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

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*  Studies show that the use of clinical information tools produce cost savings due to improved prescription drug administration and patient safety. Electronic medical records help to reduce the number of adverse drug interactions, to improve drug dosing, and promote more effective utilization of pharmaceuticals. Crane, R.M. & Raymond, B. (2003). Fulfilling the Potential of Clinical Information Systems. ''The Permanente Journal'', 7(1), 62-67.
 
*  Studies show that the use of clinical information tools produce cost savings due to improved prescription drug administration and patient safety. Electronic medical records help to reduce the number of adverse drug interactions, to improve drug dosing, and promote more effective utilization of pharmaceuticals. Crane, R.M. & Raymond, B. (2003). Fulfilling the Potential of Clinical Information Systems. ''The Permanente Journal'', 7(1), 62-67.
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*  The article in Health Management Technology  (4/2002) highlighted the considerable savings of an electronic medical record (EMR) system versus manual methods at the California Pacific Medical Center (CPMC) in San Francisco, CA. Using EMR saves 90-135 mins in Complex NICU Patient discharge summary an 75% time Improvement.
  
 
==  '''Clinical''' ==
 
==  '''Clinical''' ==
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* EMRs can be used to ascertain phenocopies, phenotype heterogeneity, and relevant covariates to enable Genome Wide Association Studies (GWAS) of Peripherial Arterial Disease.Biorepositories linked to EMRs may provide a relatively efficient means of conducting GWAS. Kullo IJ, Fan J, Pathak J, Savova GK, Ali Z, Chute CG.Leveraging informatics for genetic studies: use of the electronic medical record to enable a genome-wide association study of peripheral arterial disease.Journal of American Medical Informatics Association.(2010);17(5):568-74.
 
* EMRs can be used to ascertain phenocopies, phenotype heterogeneity, and relevant covariates to enable Genome Wide Association Studies (GWAS) of Peripherial Arterial Disease.Biorepositories linked to EMRs may provide a relatively efficient means of conducting GWAS. Kullo IJ, Fan J, Pathak J, Savova GK, Ali Z, Chute CG.Leveraging informatics for genetic studies: use of the electronic medical record to enable a genome-wide association study of peripheral arterial disease.Journal of American Medical Informatics Association.(2010);17(5):568-74.
 +
 +
* If Medical records are shared then patient can get good care easily and safely. Important information can be accounted quickly and can save time at doctor's office.
 +
 +
* Tragic events like 9/11, Hurricane Katrina, and the California fires have showcased the benefits of electronic record keeping. For those who had medical records available were easily treated then those whose medical records are not available. Large scale EMR systems replicate their stored records in several places across the country so that one tragic event won't destroy them.
 +
http://patients.about.com/od/electronicpatientrecords/a/EMRbenefits.htm
  
 
== '''Operational''' ==
 
== '''Operational''' ==

Revision as of 11:08, 10 September 2010

The following EMR-related benefits have been identified within various health care organizations. Before one assumes that just because some other organization was able to realize a specific benefit that they will be able to achieve the same thing, one must ensure that they have the same EMR features and functions available AND the clinicians are, or will, use them at their organization. See related EMR Cost Categories page...

Common EMR Benefit Categories

Financial

  • Charges for laboratory tests were 8.8% lower in the intervention group (P < 0.05) from: Tierney WM, McDonald CJ, Hui SL, Martin DK. Computer predictions of abnormal test results. Effects on outpatient testing. JAMA. 1988;259:1194-8.
  • With the use of EMR, record handling will be conducted in the office, records will not have to be sent to an outsource provider or to a transcriber for handling. This will ultimately help saving transcription cost. Reference: http://www.allscripts.com/casestudies/nffm.pdf
  • EMR can facilitate the efficient creation and transmission of reports that support patient safety, quality improvement, public health, research, and other health care operations. All of those will reduce the cost of healthcare.
  • Studies performed by the RAND Corporation and the Center for Information Technology Leadership both estimated savings of $80 billion annually from the widespread adoption of Healthcare Information Technology. This is approximately 4 percent of the $2 trillion spent annually on health care, measured in 2005 dollars. While many observers have expressed concern about the manner in which these studies were conducted, it is nonetheless very likely that society as a whole will greatly benefit from the adoption of these systems. Evidence on the Costs and Benefits of Health Information Technology
  • EMRs can remove the middle man in different instances, cutting cost by eliminating the need for the middle man. For instance, automated dictation replaces the person that would type the dictation, thus reducing total cost.
  • Financial benefits under pay for performance (P4P) accrue to the highest quality providers, both hospitals and physicians. EMR's which allow for real-time quality data can enable organizations to better meet targets to earn quality bonuses on Medicare and private insurance reimbursement.
  • Many ambulatory EMR systems are integrated with e-Prescribing. For physicians who use this technology in 2009 and 2010 for at least 50% of their eligible patients, an addtional 2% will be added to their Medicare reimbursement. The amount drops to 1% for 2011 and 2012, and thereafter, non-use becomes a penalty. [1]
  • A major component of all hospital operating budgets is the purchase of drugs with IV and IM doses generally being considerably more costly per dose versus oral. EMR's can support early transition from parenteral medications to oral, thus decreasing costs per admission and length of stay (LOS).[Reference: Fischer MA et al.Conversion from intravenous to oral medications. Arch Int Med 163(2003):2585-2589.]
  • In a paper record, clinicians are not always thinking about optimizing charges. Omission of essential information makes it difficult to justify the charges. An EMR can help reduce billing errors and help prompt users to document fields that will be essential for billing. Wang et al, A Cost-Benefit Analysis of Electronic Medical Record.
  • Effective EMRs and clinical decision support systems help notify clinical nurse specialists of patients with pressure ulcers or risk for developing pressure ulcers and avoid unnecessary costs for hospitals. Timm JA, Chick KL, Peterson JA, Epps SI, Bleimeyer RR, Harris M. Using expert rules to automate pressure ulcer alerts for the clinical nurse specialist. AMIA Annu Symp Proc. 2008 Nov 6:1154.
  • Physicians alerted on computer-screen displays to the charges for each test, and the total charges for tests ordered that day, ordered fewer tests. "In the intervention group, physicians ordered 14% fewer tests (P < 0.005) and charges for tests were 13% lower (both P < 0.05)." Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl JMed. 1990;322:1499-504. [PMID: 2186274]
  • Showing doctors the results of previous tests on computer-screen displays, including the test dates, reduced the rate of ordering new tests. "The number of tests decreased significantly in both groups, but more in the intervention group (16.8% in the intervention group and 10.9% in the control group)." Tierney WM, McDonald CJ, Martin DK, Rogers MP. Computerized display of past test results. Effect on outpatient testing. Ann Intern Med. 1987;107:569-74. [PMID: 3631792]
  • Using a CPOE system reduced total hospital charges by $887, or 12.7%, compared to the control group. The average stay was 0.89 day shorter (P = 0.11). Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA. 1993;269:379-83. [PMID: 8418345]
  • Eliminating paper chart supplies and copying expense as well as costs associated with storing paper charts.
  • On average charts are pulled approximately 600 times a year. With an average cost of $5 to pull and re-file a chart, this is a savings of approximately $3000. Ref: A Cost-Benefit Analysis of Electronic Medical Records/Wang et al
  • EMR can reduce staff time used in preparing paper records. Brigham and Women's Hospital reported a cumulative saving of $0.6 million by automatically generating medication lists at patients' discharges using their EMR. Ref: Kaushal R et al. Return on investment for a computerized physician order entry system. J Am Med Inform Assoc. 2006;13(3):261-66.
  • Hillestad et al., estimated that at 90 percent adoption, the potential efficiency savings of the EMR for both inpatient and outpatient care could average more than $77 billion per year. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117
  • Sixty-six percent of adverse drug events might be preventable with the use of ambulatory CPOE. Each avoided event saves $1,000–$2,000 because of avoided office visits, hospitalizations, and other care. Ref: D. Johnston et al., Patient Safety in the Physician’s Office: Assessing the Value of Ambulatory CPOE, April 2004, www.chcf.org/topics/view.cfm?itemID=101965.
  • Even though some research have shown considerable savings, up to billions of dollar after EMR adoption and implementation, the heavy initial investment and long term ROI still constitute one of the main barriers for implementing such systems for small size hospitals and physician offices. Thakkar and Davis suggest that specialized software systems such as EHR need to come with "one size fits all" version of the product to be massively adopted. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2047303&blobtype=pdf)
  • Can improve billing by allowing improved medical staff documentation and lack of lost or misplaced charts.
  • A study done by Hillestad et al explains that the cumulative potential net efficiency and safety savings from hospital systems could be nearly $371 billion while potential cumulative savings from physician practice EMR systems could be $142 billion. Both savings are calculated upon a course of 15 years. This potential net financial benefit could double if the health savings produced by chronic disease prevention and management were included. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117. http://content.healthaffairs.org/cgi/content/full/24/5/1103
  • The estimated net benefit from using an EMR in promary care for a 5 year period was $86,400 per provider [Wang et al. A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine (2003)]
  • EMR can track patients medications and notified them when a drug manufacturer recalls a medication. Since these recalls are not FDA class I recalls, pharmacies are not mandated to notify these patients.Corley, S. Electronic prescribing: a review of costs and benefits.(electronic prescribing software is found to be cost effective for all size practices). Topics in Health Information Management 24.1,2003: 29.
  • Electronic "triggers" can be implemented to generate notifications to physicians and pharmacists when less costly but equally efficacious drugs can be substituted for the prescribed medication.
  • The application of EMR can help ICUs to identify missed billing opportunities, which occur more often in busy ICU environments. Consequently, this can improve billing efficiency. http://www.ncbi.nlm.nih.gov/pubmed/19590335
  • One group showed a 50% reduction in pharmacy call backs. Theoretically this should mean decreased near-misses and decreased office time used answering these calls. Ref: Allscripts. Joliet Medical Group E-Prescribing Triples Performance Payment over Prior Year. 2002. (http://www.allscripts.com)
  • EMR can provide guidance to physicians at the time of order entry for drug-dosing adjustement according to the patient's renal function. These ajustments have shown significant annual cost savings. Chertow GM, Lee J, Kuperman GJ, et al. Guided medication dosing for inpatients with renal insufficiency. JAMA. 2001;286:2839–44.
  • EMR can provide clinicians information about a patient's financial status. Examples include:
    • EMR can initiate a conversation between a physician and patient about making a drug selection, such as a drug on the patient's insurance formulary or a generic drug.
    • EMR can indicate to a physician that Medicare does not cover a particular usage of a drug.
  • Hospital Managers can use historic information regarding trends in patient census to make better decisions about staffing levels and bulk purchasing opportunities for supplies which will save the facility money.
  • According to a 2004 report by the California Healthcare Foundation for the CITL (EXTRA: Patient Safety in the Physician’s Office: Assessing the Value of Ambulatory CPOE) [[2]]

Providers with a higher capitation percentage reap more financial benefits from ACPOE than those whose practices use a fee-for-service model. This is a barrier for most practices to adopt ACPOE, based on the national average of 11.6% capitation. MikeField 15:59, 23 January 2010 (CST)

  • According to the same 2004 ACPOE report by the California Healthcare Foundation, advanced ACPOE systems for 50 providers with 14.4% capitation net return is $108,000 per provider in 5 years, or an average of $21,000/provider/year. Since two-thirds of practices have 3 or fewer physicians, and capitation is not typical, both of which the model shows leads to net cost after 5 years, other than financial are needed to encourage widespread adoption of ACPOE.

MikeField 20:11, 23 January 2010 (CST)

  • Studies show that the use of clinical information tools produce cost savings due to improved prescription drug administration and patient safety. Electronic medical records help to reduce the number of adverse drug interactions, to improve drug dosing, and promote more effective utilization of pharmaceuticals. Crane, R.M. & Raymond, B. (2003). Fulfilling the Potential of Clinical Information Systems. The Permanente Journal, 7(1), 62-67.
  • The article in Health Management Technology (4/2002) highlighted the considerable savings of an electronic medical record (EMR) system versus manual methods at the California Pacific Medical Center (CPMC) in San Francisco, CA. Using EMR saves 90-135 mins in Complex NICU Patient discharge summary an 75% time Improvement.

Clinical

  • Joan Breuer, Ph.D. 01/22/2010 20:00 Clinicians can view all angles of radiology pictures, and turn each of them around up to 360 degrees for clearer sights of potential tumor(s). The patient can be present at that time, so that he/she will be up-to-date on the status of his disease.
  • Joan Breuer, Ph.D. 01/22/2010 20:00 When observing laboratory results via an EMR, a graph can be shown of values over time (e.g., glucose levels over one week or month or year). The advantage of a graph compared to a list of values, is that one can immediately see changes very clearly, and it is much more appealing visually.
  • EMR systems have been proven to decrease the amount of time nursing staff spends on documentation. Reference: A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database. Journal of Healthcare Information Management- Vol. 21, No. 1 p 67.
  • Alert and reminder programs in EMR's increase physician attentiveness to certain areas such as preventive medicine or more specifically drug level monitoring. Reference: Computer Physician Order EntryL Benefits, Costs, and Issues. Gilad Kuperman, M.D., P.h.D., Richard Gibson, M.D., P.h.D. Ann Intern Med. 2003; 139:31-39.
  • Interfacing EMR with hospital paging system allows critical laboratory results to be communicated to responsible physician timely. The system reduces the time between a critical result arises and the corresponding physician's responses. Ref: Kuperman GJ, Teich JM, Tanasijevic MJ, Luf NM, Rittenberg E, Jha A, Fiskio J, Winkelman J, Bates DW. Improving response to critical laboratory results with automation. J Am Med Inform Assoc. 1999;6(6):512-22.
  • Information on patient allergies and other medications, in combination with alerts and reminders, can decrease the number of medication-related adverse events and improve presribing practices of physicians and nurse practioners. Key Capabilities of an Electronic Health Record System
  • Increased ordering rates for pneumococcal and influenza vaccine, prophylactic heparin, and aspirin at discharge. from: Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med. 2001;345:965-70.
  • With the quality EMR, quick access to patients records can be lifesaving during the emergency situation by helping emergency decision-making process.
  • EMR can help making medical history more efficient and accurate by providing templates that can decrease the time spent in documentation.
  • EMR can reduce the number of errors associated with transcription.
  • EMR will provide the integrated view of patient to clinician so that they can spent less time for getting patients’ history, lab and radiology results and medication information so that clinicians can make diagnosis more accurately and faster.
  • EMRs have the capability to dislay previous laboratory test results can significantly reduce the number of redundant tests ordered, not only saving money, but also the preventing the patient from undergoing unnecessary tests.Key Capabilities of an Electronic Health Record System
  • By integrating guidelines and clinical information tools, EMRs improve the quality of outpatient care and safety of drug administration. Reference: Crane RM, Raymond B. Fulfilling the Potential of Clinical Information System. The Permanente Journal. 7.1 (2003). PP 63-64.
  • An effective EMR system helps clinical nurse specialists notify patients with pressure ulcers or risk for developing pressure ulcers in time and therefore improve quality of care. Timm JA, Chick KL, Peterson JA, Epps SI, Bleimeyer RR, Harris M. Using expert rules to automate pressure ulcer alerts for the clinical nurse specialist. AMIA Annu Symp Proc. 2008 Nov 6:1154.
  • Improved patient education through use of patient portal
  • Streamline communication both between patient and provider, and between clinicians
  • Process Improvement. EMR implementations allows to review the clinical processes management, customizing it for a better quality and delivered health care. University of Illinois Chicago Medical Center has published 75% reduction in chart pull requests, expected to increase, 12 paper forms eliminated and 100% availability patient records (previously 40%). The Gemini Project http://www.himss.org/content/files/davies_2001_uiccmc.pdf
  • Overhage and colleagues demonstrated that compliance with the monitoring of drug levels doubled when automated ordering reminders were implemented. Ref: Overhage JM, Tierney WM, Zhou XH, McDonald CJ. A randomized trial of “corollary orders” to prevent errors of omission. J Am Med Inform Assoc.1997;4:364-75. [PMID: 9292842]
  • Teich et al found that CPOE with reminder feature increases the providers' compliance rate in using formulary and prophylactic heparin according to clinical guidelines and improves the appropriateness of dosage. Ref: Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of computerized physician order entry on prescribing practices. Arch Intern Med. 2000;160:2741-7.
  • EMR can be instrumental in the connection to national disease registries allowing practices to compare their performance with that of others, which in turn, might improve the quality of care and facilitate research. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117.
  • Health information exchange can be easily and safely achieved for patients with multiple chronic illnesses who receive care from multiple providers in many settings. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117.
  • Secondary use of health data stored in EMR has potentials to protect and enhance public health, and facilitate health science research. Ref: American Medical Information Association. Secondary uses and re-uses of healthcare data: taxonomy and policy formulation and planning. 2007. http://www.amia.org/files/amiataxonomyncvhs.pdf
  • Can improve critical medical decisions by providing the most up-to-date clinical information at point-of-care.
  • According to a study performed by Work, the use of bedside medication scanning with EMRs decreased medication administration error rates by 67% at a pilot unit in Beloit Memorial Hospital. BCMA was then implemented to other units and measured to have decreased error rates to an average of 93% in the first four months of study and not counting the first month. Work M. Improving Medication Safety with a Wireless, Mobile Barcode System in a Community Hospital. Patient Safety & Quality Healthcare. 2005. http://www.psqh.com/mayjun05/casestudy.html
  • According to an article by the president of the University of Texas M.D. Anderson Cancer Center in Houston, a standardized nation-wide electronic medical record will ensure quality care for patients who see multiple providers at multiple sites. A national EMR could provide enormous opportunities for reducing overhead costs, identifying factors contributing to many illnesses (including cancer), determining optimal treatment, and detecting uncommon side effects of treatment. Mendelsohn J. Ten pieces to the cancer puzzle. Jan 24, 2009. http://www.chron.com/disp/story.mpl/editorial/outlook/6228636.html
  • Genome-enabled EMR can integrate resources such as OMIM and PharmGKB to facilitate the diagnosis, long-term and family member management of molecular and cytogenetic diseases. [Hoffman. The genome-enabled electronic medical record. Journal of Biomedical Informatics (2007)]
  • Electronic order sets, as part of CPOE, will improve compliance with nationally reported quality indicators e.g. core measures.
  • Clinical decision support regarding culture results can improve antibiotic utilization, reduce costs of unnecessary medications, reduce bacterial resistance rates and lessen the incidence of Clostridium difficile and fungal infections.
  • Lists of patients receiving vesicant drugs can be generated and used to contact the appropriate physicians for those patients needing special IV access to decrease incidence of phlebitis.
  • EHRs also provide important information for purposes such as health policy planning. (Definition, structure, content, use and impacts of electronic health records: a review of the research literature. Häyrinen K, Saranto K, Nykänen P.Int J Med Inform. 2008 May;77(5):291-304. Epub 2007 Oct 22.)
  • EHRs integration to personal health records may improve home telehealth management of chronic illness. (Home telehealth electronic health information lessons learned. Charters K. Stud Health Technol Inform. 2009;146:719.)
  • EHR’s prescription profiles may facilitate resident education and improve resident competency in practice based learning, by enabling educators to determine the range of medications residents prescribe. (Utilizing VA information technology to develop psychiatric resident prescription profiles; Rohrbaugh R, Federman DG, Borysiuk L, Sernyak M; Acad Psychiatry. 2009 Jan-Feb;33(1):27-30.)
  • The EHR will reduce the costs incurred by storing and keeping patient medical records. It also will ensure billing to patients.

http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art

  • Integrating digital radiology studies into the EHR allows physicians to view images from their offices, homes, and multiple sites throughout the facility. Digital studies allow small rural hospitals access to prompt 24/7 radiology reading services through telemedicine contracts. Diagonosis can occur as soon as the image is captured.
  • By integrating decision support tools and standardized patient care letters, the EMR system can link patient care with an educational program. From a pediatric respiratory department’s experiences, more asthmatic patients (58%) received an asthma action plan upon discharge in an EMR system (as opposed to 4% before the EMR). http://www.ncbi.nlm.nih.gov/pubmed/18972308
  • Some EMR systems allow patients to access their own health records. This can strengthen the connectivity between doctors and patients. Also this can help patients to figure out their health condition. http://www.ncbi.nlm.nih.gov/pubmed/17901601
  • Planning programs allow physicians to make and modify detailed treatment plans which can then be viewed by any other physician caring for the patient.
  • EMR can be integrated with computer-based monitoring to store and display information gathered from a patient automatically, such as vital signs or ECG.
  • EMR can be linked to outside knowledge resources in contexts that will influence clinicians' decisions.
  • EMRs that incorporate dynamic knowledge bases will allow Clinicians to incorporate new research and new medical knowledge and developments into their practice faster than the traditional methods self study and reading journals. New research and new medical developments are happening at such a rapid rate that it has become challenging for practitioners to respond to the new information.
  • Patient waiting time and Triage times are significantly reduced with nurse-driven template charts and a vital sign interface that automatically drops the vital signs into the nursing note once the measurements are taken. The Financial Impact of an Emergency Department Information System - Michael Hocker, Health Care Technology Volume 2.
  • EHR system with its Clinical Decision Support system brings about a change in the decision making behavior of the clinicians, increasing their confidence, ability to identify solutions, increased interpretation accuracy and thereby, more efficient decision making.
  • An EMR can help optimize the choice of individual tests based on additional considerations. This includes considering cost-effectiveness and giving additional information to help clinicians make the best choice for the patient. Osheroff J, Pifer, E, Teich J, Sittig D, Jenders R. Improving outcomes with clinical decision support: An implementer’s guide. HIMSS: Chicago. 2005 (p. 48)
  • An EMR can help improve compliance with care guidelines. The compliance can help to improve a hospital’s scores in Core Measure guidelines. Osheroff J, Pifer, E, Teich J, Sittig D, Jenders R. Improving outcomes with clinical decision support: An implementer’s guide. HIMSS: Chicago. 2005 (p. 49)
  • An EMR can improve communication among caregivers. Automatic notifications and instant messaging can improve communications between caregivers and improve patient care. Osheroff J, Pifer, E, Teich J, Sittig D, Jenders R. Improving outcomes with clinical decision support: An implementer’s guide. HIMSS: Chicago. 2005 (p. 56)
  • Joan Breuer, Ph.D. 02/03/2010 An EMR can mitigate risks such as medication administration, can improve health care process by having an expert engine, and, reduce response time for finding items in a patient medical record. This implies saving money for the Health Care Facility (ROI).
  • Facilitates research by creating an enormous source of medical data that can be standardized and aggregated. Once analyze, this information can be used to: (1) Improve treatment methods, (2) Lower the cost of health care, and (3) Support the development of public health policies. Evidence on the Costs and Benefits of Health Information Technology
  • EHRs can help providers be more effective by: (1) reminding physicans about preventive care, (2) identifying allergic reactions to prescribed drugs and highlighting potentially harmful drug interactions, and (3) providing doctors with appropriate and timely information to support decision making. Ref: Evidence on the Costs and Benefits of Health Information Technology
  • EMR systems can integrate evidence-based recommendations for preventive services (such as screening exams) with patient data (such as age, sex, and family history) to identify patients needing specific services. The system can remind providers to offer the service during routine visits and remind patients to schedule care. Reminders to patients generated by EMR systems have been shown to increase patients’ compliance with preventive care recommendations when the reminders are merely interjected into traditional outpatient workflows. Ref:"Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs" - Richard Hillestad et al.
  • Automated upload of vital signs directly into an EMR reduced the documentation error rate to less than 1%. Additional safety benefits may include improved timeliness to vital sign data and clinical work-flow processes. Ref: "Connected care: reducing errors through automated vital signs data upload. -" Smith LB, Banner L, Lozano D, Olney CM, Friedman B.
  • Mobile EMR can contribute to out patient follow-up for chronic conditions that require day to day monitoring for years and provide feedback for physicians and also for patients to avoid constly life-threating situations. Peter Boland, "Better Health Well in Hand"
  • With Mobile EMR medication levels can be adjusted based on the monitoring of patient physiological conditions, which some can be time sensitive, like distant monitoring of maternal contractions, fetal heart-rate, on high risk pregnancies.
  • Telemedicine applications like cell phone imaging of parts of the skin with dermal pathology can be sent over the network for remote diagnosis.
  • GPS tracking can contribute on Public HEalth Informatics for obtaining information that can be correlated based on geography conditions that can impact an individual's health.
  • EMRs can be integrated with any existing or future clinical information systems, which adhere to HL7 compatibility standards, thus enabling easy connection, communication,and collaboration of medical data of every patient.
  • EMRs can be used to ascertain phenocopies, phenotype heterogeneity, and relevant covariates to enable Genome Wide Association Studies (GWAS) of Peripherial Arterial Disease.Biorepositories linked to EMRs may provide a relatively efficient means of conducting GWAS. Kullo IJ, Fan J, Pathak J, Savova GK, Ali Z, Chute CG.Leveraging informatics for genetic studies: use of the electronic medical record to enable a genome-wide association study of peripheral arterial disease.Journal of American Medical Informatics Association.(2010);17(5):568-74.
  • If Medical records are shared then patient can get good care easily and safely. Important information can be accounted quickly and can save time at doctor's office.
  • Tragic events like 9/11, Hurricane Katrina, and the California fires have showcased the benefits of electronic record keeping. For those who had medical records available were easily treated then those whose medical records are not available. Large scale EMR systems replicate their stored records in several places across the country so that one tragic event won't destroy them.

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

Operational

  • Joan Breuer, Ph.D. 01/22/2010 20:00 By building an EMR, there are opportunities for the IT staff to gain clinical knowledge.
  • Overall, 6.2% increase in time spent ordering (not statistically significant); experienced users were time neutral with paperbased ordering. from: Overhage JM, Perkins S, Tierney WM, McDonald CJ. Controlled trial of direct physician order entry: effects on physicians’ time utilization in ambulatory primary care internal medicine practices. J Am Med Inform Assoc. 2001;8:361-71.
  • EMRs allow a physician to access multiple records at the touch of a button. Whether he or she is at a computer or in an exam room with a patient, the workflow is enhanced as less effort is required to retrieve information.
  • Protects patient data by preventing unauthorized individuals from accessing the clinical record.
  • Integrated communication and reporting support. EMR can facilitate the efficient creation and transmission of reports that relate to health care operations such as billing and charge information. Coiera, E (2003) Guide to Health Informatics (2nd Edition), Arnold Publishers Shortliffe, EH (ed) (2006) Biomedical Informatics (3rd Edition), Springer. pg. 119.
  • EMRs improve interdisciplinary collaborations and efficent communications between physicians and nurses via nursing documentation with greater clarity and additional information. Green SD, Thomas JD. Interdisciplinary collaboration and the electronic medical record. PMID: 18649812 [PubMed - indexed for MEDLINE]
  • Documentation completed at conclusion of encounter.
  • Preventing the missing patient paper medical records. Every time a paper chart gets stored, there is the chance it will be misplaced or maybe filed in a wrong place. This is very frequently is many hospitals, specially in those of the limited resources countries without EMR systems in where all paper medical records are located in a central repository room. EMR allows to prevents it by an unique electronic record and patient chart available in all time and stored into one central data repository server.
  • EMR is time savings for physicians and staffs by reducing in documenting the chart. According to the statistics, the average saving time is 5 minutes which can be done in real-time, point of encounter and no need for longer appointments. The total ROI per physician per year approximately is $78,000. [Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]
  • EMR is improvements in medical coding. The approximately annual loss per physician is $40,000 - $50,000 by under coding due to fear of audit and lack of time to sufficiently document the level of care. The ROI of improvement in coding per year is approximately $54,000.

[Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]

  • The benefit of an electronic medical record can increase the numerators and decrease the denominators. In addition, efficiency takes all of the duties involved in medical record medical office management divided by time and money. [Douglas. Thompson, Neil Fleming. Finding the ROI in EMRs. http://www.hfma.org]
  • Part of the money-saving nature of electronic medical record technology is the elimination of IT infrastructure and the streamlining of multiple databases. The infrastructure is simplified into one online database, even for multiple offices.[Douglas. Thompson, Neil Fleming. Finding the ROI in EMRs. http://www.hfma.org]
  • Can allow for better appreciation of clinician performance for which can be used for employee bonuses.
  • The benefit of electronic medical record primarily accrued from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors. [Wang et al. A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine (2003)]
  • CPOE will automatically date and time physician orders, as recommended by regulatory organizations.
  • EMR user authentication can protect patient records from unauthorized access.
  • EMR user logging and auditing can provide assurance to patients that only authorized personnel have accessed their record (or proof that unauthorized personnel have accessed it).
  • BCMA enhances tracking and understanding of medication delivery processes which can pinpoint opportunities for improvement in safety and efficiency.
  • With EMR, disaster planning and recovery should be easier with today technologies, and should be similar to that of any organization with electronic systems. It’s almost not possible to move all paper-based data and patients’ records to another site when nature hits the current site.
  • With correctly designed EMR, an update should only need to be done in one place and will automatically synchronize with the rest of the system where the same data may resign. With paper-based system, same data can be in multiple places and updating can be much more challenging with making sure all places are updated accordingly.
  • Better, more efficient systems can be built only on top of an EMR. Not much improvement can be made to a paper-based system.
  • There are significant time gains that can be accomplished using an EMR. A study done shows that a 75% improvement was achieved in complex NICU discharges. [3]
  • Data recovery becomes more manageable using a digital system versus a paper system. Backups can be maintained for an EMR where as there are no disaster options for paper based systems.
  • Automation of billing charges are typically included. This reduces error in submitting codes to insurance companies.
  • With anytime, anywhere access to their own EMR, patients can edit their medical history from the comfort of their home, and whenever they have time. Quickly editing a medical history in a waiting room is too error-prone. Additionally, it needs to be created only one time and could easily be corrected.
  • Patient information cannot get lost or become inaccessible. This may happen with conventional records, for example when a practice is closed, or bad materials were used for paper or film material. The loss of electronic data is less probable due to highly evolved techniques for secure data storage.
  • An EMR is almost essential in a telehealth-like setting, where a practitioner would like to ask a colleague for advice about a specific case. Through an EMR, the other side could easily access all the patient information. Besides saving time, efficiency is improved since the other side gets all information - or just part of it for privacy protection - and can decide what information is most relevant for the specific case.
  • The use of a CPOE system in an ICU setting can cut down on errors [Potts AL, Barr FE, Gregory DF, Wright L, Patel NR. Computerized physician order entry and medication errors in a pediatric critical care unit. Pediatrics. 2004;113 :59 –63]
  • The use of CPOE systems can improve the turnaround time of laboratory and radiology test results. [Thompson, Willie B, Dodek PM, Norena M, Dodek, Jordana BSc. Computerized physician order entry of diagnostic tests in an intensive care unit is associated with improved timeliness of service. Crit Care Med. 2004;32 :1306 –1309]
  • Studies on "multifunctional systems" of HIT, found evidence that implementing a multifunctional EHR system could increase the delivery of care that would adhere to guidelines and protocols, enhance the capacity of the providers of health care to perform surveillance and monitoring for disease conditions and care delivery, reduce rates of medication errors, and decrease utilization of care. [B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006;144:742-752.]
  • Increased enrollment on clinical trials by using CDS to identify eligible patients. Ref: Embi PJ, Jain A, Clark J, Harris CM. Development of an electronic health record-based Clinical Trial Alert system to enhance recruitment at the point of care. AMIA Annual Symposium Proceedings, 2005: 231-5.
  • The ability to support patient mobility. When a patient moves, is on vacation, or simply seeing a specialist; it is currently very difficult to transfer the Medical Records between hospitals. With paper the records need to be pulled, faxed, and sent. Then they need to be retrieved, processed, and then read. With Integrated EMR, these steps can occur instantly.
  • Support of Bio-Surveillance. We live in a time when man made (terrorists) and natural (epidemics) are all around us. The advantage of the EMR is to eventually automatically, track outbreaks and health issues across regions, the country, or the world. This will enable rapid detection and prevention of wide-spread out break. The H1N1 outbreak is a prime example of how even a day or a few more hours of advanced notice could have helped contain the spread.
  • Re-purposing of data. There is a push these days to do more with less. Access to a hospital's patients data enables retrospective studies and data mining. It is a ready and accessible source (assuming proper anonymity can be obtained when required). Instead of spending millions of dollars to track how infusions affect patient outcome in the ER, that data could be mined from decades of patient information.
  • Helps in better adapting to HIPAA standards. HIPAA now requires stricter control over patients data, with better audit in general. EMR are better equipped to provide the combination of security from unauthorized access and the ease of access for authorized users. Moreover, an EMR is better suited to adapt to changes that might be enforced in the future.
  • Among the problems commonly faced in all clinical settings, is the problem of conflicting prescriptions. The inability of physician to account for other prescriptions by other physicians even within the same hospital leads to over-medicating, or conflicting medications.
  • Better supervision from physicians in charge. Within academic hospital, physicians may find it impossible to maintain a high standard of care along with all the responsibilities of teaching and supervising medical students. Physicians may find it much easier to follow students' notes across all the different records to grade and suggest any changes.
  • Facilitates the communication of patients' data and needs among different hospitals. With today's videoconferencing technologies, many hospitals opted to schedule weekly meetings to discuss difficult or interesting cases with other more specialized hospitals. EMRs allow both the ease of release/communication of data as required for these cases with the retention of unnecessary/private information about the patients.
  • Many EMRs are offered as services hosted over the Internet. This allows clinicians to access them from any location worldwide using cell phone technology or laptops with cellular connectivity. In an implementation like this, patient information can be accessed literally anywhere without having any kind of network connection to the medical facility.
  • EMR systems facilitate the automation of records necessary for audit compliance with federal, state, and accreditation organization regulations. See “EXTRA: Patient Safety in the Physician’s Office: Assessing the Value of Ambulatory CPOE” [[4]]

MikeField 17:54, 23 January 2010 (CST)

  • EHR System provides valuable administrative tools wherein daily reports can be generated. Also, data collected can be sent to a spreadsheet where further analysis, data manipulation, and interpretation can occur. The Financial Impact of an Emergency Department Information System - Michael Hocker, Health Care Technology Volume 2.
  • An 11 study meta-analysis comparing paper vs. electronic demonstrated nurses saved 24 percent of their documenting time when using electronic systems. The studies time savings ranged from 28 to 36 minutes per nurse per eight hour shift. For a 32 bed unit with 1:8 patient to nurse ratio, 36 minutes per shift saves 2 hours 24 minutes. This does not allow for savings by changes in staffing with 1 less nurse. Studies with a more broad perspective suggest savings ranging from 95 to 260 minutes per 12-hour shift for each nurse. This does allow for the possibility of staffing changes, only if nursing operations and cultures can adapt. “Incremental” overtime (OT) costs are incurred when nurses complete documentation at the end of their shifts. Work compiled from 8 hospitals found a range of incremental OT to be from 96 cents to $3.23 per admission (excluding newborns). Nursing leaders estimate potential OT cost reduction of 80 percent, or 77 cents to $2.30 to be expected for a typical 300 bed hospital per non-newborn admissions or a savings of $11,000 to $33,000 per year. A 28 to 38 minute reduction per nurse per shift could reduce or eliminate “incremental” overtime costs. [Thompson MBA, Douglas I, Osheroff MC, Jerry, Classen, MD, David, and Sittig PhD, Dean F. A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database. Journal of Healthcare Information Management Vol. 21, No.1:67-68]
  • CPOE implementation reduced the mean pharmacy order processing time from composition to verification by 97%. After CPOE implementation, a new medication order was verified as appropriate by a pharmacist in three minutes, on average. Ref: "Effects of computerized prescriber order entry on pharmacy order-processing time" - Jon Wietholter, Susan Sitterson, and Steven Allison
  • Implementing an EHR can increase reuse of data that is collected at point of care for many groups downstream in the health system. Many times data is recollected and re entered in to various systems which increases time and costs.
  • Having an EHR can facilitate the need for a national person identification number that can be used to identify individuals when seen at various locations. The national person identification number will promote the ability to integrate records from various institutions to give a complete picture of the person by providers.Diabetes information systems: a rapidly emerging support for diabetes surveillance and care. Joshy G, Simmons D.Waikato Clinical School, University of Auckland, Hamilton, New Zealand. joshyg@waikatodhb.govt.nz

  • Pay for performance linked to patient health outcomes are now a real possibility with electronic medical records, which integrate a patient’s medical history, health status and other health indicators in addition to medical visit encounters. Crane, R.M. & Raymond, B. (2003). Fulfilling the Potential of Clinical Information Systems. The Permanente Journal, 7(1), 62-67.
  • Patient portals integrated in electronic medical records, which offer appointment scheduling, retrieval of test results, and other services, make it possible for patients to participate in their health care with their providers. Most savvy healthcare consumers know that they must be active in their own care if they want to obtain the highest quality. Crane, R.M. & Raymond, B. (2003). Fulfilling the Potential of Clinical Information Systems. The Permanente Journal, 7(1), 62-67.
  • EHRs have significant potential to address impending workforce shortage in health care12

National

  • The American healthcare industry needs a national database of actual EMR implementation results to meet the absence of a low-cost, easy-to-use method for a typical hospital to reasonably estimate the potential benefits of an EMR purchase. This database should include EMR implementation results using common or standardized terms, definitions, and calculation metrics, as well as information about the actual EMR implementation environment for truer apples to apples comparison. HIMSS CIS Benefits Taskforce has an initial framework to begin addressing this need. The framework consists of: 1. Hospital Demographic Information 2. Measures to describe the technology infrastructure of the organization 3. Descriptive measures of how the technology is being used by clinicians 4. Benefit categories that are defined 5. System components defined and associated with each benefit 6. Quantitative metrics for each benefit category 7. Entry of above framework data into a web-based data collection tool by hospitals expanding the database and allowing others to find similar hospitals to estimate their own costs [Thompson MBA, Douglas I, Osheroff MC, Jerry, Classen, MD, David, and Sittig PhD, Dean F. A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database. Journal of Healthcare Information Management Vol. 21, No.1: 66-67]
  • Sound public policy recommendations worthy of serious consideration have been identified by Crane, Raymond [1] to enable widespread clinical IT systems implementation. 1. Leadership in the development of standard clinical vocabulary, standards for exchange of clinical information, and interoperability standards. 2. Barriers to legitimate development and use of clinical information supporting a balance between public privacy right’s and a clinician’s ability, within an uncoordinated delivery system, to manage care and perform research that benefits society. 3. Costs of health information technology (HIT) should be shared among those that benefit. 4. Promotion of and focused study on research and development focused on HIT implementations. The Stimulus Act of 2009 is providing clear movement in this direction[2]. The American Recovery and Reinvestment Act (ARRA), has many implications on health information issues. AHIMA is actively monitoring, participating and developing resources to assist in understanding the key components of this law and the impact on the industry and practice. Information on healthcare reform will be continually evolving. Important HIM issues include: 1. Incentives for adoption of EHRs, 2. Health information exchange (HIE), 3. New privacy regulations for both HIPAA and non-HIPAA entities, and 4. HIM workforce opportunities. [1] Crane MPA, Robert; Raymond MPH, Brian. Fulfilling the Potential of Clinical Information Systems. The Permanente Journal Winter 2003, Vol. 7, No. 1: 66 [2] http://www.ahima.org/arra/
  • With the public and government demand for healthcare reform is critical that health care technology structure is improved to facilitate change the change that is needed for reform. Implementing EMR will help achieve that success but uptake by the US has been slow with only 7% of the providers using them. Taking the Pulse: Physicians and the Internet(1). (1) New York:Deloitte and Touche 2000. Other industries have improvement in quality, security and productivity using IT infrastructure and it seems this could also translate to the healthcare Industry to slow down the rising healthcare costs while improving quality.(2) A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database. (2)Thompson, MBA; Osheroff, MD; Classen, MD; Sittig, PhD. Journal of Healthcare Information Management Vol 21.1 pp 63
  • To realize the plan to create a National Health Information Network for providers, hospitals and public health systems an EHR system is needed to facilitate data exchange. The implementation of an EHR system for national use will improve the health of the population which is a goal of the Department of Health and Human Services. An Electronic Health Record - Public Health (EHR-PH) System Prototype for Interoperability in 21st Century Healthcare Systems Anna O. Orlova, PhD,Mark Dunnagan, Terese Finitzo, PhD, Michael Higgins, PhD, Todd Watkins, Allen Tien, MD, MHS, and Steven Beales AMIA Annu Symp Proc. 2005; 2005: 575–579.
  • EMRs can support federal and state mandatory reporting requirements. Electronic data storage that employs uniform data standards will enable health care organizations to respond more quickly, thus improving disease surveillance and there by promoting early detection of fatal infectious diseases 1, 2.


• Provides complete and accurate access to patient information for providers and demonstrates time saved over paper record. • Expedites results reporting through customizable displays • Supports a common user interface for accessing patient information, usually through a workstation. • Supports monitoring and analysis of patient care outcomes