EMR Benefits and Return on Investment Categories

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

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.
  • 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)]
  • 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

Clinical

  • EMR systems have been proven to decrease the amount of time nursing staff spends on documentation. Reference: A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database. Journal of Healthcare Information Management- Vol. 21, No. 1 p 67.
  • Alert and reminder programs in EMR's increase physician attentiveness to certain areas such as preventive medicine or more specifically drug level monitoring. Reference: Computer Physician Order EntryL Benefits, Costs, and Issues. Gilad Kuperman, M.D., P.h.D., Richard Gibson, M.D., P.h.D. Ann Intern Med. 2003; 139:31-39.
  • 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

Operational

  • 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. [2]
  • 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.]