaw, B. ( 2013). Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. Journal of the American Medical Informatics Association : Jamia, 20, 3, 470-6.

11. Kuperman,G.J.,Gibson,R.F. (2003)Computer Order Physician Entry: Benefits, Costs, and Issues. Annals of Internal Medicine,139,31-19

  1. Sittig, D. (2014, September). Return on Investment Calculations. Lecture conducted from University of Texas Health Science Center at Houston, Houston, TX.
  2. The American Journal of Medicine , Volume 114 , Issue 5 , 397 - 403
  3. Jamoom E, Beatty P, Bercovitz A, et al. (2012) Physician adoption of electronic health record systems: United States, 2011. NCHS data brief, no 98. Hyattsville, MD: National Center for Health Statistics.
  4. http://www.healthit.gov/providers-professionals/patient-participation
  5. AHRQ Daignostic errors”http://psnet.ahrq.gov/primer.aspx?primerID=12.
  6. EHRS and other technology can reduce diagnostic errors http://www.exscribe.com/orthopedic-e-news/ehremr/ehrs-and-other-technology-can-reduce-diagnostic-errors.
  7. McGregor JC, Weekes E, Forrest GN, et al. Impact of a Computerized Clinical Decision Support System on Reducing Inappropriate Antimicrobial Use: A Randomized Controlled Trial.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513678/.
  8. Top 5 Benefits of Clinical Decision Support in the ED http://www.govhealthit.com/blog/top-5-benefits-clinical-decision-support-ed.
  1. Hoyt, R., & Yoshihashi, A. (2014). Health Informatics: Practical guide for healthcare and information technology professionals.(6th ed.). Informatics Education.
  2. Hibbs, SP, Nielsen, ND, Brunskill, S, Doree, C, Yazer , MH Kufman RM, Murphy MF.
  (Jan 2015). The Impact of Electronic Decision Support on Transfusion Practice: A systemic Review [Abstruct]. Transfusion Medicine Review, 29(1),14-23 doi: 10.1016/j.tmrv.2014.10.002
  1. Nitrosi, A, Borasi, G, Nicoli, F, Modigliani, G, Botti, A, Bertolini, M, Notari, P.
  (June, 2007). A Filmless Radiology Department in a Full Digital Regional Hospital: Quantitative Evaluation of the Increased Quality and Efficiency [Abstract]. Journal of Digital Imaging, 20(2), 140-148. doi:  10.1007/s10278-007-9006-y
  1. Tolomeo, C, Shiffman, R, Bazzy-Asaad, A (Nov, 2008). Electronic medical records in a sub-specialty practice: one asthma center’s [Abstract]. Journal of Asthma, 45
  (9), 849-51 doi: 10.1080/02770900802380803