http://www.clinfowiki.org/wiki/api.php?action=feedcontributions&user=RTompkins&feedformat=atomClinfowiki - User contributions [en]2024-03-28T14:45:18ZUser contributionsMediaWiki 1.22.4http://www.clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2011-01-26T05:28:00Z<p>RTompkins: </p>
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<div>== Example Vendor Evaluation Criteria ==<br />
<br />
<br />
=== Demonstrate Clinical Functionality (25%) ===<br />
* How do EMR software implement HIPAA Privacy and Security Compliance and other regulatory requirements and Local laws. <br />
* How does EMR software have customer support. Do they have a local workforce, a testing plan, prioritization of issues <br />
* Do they have multiple note creation options like template, macros, dictation, voice recognition, hand writing recognition.<br />
* Does EMR software enable a user to maintain up-to-date problem list? For e.g.: Does it enable a user to electronically record, modify, and retrieve a patient's problem list for longitudinal care (i.e. over multiple visits with the same provider and using the problem list vocabulary standards.) in accordance with certification criteria defined by the ONC’s Interim Final Rule?<br />
* Does EMR software enable a user to electronically record, modify, and retrieve a patient's active medication list as well as medication history for longitudinal care (i.e. over multiple visits with the same provider and using the medication list vocabulary standards.) in accordance certification criteria defined by the ONC’s Interim Final Rule?<br />
* If EMR software provides CPOE Functionality then does it enable a user to electronically record, store, retrieve, and manage, at a minimum, the order types like 1) Medications 2) Laboratory, 3) Radiology and Imaging and 4) Provider referrals according to certification criteria defined by the ONC’s Interim Final Rule.<br />
* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.<br />
* Will it support the Clinical pathways for the Physicians and the Residents for standardization of care processes?<br />
* Will it have the direct export options of the collected data to the State and Federal Health Departments and for other research sites?<br />
* How well is the vendor able to demonstrate the clinical functionality required by [your organization]?<br />
* Is the software flexible enough to meet our current needs and allow for future changes?<br />
* Specifically how does the system support many 24/7 functions, like medication administration changes in an environment that does not have 24/7 pharmacy or CPOE users on site?<br />
* Can a demonstration of the software successfully handle a scenario you have prepared?<br />
* Does the software have functions of supporting clinical decisions?<br />
* Does the software have functions of assisting nurses in documentations?<br />
* Is the vendor able to create interfaces for physicians' office EMRs to allow viewing and sharing of clinical, financial (insurance) and other data?<br />
* Does it have the capability to provide advanced reporting and analytics?<br />
* What is the ease of use for front-line workers? Does the user interface modern and able to adapt to different role-based requirements?<br />
* How easily and quickly can the embedded clinical decision support be modified when new published guidelines or evidence-based medicine studies are published? Will they be responsible for these updates (and at what cost) or will that be our responsibility?<br />
* Is the vendor software compliant with the Certification Commission of Healthcare Information Technology (CCHIT) criteria?<br />
* Can the company categorize users according to their characteristic and provide user-centered usability design? Old physicians usually have vision problem and do not like to use keyboard. <br />
* Can the company provide different levels of decision support based on user working experience? For resident, attending physician, the decision support should be different.<br />
* What capabilities does the application provide for patients with psychiatric, psychological, or severe behavioral disorders?<br />
* If your organization's mission includes clinical research, does the software include decision support and data query functions to support research?<br />
* Can the medical records be easily transferred to another clinic with patient approval?<br />
* With what other HIT software systems have you established successful interfaces? (organization may use a variety of systems for BCMA, clinical documentation, laboratory data, business functions that need to have data interchange)<br />
* What capability does the application demonstrate to produce information for patient education?<br />
* Does the system provide capability for patient portals (web access)?<br />
* What wireless functions has the system supported?<br />
* Does the system satisfy security requirements (access control and logging)?<br />
* Does the system provide configurable workflow options?<br />
* Does the system provide integration options with other service providers’ systems (hospitals, insurance companies, labs, …)<br />
* Does the system provide any linkage between clinical notes and structured medical vocabularies?<br />
* Joan Breuer, Ph.D. 01/27/2010 17:19 The Vendor product must have vocabulary standards such as SNOMED, NDC, LOINC, WHO Drug Dictionary, MeSH, CPT, DRG, and UMLS.<br />
* Can the EHR vendor provide a standardized system for the market? And at the same time, can they customize the EHR for different clients and requirements? <br />
* How “personalizable” is the system for individual users to eliminate screen clutter and focus their electronic work process.<br />
* Is the EHR system Health Level Seven (HL7) ready? <br />
* Does the EHR vendor have a procedure to integrate other record/data (e.g. personal health record, public health disease surveillance data) into the system? <br />
*Functionality Matching: Vendor with best functional match. All product selection exercises should start with determining your organization's specific needs.<br />
* Joan Breuer, Ph.D. 01/27/2010 17:20 There needs to be a plan so In-house developers can work with the Vendor such that all algorithms are carried out seamlessly.<br />
* Is the system’s data entry interface intuitive for new users?<br />
* Can the system pull from clinical documentation for billing and patient safety reporting?<br />
* Does the system have meet specific specialty practice needs of users?<br />
* How granular is user access to information? Is the user access hierarchy flexible to accomodate HIPPA standards?<br />
* Has this software shown to decreased adverse drug reactions when implemented in other facilities?<br />
* Does the EMR have different modules for different specialties in our healthcare facility? <br />
* Are these modules “home-grown” at your company or have they been acquired from different companies as your EMR has grown?<br />
* Are the module structures set or can they be used as a template which can be modified to suit or healthcare facilities needs?<br />
* Ask all staff who evaluate the system for their assessment of the strengths and weakness of the system as they perceive that the system would apply to the practice.<br />
* Does the software meet the JCAHO standards?<br />
* What makes this vendor software better than others?<br />
* Does the ASP (remote hosting) model provide local caching of active sessions in the event the network connection is lost briefly? If so, what functionality is guaranteed during the network outage? [[User:MikeField|MikeField]] 20:43, 29 January 2010 (CST)<br />
* Does the EHR system support disease/domain specific profiles that accommodate the level of data needed to support specialty groups such as mental health, oncology and iridology?<br />
* Does the vendor offer a Document Imaging component as part of their solution to allow incorporation of paper records that contain previous patient histories?<br />
* How does the software handle continuity of care as patients transfer from inpatient to outpatient, from one department to another or even between providers? Does the system provide for the writing of discharge notes that list diagnoses, medications and other instructions?<br />
* Is the system easily configurable to allow customized structured data for efficient coding and revenue capture? Clinical data should not be restricted to some arbitrary minimum.<br />
* Does the system handle clinical reminders (i.e: immunization, drug monitoring, dosage) ?<br />
* Does your system handle live pharmacy stock when e-prescribing?<br />
* The user interace includes interoperability with PACS systems?<br />
* Are there tools for manually triggering simple alerts/messages between clinicians for situations that may not yet trigger CDS alerts?<br />
* Does the vendor’s application support external access by physicians, and if so is it part of the system or a user addition?<br />
* Does the vendor offer any data conversion services? At what cost? How long will it take to transfer the data? [http://www.ama-assn.org American Medical Association]<br />
* Can the system indicate normal and abnormal lab results when a patient's lab data are reviewed?<br />
* Can the system display patients' lab data in flowsheets or graphical form to compare results and see trends?<br />
* Can the system document medication administration?<br />
* Does the system support the standards identified and recommended by the Health Information Technology Standards Panel in the latest version of its HITSPTP13 document?<br />
* Does the system support two-factor authentication in alignment with NIST 800-63 Level 3 Authentication?<br />
* If the system provides access to PHI using a web browser via HTML over HTTP, does the system provide data encryption capability via SSL?<br />
* Does the system provide the ability to display the patient's allergy list, including the date of entry? (CCHIT certified 2011 Ambulatory EHR criteria # FN 05.12)<br />
* Does the system provide the ability to display CCD (Continuity of Care Documents) and file them in the EHR, where the summary document must include information on - patient demographics, medication list, and medication allergy list? (CCHIT certified 2011 Ambulatory EHR criteria # IO-AM 10.10)<br />
* Does the system provide the ability to generate and format patient summary XML documents per the HITSP C32 specifications using industry standard vocabularies and terminologies? (CCHIT certified 2011 Ambulatory EHR criteria # IO-AM 10.20)<br />
* Does the software have the ability to allow physicians, such as ophthalmologists, to draw pictures?<br />
* Does the EMR improve the materials management and supply chain management?<br />
* Does the EMR is capable to generate reports with the list of patients with specific conditions which will help for quality improvement, reduction of disparities. ( http://geekdoctor.blogspot.com/2010/01/achieving-meaningful-use.html)<br />
* Does the EMR system can check drug-to-drug interactions and drug allergies and also has the capability to check plan formularies and prescribing patterns. (http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357) <br />
* Does EMR system capable of monitoring the health maintenance of chronic care patients? (http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357)<br />
* Ability of the EMR to support research. i.e., conducting large scale research with data capture and retrieval? Also whether the EMR can attain regulatory compliance regarding billing. <br />
* Does the EHR vendor provide a test version of EHR product for training and quality assurance (QA) purposes as well as the full production environment that is installed in the clinic? (The test version is a segmented area where users can make changes to templates or forms without it affecting the live environment) (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* Will the EHR company build custom templates to the practices specifications? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* Can patients be scheduled for appointments in multiple practices, facilities, etc.?<br />
* Does the EMR system contain physical therapy-centric flow sheets? <br />
<br />
<br />
=== Acquisition and Implementation Cost (25%) ===<br />
<br />
* What is the total financial investment required to acquire and fully implement the proposed solution? Break out costs for the following and detail any time or resource constraints for each item. If additional resources or time are required, what are the additional costs per unit?<br />
** Application<br />
** Per-user licenses (and tier pricing, if offered)<br />
** Database (if treated as a separate item)<br />
***Data integration from legacy systems<br />
** Application documentation<br />
** Annual maintenance agreement<br />
** Training<br />
*** End-user<br />
*** System administrators<br />
*** In-house developers<br />
*** Re-current training<br />
** Professional services:<br />
*** Project management<br />
*** Software development or customizations<br />
*** Technical support<br />
* What is the estimated time that it will take for the investment of the vendor to pay for itself based on projected savings?<br />
* Does the system allows to track and detail log audits and transactions made by users? <br />
* Does the system have the functionality to generate customizable reports given a determinate frequency?<br />
* What is the cost for upgrading when new releases are available?<br />
* What is the projected timeline for upgrades? What training support is included if any, and what is covered by the service fees?<br />
* Upon go-live, business imperatives will define a timeframe within which workflows and processes are to to be run in parallel, until agreed upon metrics/milestones are achieved and the system is signed off into full production: which system is more flexible, less complex, and least disruptive in terms of workflow and process change/adjustments?<br />
* Implementation costs associated with organizational changes to clinician, administrative, etc. processes should be considered in calculating ROI.<br />
* At what point are implemenation costs (and other factors) considered too extreme and a GO/NO decision is given serious consideration?<br />
* All implementation risks must be calculated for "impact and probability" and rank accordingly when analyzing EHR solutions.<br />
* Does the vendor provide functionality to track ROI? If not what reports can be produced that could help track usage?<br />
* Is the vendor ready to send some of its employees onsite during and after deployment?<br />
* Who will bear the cost of these employees?<br />
<br />
=== Hardware Platform and Technical Requirements (20%) ===<br />
<br />
* Which vendor uses less proprietary systems and has partnerships with established industry players? Are they certified developers for the platform they are using? Is the vendor's system and devleopment lifecycle management aligned with their respective industry partners?<br />
*Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
* Identify all hardware and system software that would be required to support an implementation of our scope and scale.<br />
* How well is the vendor able to meet our technical requirements ? <br />
* How flexible is the vendor to change requirements and what are the cost?<br />
* How hard is to implement new modules within the system? <br />
* How well is the vendor able to create and maintain interfaces to our existing systems?<br />
* How well is the vendor able to migrate our data from actual system to the new, if it is neccesary?<br />
* Is the vendors's software created with the most adequate developing technology? Platform? Language? Databases?<br />
* Will we do periodic updates, or will the vendor do this as part of the contract? How often are they released?<br />
* Do we plan on-site or remote hosting for the system?<br />
* If we plan to utilize remote hosting, how safe, sound, and accessible are these data?<br />
* Is the hardware user friendly in all departments? (i.e. nursing, pharmacy, pulmonary,..etc.)<br />
* Will the vendor provide a mock system for testing?<br />
* What is the responding duration of each entry and information extraction? Is there any delay? <br />
* How the data structure for storing data? Is it expandable? Is it easy to be extracted for future analysis?<br />
* How often does the system need to be updated or serviced?<br />
* As the technology is changing and the hospital decides to upgrade their hardware, will your system be able to handles these changes or will we have to buy a new program?<br />
* What language is the vendor's systems software coded in?<br />
* Scaling:<br />
** To how many patients has the system been scaled?<br />
** To how many users has the system been scaled?<br />
** Has the system been scaled to the size of the evaluating institution?<br />
** What are the hardware/software licensing implications of growth?<br />
* Is it necessary to buy (possibly expensive) hardware from the vendor, or can we just install their software on our standard desktop computers (at least for the clients)?<br />
* For already existing software functionality, does the vendor employ reliable and trustworthy software like an open-source MySQL or Apache server? Or do they develop their own system, or do we have to license a proprietary one (extra cost)?<br />
* How the vendor estimates the total amount of users and licenses needed? Will they be concurrent user licenses or asynchronic?<br />
* Will technical support remain active even if the Hospital is running a non upgrade system? For how long?<br />
* Does the system use DICOM standards for the transmission of image data?<br />
* How frequently does the vendor provide patch upgrades for the product?<br />
*Is the system using standards such as Snomed, ICD 10; HL7 Version 2 or 3; HL7 infobutton…)<br />
* If this is a hosted solution, how many computing facilities does the vendor have capable of hosting the application and where are they located? What are the vendors' security and disaster recovery plans?<br />
* How do you handle redundancy for clinical records, like off-site backups and such?<br />
* For Mobile EMR implementations, how do you handle communication to remote wireless clients? security interfaces? types of devices and minimum requirements?<br />
* Is the database program one likely to be waning in use and are personnel available at my site with adequate skills/knowledge to provide support post implementation?<br />
* What database and programming tools (such as instrumented code) are in place for quick problem resolution?<br />
* If software licenses are sold per physician or user, how are part-time physicians, physician assistants and/or advanced nurse practitioners calculated? [http://www.ama-assn.org American Medical Association]<br />
* What is the vendors debugging process?<br />
* How will the data captured by the EMR be migrated to new technology as upgrades are made to the EMR?<br />
* Are software upgrades provided as part of the software maintenance contract?<br />
* How much of the system has to be taken out of service in order to install software updates? Ie., how widespread is the impact?<br />
* Does the system allow for any sort of biometric user identification, as opposed to typing a user name and password?<br />
<br />
=== Implementability (15%) ===<br />
<br />
* How does the vendor compare in KLAS rankings of similar systems and applications?<br />
* How much time, effort, and resources will be required to successfully implement?<br />
* What is the vendors track record for successfully implementing its system in similar settings?<br />
* Do the vendors provide detailed plan for implementation, training and quality control?<br />
* Will the vendor supply on site support when we "go-live" and how long will they be available?<br />
* How responsive is the vendor to emergencies? Do they have a quick and accurate response to support issues?<br />
* Do they have a backup or alternative plan if the system or partial of the system is not working? The situation could be out of energy or computer virus attack.<br />
* How long is the training that is required for each subgroup to fully implement the system?<br />
* What are the training requirements for the vendor? For the clinic/hospital?<br />
* What is the vendor's track record for successfully training a new system for your clinic/hospital size?<br />
* What training manuals, user guides, on-line training assets, and any other training materials will be made available to the clinic/hospital?<br />
* Will the implementation require a consulting "team" and how much will this cost?<br />
* Is the vendor sufficiently well known that most health care consulting firms have familiarity with the system?<br />
* How will legacy patient record data be integrated into the new system?<br />
* Is the vendor's system compliant with the Health Insurance Portability and Accountability Act (HIPAA)?<br />
* Is the vendor's system compliant with the Patient Safety and Quality Improvement Act (PSQIA) Patient Safety Rule?<br />
* How is the evaluation procedure for the approval of the ongoing stages of implementation? How objective will be the defined how to proceed with the approval and payment?<br />
* Is the vendor's system compliant with ISO standards for EHRs?<br />
* Does the system have a proper data recovery plan in case of an crash or any other unexpected event? Can the system be restored without any data loss? Does the vendor have a proper disaster recovery plan?<br />
* How does a legacy Practice Management System integrate with the EHR system? Is there a list of successful PM vendor integrations? [[User:MikeField|MikeField]] 20:47, 29 January 2010 (CST)<br />
* What is the legacy Practice Management System conversion process for legacy data import into the EHR system? Time/cost and loose-ends? What reference clients are there for particular legacy PM systems? [[User:MikeField|MikeField]] 20:47, 29 January 2010 (CST)<br />
* Does the vendor have a List of Lessons Learned from previous implementations?<br />
* Does the vendor have a legal license to essential code sets, such as the AMA Current Procedural Terminology (CPT®) file? Will the vendor maintain this license annually as part of your service or maintenance agreement?[http://www.ama-assn.org American Medical Association]<br />
* Does the vendor offer a “test environment” in which upgrades are loaded to allow you time to test and learn their functionality without affecting your live system? [http://www.ama-assn.org American Medical Association]<br />
* What is the vendor's rate for on time & under budget implementations?<br />
* Are other consulting firms certified to implent the vendor's product? If so will the vendor provide system updates and customer service if system issues (not related to implementation) arise?<br />
* Check whether the vendors EMR products are CCHIT certified (http://www.cchit.org/products/cchit)<br />
* What training mechanisms are used by the EHR Vendor? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85) <br />
* What services does the EHR vendor offers for post-implementation optimization of the system with respect to training and system customization? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* Does the EHR vendor provide any guarantees regarding the ability of a practice to meet meaningful use requirements? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* What is the company policy regarding data ownership for the ASP EHR? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
<br />
=== Vendor Partnership and On-going viability (10%) ===<br />
* Please provide audited financial statements for the last five years, including Balance Sheet, Income Statement, and Statement of Cash Flows, as well as any accompanying footnotes.<br />
* Provide a list of customers who have implemented the systems and applications that you are recommending to us. <br />
*Create a list of vendor selection criteria, and evaluate the vendors and software: review responses to the RFP; schedule demonstrations; check references; and, use proven tools/templates for assessing and consistently comparing vendors. <br />
<br />
*Research available EMR systems and vendors: determine if your jurisdiction has a "pre-approved" vendor list; develop checklists & questionnaires to assist with product comparison; and, prepare a Request for Proposals (RFP). <br />
<br />
* What type of long-term relationship do we think we can expect from the vendor?<br />
* How stable vs risky is the company? <br />
** Request that the software source code be put in escrow with specific provisions established under which it could be accessed. <br />
** How long has the company been in business?<br />
** How large is the company?<br />
*** How much money did they bring in last quarter? year? 3-years?<br />
*** How much is the Vendor company revenue in $M?<br />
*** How much is the vendor company net income in $M?<br />
*** How much are the total assets and liabilities of the company?<br />
*** What is the growth strategy of the company?<br />
*** Are they a private or a public company?<br />
*** How many employees? <br />
* How many contracts have they should to Health Care Systems like yours? <br />
** Can you contact and/or visit a few representative samples? <br />
* How many new contracts have they signed in the past year?<br />
* How many uninstall's have been done the last year?<br />
* Does word of mouth support that the company believes in service after the sale?<br />
* Joan Breuer, Ph.D. 01/27/2010 17:22 The HCF needs formal documentation from other HCFs who have used this Vendor’s product signed by the other HCFs’ CEOs, prepared by an attorney. Note: “Word of mouth” does not stand up in court, especially when we are talking about millions of dollars. <br />
* What is the vendor's cost per year after implementation?<br />
* How the vendor provides technical support? On site or remote? Package or individual project based?<br />
* What provisions exist in the contract for termination and/or penalties if the application does not perform as specified or if the vendor fails to provide any services that are agreed to?<br />
** Ensure that all application specifications that can be measured or quantified are incorporated into the contract.<br />
** Ensure that all services verbally offered by the vendor are incorporated into the contract.<br />
** Does the vendor have service level agreements (SLAs) with appropriate penalties for technical support of the application?<br />
** Does the system’s implementation plan consider proper risks evaluation and mitigation strategies?<br />
*An important consideration is whether the vendor or any of its industry partners have done an analysis of processes in healthcare<br />
* In a HIPAA complaint product, one should consider the feasibility of implementing future mandates. The cost should be considered in terms of both money and time. <br />
<br />
* Obtain references of current customers that are similar in size, have similar patient population, and have similar required functionality needs to your practice and evaluate the ease of implementation, current satisfaction, and costs. <br />
<br />
* What kind of service level agreements are offered by the vendor and what is their track record for maintaining those SLAs?<br />
<br />
=== Future Vision (5%) ===<br />
<br />
* Does the vendor have a meaningful Product Lifecycle that defines major and minor releases, their associated costs, and delivery (push or pull) methods?<br />
* What is the vendor's five-year strategic plan?<br />
* What percentage of revenue is being re-invested into R&D?<br />
* How does the company capture/communicate client concerns for re-engineering? i.e. Is this a learning company?<br />
* What "game changers" are on the drawing board? Are these related to one of our organization's core goals?<br />
* Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
* Lifespan and Staying Power: One should consider the track record of the vendor and viability as a company to sustain the ups and downs of the industry. One sub-criteria in this category often used is how long the vendor has been around.<br />
* Does the vendor plan to offer interoperability options in the event of a nationally implemented CIS?<br />
*What is the plan to support smart phone applications to enhance interoperability and custom accessibility of EHR data while maintaining security? (DROID, IPHONE)<br />
* Upon the termination of a license or agreement, is there an orderly process for you to extract your data? This is applicable if you access the vendor’s software within an application service provider (ASP) model.[http://www.ama-assn.org American Medical Association]<br />
* Ability to have HIE compatibility<br />
* Improved billing accuracy and charge capture<br />
<br />
=== Extra Credit (optional) ===<br />
<br />
* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating it's system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Does the system have e-prescribing functionality?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* Cost reductions associated with risk reduction of adverse drug events<br />
[[Category:EMR]]<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?</div>RTompkinshttp://www.clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2011-01-26T05:21:56Z<p>RTompkins: </p>
<hr />
<div>== Example Vendor Evaluation Criteria ==<br />
<br />
<br />
=== Demonstrate Clinical Functionality (25%) ===<br />
* How do EMR software implement HIPAA Privacy and Security Compliance and other regulatory requirements and Local laws. <br />
* How does EMR software have customer support. Do they have a local workforce, a testing plan, prioritization of issues <br />
* Do they have multiple note creation options like template, macros, dictation, voice recognition, hand writing recognition.<br />
* Does EMR software enable a user to maintain up-to-date problem list? For e.g.: Does it enable a user to electronically record, modify, and retrieve a patient's problem list for longitudinal care (i.e. over multiple visits with the same provider and using the problem list vocabulary standards.) in accordance with certification criteria defined by the ONC’s Interim Final Rule?<br />
* Does EMR software enable a user to electronically record, modify, and retrieve a patient's active medication list as well as medication history for longitudinal care (i.e. over multiple visits with the same provider and using the medication list vocabulary standards.) in accordance certification criteria defined by the ONC’s Interim Final Rule?<br />
* If EMR software provides CPOE Functionality then does it enable a user to electronically record, store, retrieve, and manage, at a minimum, the order types like 1) Medications 2) Laboratory, 3) Radiology and Imaging and 4) Provider referrals according to certification criteria defined by the ONC’s Interim Final Rule.<br />
* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.<br />
* Will it support the Clinical pathways for the Physicians and the Residents for standardization of care processes?<br />
* Will it have the direct export options of the collected data to the State and Federal Health Departments and for other research sites?<br />
* How well is the vendor able to demonstrate the clinical functionality required by [your organization]?<br />
* Is the software flexible enough to meet our current needs and allow for future changes?<br />
* Specifically how does the system support many 24/7 functions, like medication administration changes in an environment that does not have 24/7 pharmacy or CPOE users on site?<br />
* Can a demonstration of the software successfully handle a scenario you have prepared?<br />
* Does the software have functions of supporting clinical decisions?<br />
* Does the software have functions of assisting nurses in documentations?<br />
* Is the vendor able to create interfaces for physicians' office EMRs to allow viewing and sharing of clinical, financial (insurance) and other data?<br />
* Does it have the capability to provide advanced reporting and analytics?<br />
* What is the ease of use for front-line workers? Does the user interface modern and able to adapt to different role-based requirements?<br />
* How easily and quickly can the embedded clinical decision support be modified when new published guidelines or evidence-based medicine studies are published? Will they be responsible for these updates (and at what cost) or will that be our responsibility?<br />
* Is the vendor software compliant with the Certification Commission of Healthcare Information Technology (CCHIT) criteria?<br />
* Can the company categorize users according to their characteristic and provide user-centered usability design? Old physicians usually have vision problem and do not like to use keyboard. <br />
* Can the company provide different levels of decision support based on user working experience? For resident, attending physician, the decision support should be different.<br />
* What capabilities does the application provide for patients with psychiatric, psychological, or severe behavioral disorders?<br />
* If your organization's mission includes clinical research, does the software include decision support and data query functions to support research?<br />
* Can the medical records be easily transferred to another clinic with patient approval?<br />
* With what other HIT software systems have you established successful interfaces? (organization may use a variety of systems for BCMA, clinical documentation, laboratory data, business functions that need to have data interchange)<br />
* What capability does the application demonstrate to produce information for patient education?<br />
* Does the system provide capability for patient portals (web access)?<br />
* What wireless functions has the system supported?<br />
* Does the system satisfy security requirements (access control and logging)?<br />
* Does the system provide configurable workflow options?<br />
* Does the system provide integration options with other service providers’ systems (hospitals, insurance companies, labs, …)<br />
* Does the system provide any linkage between clinical notes and structured medical vocabularies?<br />
* Joan Breuer, Ph.D. 01/27/2010 17:19 The Vendor product must have vocabulary standards such as SNOMED, NDC, LOINC, WHO Drug Dictionary, MeSH, CPT, DRG, and UMLS.<br />
* Can the EHR vendor provide a standardized system for the market? And at the same time, can they customize the EHR for different clients and requirements? <br />
* How “personalizable” is the system for individual users to eliminate screen clutter and focus their electronic work process.<br />
* Is the EHR system Health Level Seven (HL7) ready? <br />
* Does the EHR vendor have a procedure to integrate other record/data (e.g. personal health record, public health disease surveillance data) into the system? <br />
*Functionality Matching: Vendor with best functional match. All product selection exercises should start with determining your organization's specific needs.<br />
* Joan Breuer, Ph.D. 01/27/2010 17:20 There needs to be a plan so In-house developers can work with the Vendor such that all algorithms are carried out seamlessly.<br />
* Is the system’s data entry interface intuitive for new users?<br />
* Can the system pull from clinical documentation for billing and patient safety reporting?<br />
* Does the system have meet specific specialty practice needs of users?<br />
* How granular is user access to information? Is the user access hierarchy flexible to accomodate HIPPA standards?<br />
* Has this software shown to decreased adverse drug reactions when implemented in other facilities?<br />
* Does the EMR have different modules for different specialties in our healthcare facility? <br />
* Are these modules “home-grown” at your company or have they been acquired from different companies as your EMR has grown?<br />
* Are the module structures set or can they be used as a template which can be modified to suit or healthcare facilities needs?<br />
* Ask all staff who evaluate the system for their assessment of the strengths and weakness of the system as they perceive that the system would apply to the practice.<br />
* Does the software meet the JCAHO standards?<br />
* What makes this vendor software better than others?<br />
* Does the ASP (remote hosting) model provide local caching of active sessions in the event the network connection is lost briefly? If so, what functionality is guaranteed during the network outage? [[User:MikeField|MikeField]] 20:43, 29 January 2010 (CST)<br />
* Does the EHR system support disease/domain specific profiles that accommodate the level of data needed to support specialty groups such as mental health, oncology and iridology?<br />
* Does the vendor offer a Document Imaging component as part of their solution to allow incorporation of paper records that contain previous patient histories?<br />
* How does the software handle continuity of care as patients transfer from inpatient to outpatient, from one department to another or even between providers? Does the system provide for the writing of discharge notes that list diagnoses, medications and other instructions?<br />
* Is the system easily configurable to allow customized structured data for efficient coding and revenue capture? Clinical data should not be restricted to some arbitrary minimum.<br />
* Does the system handle clinical reminders (i.e: immunization, drug monitoring, dosage) ?<br />
* Does your system handle live pharmacy stock when e-prescribing?<br />
* The user interace includes interoperability with PACS systems?<br />
* Are there tools for manually triggering simple alerts/messages between clinicians for situations that may not yet trigger CDS alerts?<br />
* Does the vendor’s application support external access by physicians, and if so is it part of the system or a user addition?<br />
* Does the vendor offer any data conversion services? At what cost? How long will it take to transfer the data? [http://www.ama-assn.org American Medical Association]<br />
* Can the system indicate normal and abnormal lab results when a patient's lab data are reviewed?<br />
* Can the system display patients' lab data in flowsheets or graphical form to compare results and see trends?<br />
* Can the system document medication administration?<br />
* Does the system support the standards identified and recommended by the Health Information Technology Standards Panel in the latest version of its HITSPTP13 document?<br />
* Does the system support two-factor authentication in alignment with NIST 800-63 Level 3 Authentication?<br />
* If the system provides access to PHI using a web browser via HTML over HTTP, does the system provide data encryption capability via SSL?<br />
* Does the system provide the ability to display the patient's allergy list, including the date of entry? (CCHIT certified 2011 Ambulatory EHR criteria # FN 05.12)<br />
* Does the system provide the ability to display CCD (Continuity of Care Documents) and file them in the EHR, where the summary document must include information on - patient demographics, medication list, and medication allergy list? (CCHIT certified 2011 Ambulatory EHR criteria # IO-AM 10.10)<br />
* Does the system provide the ability to generate and format patient summary XML documents per the HITSP C32 specifications using industry standard vocabularies and terminologies? (CCHIT certified 2011 Ambulatory EHR criteria # IO-AM 10.20)<br />
* Does the software have the ability to allow physicians, such as ophthalmologists, to draw pictures?<br />
* Does the EMR improve the materials management and supply chain management?<br />
* Does the EMR is capable to generate reports with the list of patients with specific conditions which will help for quality improvement, reduction of disparities. ( http://geekdoctor.blogspot.com/2010/01/achieving-meaningful-use.html)<br />
* Does the EMR system can check drug-to-drug interactions and drug allergies and also has the capability to check plan formularies and prescribing patterns. (http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357) <br />
* Does EMR system capable of monitoring the health maintenance of chronic care patients? (http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357)<br />
* Ability of the EMR to support research. i.e., conducting large scale research with data capture and retrieval? Also whether the EMR can attain regulatory compliance regarding billing. <br />
* Does the EHR vendor provide a test version of EHR product for training and quality assurance (QA) purposes as well as the full production environment that is installed in the clinic? (The test version is a segmented area where users can make changes to templates or forms without it affecting the live environment) (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* Will the EHR company build custom templates to the practices specifications? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* Can patients be scheduled for appointments in multiple practices, facilities, etc.?<br />
* Does the EMR system contain physical therapy-centric flow sheets? <br />
<br />
<br />
=== Acquisition and Implementation Cost (25%) ===<br />
<br />
* What is the total financial investment required to acquire and fully implement the proposed solution? Break out costs for the following and detail any time or resource constraints for each item. If additional resources or time are required, what are the additional costs per unit?<br />
** Application<br />
** Per-user licenses (and tier pricing, if offered)<br />
** Database (if treated as a separate item)<br />
***Data integration from legacy systems<br />
** Application documentation<br />
** Annual maintenance agreement<br />
** Training<br />
*** End-user<br />
*** System administrators<br />
*** In-house developers<br />
*** Re-current training<br />
** Professional services:<br />
*** Project management<br />
*** Software development or customizations<br />
*** Technical support<br />
* What is the estimated time that it will take for the investment of the vendor to pay for itself based on projected savings?<br />
* Does the system allows to track and detail log audits and transactions made by users? <br />
* Does the system have the functionality to generate customizable reports given a determinate frequency?<br />
* What is the cost for upgrading when new releases are available?<br />
* What is the projected timeline for upgrades? What training support is included if any, and what is covered by the service fees?<br />
* Upon go-live, business imperatives will define a timeframe within which workflows and processes are to to be run in parallel, until agreed upon metrics/milestones are achieved and the system is signed off into full production: which system is more flexible, less complex, and least disruptive in terms of workflow and process change/adjustments?<br />
* Implementation costs associated with organizational changes to clinician, administrative, etc. processes should be considered in calculating ROI.<br />
* At what point are implemenation costs (and other factors) considered too extreme and a GO/NO decision is given serious consideration?<br />
* All implementation risks must be calculated for "impact and probability" and rank accordingly when analyzing EHR solutions.<br />
* Does the vendor provide functionality to track ROI? If not what reports can be produced that could help track usage?<br />
* Is the vendor ready to send some of its employees onsite during and after deployment?<br />
* Who will bear the cost of these employees?<br />
<br />
=== Hardware Platform and Technical Requirements (20%) ===<br />
<br />
* Which vendor uses less proprietary systems and has partnerships with established industry players? Are they certified developers for the platform they are using? Is the vendor's system and devleopment lifecycle management aligned with their respective industry partners?<br />
*Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
* Identify all hardware and system software that would be required to support an implementation of our scope and scale.<br />
* How well is the vendor able to meet our technical requirements ? <br />
* How flexible is the vendor to change requirements and what are the cost?<br />
* How hard is to implement new modules within the system? <br />
* How well is the vendor able to create and maintain interfaces to our existing systems?<br />
* How well is the vendor able to migrate our data from actual system to the new, if it is neccesary?<br />
* Is the vendors's software created with the most adequate developing technology? Platform? Language? Databases?<br />
* Will we do periodic updates, or will the vendor do this as part of the contract? How often are they released?<br />
* Do we plan on-site or remote hosting for the system?<br />
* If we plan to utilize remote hosting, how safe, sound, and accessible are these data?<br />
* Is the hardware user friendly in all departments? (i.e. nursing, pharmacy, pulmonary,..etc.)<br />
* Will the vendor provide a mock system for testing?<br />
* What is the responding duration of each entry and information extraction? Is there any delay? <br />
* How the data structure for storing data? Is it expandable? Is it easy to be extracted for future analysis?<br />
* How often does the system need to be updated or serviced?<br />
* As the technology is changing and the hospital decides to upgrade their hardware, will your system be able to handles these changes or will we have to buy a new program?<br />
* What language is the vendor's systems software coded in?<br />
* Scaling:<br />
** To how many patients has the system been scaled?<br />
** To how many users has the system been scaled?<br />
** Has the system been scaled to the size of the evaluating institution?<br />
** What are the hardware/software licensing implications of growth?<br />
* Is it necessary to buy (possibly expensive) hardware from the vendor, or can we just install their software on our standard desktop computers (at least for the clients)?<br />
* For already existing software functionality, does the vendor employ reliable and trustworthy software like an open-source MySQL or Apache server? Or do they develop their own system, or do we have to license a proprietary one (extra cost)?<br />
* How the vendor estimates the total amount of users and licenses needed? Will they be concurrent user licenses or asynchronic?<br />
* Will technical support remain active even if the Hospital is running a non upgrade system? For how long?<br />
* Does the system use DICOM standards for the transmission of image data?<br />
* How frequently does the vendor provide patch upgrades for the product?<br />
*Is the system using standards such as Snomed, ICD 10; HL7 Version 2 or 3; HL7 infobutton…)<br />
* If this is a hosted solution, how many computing facilities does the vendor have capable of hosting the application and where are they located? What are the vendors' security and disaster recovery plans?<br />
* How do you handle redundancy for clinical records, like off-site backups and such?<br />
* For Mobile EMR implementations, how do you handle communication to remote wireless clients? security interfaces? types of devices and minimum requirements?<br />
* Is the database program one likely to be waning in use and are personnel available at my site with adequate skills/knowledge to provide support post implementation?<br />
* What database and programming tools (such as instrumented code) are in place for quick problem resolution?<br />
* If software licenses are sold per physician or user, how are part-time physicians, physician assistants and/or advanced nurse practitioners calculated? [http://www.ama-assn.org American Medical Association]<br />
* What is the vendors debugging process?<br />
* How will the data captured by the EMR be migrated to new technology as upgrades are made to the EMR?<br />
* Are software upgrades provided as part of the software maintenance contract?<br />
* How much of the system has to be taken out of service in order to install software updates? Ie., how widespread is the impact?<br />
<br />
=== Implementability (15%) ===<br />
<br />
* How does the vendor compare in KLAS rankings of similar systems and applications?<br />
* How much time, effort, and resources will be required to successfully implement?<br />
* What is the vendors track record for successfully implementing its system in similar settings?<br />
* Do the vendors provide detailed plan for implementation, training and quality control?<br />
* Will the vendor supply on site support when we "go-live" and how long will they be available?<br />
* How responsive is the vendor to emergencies? Do they have a quick and accurate response to support issues?<br />
* Do they have a backup or alternative plan if the system or partial of the system is not working? The situation could be out of energy or computer virus attack.<br />
* How long is the training that is required for each subgroup to fully implement the system?<br />
* What are the training requirements for the vendor? For the clinic/hospital?<br />
* What is the vendor's track record for successfully training a new system for your clinic/hospital size?<br />
* What training manuals, user guides, on-line training assets, and any other training materials will be made available to the clinic/hospital?<br />
* Will the implementation require a consulting "team" and how much will this cost?<br />
* Is the vendor sufficiently well known that most health care consulting firms have familiarity with the system?<br />
* How will legacy patient record data be integrated into the new system?<br />
* Is the vendor's system compliant with the Health Insurance Portability and Accountability Act (HIPAA)?<br />
* Is the vendor's system compliant with the Patient Safety and Quality Improvement Act (PSQIA) Patient Safety Rule?<br />
* How is the evaluation procedure for the approval of the ongoing stages of implementation? How objective will be the defined how to proceed with the approval and payment?<br />
* Is the vendor's system compliant with ISO standards for EHRs?<br />
* Does the system have a proper data recovery plan in case of an crash or any other unexpected event? Can the system be restored without any data loss? Does the vendor have a proper disaster recovery plan?<br />
* How does a legacy Practice Management System integrate with the EHR system? Is there a list of successful PM vendor integrations? [[User:MikeField|MikeField]] 20:47, 29 January 2010 (CST)<br />
* What is the legacy Practice Management System conversion process for legacy data import into the EHR system? Time/cost and loose-ends? What reference clients are there for particular legacy PM systems? [[User:MikeField|MikeField]] 20:47, 29 January 2010 (CST)<br />
* Does the vendor have a List of Lessons Learned from previous implementations?<br />
* Does the vendor have a legal license to essential code sets, such as the AMA Current Procedural Terminology (CPT®) file? Will the vendor maintain this license annually as part of your service or maintenance agreement?[http://www.ama-assn.org American Medical Association]<br />
* Does the vendor offer a “test environment” in which upgrades are loaded to allow you time to test and learn their functionality without affecting your live system? [http://www.ama-assn.org American Medical Association]<br />
* What is the vendor's rate for on time & under budget implementations?<br />
* Are other consulting firms certified to implent the vendor's product? If so will the vendor provide system updates and customer service if system issues (not related to implementation) arise?<br />
* Check whether the vendors EMR products are CCHIT certified (http://www.cchit.org/products/cchit)<br />
* What training mechanisms are used by the EHR Vendor? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85) <br />
* What services does the EHR vendor offers for post-implementation optimization of the system with respect to training and system customization? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* Does the EHR vendor provide any guarantees regarding the ability of a practice to meet meaningful use requirements? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* What is the company policy regarding data ownership for the ASP EHR? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
<br />
=== Vendor Partnership and On-going viability (10%) ===<br />
* Please provide audited financial statements for the last five years, including Balance Sheet, Income Statement, and Statement of Cash Flows, as well as any accompanying footnotes.<br />
* Provide a list of customers who have implemented the systems and applications that you are recommending to us. <br />
*Create a list of vendor selection criteria, and evaluate the vendors and software: review responses to the RFP; schedule demonstrations; check references; and, use proven tools/templates for assessing and consistently comparing vendors. <br />
<br />
*Research available EMR systems and vendors: determine if your jurisdiction has a "pre-approved" vendor list; develop checklists & questionnaires to assist with product comparison; and, prepare a Request for Proposals (RFP). <br />
<br />
* What type of long-term relationship do we think we can expect from the vendor?<br />
* How stable vs risky is the company? <br />
** Request that the software source code be put in escrow with specific provisions established under which it could be accessed. <br />
** How long has the company been in business?<br />
** How large is the company?<br />
*** How much money did they bring in last quarter? year? 3-years?<br />
*** How much is the Vendor company revenue in $M?<br />
*** How much is the vendor company net income in $M?<br />
*** How much are the total assets and liabilities of the company?<br />
*** What is the growth strategy of the company?<br />
*** Are they a private or a public company?<br />
*** How many employees? <br />
* How many contracts have they should to Health Care Systems like yours? <br />
** Can you contact and/or visit a few representative samples? <br />
* How many new contracts have they signed in the past year?<br />
* How many uninstall's have been done the last year?<br />
* Does word of mouth support that the company believes in service after the sale?<br />
* Joan Breuer, Ph.D. 01/27/2010 17:22 The HCF needs formal documentation from other HCFs who have used this Vendor’s product signed by the other HCFs’ CEOs, prepared by an attorney. Note: “Word of mouth” does not stand up in court, especially when we are talking about millions of dollars. <br />
* What is the vendor's cost per year after implementation?<br />
* How the vendor provides technical support? On site or remote? Package or individual project based?<br />
* What provisions exist in the contract for termination and/or penalties if the application does not perform as specified or if the vendor fails to provide any services that are agreed to?<br />
** Ensure that all application specifications that can be measured or quantified are incorporated into the contract.<br />
** Ensure that all services verbally offered by the vendor are incorporated into the contract.<br />
** Does the vendor have service level agreements (SLAs) with appropriate penalties for technical support of the application?<br />
** Does the system’s implementation plan consider proper risks evaluation and mitigation strategies?<br />
*An important consideration is whether the vendor or any of its industry partners have done an analysis of processes in healthcare<br />
* In a HIPAA complaint product, one should consider the feasibility of implementing future mandates. The cost should be considered in terms of both money and time. <br />
<br />
* Obtain references of current customers that are similar in size, have similar patient population, and have similar required functionality needs to your practice and evaluate the ease of implementation, current satisfaction, and costs. <br />
<br />
* What kind of service level agreements are offered by the vendor and what is their track record for maintaining those SLAs?<br />
<br />
=== Future Vision (5%) ===<br />
<br />
* Does the vendor have a meaningful Product Lifecycle that defines major and minor releases, their associated costs, and delivery (push or pull) methods?<br />
* What is the vendor's five-year strategic plan?<br />
* What percentage of revenue is being re-invested into R&D?<br />
* How does the company capture/communicate client concerns for re-engineering? i.e. Is this a learning company?<br />
* What "game changers" are on the drawing board? Are these related to one of our organization's core goals?<br />
* Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
* Lifespan and Staying Power: One should consider the track record of the vendor and viability as a company to sustain the ups and downs of the industry. One sub-criteria in this category often used is how long the vendor has been around.<br />
* Does the vendor plan to offer interoperability options in the event of a nationally implemented CIS?<br />
*What is the plan to support smart phone applications to enhance interoperability and custom accessibility of EHR data while maintaining security? (DROID, IPHONE)<br />
* Upon the termination of a license or agreement, is there an orderly process for you to extract your data? This is applicable if you access the vendor’s software within an application service provider (ASP) model.[http://www.ama-assn.org American Medical Association]<br />
* Ability to have HIE compatibility<br />
* Improved billing accuracy and charge capture<br />
<br />
=== Extra Credit (optional) ===<br />
<br />
* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating it's system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Does the system have e-prescribing functionality?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* Cost reductions associated with risk reduction of adverse drug events<br />
[[Category:EMR]]<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?</div>RTompkinshttp://www.clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2011-01-26T05:17:30Z<p>RTompkins: </p>
<hr />
<div>== Example Vendor Evaluation Criteria ==<br />
<br />
<br />
=== Demonstrate Clinical Functionality (25%) ===<br />
* How do EMR software implement HIPAA Privacy and Security Compliance and other regulatory requirements and Local laws. <br />
* How does EMR software have customer support. Do they have a local workforce, a testing plan, prioritization of issues <br />
* Do they have multiple note creation options like template, macros, dictation, voice recognition, hand writing recognition.<br />
* Does EMR software enable a user to maintain up-to-date problem list? For e.g.: Does it enable a user to electronically record, modify, and retrieve a patient's problem list for longitudinal care (i.e. over multiple visits with the same provider and using the problem list vocabulary standards.) in accordance with certification criteria defined by the ONC’s Interim Final Rule?<br />
* Does EMR software enable a user to electronically record, modify, and retrieve a patient's active medication list as well as medication history for longitudinal care (i.e. over multiple visits with the same provider and using the medication list vocabulary standards.) in accordance certification criteria defined by the ONC’s Interim Final Rule?<br />
* If EMR software provides CPOE Functionality then does it enable a user to electronically record, store, retrieve, and manage, at a minimum, the order types like 1) Medications 2) Laboratory, 3) Radiology and Imaging and 4) Provider referrals according to certification criteria defined by the ONC’s Interim Final Rule.<br />
* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.<br />
* Will it support the Clinical pathways for the Physicians and the Residents for standardization of care processes?<br />
* Will it have the direct export options of the collected data to the State and Federal Health Departments and for other research sites?<br />
* How well is the vendor able to demonstrate the clinical functionality required by [your organization]?<br />
* Is the software flexible enough to meet our current needs and allow for future changes?<br />
* Specifically how does the system support many 24/7 functions, like medication administration changes in an environment that does not have 24/7 pharmacy or CPOE users on site?<br />
* Can a demonstration of the software successfully handle a scenario you have prepared?<br />
* Does the software have functions of supporting clinical decisions?<br />
* Does the software have functions of assisting nurses in documentations?<br />
* Is the vendor able to create interfaces for physicians' office EMRs to allow viewing and sharing of clinical, financial (insurance) and other data?<br />
* Does it have the capability to provide advanced reporting and analytics?<br />
* What is the ease of use for front-line workers? Does the user interface modern and able to adapt to different role-based requirements?<br />
* How easily and quickly can the embedded clinical decision support be modified when new published guidelines or evidence-based medicine studies are published? Will they be responsible for these updates (and at what cost) or will that be our responsibility?<br />
* Is the vendor software compliant with the Certification Commission of Healthcare Information Technology (CCHIT) criteria?<br />
* Can the company categorize users according to their characteristic and provide user-centered usability design? Old physicians usually have vision problem and do not like to use keyboard. <br />
* Can the company provide different levels of decision support based on user working experience? For resident, attending physician, the decision support should be different.<br />
* What capabilities does the application provide for patients with psychiatric, psychological, or severe behavioral disorders?<br />
* If your organization's mission includes clinical research, does the software include decision support and data query functions to support research?<br />
* Can the medical records be easily transferred to another clinic with patient approval?<br />
* With what other HIT software systems have you established successful interfaces? (organization may use a variety of systems for BCMA, clinical documentation, laboratory data, business functions that need to have data interchange)<br />
* What capability does the application demonstrate to produce information for patient education?<br />
* Does the system provide capability for patient portals (web access)?<br />
* What wireless functions has the system supported?<br />
* Does the system satisfy security requirements (access control and logging)?<br />
* Does the system provide configurable workflow options?<br />
* Does the system provide integration options with other service providers’ systems (hospitals, insurance companies, labs, …)<br />
* Does the system provide any linkage between clinical notes and structured medical vocabularies?<br />
* Joan Breuer, Ph.D. 01/27/2010 17:19 The Vendor product must have vocabulary standards such as SNOMED, NDC, LOINC, WHO Drug Dictionary, MeSH, CPT, DRG, and UMLS.<br />
* Can the EHR vendor provide a standardized system for the market? And at the same time, can they customize the EHR for different clients and requirements? <br />
* How “personalizable” is the system for individual users to eliminate screen clutter and focus their electronic work process.<br />
* Is the EHR system Health Level Seven (HL7) ready? <br />
* Does the EHR vendor have a procedure to integrate other record/data (e.g. personal health record, public health disease surveillance data) into the system? <br />
*Functionality Matching: Vendor with best functional match. All product selection exercises should start with determining your organization's specific needs.<br />
* Joan Breuer, Ph.D. 01/27/2010 17:20 There needs to be a plan so In-house developers can work with the Vendor such that all algorithms are carried out seamlessly.<br />
* Is the system’s data entry interface intuitive for new users?<br />
* Can the system pull from clinical documentation for billing and patient safety reporting?<br />
* Does the system have meet specific specialty practice needs of users?<br />
* How granular is user access to information? Is the user access hierarchy flexible to accomodate HIPPA standards?<br />
* Has this software shown to decreased adverse drug reactions when implemented in other facilities?<br />
* Does the EMR have different modules for different specialties in our healthcare facility? <br />
* Are these modules “home-grown” at your company or have they been acquired from different companies as your EMR has grown?<br />
* Are the module structures set or can they be used as a template which can be modified to suit or healthcare facilities needs?<br />
* Ask all staff who evaluate the system for their assessment of the strengths and weakness of the system as they perceive that the system would apply to the practice.<br />
* Does the software meet the JCAHO standards?<br />
* What makes this vendor software better than others?<br />
* Does the ASP (remote hosting) model provide local caching of active sessions in the event the network connection is lost briefly? If so, what functionality is guaranteed during the network outage? [[User:MikeField|MikeField]] 20:43, 29 January 2010 (CST)<br />
* Does the EHR system support disease/domain specific profiles that accommodate the level of data needed to support specialty groups such as mental health, oncology and iridology?<br />
* Does the vendor offer a Document Imaging component as part of their solution to allow incorporation of paper records that contain previous patient histories?<br />
* How does the software handle continuity of care as patients transfer from inpatient to outpatient, from one department to another or even between providers? Does the system provide for the writing of discharge notes that list diagnoses, medications and other instructions?<br />
* Is the system easily configurable to allow customized structured data for efficient coding and revenue capture? Clinical data should not be restricted to some arbitrary minimum.<br />
* Does the system handle clinical reminders (i.e: immunization, drug monitoring, dosage) ?<br />
* Does your system handle live pharmacy stock when e-prescribing?<br />
* The user interace includes interoperability with PACS systems?<br />
* Are there tools for manually triggering simple alerts/messages between clinicians for situations that may not yet trigger CDS alerts?<br />
* Does the vendor’s application support external access by physicians, and if so is it part of the system or a user addition?<br />
* Does the vendor offer any data conversion services? At what cost? How long will it take to transfer the data? [http://www.ama-assn.org American Medical Association]<br />
* Can the system indicate normal and abnormal lab results when a patient's lab data are reviewed?<br />
* Can the system display patients' lab data in flowsheets or graphical form to compare results and see trends?<br />
* Can the system document medication administration?<br />
* Does the system support the standards identified and recommended by the Health Information Technology Standards Panel in the latest version of its HITSPTP13 document?<br />
* Does the system support two-factor authentication in alignment with NIST 800-63 Level 3 Authentication?<br />
* If the system provides access to PHI using a web browser via HTML over HTTP, does the system provide data encryption capability via SSL?<br />
* Does the system provide the ability to display the patient's allergy list, including the date of entry? (CCHIT certified 2011 Ambulatory EHR criteria # FN 05.12)<br />
* Does the system provide the ability to display CCD (Continuity of Care Documents) and file them in the EHR, where the summary document must include information on - patient demographics, medication list, and medication allergy list? (CCHIT certified 2011 Ambulatory EHR criteria # IO-AM 10.10)<br />
* Does the system provide the ability to generate and format patient summary XML documents per the HITSP C32 specifications using industry standard vocabularies and terminologies? (CCHIT certified 2011 Ambulatory EHR criteria # IO-AM 10.20)<br />
* Does the software have the ability to allow physicians, such as ophthalmologists, to draw pictures?<br />
* Does the EMR improve the materials management and supply chain management?<br />
* Does the EMR is capable to generate reports with the list of patients with specific conditions which will help for quality improvement, reduction of disparities. ( http://geekdoctor.blogspot.com/2010/01/achieving-meaningful-use.html)<br />
* Does the EMR system can check drug-to-drug interactions and drug allergies and also has the capability to check plan formularies and prescribing patterns. (http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357) <br />
* Does EMR system capable of monitoring the health maintenance of chronic care patients? (http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357)<br />
* Ability of the EMR to support research. i.e., conducting large scale research with data capture and retrieval? Also whether the EMR can attain regulatory compliance regarding billing. <br />
* Does the EHR vendor provide a test version of EHR product for training and quality assurance (QA) purposes as well as the full production environment that is installed in the clinic? (The test version is a segmented area where users can make changes to templates or forms without it affecting the live environment) (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* Will the EHR company build custom templates to the practices specifications? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* Can patients be scheduled for appointments in multiple practices, facilities, etc.?<br />
* Does the EMR system contain physical therapy-centric flow sheets? <br />
<br />
<br />
=== Acquisition and Implementation Cost (25%) ===<br />
<br />
* What is the total financial investment required to acquire and fully implement the proposed solution? Break out costs for the following and detail any time or resource constraints for each item. If additional resources or time are required, what are the additional costs per unit?<br />
** Application<br />
** Per-user licenses (and tier pricing, if offered)<br />
** Database (if treated as a separate item)<br />
***Data integration from legacy systems<br />
** Application documentation<br />
** Annual maintenance agreement<br />
** Training<br />
*** End-user<br />
*** System administrators<br />
*** In-house developers<br />
*** Re-current training<br />
** Professional services:<br />
*** Project management<br />
*** Software development or customizations<br />
*** Technical support<br />
* What is the estimated time that it will take for the investment of the vendor to pay for itself based on projected savings?<br />
* Does the system allows to track and detail log audits and transactions made by users? <br />
* Does the system have the functionality to generate customizable reports given a determinate frequency?<br />
* What is the cost for upgrading when new releases are available?<br />
* What is the projected timeline for upgrades? What training support is included if any, and what is covered by the service fees?<br />
* Upon go-live, business imperatives will define a timeframe within which workflows and processes are to to be run in parallel, until agreed upon metrics/milestones are achieved and the system is signed off into full production: which system is more flexible, less complex, and least disruptive in terms of workflow and process change/adjustments?<br />
* Implementation costs associated with organizational changes to clinician, administrative, etc. processes should be considered in calculating ROI.<br />
* At what point are implemenation costs (and other factors) considered too extreme and a GO/NO decision is given serious consideration?<br />
* All implementation risks must be calculated for "impact and probability" and rank accordingly when analyzing EHR solutions.<br />
* Does the vendor provide functionality to track ROI? If not what reports can be produced that could help track usage?<br />
* Is the vendor ready to send some of its employees onsite during and after deployment?<br />
* Who will bear the cost of these employees?<br />
<br />
=== Hardware Platform and Technical Requirements (20%) ===<br />
<br />
* Which vendor uses less proprietary systems and has partnerships with established industry players? Are they certified developers for the platform they are using? Is the vendor's system and devleopment lifecycle management aligned with their respective industry partners?<br />
*Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
* Identify all hardware and system software that would be required to support an implementation of our scope and scale.<br />
* How well is the vendor able to meet our technical requirements ? <br />
* How flexible is the vendor to change requirements and what are the cost?<br />
* How hard is to implement new modules within the system? <br />
* How well is the vendor able to create and maintain interfaces to our existing systems?<br />
* How well is the vendor able to migrate our data from actual system to the new, if it is neccesary?<br />
* Is the vendors's software created with the most adequate developing technology? Platform? Language? Databases?<br />
* Will we do periodic updates, or will the vendor do this as part of the contract? How often are they released?<br />
* Do we plan on-site or remote hosting for the system?<br />
* If we plan to utilize remote hosting, how safe, sound, and accessible are these data?<br />
* Is the hardware user friendly in all departments? (i.e. nursing, pharmacy, pulmonary,..etc.)<br />
* Will the vendor provide a mock system for testing?<br />
* What is the responding duration of each entry and information extraction? Is there any delay? <br />
* How the data structure for storing data? Is it expandable? Is it easy to be extracted for future analysis?<br />
* How often does the system need to be updated or serviced?<br />
* As the technology is changing and the hospital decides to upgrade their hardware, will your system be able to handles these changes or will we have to buy a new program?<br />
* What language is the vendor's systems software coded in?<br />
* Scaling:<br />
** To how many patients has the system been scaled?<br />
** To how many users has the system been scaled?<br />
** Has the system been scaled to the size of the evaluating institution?<br />
** What are the hardware/software licensing implications of growth?<br />
* Is it necessary to buy (possibly expensive) hardware from the vendor, or can we just install their software on our standard desktop computers (at least for the clients)?<br />
* For already existing software functionality, does the vendor employ reliable and trustworthy software like an open-source MySQL or Apache server? Or do they develop their own system, or do we have to license a proprietary one (extra cost)?<br />
* How the vendor estimates the total amount of users and licenses needed? Will they be concurrent user licenses or asynchronic?<br />
* Will technical support remain active even if the Hospital is running a non upgrade system? For how long?<br />
* Does the system use DICOM standards for the transmission of image data?<br />
* How frequently does the vendor provide patch upgrades for the product?<br />
*Is the system using standards such as Snomed, ICD 10; HL7 Version 2 or 3; HL7 infobutton…)<br />
* If this is a hosted solution, how many computing facilities does the vendor have capable of hosting the application and where are they located? What are the vendors' security and disaster recovery plans?<br />
* How do you handle redundancy for clinical records, like off-site backups and such?<br />
* For Mobile EMR implementations, how do you handle communication to remote wireless clients? security interfaces? types of devices and minimum requirements?<br />
* Is the database program one likely to be waning in use and are personnel available at my site with adequate skills/knowledge to provide support post implementation?<br />
* What database and programming tools (such as instrumented code) are in place for quick problem resolution?<br />
* If software licenses are sold per physician or user, how are part-time physicians, physician assistants and/or advanced nurse practitioners calculated? [http://www.ama-assn.org American Medical Association]<br />
* What is the vendors debugging process?<br />
* How will the data captured by the EMR be migrated to new technology as upgrades are made to the EMR?<br />
* Are software upgrades provided as part of the software maintenance contract?<br />
<br />
=== Implementability (15%) ===<br />
<br />
* How does the vendor compare in KLAS rankings of similar systems and applications?<br />
* How much time, effort, and resources will be required to successfully implement?<br />
* What is the vendors track record for successfully implementing its system in similar settings?<br />
* Do the vendors provide detailed plan for implementation, training and quality control?<br />
* Will the vendor supply on site support when we "go-live" and how long will they be available?<br />
* How responsive is the vendor to emergencies? Do they have a quick and accurate response to support issues?<br />
* Do they have a backup or alternative plan if the system or partial of the system is not working? The situation could be out of energy or computer virus attack.<br />
* How long is the training that is required for each subgroup to fully implement the system?<br />
* What are the training requirements for the vendor? For the clinic/hospital?<br />
* What is the vendor's track record for successfully training a new system for your clinic/hospital size?<br />
* What training manuals, user guides, on-line training assets, and any other training materials will be made available to the clinic/hospital?<br />
* Will the implementation require a consulting "team" and how much will this cost?<br />
* Is the vendor sufficiently well known that most health care consulting firms have familiarity with the system?<br />
* How will legacy patient record data be integrated into the new system?<br />
* Is the vendor's system compliant with the Health Insurance Portability and Accountability Act (HIPAA)?<br />
* Is the vendor's system compliant with the Patient Safety and Quality Improvement Act (PSQIA) Patient Safety Rule?<br />
* How is the evaluation procedure for the approval of the ongoing stages of implementation? How objective will be the defined how to proceed with the approval and payment?<br />
* Is the vendor's system compliant with ISO standards for EHRs?<br />
* Does the system have a proper data recovery plan in case of an crash or any other unexpected event? Can the system be restored without any data loss? Does the vendor have a proper disaster recovery plan?<br />
* How does a legacy Practice Management System integrate with the EHR system? Is there a list of successful PM vendor integrations? [[User:MikeField|MikeField]] 20:47, 29 January 2010 (CST)<br />
* What is the legacy Practice Management System conversion process for legacy data import into the EHR system? Time/cost and loose-ends? What reference clients are there for particular legacy PM systems? [[User:MikeField|MikeField]] 20:47, 29 January 2010 (CST)<br />
* Does the vendor have a List of Lessons Learned from previous implementations?<br />
* Does the vendor have a legal license to essential code sets, such as the AMA Current Procedural Terminology (CPT®) file? Will the vendor maintain this license annually as part of your service or maintenance agreement?[http://www.ama-assn.org American Medical Association]<br />
* Does the vendor offer a “test environment” in which upgrades are loaded to allow you time to test and learn their functionality without affecting your live system? [http://www.ama-assn.org American Medical Association]<br />
* What is the vendor's rate for on time & under budget implementations?<br />
* Are other consulting firms certified to implent the vendor's product? If so will the vendor provide system updates and customer service if system issues (not related to implementation) arise?<br />
* Check whether the vendors EMR products are CCHIT certified (http://www.cchit.org/products/cchit)<br />
* What training mechanisms are used by the EHR Vendor? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85) <br />
* What services does the EHR vendor offers for post-implementation optimization of the system with respect to training and system customization? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* Does the EHR vendor provide any guarantees regarding the ability of a practice to meet meaningful use requirements? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* What is the company policy regarding data ownership for the ASP EHR? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
<br />
=== Vendor Partnership and On-going viability (10%) ===<br />
* Please provide audited financial statements for the last five years, including Balance Sheet, Income Statement, and Statement of Cash Flows, as well as any accompanying footnotes.<br />
* Provide a list of customers who have implemented the systems and applications that you are recommending to us. <br />
*Create a list of vendor selection criteria, and evaluate the vendors and software: review responses to the RFP; schedule demonstrations; check references; and, use proven tools/templates for assessing and consistently comparing vendors. <br />
<br />
*Research available EMR systems and vendors: determine if your jurisdiction has a "pre-approved" vendor list; develop checklists & questionnaires to assist with product comparison; and, prepare a Request for Proposals (RFP). <br />
<br />
* What type of long-term relationship do we think we can expect from the vendor?<br />
* How stable vs risky is the company? <br />
** Request that the software source code be put in escrow with specific provisions established under which it could be accessed. <br />
** How long has the company been in business?<br />
** How large is the company?<br />
*** How much money did they bring in last quarter? year? 3-years?<br />
*** How much is the Vendor company revenue in $M?<br />
*** How much is the vendor company net income in $M?<br />
*** How much are the total assets and liabilities of the company?<br />
*** What is the growth strategy of the company?<br />
*** Are they a private or a public company?<br />
*** How many employees? <br />
* How many contracts have they should to Health Care Systems like yours? <br />
** Can you contact and/or visit a few representative samples? <br />
* How many new contracts have they signed in the past year?<br />
* How many uninstall's have been done the last year?<br />
* Does word of mouth support that the company believes in service after the sale?<br />
* Joan Breuer, Ph.D. 01/27/2010 17:22 The HCF needs formal documentation from other HCFs who have used this Vendor’s product signed by the other HCFs’ CEOs, prepared by an attorney. Note: “Word of mouth” does not stand up in court, especially when we are talking about millions of dollars. <br />
* What is the vendor's cost per year after implementation?<br />
* How the vendor provides technical support? On site or remote? Package or individual project based?<br />
* What provisions exist in the contract for termination and/or penalties if the application does not perform as specified or if the vendor fails to provide any services that are agreed to?<br />
** Ensure that all application specifications that can be measured or quantified are incorporated into the contract.<br />
** Ensure that all services verbally offered by the vendor are incorporated into the contract.<br />
** Does the vendor have service level agreements (SLAs) with appropriate penalties for technical support of the application?<br />
** Does the system’s implementation plan consider proper risks evaluation and mitigation strategies?<br />
*An important consideration is whether the vendor or any of its industry partners have done an analysis of processes in healthcare<br />
* In a HIPAA complaint product, one should consider the feasibility of implementing future mandates. The cost should be considered in terms of both money and time. <br />
<br />
* Obtain references of current customers that are similar in size, have similar patient population, and have similar required functionality needs to your practice and evaluate the ease of implementation, current satisfaction, and costs. <br />
<br />
* What kind of service level agreements are offered by the vendor and what is their track record for maintaining those SLAs?<br />
<br />
=== Future Vision (5%) ===<br />
<br />
* Does the vendor have a meaningful Product Lifecycle that defines major and minor releases, their associated costs, and delivery (push or pull) methods?<br />
* What is the vendor's five-year strategic plan?<br />
* What percentage of revenue is being re-invested into R&D?<br />
* How does the company capture/communicate client concerns for re-engineering? i.e. Is this a learning company?<br />
* What "game changers" are on the drawing board? Are these related to one of our organization's core goals?<br />
* Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
* Lifespan and Staying Power: One should consider the track record of the vendor and viability as a company to sustain the ups and downs of the industry. One sub-criteria in this category often used is how long the vendor has been around.<br />
* Does the vendor plan to offer interoperability options in the event of a nationally implemented CIS?<br />
*What is the plan to support smart phone applications to enhance interoperability and custom accessibility of EHR data while maintaining security? (DROID, IPHONE)<br />
* Upon the termination of a license or agreement, is there an orderly process for you to extract your data? This is applicable if you access the vendor’s software within an application service provider (ASP) model.[http://www.ama-assn.org American Medical Association]<br />
* Ability to have HIE compatibility<br />
* Improved billing accuracy and charge capture<br />
<br />
=== Extra Credit (optional) ===<br />
<br />
* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating it's system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Does the system have e-prescribing functionality?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* Cost reductions associated with risk reduction of adverse drug events<br />
[[Category:EMR]]<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?</div>RTompkinshttp://www.clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2011-01-26T05:15:50Z<p>RTompkins: </p>
<hr />
<div>== Example Vendor Evaluation Criteria ==<br />
<br />
<br />
=== Demonstrate Clinical Functionality (25%) ===<br />
* How do EMR software implement HIPAA Privacy and Security Compliance and other regulatory requirements and Local laws. <br />
* How does EMR software have customer support. Do they have a local workforce, a testing plan, prioritization of issues <br />
* Do they have multiple note creation options like template, macros, dictation, voice recognition, hand writing recognition.<br />
* Does EMR software enable a user to maintain up-to-date problem list? For e.g.: Does it enable a user to electronically record, modify, and retrieve a patient's problem list for longitudinal care (i.e. over multiple visits with the same provider and using the problem list vocabulary standards.) in accordance with certification criteria defined by the ONC’s Interim Final Rule?<br />
* Does EMR software enable a user to electronically record, modify, and retrieve a patient's active medication list as well as medication history for longitudinal care (i.e. over multiple visits with the same provider and using the medication list vocabulary standards.) in accordance certification criteria defined by the ONC’s Interim Final Rule?<br />
* If EMR software provides CPOE Functionality then does it enable a user to electronically record, store, retrieve, and manage, at a minimum, the order types like 1) Medications 2) Laboratory, 3) Radiology and Imaging and 4) Provider referrals according to certification criteria defined by the ONC’s Interim Final Rule.<br />
* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.<br />
* Will it support the Clinical pathways for the Physicians and the Residents for standardization of care processes?<br />
* Will it have the direct export options of the collected data to the State and Federal Health Departments and for other research sites?<br />
* How well is the vendor able to demonstrate the clinical functionality required by [your organization]?<br />
* Is the software flexible enough to meet our current needs and allow for future changes?<br />
* Specifically how does the system support many 24/7 functions, like medication administration changes in an environment that does not have 24/7 pharmacy or CPOE users on site?<br />
* Can a demonstration of the software successfully handle a scenario you have prepared?<br />
* Does the software have functions of supporting clinical decisions?<br />
* Does the software have functions of assisting nurses in documentations?<br />
* Is the vendor able to create interfaces for physicians' office EMRs to allow viewing and sharing of clinical, financial (insurance) and other data?<br />
* Does it have the capability to provide advanced reporting and analytics?<br />
* What is the ease of use for front-line workers? Does the user interface modern and able to adapt to different role-based requirements?<br />
* How easily and quickly can the embedded clinical decision support be modified when new published guidelines or evidence-based medicine studies are published? Will they be responsible for these updates (and at what cost) or will that be our responsibility?<br />
* Is the vendor software compliant with the Certification Commission of Healthcare Information Technology (CCHIT) criteria?<br />
* Can the company categorize users according to their characteristic and provide user-centered usability design? Old physicians usually have vision problem and do not like to use keyboard. <br />
* Can the company provide different levels of decision support based on user working experience? For resident, attending physician, the decision support should be different.<br />
* What capabilities does the application provide for patients with psychiatric, psychological, or severe behavioral disorders?<br />
* If your organization's mission includes clinical research, does the software include decision support and data query functions to support research?<br />
* Can the medical records be easily transferred to another clinic with patient approval?<br />
* With what other HIT software systems have you established successful interfaces? (organization may use a variety of systems for BCMA, clinical documentation, laboratory data, business functions that need to have data interchange)<br />
* What capability does the application demonstrate to produce information for patient education?<br />
* Does the system provide capability for patient portals (web access)?<br />
* What wireless functions has the system supported?<br />
* Does the system satisfy security requirements (access control and logging)?<br />
* Does the system provide configurable workflow options?<br />
* Does the system provide integration options with other service providers’ systems (hospitals, insurance companies, labs, …)<br />
* Does the system provide any linkage between clinical notes and structured medical vocabularies?<br />
* Joan Breuer, Ph.D. 01/27/2010 17:19 The Vendor product must have vocabulary standards such as SNOMED, NDC, LOINC, WHO Drug Dictionary, MeSH, CPT, DRG, and UMLS.<br />
* Can the EHR vendor provide a standardized system for the market? And at the same time, can they customize the EHR for different clients and requirements? <br />
* How “personalizable” is the system for individual users to eliminate screen clutter and focus their electronic work process.<br />
* Is the EHR system Health Level Seven (HL7) ready? <br />
* Does the EHR vendor have a procedure to integrate other record/data (e.g. personal health record, public health disease surveillance data) into the system? <br />
*Functionality Matching: Vendor with best functional match. All product selection exercises should start with determining your organization's specific needs.<br />
* Joan Breuer, Ph.D. 01/27/2010 17:20 There needs to be a plan so In-house developers can work with the Vendor such that all algorithms are carried out seamlessly.<br />
* Is the system’s data entry interface intuitive for new users?<br />
* Can the system pull from clinical documentation for billing and patient safety reporting?<br />
* Does the system have meet specific specialty practice needs of users?<br />
* How granular is user access to information? Is the user access hierarchy flexible to accomodate HIPPA standards?<br />
* Has this software shown to decreased adverse drug reactions when implemented in other facilities?<br />
* Does the EMR have different modules for different specialties in our healthcare facility? <br />
* Are these modules “home-grown” at your company or have they been acquired from different companies as your EMR has grown?<br />
* Are the module structures set or can they be used as a template which can be modified to suit or healthcare facilities needs?<br />
* Ask all staff who evaluate the system for their assessment of the strengths and weakness of the system as they perceive that the system would apply to the practice.<br />
* Does the software meet the JCAHO standards?<br />
* What makes this vendor software better than others?<br />
* Does the ASP (remote hosting) model provide local caching of active sessions in the event the network connection is lost briefly? If so, what functionality is guaranteed during the network outage? [[User:MikeField|MikeField]] 20:43, 29 January 2010 (CST)<br />
* Does the EHR system support disease/domain specific profiles that accommodate the level of data needed to support specialty groups such as mental health, oncology and iridology?<br />
* Does the vendor offer a Document Imaging component as part of their solution to allow incorporation of paper records that contain previous patient histories?<br />
* How does the software handle continuity of care as patients transfer from inpatient to outpatient, from one department to another or even between providers? Does the system provide for the writing of discharge notes that list diagnoses, medications and other instructions?<br />
* Is the system easily configurable to allow customized structured data for efficient coding and revenue capture? Clinical data should not be restricted to some arbitrary minimum.<br />
* Does the system handle clinical reminders (i.e: immunization, drug monitoring, dosage) ?<br />
* Does your system handle live pharmacy stock when e-prescribing?<br />
* The user interace includes interoperability with PACS systems?<br />
* Are there tools for manually triggering simple alerts/messages between clinicians for situations that may not yet trigger CDS alerts?<br />
* Does the vendor’s application support external access by physicians, and if so is it part of the system or a user addition?<br />
* Does the vendor offer any data conversion services? At what cost? How long will it take to transfer the data? [http://www.ama-assn.org American Medical Association]<br />
* Can the system indicate normal and abnormal lab results when a patient's lab data are reviewed?<br />
* Can the system display patients' lab data in flowsheets or graphical form to compare results and see trends?<br />
* Can the system document medication administration?<br />
* Does the system support the standards identified and recommended by the Health Information Technology Standards Panel in the latest version of its HITSPTP13 document?<br />
* Does the system support two-factor authentication in alignment with NIST 800-63 Level 3 Authentication?<br />
* If the system provides access to PHI using a web browser via HTML over HTTP, does the system provide data encryption capability via SSL?<br />
* Does the system provide the ability to display the patient's allergy list, including the date of entry? (CCHIT certified 2011 Ambulatory EHR criteria # FN 05.12)<br />
* Does the system provide the ability to display CCD (Continuity of Care Documents) and file them in the EHR, where the summary document must include information on - patient demographics, medication list, and medication allergy list? (CCHIT certified 2011 Ambulatory EHR criteria # IO-AM 10.10)<br />
* Does the system provide the ability to generate and format patient summary XML documents per the HITSP C32 specifications using industry standard vocabularies and terminologies? (CCHIT certified 2011 Ambulatory EHR criteria # IO-AM 10.20)<br />
* Does the software have the ability to allow physicians, such as ophthalmologists, to draw pictures?<br />
* Does the EMR improve the materials management and supply chain management?<br />
* Does the EMR is capable to generate reports with the list of patients with specific conditions which will help for quality improvement, reduction of disparities. ( http://geekdoctor.blogspot.com/2010/01/achieving-meaningful-use.html)<br />
* Does the EMR system can check drug-to-drug interactions and drug allergies and also has the capability to check plan formularies and prescribing patterns. (http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357) <br />
* Does EMR system capable of monitoring the health maintenance of chronic care patients? (http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357)<br />
* Ability of the EMR to support research. i.e., conducting large scale research with data capture and retrieval? Also whether the EMR can attain regulatory compliance regarding billing. <br />
* Does the EHR vendor provide a test version of EHR product for training and quality assurance (QA) purposes as well as the full production environment that is installed in the clinic? (The test version is a segmented area where users can make changes to templates or forms without it affecting the live environment) (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* Will the EHR company build custom templates to the practices specifications? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* Can patients be scheduled for appointments in multiple practices, facilities, etc.?<br />
<br />
=== Acquisition and Implementation Cost (25%) ===<br />
<br />
* What is the total financial investment required to acquire and fully implement the proposed solution? Break out costs for the following and detail any time or resource constraints for each item. If additional resources or time are required, what are the additional costs per unit?<br />
** Application<br />
** Per-user licenses (and tier pricing, if offered)<br />
** Database (if treated as a separate item)<br />
***Data integration from legacy systems<br />
** Application documentation<br />
** Annual maintenance agreement<br />
** Training<br />
*** End-user<br />
*** System administrators<br />
*** In-house developers<br />
*** Re-current training<br />
** Professional services:<br />
*** Project management<br />
*** Software development or customizations<br />
*** Technical support<br />
* What is the estimated time that it will take for the investment of the vendor to pay for itself based on projected savings?<br />
* Does the system allows to track and detail log audits and transactions made by users? <br />
* Does the system have the functionality to generate customizable reports given a determinate frequency?<br />
* What is the cost for upgrading when new releases are available?<br />
* What is the projected timeline for upgrades? What training support is included if any, and what is covered by the service fees?<br />
* Upon go-live, business imperatives will define a timeframe within which workflows and processes are to to be run in parallel, until agreed upon metrics/milestones are achieved and the system is signed off into full production: which system is more flexible, less complex, and least disruptive in terms of workflow and process change/adjustments?<br />
* Implementation costs associated with organizational changes to clinician, administrative, etc. processes should be considered in calculating ROI.<br />
* At what point are implemenation costs (and other factors) considered too extreme and a GO/NO decision is given serious consideration?<br />
* All implementation risks must be calculated for "impact and probability" and rank accordingly when analyzing EHR solutions.<br />
* Does the vendor provide functionality to track ROI? If not what reports can be produced that could help track usage?<br />
* Is the vendor ready to send some of its employees onsite during and after deployment?<br />
* Who will bear the cost of these employees?<br />
<br />
=== Hardware Platform and Technical Requirements (20%) ===<br />
<br />
* Which vendor uses less proprietary systems and has partnerships with established industry players? Are they certified developers for the platform they are using? Is the vendor's system and devleopment lifecycle management aligned with their respective industry partners?<br />
*Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
* Identify all hardware and system software that would be required to support an implementation of our scope and scale.<br />
* How well is the vendor able to meet our technical requirements ? <br />
* How flexible is the vendor to change requirements and what are the cost?<br />
* How hard is to implement new modules within the system? <br />
* How well is the vendor able to create and maintain interfaces to our existing systems?<br />
* How well is the vendor able to migrate our data from actual system to the new, if it is neccesary?<br />
* Is the vendors's software created with the most adequate developing technology? Platform? Language? Databases?<br />
* Will we do periodic updates, or will the vendor do this as part of the contract? How often are they released?<br />
* Do we plan on-site or remote hosting for the system?<br />
* If we plan to utilize remote hosting, how safe, sound, and accessible are these data?<br />
* Is the hardware user friendly in all departments? (i.e. nursing, pharmacy, pulmonary,..etc.)<br />
* Will the vendor provide a mock system for testing?<br />
* What is the responding duration of each entry and information extraction? Is there any delay? <br />
* How the data structure for storing data? Is it expandable? Is it easy to be extracted for future analysis?<br />
* How often does the system need to be updated or serviced?<br />
* As the technology is changing and the hospital decides to upgrade their hardware, will your system be able to handles these changes or will we have to buy a new program?<br />
* What language is the vendor's systems software coded in?<br />
* Scaling:<br />
** To how many patients has the system been scaled?<br />
** To how many users has the system been scaled?<br />
** Has the system been scaled to the size of the evaluating institution?<br />
** What are the hardware/software licensing implications of growth?<br />
* Is it necessary to buy (possibly expensive) hardware from the vendor, or can we just install their software on our standard desktop computers (at least for the clients)?<br />
* For already existing software functionality, does the vendor employ reliable and trustworthy software like an open-source MySQL or Apache server? Or do they develop their own system, or do we have to license a proprietary one (extra cost)?<br />
* How the vendor estimates the total amount of users and licenses needed? Will they be concurrent user licenses or asynchronic?<br />
* Will technical support remain active even if the Hospital is running a non upgrade system? For how long?<br />
* Does the system use DICOM standards for the transmission of image data?<br />
* How frequently does the vendor provide patch upgrades for the product?<br />
*Is the system using standards such as Snomed, ICD 10; HL7 Version 2 or 3; HL7 infobutton…)<br />
* If this is a hosted solution, how many computing facilities does the vendor have capable of hosting the application and where are they located? What are the vendors' security and disaster recovery plans?<br />
* How do you handle redundancy for clinical records, like off-site backups and such?<br />
* For Mobile EMR implementations, how do you handle communication to remote wireless clients? security interfaces? types of devices and minimum requirements?<br />
* Is the database program one likely to be waning in use and are personnel available at my site with adequate skills/knowledge to provide support post implementation?<br />
* What database and programming tools (such as instrumented code) are in place for quick problem resolution?<br />
* If software licenses are sold per physician or user, how are part-time physicians, physician assistants and/or advanced nurse practitioners calculated? [http://www.ama-assn.org American Medical Association]<br />
* What is the vendors debugging process?<br />
* How will the data captured by the EMR be migrated to new technology as upgrades are made to the EMR?<br />
* Are software upgrades provided as part of the software maintenance contract?<br />
<br />
=== Implementability (15%) ===<br />
<br />
* How does the vendor compare in KLAS rankings of similar systems and applications?<br />
* How much time, effort, and resources will be required to successfully implement?<br />
* What is the vendors track record for successfully implementing its system in similar settings?<br />
* Do the vendors provide detailed plan for implementation, training and quality control?<br />
* Will the vendor supply on site support when we "go-live" and how long will they be available?<br />
* How responsive is the vendor to emergencies? Do they have a quick and accurate response to support issues?<br />
* Do they have a backup or alternative plan if the system or partial of the system is not working? The situation could be out of energy or computer virus attack.<br />
* How long is the training that is required for each subgroup to fully implement the system?<br />
* What are the training requirements for the vendor? For the clinic/hospital?<br />
* What is the vendor's track record for successfully training a new system for your clinic/hospital size?<br />
* What training manuals, user guides, on-line training assets, and any other training materials will be made available to the clinic/hospital?<br />
* Will the implementation require a consulting "team" and how much will this cost?<br />
* Is the vendor sufficiently well known that most health care consulting firms have familiarity with the system?<br />
* How will legacy patient record data be integrated into the new system?<br />
* Is the vendor's system compliant with the Health Insurance Portability and Accountability Act (HIPAA)?<br />
* Is the vendor's system compliant with the Patient Safety and Quality Improvement Act (PSQIA) Patient Safety Rule?<br />
* How is the evaluation procedure for the approval of the ongoing stages of implementation? How objective will be the defined how to proceed with the approval and payment?<br />
* Is the vendor's system compliant with ISO standards for EHRs?<br />
* Does the system have a proper data recovery plan in case of an crash or any other unexpected event? Can the system be restored without any data loss? Does the vendor have a proper disaster recovery plan?<br />
* How does a legacy Practice Management System integrate with the EHR system? Is there a list of successful PM vendor integrations? [[User:MikeField|MikeField]] 20:47, 29 January 2010 (CST)<br />
* What is the legacy Practice Management System conversion process for legacy data import into the EHR system? Time/cost and loose-ends? What reference clients are there for particular legacy PM systems? [[User:MikeField|MikeField]] 20:47, 29 January 2010 (CST)<br />
* Does the vendor have a List of Lessons Learned from previous implementations?<br />
* Does the vendor have a legal license to essential code sets, such as the AMA Current Procedural Terminology (CPT®) file? Will the vendor maintain this license annually as part of your service or maintenance agreement?[http://www.ama-assn.org American Medical Association]<br />
* Does the vendor offer a “test environment” in which upgrades are loaded to allow you time to test and learn their functionality without affecting your live system? [http://www.ama-assn.org American Medical Association]<br />
* What is the vendor's rate for on time & under budget implementations?<br />
* Are other consulting firms certified to implent the vendor's product? If so will the vendor provide system updates and customer service if system issues (not related to implementation) arise?<br />
* Check whether the vendors EMR products are CCHIT certified (http://www.cchit.org/products/cchit)<br />
* What training mechanisms are used by the EHR Vendor? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85) <br />
* What services does the EHR vendor offers for post-implementation optimization of the system with respect to training and system customization? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* Does the EHR vendor provide any guarantees regarding the ability of a practice to meet meaningful use requirements? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
* What is the company policy regarding data ownership for the ASP EHR? (http://www.americanehr.com/find-an-ehr/ehr-vendor-comparisons/comparison-engine.aspx?left=57&right=85)<br />
<br />
=== Vendor Partnership and On-going viability (10%) ===<br />
* Please provide audited financial statements for the last five years, including Balance Sheet, Income Statement, and Statement of Cash Flows, as well as any accompanying footnotes.<br />
* Provide a list of customers who have implemented the systems and applications that you are recommending to us. <br />
*Create a list of vendor selection criteria, and evaluate the vendors and software: review responses to the RFP; schedule demonstrations; check references; and, use proven tools/templates for assessing and consistently comparing vendors. <br />
<br />
*Research available EMR systems and vendors: determine if your jurisdiction has a "pre-approved" vendor list; develop checklists & questionnaires to assist with product comparison; and, prepare a Request for Proposals (RFP). <br />
<br />
* What type of long-term relationship do we think we can expect from the vendor?<br />
* How stable vs risky is the company? <br />
** Request that the software source code be put in escrow with specific provisions established under which it could be accessed. <br />
** How long has the company been in business?<br />
** How large is the company?<br />
*** How much money did they bring in last quarter? year? 3-years?<br />
*** How much is the Vendor company revenue in $M?<br />
*** How much is the vendor company net income in $M?<br />
*** How much are the total assets and liabilities of the company?<br />
*** What is the growth strategy of the company?<br />
*** Are they a private or a public company?<br />
*** How many employees? <br />
* How many contracts have they should to Health Care Systems like yours? <br />
** Can you contact and/or visit a few representative samples? <br />
* How many new contracts have they signed in the past year?<br />
* How many uninstall's have been done the last year?<br />
* Does word of mouth support that the company believes in service after the sale?<br />
* Joan Breuer, Ph.D. 01/27/2010 17:22 The HCF needs formal documentation from other HCFs who have used this Vendor’s product signed by the other HCFs’ CEOs, prepared by an attorney. Note: “Word of mouth” does not stand up in court, especially when we are talking about millions of dollars. <br />
* What is the vendor's cost per year after implementation?<br />
* How the vendor provides technical support? On site or remote? Package or individual project based?<br />
* What provisions exist in the contract for termination and/or penalties if the application does not perform as specified or if the vendor fails to provide any services that are agreed to?<br />
** Ensure that all application specifications that can be measured or quantified are incorporated into the contract.<br />
** Ensure that all services verbally offered by the vendor are incorporated into the contract.<br />
** Does the vendor have service level agreements (SLAs) with appropriate penalties for technical support of the application?<br />
** Does the system’s implementation plan consider proper risks evaluation and mitigation strategies?<br />
*An important consideration is whether the vendor or any of its industry partners have done an analysis of processes in healthcare<br />
* In a HIPAA complaint product, one should consider the feasibility of implementing future mandates. The cost should be considered in terms of both money and time. <br />
<br />
* Obtain references of current customers that are similar in size, have similar patient population, and have similar required functionality needs to your practice and evaluate the ease of implementation, current satisfaction, and costs. <br />
<br />
* What kind of service level agreements are offered by the vendor and what is their track record for maintaining those SLAs?<br />
<br />
=== Future Vision (5%) ===<br />
<br />
* Does the vendor have a meaningful Product Lifecycle that defines major and minor releases, their associated costs, and delivery (push or pull) methods?<br />
* What is the vendor's five-year strategic plan?<br />
* What percentage of revenue is being re-invested into R&D?<br />
* How does the company capture/communicate client concerns for re-engineering? i.e. Is this a learning company?<br />
* What "game changers" are on the drawing board? Are these related to one of our organization's core goals?<br />
* Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
* Lifespan and Staying Power: One should consider the track record of the vendor and viability as a company to sustain the ups and downs of the industry. One sub-criteria in this category often used is how long the vendor has been around.<br />
* Does the vendor plan to offer interoperability options in the event of a nationally implemented CIS?<br />
*What is the plan to support smart phone applications to enhance interoperability and custom accessibility of EHR data while maintaining security? (DROID, IPHONE)<br />
* Upon the termination of a license or agreement, is there an orderly process for you to extract your data? This is applicable if you access the vendor’s software within an application service provider (ASP) model.[http://www.ama-assn.org American Medical Association]<br />
* Ability to have HIE compatibility<br />
* Improved billing accuracy and charge capture<br />
<br />
=== Extra Credit (optional) ===<br />
<br />
* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating it's system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Does the system have e-prescribing functionality?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* Cost reductions associated with risk reduction of adverse drug events<br />
[[Category:EMR]]<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?</div>RTompkinshttp://www.clinfowiki.org/wiki/index.php/EMR_Benefits_and_Return_on_Investment_CategoriesEMR Benefits and Return on Investment Categories2011-01-22T20:27:01Z<p>RTompkins: Added Health Record Banking section</p>
<hr />
<div>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...<br />
<br />
= '''Common EMR Benefit Categories''' =<br />
<br />
== '''Security and Privacy''' ==<br />
<br />
* Though electronic systems facilitate audit trails, they are not immune to breaches. In just about any information system designed with commercial or security concerns, there are a handful of provisions that provide tracking and trending, tagging for storage (ex. CAS), history, billing (which is a form of data tagging for billing purposes, essentially providing financial audit trail), and numerous other forms and systematic ways of enhancing security by making it possible to trace back actions on important and private data.<br />
<br />
* Electronic objects can easily be tagged for conditional processing. This enhances privacy by providing different levels of security tags based on group policies, access control policies, government policies and other regulatory body public or private. However, it also lends itself to some false sense of security in that it doesn’t prevent humans from mislabeling, incorrectly tagging objects, or malicious tampering.<br />
<br />
* Digital data is, for better or for worse, immortal: once electronic data is created, it can be argued that it can never be destroyed providing everlasting durability and consistency.<br />
<br />
* Privacy and confidentiality remains a patient right! As digital data is permanent so are the trails of access to such data. There are news reports of staff being fired due to accessing 'celebrity-status' patient medical records. (http://www.nydailynews.com/news/national/2011/01/13/2011-01-13_staffers_at_tucson_university_medical_center_fired_after_staffers_violated_feder.html).<br />
<br />
* EMR's add an important layer of security by restricting unlimited access to confidential sections of a patient file to all healthcare works and support staff. By simply adding user name and password codes, access for employees is restricted to only the portions of the record needed to complete their work tasks.<br />
<br />
== '''Financial''' ==<br />
* EMR can prevent unnecessary duplication of diagnostic tests that might occur when a patient sees multiple healthcare providers. Reference: Evidence on the Costs and Benefits of Health Information Technology. http://www.cbo.gov/ftpdocs/91xx/doc9168/MainText.3.1.shtml#1096012<br />
<br />
* 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.<br />
<br />
* 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<br />
<br />
* 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.<br />
<br />
* 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. [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* Many ambulatory EMR systems are integrated with [http://www.drfirst.com/e-prescribing.jsp e-Prescribing]. For physicians who use this technology in 2009 and 2010 for at least 50% of their eligible patients, an addtional 2% will be added to their Medicare reimbursement. The amount drops to 1% for 2011 and 2012, and thereafter, non-use becomes a penalty. [http://www.cms.hhs.gov/PQRI/Downloads/PQRIEPrescribingFactSheet.pdf] <br />
<br />
* 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.]<br />
<br />
*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.<br />
<br />
* EMR systems can minimize coding errors, time delays in filing the claims and filing of an incomplete claim resulting in claim delay or denial.<br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
*Eliminating paper chart supplies and copying expense as well as costs associated with storing paper charts.<br />
<br />
* 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<br />
<br />
* Using an EMR can lead to reduced malpractice insurance rates for hospitals and clinical practices. Some insurance companies offer lower rates when clinicians use EMRs. Ref: http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm<br />
<br />
* 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.<br />
<br />
* 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 <br />
<br />
*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.<br />
<br />
* 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)<br />
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* Can improve billing by allowing improved medical staff documentation and lack of lost or misplaced charts.<br />
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* 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<br />
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* With the use of the Eclipsys system, Lucile Packard Children’s Hospital identified $49 million in underpayments, collected $27 million of that amount, and saved $6.5 million in outsourcing costs. This was in between August 2002 and April 2006. Ref: http://www.eclipsys.com/ourclients/success_stories_details_LucilePackardChildrensHospital.asp<br />
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* 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)]<br />
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* 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.<br />
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* One-third of the physicians/ nurses time is being spent responding to phone calls from pharmacies regarding prescriptions. Because of EMR system's features like e-prescribing and having potential implementation of interagency interoperability with pharmacy systems, clinics can save time, increase productivity (due to less interruptions in the workflow) and reduce the number of call backs from the pharmacies regarding wrong medicines prescribed, wrong dosages and illegibility of the prescription. Reference: http://www.emrconsultant.com/education/e-prescribing<br />
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* 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.<br />
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* 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<br />
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* 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)<br />
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* 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.<br />
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* EMR can provide clinicians information about a patient's financial status. Examples include:<br />
** 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.<br />
** EMR can indicate to a physician that Medicare does not cover a particular usage of a drug.<br />
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* 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.<br />
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* 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) [[http://www.chcf.org/documents/ihealth/PatientSafetyInPhysiciansOfficeACPOE.pdf]]<br />
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.<br />
[[User:MikeField|MikeField]] 15:59, 23 January 2010 (CST)<br />
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* 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.<br />
[[User:MikeField|MikeField]] 20:11, 23 January 2010 (CST)<br />
<br />
* 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.<br />
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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.<br />
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* A technology evaluation study published in JAMIA in 2006 by Kaushal et al reported cumulative benefits for some clinical decision support systems' (CDSS) elements at Brigham’s and Women’s Hospital. The largest savings were from renal dosing guidance. Other savings were related to improvements in nursing time utilization, specific or expensive drug guidance, adverse drug event (ADE) prevention, laboratory charge display and redundant lab warnings. Some CDSS features were added to the system at a later time and were therefore not included in the analyses. The pilot studies related to these other features were also indicative of associated savings. These features included a transfusion guidance system, the appropriate ordering of Cl. Difficile toxin assays, and ordering of digoxin levels.<br />
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* More complete records helps clinicians and staff to avoid mistakes and to manage the cost of malpractice insurance. <br />
[http://www.msdc.com/EMR_Benefits.htm]<br />
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* As a tried and proven EMR system, the VistA system offers a low-cost, low-risk EMR option. The system that has become VistA was initiated and planned at the beginning of the 1970s by the National Center for Health Services Research and Development of the U.S. Public Health Service (NCHSR&D/PHS). (The NCHSR&D is now known as the Agency for Healthcare Research and Quality (AHRQ).)[http://en.wikipedia.org/wiki/VistA] Cost has been cited as the primary reason healthcare facilities have not implemented EMR systems.[Jha, et. al., “Use of Electronic Health Records in U.S. Hospitals”, http://www.nejm.org/doi/pdf/10.1056/NEJMsa0900592] Under the US Freedom of Information Act, the VistA software is available free of charge, bypassing one of the major costs of an implementation. <br />
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<br />
== '''Clinical''' ==<br />
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* 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.<br />
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* 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. <br />
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* According to Sanders and Miller, "decision support ordering screen helps to improve physician compliance with guidelines for use of brain MRI". Sanders D.L, Miller R.A, The effects on clinician ordering patterns of a computerized decision support system for neuroradiology imaging studies. Proc AMIA Symp, 2001:583-7. [PMID: 11825254]<br />
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* 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.<br />
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* 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. <br />
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* 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.<br />
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* Information on patient allergies and other medications, in combination with alerts and reminders, can decrease the number of medication-related adverse events and improve presribing practices of physicians and nurse practioners. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
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* 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.<br />
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<br />
* EMRs have the capability to dislay previous laboratory test results can significantly reduce the number of redundant tests ordered, not only saving money, but also the preventing the patient from undergoing unnecessary tests.[http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
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* 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.<br />
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* 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.<br />
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*Improved patient education through use of patient portal<br />
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* EMR data can be accessed by patients via web portals. Web portal usage increases patient satisfaction overall and increases patient communication with informational and psychosocial content. [http://www.pubmedcentral.nih.gov/articlerender.fcgi?pmid=16236699 Lin et al. An Internet-Based Patient-Provider Communication System: Randomized Controlled Trial. J Med Internet Res. 2005 Jul–Sep; 7(4): e47.]<br />
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*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<br />
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*EMR improves the patient safety by reducing medication discrepancies. Maimonides Medical Center, Brooklyn, New York, has published 58% decrease in medication orders and 55% decrease in medication discrepancies after EMR implementation. http://www.himss.org/content/files/davies_2002_maimonides.pdf<br />
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*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]<br />
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*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.<br />
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* 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.<br />
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PHR has appeal as it eliminates collaborative governance challenges, trades providers' high cost technology for patient managed lower cost technology, and places information of educational value directly in the hands patients.<br />
Ref: Tang PC, Ash JS, Bates DW, et al. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc 2006;13:121–6.<br />
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*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.<br />
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* Features such as remote access and electronic messaging were shown very usefull and successfull for primary care practice. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1839545&blobtype=pdf)<br />
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* 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<br />
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* Can improve critical medical decisions by providing the most up-to-date clinical information at point-of-care.<br />
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* 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<br />
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* 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<br />
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* 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)]<br />
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* Electronic order sets, as part of CPOE, will improve compliance with nationally reported quality indicators e.g. core measures.<br />
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* 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.<br />
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* EMRs systems generates reports like flowsheets, a specialty snap shot about progression of a patient status which are very useful in management of chronic illnesses like diabetes.<br />
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* 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.<br />
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* 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.) <br />
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* 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.) <br />
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*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.)<br />
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*The EHR will reduce the costs incurred by storing and keeping patient medical records. It also will ensure billing to patients.<br />
http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art<br />
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*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.<br />
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* 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<br />
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* 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<br />
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* Planning programs allow physicians to make and modify detailed treatment plans which can then be viewed by any other physician caring for the patient.<br />
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* EMR can be integrated with computer-based monitoring to store and display information gathered from a patient automatically, such as vital signs or ECG.<br />
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* 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.<br />
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* 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.<br />
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* 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. <br />
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* 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)<br />
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* 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)<br />
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* 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) <br />
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* 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).<br />
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* 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. [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]<br />
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* 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: [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]<br />
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* 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.<br />
*<br />
* 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.<br />
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* 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" <br />
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* 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. <br />
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* 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.<br />
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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.<br />
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* 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.<br />
http://patients.about.com/od/electronicpatientrecords/a/EMRbenefits.htm <br />
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* Significant positive associations between specific objective quality indicators and CPOE implementation have been have been found. After controlling for confounders, CPOE hospitals outperformed comparison hospitals on 5 of 11 measures related to ordering medications and on 1 of 9 nonmedication-related quality measures. [http://ajm.sagepub.com/content/24/4/278.abstract (American Journal of Medical Quality 2009;24:278-286)]<br />
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* Regarding abnormal cervical cytology results and follow-up care, in an at-risk urban population, an automated, EMR-based tracking system has been shown to reduce the time to resolution and increase the number of women who achieved diagnostic resolution. [http://www.springerlink.com/content/7t116l968n5u5167/ (Journal of General Internal Medicine 2010;25(6):575-580)]<br />
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* The May 2008 Congressional Budget Office report - ‘Evidence on the Costs and Benefits of Health Information Technology’ discusses evidence related to a multi-functional EHR (Jha and colleagues, 2006). The report discusses electronic referral communication between providers, among other EHR functions, that could have a significant impact on medical practice.<br />
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* Use of Computerized physician order entry (CPOE) with clinical decision support (CDS) has been shown to decrease Adverse Drug Events (ADE’s) in 5 studies. Wolfstadt JI, Gurwitz JH, Field TS, et al. The effect of computerized physician order entry with clinical decision support on the rates of adverse drug events: a systematic review. J Gen Intern Med. 2008;23:451-8.<br />
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* Electronic prescribing of chemotherapy medications has been shown to ensure that safe chemotherapy practices were followed. Huertas, M. J., Baena-Cañada, J. M., Martínez, M. J., Arriola, E. & García, M. V. The impact of computerised chemotherapy prescriptions on the prevention of medication errors. Clin. Transl. Oncol. 8, 821–825 (2006).<br />
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* Prescribing accuracy has been shown to be greatly increased as the occurrence of missing or incomplete data in prescriptions dropped by a factor of 10 by implementing a CPOE. C Mir, A Gadri, GL Zelger, et al. Impact of a computerized physician order entry system on compliance with prescription accuracy requirements. Pharmacy World and Science, Oct 2009, vol. 31, no. 5, p. 596-602<br />
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* Reminders indicating that patient is eligible for preventive care measures. Dexter et al.<br />
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* On-screen display of the charges for laboratory and radiologic tests at the time of computer ordering led to 4.5% fewer laboratory tests ordered in the intervention group (not statistically significant); minimal difference for radiologic tests. Bates et al.<br />
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* A study performed by Bates et al., 55% reduction in serious medication errors (P = 0.01); decrease in preventable adverse drug events of 17% (P > 0.2). Bates et al.<br />
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* Compliance with drug monitoring and preventive care guidelines. Overhage et al.<br />
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* A CPOE system and an electronic medication administration record led to significant decreases in turnaround times, elimination of transcription errors, improvements in order countersignature, and decrease in length of stay. Mekhjian et al.<br />
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* EMR helps healthcare providers to target patients with specific needs like immunization.<br />
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* EMR allows various views of patient data to physicians. i.e, In a chronological order by report date- which helps the physicians to find the newest test results, they can highlight the changes etc. Edward H. Shortliffe, James J. Cimino. Biomedical Informatics Computer Applications in Health Care and Biomedicine. 3rd edition.<br />
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* EMR is capable of generating reports. By generating reports healthcare providers can know the amount of vaccines used in the previous year and with that number they can plan for the coming years. Also they can know which patients are due for shots.(http://www.ama-assn.org/amednews/2008/05/05/bisa0505.html)<br />
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* EMR allows researchers to efficiently search patient medical information by medical condition, date of treatment, physician name and test category. Researchers can use the EMR to analyze large amounts of patient information more efficiently, speeding the application of new research findings to improving patient care. (http://www.mayoclinic.org/emr/benefits.html)<br />
<br />
== '''Operational''' ==<br />
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* With back-office management software packages integrated with the EMR software, it is easier than the paper record systems to produce statistical analysis reports for administrative purposes like scorecard reports for clinic performance, or individual physician contributions.<br />
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* Joan Breuer, Ph.D. 01/22/2010 20:00 By building an EMR, there are opportunities for the IT staff to gain clinical knowledge.<br />
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* 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.<br />
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* 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.<br />
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* Protects patient data by preventing unauthorized individuals from accessing the clinical record. <br />
<br />
* 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.<br />
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* 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]<br />
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* Documentation completed at conclusion of encounter.<br />
<br />
* 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.<br />
<br />
* Eliminates lost orders and ambiguities caused by illegible handwriting, generating realated orders automatically, monitoring for duplicate orders and reducing time to o fill orders. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* 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]<br />
<br />
* 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. <br />
[Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
* During the implementation phase of the EMR, was noted a closer cooperation between the clinical, and administrative setvices of hospitals. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2245928&blobtype=pdf)<br />
<br />
* Can allow for better appreciation of clinician performance for which can be used for employee bonuses.<br />
<br />
* 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)]<br />
<br />
* CPOE will automatically date and time physician orders, as recommended by regulatory organizations.<br />
<br />
* EMR user authentication can protect patient records from unauthorized access.<br />
<br />
* 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).<br />
<br />
*It reduces redundancy by eliminating duplicate testing. http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art<br />
<br />
*It increases patient privacy, by requiring secure login access. It also gives patients access to their records at any time. http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art<br />
<br />
* BCMA enhances tracking and understanding of medication delivery processes which can pinpoint opportunities for improvement in safety and efficiency.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* Better, more efficient systems can be built only on top of an EMR. Not much improvement can be made to a paper-based system.<br />
<br />
* 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. [http://www.msdc.com/EMR_Benefits.htm]<br />
<br />
* 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.<br />
<br />
* Automation of billing charges are typically included. This reduces error in submitting codes to insurance companies.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
* 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.]<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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. <br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* EMRs allow better integration to other operations such as billing, external departments and patient portals to manage, share, collect and protect the critical medical information. 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.<br />
<br />
* 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” [[http://www.chcf.org/documents/ihealth/PatientSafetyInPhysiciansOfficeACPOE.pdf]] <br />
[[User:MikeField|MikeField]] 17:54, 23 January 2010 (CST)<br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* 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<br />
<br />
*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.<br />
<br />
*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<br />
''<br />
<br />
* 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.<br />
* 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.<br />
<br />
* EMRs have significant potential to address impending workforce shortage in health care[http://www.hemonctoday.com/article.aspx?rid=67420 1][http://www.asco.org/ASCO/Downloads/Research%20Policy/Workforce%20Presentation%20at%202007%20Annual%20Meeting.pdf 2]<br />
<br />
* Greater EMR sophistication may be associated with emergency department (ED) efficiency. Relative to EDs with minimal or no EMR, fully functional EMR was associated with 22.4% lower ED length of stay and 13.1% lower diagnosis/treatment time. However, relationships varied by patient acuity level and diagnostic services provided. [http://mcr.sagepub.com/content/early/2010/06/07/1077558710372108.abstract (Medical Care and Research Review, 2010 Jun 16; Epub 2010 Jun 16)]<br />
<br />
<br />
* A 2007 article by Liang, titled ‘The Gap Between Evidence and Practice’, in Health Affairs, discusses the opportunities to improve healthcare by learning from the data available in electronic health record databases in order to bridge the gap between evidence and practice. The paper emphasizes the importance of the use of EHR data for comparative clinical effectiveness research. This potential benefit of EHRs is also addressed by the May 2008 Congressional Budget Office report - ‘Evidence on the Costs and Benefits of Health Information Technology’.<br />
<br />
* Software and hardware vendors are making things easier for doctors with cloud computing and secure web-based computing. These applications let doctors use the same laptops they’ve always used, but it gives them access to large volumes of clinical data, patient history and even 3D avatars that help doctors visualize medical records. The use of EMR as a standard way to exchange healthcare information will lower the costs of healthcare delivery and let physicians get back to the basics — thoughtful, holistic patient care. And it won’t stop there. Doctors will be able to take a proactive role in patient care, anticipating potential problems and dealing with them before they even arise, because they will have visibility into their patients’ complete medical records across the full range of doctors and healthcare providers.[http://classic.cnbc.com/id/38973121]<br />
<br />
* Software like Medical Dragon NaturallySpeaking with its ability to produce real-time language as enriched the lives of medical practitioners and their patients. It allows direct data entry by clinicians and staff by voice eliminates the need for transcription. Voice recognition software helps “voice writing” to document a verbatim record of medical examinations and surgeries saving approximately $10,000 per year. Dragon Naturally Speaking costs 80% less than manual medical transcription.[http://www.ehrdoctors.com/page/2/],[http://www.dragon-medical-transcription.com/]<br />
<br />
* Electronic claims processing is one of the many benefits of EMR software and service packages. With EMRs, electronic claims processing makes receiving payments faster, billing easier and more accurate.(http://hubpages.com/hub/The-Benefits-of-Electronic-Claims-Processing-with-EMR)<br />
<br />
* EMR allows fast access to patient’s medical record, update the record with changes in address or insurance carrier.(http://www.mayoclinic.org/emr/benefits.html)<br />
<br />
*EMR enables generation of report easily and instantly. Reports can be conveniently generated and programmed to automatic settings. Such reports can be used for assessment of various variables of performance, analysis, compliance and for research studies.<br />
<br />
== '''National''' ==<br />
<br />
* 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]<br />
<br />
* 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/<br />
<br />
*With the public and government demand for healthcare reform it is critical that health care technology structure be improved. 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''<br />
<br />
* 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.<br />
<br />
* Regional Health Information Organizations have the potential to revolutionize health care delivery. By connecting disparate providers, payers and other stakeholders, RHIOs are supposed to streamline and accelerate the flow of patient data. Medical records will move seamlessly from doctors’ offices to hospital to outpatient clinic. The ultimate goal is better care for patients, and billions of dollars in savings for the industry as a whole. But RHIOs are still very much in their infancy and are plagued by many unresolved issues, including a clear definition of what they are. [www.hhnmag.com, "A Primer for Building RHIOs", By Dagmara Scalise] [EarnValle9_11_10]<br />
<br />
* HIE and RHIO benefits can be measured along following key axis: <br />
•Quality of care improvement by way of greater access to data, newer data sources and technologies<br />
•Reduction in costs achieved either through efficiency and productivity gains or avoidance of redundant provider services<br />
•Improved patient experience with the system resulting in higher “customer satisfaction”<br />
•Compliance with legal, accreditation and standards of care practices<br />
•Ability to add new revenue stream due to new business opportunity the network creates [http://www.healthunity.com/handbook_hie_benefits.aspx] [EarnValle_9_12_10]<br />
<br />
* One feature of health IT that may qualify as a public good is the wealth of information that can be captured through EHR systems. (As discussed earlier, if researchers<br />
combined data from the EHRs of the population, they might be able to understand the spread and prevention of various diseases and injuries—and eventually develop cures and treatments; assess the effectiveness of various treatments; and more readily detect potential treatment hazards.) [http://www.cbo.gov/ftpdocs/91xx/doc9168/05-20-HealthIT.pdf] [EarnValle_9_12_10]<br />
<br />
* 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 [http://www.openclinical.org/emr.html 1], [http://www.bt.cdc.gov/episurv/ 2].<br />
<br />
<br />
<br />
• Provides complete and accurate access to patient information for providers and demonstrates time saved over paper record.<br />
• Expedites results reporting through customizable displays<br />
• Supports a common user interface for accessing patient information, usually through a workstation.<br />
• Supports monitoring and analysis of patient care outcomes<br />
<br />
• On a national and even international level, one benefit of EMR’s is to have potential research information readily available for multiple studies. The result would be not only more data but more immediate data. This allows for more studies to validate or eliminate new approved therapies and medications resulting in improved health care. <br />
<br />
• EMR’s systems that are linked nationally would allow for healthcare workers to identify and treat new outbreaks in infectious/communicable diseases in a specified region. Faster identification of the cause would allow for faster treatment and a decrease in illness and death.<br />
<br />
== Health Record Banking ==<br />
One benefit of EMR's is that they enable the implementation of health record banks. A health record bank is a centralized location for storage of an individual's EMRs. Whenever care is provided the records generated can be added to the individual's banked personal health record (PHR). At any time an individual can access their own medical records and review them for accuracy. [Ref: Health Record Banking Alliance, http://www.healthbanking.org]<br />
<br />
When a person with banked health records seeks medical care, they can give their care provider access to all or part of their PHR that has been stored in the bank up to that point. Over time a person who uses a health record bank could collect all their relevant medical history and have it accessible in one location.<br />
<br />
The concept of the health record bank was first introduced in an article in the July/August 2000 issue of MD Computing. [Ramsaroop P & Ball J. The "Bank of Health" - A Model for More Useful Patient Health Records. MD Computing. Vol. 17, No. 4, July/August 2000:45-48.]</div>RTompkinshttp://www.clinfowiki.org/wiki/index.php/EMR_Benefits_and_Return_on_Investment_CategoriesEMR Benefits and Return on Investment Categories2011-01-22T20:17:50Z<p>RTompkins: </p>
<hr />
<div>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...<br />
<br />
= '''Common EMR Benefit Categories''' =<br />
<br />
== '''Security and Privacy''' ==<br />
<br />
* Though electronic systems facilitate audit trails, they are not immune to breaches. In just about any information system designed with commercial or security concerns, there are a handful of provisions that provide tracking and trending, tagging for storage (ex. CAS), history, billing (which is a form of data tagging for billing purposes, essentially providing financial audit trail), and numerous other forms and systematic ways of enhancing security by making it possible to trace back actions on important and private data.<br />
<br />
* Electronic objects can easily be tagged for conditional processing. This enhances privacy by providing different levels of security tags based on group policies, access control policies, government policies and other regulatory body public or private. However, it also lends itself to some false sense of security in that it doesn’t prevent humans from mislabeling, incorrectly tagging objects, or malicious tampering.<br />
<br />
* Digital data is, for better or for worse, immortal: once electronic data is created, it can be argued that it can never be destroyed providing everlasting durability and consistency.<br />
<br />
* Privacy and confidentiality remains a patient right! As digital data is permanent so are the trails of access to such data. There are news reports of staff being fired due to accessing 'celebrity-status' patient medical records. (http://www.nydailynews.com/news/national/2011/01/13/2011-01-13_staffers_at_tucson_university_medical_center_fired_after_staffers_violated_feder.html).<br />
<br />
* EMR's add an important layer of security by restricting unlimited access to confidential sections of a patient file to all healthcare works and support staff. By simply adding user name and password codes, access for employees is restricted to only the portions of the record needed to complete their work tasks.<br />
<br />
== '''Financial''' ==<br />
* EMR can prevent unnecessary duplication of diagnostic tests that might occur when a patient sees multiple healthcare providers. Reference: Evidence on the Costs and Benefits of Health Information Technology. http://www.cbo.gov/ftpdocs/91xx/doc9168/MainText.3.1.shtml#1096012<br />
<br />
* 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.<br />
<br />
* 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<br />
<br />
* 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.<br />
<br />
* 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. [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* Many ambulatory EMR systems are integrated with [http://www.drfirst.com/e-prescribing.jsp e-Prescribing]. For physicians who use this technology in 2009 and 2010 for at least 50% of their eligible patients, an addtional 2% will be added to their Medicare reimbursement. The amount drops to 1% for 2011 and 2012, and thereafter, non-use becomes a penalty. [http://www.cms.hhs.gov/PQRI/Downloads/PQRIEPrescribingFactSheet.pdf] <br />
<br />
* 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.]<br />
<br />
*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.<br />
<br />
* EMR systems can minimize coding errors, time delays in filing the claims and filing of an incomplete claim resulting in claim delay or denial.<br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
*Eliminating paper chart supplies and copying expense as well as costs associated with storing paper charts.<br />
<br />
* 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<br />
<br />
* Using an EMR can lead to reduced malpractice insurance rates for hospitals and clinical practices. Some insurance companies offer lower rates when clinicians use EMRs. Ref: http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm<br />
<br />
* 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.<br />
<br />
* 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 <br />
<br />
*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.<br />
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* 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)<br />
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* Can improve billing by allowing improved medical staff documentation and lack of lost or misplaced charts.<br />
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* 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<br />
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* With the use of the Eclipsys system, Lucile Packard Children’s Hospital identified $49 million in underpayments, collected $27 million of that amount, and saved $6.5 million in outsourcing costs. This was in between August 2002 and April 2006. Ref: http://www.eclipsys.com/ourclients/success_stories_details_LucilePackardChildrensHospital.asp<br />
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* 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)]<br />
<br />
* 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.<br />
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* One-third of the physicians/ nurses time is being spent responding to phone calls from pharmacies regarding prescriptions. Because of EMR system's features like e-prescribing and having potential implementation of interagency interoperability with pharmacy systems, clinics can save time, increase productivity (due to less interruptions in the workflow) and reduce the number of call backs from the pharmacies regarding wrong medicines prescribed, wrong dosages and illegibility of the prescription. Reference: http://www.emrconsultant.com/education/e-prescribing<br />
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* 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.<br />
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* 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<br />
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* 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)<br />
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* 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.<br />
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* EMR can provide clinicians information about a patient's financial status. Examples include:<br />
** 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.<br />
** EMR can indicate to a physician that Medicare does not cover a particular usage of a drug.<br />
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* 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.<br />
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* 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) [[http://www.chcf.org/documents/ihealth/PatientSafetyInPhysiciansOfficeACPOE.pdf]]<br />
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.<br />
[[User:MikeField|MikeField]] 15:59, 23 January 2010 (CST)<br />
<br />
* 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.<br />
[[User:MikeField|MikeField]] 20:11, 23 January 2010 (CST)<br />
<br />
* 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.<br />
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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.<br />
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* A technology evaluation study published in JAMIA in 2006 by Kaushal et al reported cumulative benefits for some clinical decision support systems' (CDSS) elements at Brigham’s and Women’s Hospital. The largest savings were from renal dosing guidance. Other savings were related to improvements in nursing time utilization, specific or expensive drug guidance, adverse drug event (ADE) prevention, laboratory charge display and redundant lab warnings. Some CDSS features were added to the system at a later time and were therefore not included in the analyses. The pilot studies related to these other features were also indicative of associated savings. These features included a transfusion guidance system, the appropriate ordering of Cl. Difficile toxin assays, and ordering of digoxin levels.<br />
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<br />
* More complete records helps clinicians and staff to avoid mistakes and to manage the cost of malpractice insurance. <br />
[http://www.msdc.com/EMR_Benefits.htm]<br />
<br />
* As a tried and proven EMR system, the VistA system offers a low-cost, low-risk EMR option. The system that has become VistA was initiated and planned at the beginning of the 1970s by the National Center for Health Services Research and Development of the U.S. Public Health Service (NCHSR&D/PHS). (The NCHSR&D is now known as the Agency for Healthcare Research and Quality (AHRQ).)[http://en.wikipedia.org/wiki/VistA] Cost has been cited as the primary reason healthcare facilities have not implemented EMR systems.[Jha, et. al., “Use of Electronic Health Records in U.S. Hospitals”, http://www.nejm.org/doi/pdf/10.1056/NEJMsa0900592] Under the US Freedom of Information Act, the VistA software is available free of charge, bypassing one of the major costs of an implementation. <br />
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<br />
== '''Clinical''' ==<br />
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* 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.<br />
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* 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. <br />
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* According to Sanders and Miller, "decision support ordering screen helps to improve physician compliance with guidelines for use of brain MRI". Sanders D.L, Miller R.A, The effects on clinician ordering patterns of a computerized decision support system for neuroradiology imaging studies. Proc AMIA Symp, 2001:583-7. [PMID: 11825254]<br />
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* 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.<br />
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* 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. <br />
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* 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.<br />
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* Information on patient allergies and other medications, in combination with alerts and reminders, can decrease the number of medication-related adverse events and improve presribing practices of physicians and nurse practioners. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
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* 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.<br />
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<br />
* EMRs have the capability to dislay previous laboratory test results can significantly reduce the number of redundant tests ordered, not only saving money, but also the preventing the patient from undergoing unnecessary tests.[http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
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* 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.<br />
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* 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.<br />
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*Improved patient education through use of patient portal<br />
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* EMR data can be accessed by patients via web portals. Web portal usage increases patient satisfaction overall and increases patient communication with informational and psychosocial content. [http://www.pubmedcentral.nih.gov/articlerender.fcgi?pmid=16236699 Lin et al. An Internet-Based Patient-Provider Communication System: Randomized Controlled Trial. J Med Internet Res. 2005 Jul–Sep; 7(4): e47.]<br />
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*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<br />
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*EMR improves the patient safety by reducing medication discrepancies. Maimonides Medical Center, Brooklyn, New York, has published 58% decrease in medication orders and 55% decrease in medication discrepancies after EMR implementation. http://www.himss.org/content/files/davies_2002_maimonides.pdf<br />
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*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]<br />
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*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.<br />
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* 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.<br />
<br />
PHR has appeal as it eliminates collaborative governance challenges, trades providers' high cost technology for patient managed lower cost technology, and places information of educational value directly in the hands patients.<br />
Ref: Tang PC, Ash JS, Bates DW, et al. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc 2006;13:121–6.<br />
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*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.<br />
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* Features such as remote access and electronic messaging were shown very usefull and successfull for primary care practice. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1839545&blobtype=pdf)<br />
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* 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<br />
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* Can improve critical medical decisions by providing the most up-to-date clinical information at point-of-care.<br />
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* 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<br />
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* 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<br />
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* 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)]<br />
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* Electronic order sets, as part of CPOE, will improve compliance with nationally reported quality indicators e.g. core measures.<br />
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* 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.<br />
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* EMRs systems generates reports like flowsheets, a specialty snap shot about progression of a patient status which are very useful in management of chronic illnesses like diabetes.<br />
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* 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.<br />
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* 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.) <br />
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* 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.) <br />
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*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.)<br />
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*The EHR will reduce the costs incurred by storing and keeping patient medical records. It also will ensure billing to patients.<br />
http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art<br />
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*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.<br />
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* 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<br />
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* 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<br />
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* Planning programs allow physicians to make and modify detailed treatment plans which can then be viewed by any other physician caring for the patient.<br />
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* EMR can be integrated with computer-based monitoring to store and display information gathered from a patient automatically, such as vital signs or ECG.<br />
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* 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.<br />
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* 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.<br />
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* 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. <br />
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* 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)<br />
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* 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)<br />
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* 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) <br />
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* 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).<br />
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* 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. [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]<br />
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* 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: [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]<br />
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* 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.<br />
*<br />
* 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.<br />
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* 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" <br />
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* 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. <br />
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* 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.<br />
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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.<br />
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* 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.<br />
http://patients.about.com/od/electronicpatientrecords/a/EMRbenefits.htm <br />
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* Significant positive associations between specific objective quality indicators and CPOE implementation have been have been found. After controlling for confounders, CPOE hospitals outperformed comparison hospitals on 5 of 11 measures related to ordering medications and on 1 of 9 nonmedication-related quality measures. [http://ajm.sagepub.com/content/24/4/278.abstract (American Journal of Medical Quality 2009;24:278-286)]<br />
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* Regarding abnormal cervical cytology results and follow-up care, in an at-risk urban population, an automated, EMR-based tracking system has been shown to reduce the time to resolution and increase the number of women who achieved diagnostic resolution. [http://www.springerlink.com/content/7t116l968n5u5167/ (Journal of General Internal Medicine 2010;25(6):575-580)]<br />
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<br />
* The May 2008 Congressional Budget Office report - ‘Evidence on the Costs and Benefits of Health Information Technology’ discusses evidence related to a multi-functional EHR (Jha and colleagues, 2006). The report discusses electronic referral communication between providers, among other EHR functions, that could have a significant impact on medical practice.<br />
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* Use of Computerized physician order entry (CPOE) with clinical decision support (CDS) has been shown to decrease Adverse Drug Events (ADE’s) in 5 studies. Wolfstadt JI, Gurwitz JH, Field TS, et al. The effect of computerized physician order entry with clinical decision support on the rates of adverse drug events: a systematic review. J Gen Intern Med. 2008;23:451-8.<br />
<br />
* Electronic prescribing of chemotherapy medications has been shown to ensure that safe chemotherapy practices were followed. Huertas, M. J., Baena-Cañada, J. M., Martínez, M. J., Arriola, E. & García, M. V. The impact of computerised chemotherapy prescriptions on the prevention of medication errors. Clin. Transl. Oncol. 8, 821–825 (2006).<br />
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* Prescribing accuracy has been shown to be greatly increased as the occurrence of missing or incomplete data in prescriptions dropped by a factor of 10 by implementing a CPOE. C Mir, A Gadri, GL Zelger, et al. Impact of a computerized physician order entry system on compliance with prescription accuracy requirements. Pharmacy World and Science, Oct 2009, vol. 31, no. 5, p. 596-602<br />
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* Reminders indicating that patient is eligible for preventive care measures. Dexter et al.<br />
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* On-screen display of the charges for laboratory and radiologic tests at the time of computer ordering led to 4.5% fewer laboratory tests ordered in the intervention group (not statistically significant); minimal difference for radiologic tests. Bates et al.<br />
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* A study performed by Bates et al., 55% reduction in serious medication errors (P = 0.01); decrease in preventable adverse drug events of 17% (P > 0.2). Bates et al.<br />
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* Compliance with drug monitoring and preventive care guidelines. Overhage et al.<br />
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* A CPOE system and an electronic medication administration record led to significant decreases in turnaround times, elimination of transcription errors, improvements in order countersignature, and decrease in length of stay. Mekhjian et al.<br />
<br />
* EMR helps healthcare providers to target patients with specific needs like immunization.<br />
<br />
* EMR allows various views of patient data to physicians. i.e, In a chronological order by report date- which helps the physicians to find the newest test results, they can highlight the changes etc. Edward H. Shortliffe, James J. Cimino. Biomedical Informatics Computer Applications in Health Care and Biomedicine. 3rd edition.<br />
<br />
* EMR is capable of generating reports. By generating reports healthcare providers can know the amount of vaccines used in the previous year and with that number they can plan for the coming years. Also they can know which patients are due for shots.(http://www.ama-assn.org/amednews/2008/05/05/bisa0505.html)<br />
<br />
* EMR allows researchers to efficiently search patient medical information by medical condition, date of treatment, physician name and test category. Researchers can use the EMR to analyze large amounts of patient information more efficiently, speeding the application of new research findings to improving patient care. (http://www.mayoclinic.org/emr/benefits.html)<br />
<br />
== '''Operational''' ==<br />
<br />
* With back-office management software packages integrated with the EMR software, it is easier than the paper record systems to produce statistical analysis reports for administrative purposes like scorecard reports for clinic performance, or individual physician contributions.<br />
<br />
* Joan Breuer, Ph.D. 01/22/2010 20:00 By building an EMR, there are opportunities for the IT staff to gain clinical knowledge.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* Protects patient data by preventing unauthorized individuals from accessing the clinical record. <br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* Documentation completed at conclusion of encounter.<br />
<br />
* 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.<br />
<br />
* Eliminates lost orders and ambiguities caused by illegible handwriting, generating realated orders automatically, monitoring for duplicate orders and reducing time to o fill orders. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* 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]<br />
<br />
* 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. <br />
[Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
* During the implementation phase of the EMR, was noted a closer cooperation between the clinical, and administrative setvices of hospitals. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2245928&blobtype=pdf)<br />
<br />
* Can allow for better appreciation of clinician performance for which can be used for employee bonuses.<br />
<br />
* 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)]<br />
<br />
* CPOE will automatically date and time physician orders, as recommended by regulatory organizations.<br />
<br />
* EMR user authentication can protect patient records from unauthorized access.<br />
<br />
* 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).<br />
<br />
*It reduces redundancy by eliminating duplicate testing. http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art<br />
<br />
*It increases patient privacy, by requiring secure login access. It also gives patients access to their records at any time. http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art<br />
<br />
* BCMA enhances tracking and understanding of medication delivery processes which can pinpoint opportunities for improvement in safety and efficiency.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* Better, more efficient systems can be built only on top of an EMR. Not much improvement can be made to a paper-based system.<br />
<br />
* 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. [http://www.msdc.com/EMR_Benefits.htm]<br />
<br />
* 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.<br />
<br />
* Automation of billing charges are typically included. This reduces error in submitting codes to insurance companies.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
* 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.]<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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. <br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* EMRs allow better integration to other operations such as billing, external departments and patient portals to manage, share, collect and protect the critical medical information. 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.<br />
<br />
* 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” [[http://www.chcf.org/documents/ihealth/PatientSafetyInPhysiciansOfficeACPOE.pdf]] <br />
[[User:MikeField|MikeField]] 17:54, 23 January 2010 (CST)<br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* 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<br />
<br />
*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.<br />
<br />
*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<br />
''<br />
<br />
* 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.<br />
* 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.<br />
<br />
* EMRs have significant potential to address impending workforce shortage in health care[http://www.hemonctoday.com/article.aspx?rid=67420 1][http://www.asco.org/ASCO/Downloads/Research%20Policy/Workforce%20Presentation%20at%202007%20Annual%20Meeting.pdf 2]<br />
<br />
* Greater EMR sophistication may be associated with emergency department (ED) efficiency. Relative to EDs with minimal or no EMR, fully functional EMR was associated with 22.4% lower ED length of stay and 13.1% lower diagnosis/treatment time. However, relationships varied by patient acuity level and diagnostic services provided. [http://mcr.sagepub.com/content/early/2010/06/07/1077558710372108.abstract (Medical Care and Research Review, 2010 Jun 16; Epub 2010 Jun 16)]<br />
<br />
<br />
* A 2007 article by Liang, titled ‘The Gap Between Evidence and Practice’, in Health Affairs, discusses the opportunities to improve healthcare by learning from the data available in electronic health record databases in order to bridge the gap between evidence and practice. The paper emphasizes the importance of the use of EHR data for comparative clinical effectiveness research. This potential benefit of EHRs is also addressed by the May 2008 Congressional Budget Office report - ‘Evidence on the Costs and Benefits of Health Information Technology’.<br />
<br />
* Software and hardware vendors are making things easier for doctors with cloud computing and secure web-based computing. These applications let doctors use the same laptops they’ve always used, but it gives them access to large volumes of clinical data, patient history and even 3D avatars that help doctors visualize medical records. The use of EMR as a standard way to exchange healthcare information will lower the costs of healthcare delivery and let physicians get back to the basics — thoughtful, holistic patient care. And it won’t stop there. Doctors will be able to take a proactive role in patient care, anticipating potential problems and dealing with them before they even arise, because they will have visibility into their patients’ complete medical records across the full range of doctors and healthcare providers.[http://classic.cnbc.com/id/38973121]<br />
<br />
* Software like Medical Dragon NaturallySpeaking with its ability to produce real-time language as enriched the lives of medical practitioners and their patients. It allows direct data entry by clinicians and staff by voice eliminates the need for transcription. Voice recognition software helps “voice writing” to document a verbatim record of medical examinations and surgeries saving approximately $10,000 per year. Dragon Naturally Speaking costs 80% less than manual medical transcription.[http://www.ehrdoctors.com/page/2/],[http://www.dragon-medical-transcription.com/]<br />
<br />
* Electronic claims processing is one of the many benefits of EMR software and service packages. With EMRs, electronic claims processing makes receiving payments faster, billing easier and more accurate.(http://hubpages.com/hub/The-Benefits-of-Electronic-Claims-Processing-with-EMR)<br />
<br />
* EMR allows fast access to patient’s medical record, update the record with changes in address or insurance carrier.(http://www.mayoclinic.org/emr/benefits.html)<br />
<br />
*EMR enables generation of report easily and instantly. Reports can be conveniently generated and programmed to automatic settings. Such reports can be used for assessment of various variables of performance, analysis, compliance and for research studies.<br />
<br />
== '''National''' ==<br />
<br />
* 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]<br />
<br />
* 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/<br />
<br />
*With the public and government demand for healthcare reform it is critical that health care technology structure be improved. 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''<br />
<br />
* 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.<br />
<br />
* Regional Health Information Organizations have the potential to revolutionize health care delivery. By connecting disparate providers, payers and other stakeholders, RHIOs are supposed to streamline and accelerate the flow of patient data. Medical records will move seamlessly from doctors’ offices to hospital to outpatient clinic. The ultimate goal is better care for patients, and billions of dollars in savings for the industry as a whole. But RHIOs are still very much in their infancy and are plagued by many unresolved issues, including a clear definition of what they are. [www.hhnmag.com, "A Primer for Building RHIOs", By Dagmara Scalise] [EarnValle9_11_10]<br />
<br />
* HIE and RHIO benefits can be measured along following key axis: <br />
•Quality of care improvement by way of greater access to data, newer data sources and technologies<br />
•Reduction in costs achieved either through efficiency and productivity gains or avoidance of redundant provider services<br />
•Improved patient experience with the system resulting in higher “customer satisfaction”<br />
•Compliance with legal, accreditation and standards of care practices<br />
•Ability to add new revenue stream due to new business opportunity the network creates [http://www.healthunity.com/handbook_hie_benefits.aspx] [EarnValle_9_12_10]<br />
<br />
* One feature of health IT that may qualify as a public good is the wealth of information that can be captured through EHR systems. (As discussed earlier, if researchers<br />
combined data from the EHRs of the population, they might be able to understand the spread and prevention of various diseases and injuries—and eventually develop cures and treatments; assess the effectiveness of various treatments; and more readily detect potential treatment hazards.) [http://www.cbo.gov/ftpdocs/91xx/doc9168/05-20-HealthIT.pdf] [EarnValle_9_12_10]<br />
<br />
* 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 [http://www.openclinical.org/emr.html 1], [http://www.bt.cdc.gov/episurv/ 2].<br />
<br />
<br />
<br />
• Provides complete and accurate access to patient information for providers and demonstrates time saved over paper record.<br />
• Expedites results reporting through customizable displays<br />
• Supports a common user interface for accessing patient information, usually through a workstation.<br />
• Supports monitoring and analysis of patient care outcomes<br />
<br />
• On a national and even international level, one benefit of EMR’s is to have potential research information readily available for multiple studies. The result would be not only more data but more immediate data. This allows for more studies to validate or eliminate new approved therapies and medications resulting in improved health care. <br />
<br />
• EMR’s systems that are linked nationally would allow for healthcare workers to identify and treat new outbreaks in infectious/communicable diseases in a specified region. Faster identification of the cause would allow for faster treatment and a decrease in illness and death.</div>RTompkinshttp://www.clinfowiki.org/wiki/index.php/EMR_Benefits_and_Return_on_Investment_CategoriesEMR Benefits and Return on Investment Categories2011-01-22T20:15:09Z<p>RTompkins: Added to Financial section</p>
<hr />
<div>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...<br />
<br />
= '''Common EMR Benefit Categories''' =<br />
<br />
== '''Security and Privacy''' ==<br />
<br />
* Though electronic systems facilitate audit trails, they are not immune to breaches. In just about any information system designed with commercial or security concerns, there are a handful of provisions that provide tracking and trending, tagging for storage (ex. CAS), history, billing (which is a form of data tagging for billing purposes, essentially providing financial audit trail), and numerous other forms and systematic ways of enhancing security by making it possible to trace back actions on important and private data.<br />
<br />
* Electronic objects can easily be tagged for conditional processing. This enhances privacy by providing different levels of security tags based on group policies, access control policies, government policies and other regulatory body public or private. However, it also lends itself to some false sense of security in that it doesn’t prevent humans from mislabeling, incorrectly tagging objects, or malicious tampering.<br />
<br />
* Digital data is, for better or for worse, immortal: once electronic data is created, it can be argued that it can never be destroyed providing everlasting durability and consistency.<br />
<br />
* Privacy and confidentiality remains a patient right! As digital data is permanent so are the trails of access to such data. There are news reports of staff being fired due to accessing 'celebrity-status' patient medical records. (http://www.nydailynews.com/news/national/2011/01/13/2011-01-13_staffers_at_tucson_university_medical_center_fired_after_staffers_violated_feder.html).<br />
<br />
* EMR's add an important layer of security by restricting unlimited access to confidential sections of a patient file to all healthcare works and support staff. By simply adding user name and password codes, access for employees is restricted to only the portions of the record needed to complete their work tasks.<br />
<br />
== '''Financial''' ==<br />
* EMR can prevent unnecessary duplication of diagnostic tests that might occur when a patient sees multiple healthcare providers. Reference: Evidence on the Costs and Benefits of Health Information Technology. http://www.cbo.gov/ftpdocs/91xx/doc9168/MainText.3.1.shtml#1096012<br />
<br />
* 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.<br />
<br />
* 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<br />
<br />
* 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.<br />
<br />
* 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. [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* Many ambulatory EMR systems are integrated with [http://www.drfirst.com/e-prescribing.jsp e-Prescribing]. For physicians who use this technology in 2009 and 2010 for at least 50% of their eligible patients, an addtional 2% will be added to their Medicare reimbursement. The amount drops to 1% for 2011 and 2012, and thereafter, non-use becomes a penalty. [http://www.cms.hhs.gov/PQRI/Downloads/PQRIEPrescribingFactSheet.pdf] <br />
<br />
* 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.]<br />
<br />
*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.<br />
<br />
* EMR systems can minimize coding errors, time delays in filing the claims and filing of an incomplete claim resulting in claim delay or denial.<br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
*Eliminating paper chart supplies and copying expense as well as costs associated with storing paper charts.<br />
<br />
* 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<br />
<br />
* Using an EMR can lead to reduced malpractice insurance rates for hospitals and clinical practices. Some insurance companies offer lower rates when clinicians use EMRs. Ref: http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm<br />
<br />
* 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.<br />
<br />
* 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 <br />
<br />
*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.<br />
<br />
* 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)<br />
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* Can improve billing by allowing improved medical staff documentation and lack of lost or misplaced charts.<br />
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* 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<br />
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* With the use of the Eclipsys system, Lucile Packard Children’s Hospital identified $49 million in underpayments, collected $27 million of that amount, and saved $6.5 million in outsourcing costs. This was in between August 2002 and April 2006. Ref: http://www.eclipsys.com/ourclients/success_stories_details_LucilePackardChildrensHospital.asp<br />
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* 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)]<br />
<br />
* 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.<br />
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* One-third of the physicians/ nurses time is being spent responding to phone calls from pharmacies regarding prescriptions. Because of EMR system's features like e-prescribing and having potential implementation of interagency interoperability with pharmacy systems, clinics can save time, increase productivity (due to less interruptions in the workflow) and reduce the number of call backs from the pharmacies regarding wrong medicines prescribed, wrong dosages and illegibility of the prescription. Reference: http://www.emrconsultant.com/education/e-prescribing<br />
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* 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.<br />
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* 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<br />
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* 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)<br />
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* 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.<br />
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* EMR can provide clinicians information about a patient's financial status. Examples include:<br />
** 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.<br />
** EMR can indicate to a physician that Medicare does not cover a particular usage of a drug.<br />
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* 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.<br />
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* 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) [[http://www.chcf.org/documents/ihealth/PatientSafetyInPhysiciansOfficeACPOE.pdf]]<br />
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.<br />
[[User:MikeField|MikeField]] 15:59, 23 January 2010 (CST)<br />
<br />
* 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.<br />
[[User:MikeField|MikeField]] 20:11, 23 January 2010 (CST)<br />
<br />
* 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.<br />
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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.<br />
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* A technology evaluation study published in JAMIA in 2006 by Kaushal et al reported cumulative benefits for some clinical decision support systems' (CDSS) elements at Brigham’s and Women’s Hospital. The largest savings were from renal dosing guidance. Other savings were related to improvements in nursing time utilization, specific or expensive drug guidance, adverse drug event (ADE) prevention, laboratory charge display and redundant lab warnings. Some CDSS features were added to the system at a later time and were therefore not included in the analyses. The pilot studies related to these other features were also indicative of associated savings. These features included a transfusion guidance system, the appropriate ordering of Cl. Difficile toxin assays, and ordering of digoxin levels.<br />
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<br />
* More complete records helps clinicians and staff to avoid mistakes and to manage the cost of malpractice insurance. <br />
[http://www.msdc.com/EMR_Benefits.htm]<br />
<br />
* As a tried and proven EMR system, the VistA system offers a low-cost, low-risk EMR option. The system that has become VistA was initiated and planned at the beginning of the 1970s by the National Center for Health Services Research and Development of the U.S. Public Health Service (NCHSR&D/PHS). (The NCHSR&D is now known as the Agency for Healthcare Research and Quality (AHRQ).)[http://en.wikipedia.org/wiki/VistA] <br />
Cost has been cited as the primary reason healthcare facilities have not implemented EMR systems.[Jha, et. al., “Use of Electronic Health Records in U.S. Hospitals”, http://www.nejm.org/doi/pdf/10.1056/NEJMsa0900592] Under the US Freedom of Information Act, the VistA software is available free of charge, bypassing one of the major costs of an implementation. <br />
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<br />
== '''Clinical''' ==<br />
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* 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.<br />
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* 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. <br />
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* According to Sanders and Miller, "decision support ordering screen helps to improve physician compliance with guidelines for use of brain MRI". Sanders D.L, Miller R.A, The effects on clinician ordering patterns of a computerized decision support system for neuroradiology imaging studies. Proc AMIA Symp, 2001:583-7. [PMID: 11825254]<br />
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* 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.<br />
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* 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. <br />
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* 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.<br />
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* Information on patient allergies and other medications, in combination with alerts and reminders, can decrease the number of medication-related adverse events and improve presribing practices of physicians and nurse practioners. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
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* 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.<br />
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<br />
* EMRs have the capability to dislay previous laboratory test results can significantly reduce the number of redundant tests ordered, not only saving money, but also the preventing the patient from undergoing unnecessary tests.[http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
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* 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.<br />
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* 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.<br />
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*Improved patient education through use of patient portal<br />
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* EMR data can be accessed by patients via web portals. Web portal usage increases patient satisfaction overall and increases patient communication with informational and psychosocial content. [http://www.pubmedcentral.nih.gov/articlerender.fcgi?pmid=16236699 Lin et al. An Internet-Based Patient-Provider Communication System: Randomized Controlled Trial. J Med Internet Res. 2005 Jul–Sep; 7(4): e47.]<br />
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*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<br />
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*EMR improves the patient safety by reducing medication discrepancies. Maimonides Medical Center, Brooklyn, New York, has published 58% decrease in medication orders and 55% decrease in medication discrepancies after EMR implementation. http://www.himss.org/content/files/davies_2002_maimonides.pdf<br />
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*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]<br />
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*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.<br />
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* 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.<br />
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PHR has appeal as it eliminates collaborative governance challenges, trades providers' high cost technology for patient managed lower cost technology, and places information of educational value directly in the hands patients.<br />
Ref: Tang PC, Ash JS, Bates DW, et al. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc 2006;13:121–6.<br />
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*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.<br />
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* Features such as remote access and electronic messaging were shown very usefull and successfull for primary care practice. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1839545&blobtype=pdf)<br />
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* 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<br />
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* Can improve critical medical decisions by providing the most up-to-date clinical information at point-of-care.<br />
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* 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<br />
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* 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<br />
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* 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)]<br />
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* Electronic order sets, as part of CPOE, will improve compliance with nationally reported quality indicators e.g. core measures.<br />
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* 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.<br />
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* EMRs systems generates reports like flowsheets, a specialty snap shot about progression of a patient status which are very useful in management of chronic illnesses like diabetes.<br />
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* 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.<br />
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* 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.) <br />
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* 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.) <br />
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*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.)<br />
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*The EHR will reduce the costs incurred by storing and keeping patient medical records. It also will ensure billing to patients.<br />
http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art<br />
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*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.<br />
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* 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<br />
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* 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<br />
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* Planning programs allow physicians to make and modify detailed treatment plans which can then be viewed by any other physician caring for the patient.<br />
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* EMR can be integrated with computer-based monitoring to store and display information gathered from a patient automatically, such as vital signs or ECG.<br />
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* 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.<br />
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* 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.<br />
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* 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. <br />
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* 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)<br />
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* 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)<br />
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* 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) <br />
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* 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).<br />
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* 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. [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]<br />
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* 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: [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]<br />
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* 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.<br />
*<br />
* 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.<br />
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* 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" <br />
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* 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. <br />
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* 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.<br />
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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.<br />
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* 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.<br />
http://patients.about.com/od/electronicpatientrecords/a/EMRbenefits.htm <br />
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* Significant positive associations between specific objective quality indicators and CPOE implementation have been have been found. After controlling for confounders, CPOE hospitals outperformed comparison hospitals on 5 of 11 measures related to ordering medications and on 1 of 9 nonmedication-related quality measures. [http://ajm.sagepub.com/content/24/4/278.abstract (American Journal of Medical Quality 2009;24:278-286)]<br />
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* Regarding abnormal cervical cytology results and follow-up care, in an at-risk urban population, an automated, EMR-based tracking system has been shown to reduce the time to resolution and increase the number of women who achieved diagnostic resolution. [http://www.springerlink.com/content/7t116l968n5u5167/ (Journal of General Internal Medicine 2010;25(6):575-580)]<br />
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<br />
* The May 2008 Congressional Budget Office report - ‘Evidence on the Costs and Benefits of Health Information Technology’ discusses evidence related to a multi-functional EHR (Jha and colleagues, 2006). The report discusses electronic referral communication between providers, among other EHR functions, that could have a significant impact on medical practice.<br />
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* Use of Computerized physician order entry (CPOE) with clinical decision support (CDS) has been shown to decrease Adverse Drug Events (ADE’s) in 5 studies. Wolfstadt JI, Gurwitz JH, Field TS, et al. The effect of computerized physician order entry with clinical decision support on the rates of adverse drug events: a systematic review. J Gen Intern Med. 2008;23:451-8.<br />
<br />
* Electronic prescribing of chemotherapy medications has been shown to ensure that safe chemotherapy practices were followed. Huertas, M. J., Baena-Cañada, J. M., Martínez, M. J., Arriola, E. & García, M. V. The impact of computerised chemotherapy prescriptions on the prevention of medication errors. Clin. Transl. Oncol. 8, 821–825 (2006).<br />
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* Prescribing accuracy has been shown to be greatly increased as the occurrence of missing or incomplete data in prescriptions dropped by a factor of 10 by implementing a CPOE. C Mir, A Gadri, GL Zelger, et al. Impact of a computerized physician order entry system on compliance with prescription accuracy requirements. Pharmacy World and Science, Oct 2009, vol. 31, no. 5, p. 596-602<br />
<br />
* Reminders indicating that patient is eligible for preventive care measures. Dexter et al.<br />
<br />
* On-screen display of the charges for laboratory and radiologic tests at the time of computer ordering led to 4.5% fewer laboratory tests ordered in the intervention group (not statistically significant); minimal difference for radiologic tests. Bates et al.<br />
<br />
* A study performed by Bates et al., 55% reduction in serious medication errors (P = 0.01); decrease in preventable adverse drug events of 17% (P > 0.2). Bates et al.<br />
<br />
* Compliance with drug monitoring and preventive care guidelines. Overhage et al.<br />
<br />
* A CPOE system and an electronic medication administration record led to significant decreases in turnaround times, elimination of transcription errors, improvements in order countersignature, and decrease in length of stay. Mekhjian et al.<br />
<br />
* EMR helps healthcare providers to target patients with specific needs like immunization.<br />
<br />
* EMR allows various views of patient data to physicians. i.e, In a chronological order by report date- which helps the physicians to find the newest test results, they can highlight the changes etc. Edward H. Shortliffe, James J. Cimino. Biomedical Informatics Computer Applications in Health Care and Biomedicine. 3rd edition.<br />
<br />
* EMR is capable of generating reports. By generating reports healthcare providers can know the amount of vaccines used in the previous year and with that number they can plan for the coming years. Also they can know which patients are due for shots.(http://www.ama-assn.org/amednews/2008/05/05/bisa0505.html)<br />
<br />
* EMR allows researchers to efficiently search patient medical information by medical condition, date of treatment, physician name and test category. Researchers can use the EMR to analyze large amounts of patient information more efficiently, speeding the application of new research findings to improving patient care. (http://www.mayoclinic.org/emr/benefits.html)<br />
<br />
== '''Operational''' ==<br />
<br />
* With back-office management software packages integrated with the EMR software, it is easier than the paper record systems to produce statistical analysis reports for administrative purposes like scorecard reports for clinic performance, or individual physician contributions.<br />
<br />
* Joan Breuer, Ph.D. 01/22/2010 20:00 By building an EMR, there are opportunities for the IT staff to gain clinical knowledge.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* Protects patient data by preventing unauthorized individuals from accessing the clinical record. <br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* Documentation completed at conclusion of encounter.<br />
<br />
* 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.<br />
<br />
* Eliminates lost orders and ambiguities caused by illegible handwriting, generating realated orders automatically, monitoring for duplicate orders and reducing time to o fill orders. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* 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]<br />
<br />
* 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. <br />
[Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
* During the implementation phase of the EMR, was noted a closer cooperation between the clinical, and administrative setvices of hospitals. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2245928&blobtype=pdf)<br />
<br />
* Can allow for better appreciation of clinician performance for which can be used for employee bonuses.<br />
<br />
* 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)]<br />
<br />
* CPOE will automatically date and time physician orders, as recommended by regulatory organizations.<br />
<br />
* EMR user authentication can protect patient records from unauthorized access.<br />
<br />
* 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).<br />
<br />
*It reduces redundancy by eliminating duplicate testing. http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art<br />
<br />
*It increases patient privacy, by requiring secure login access. It also gives patients access to their records at any time. http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art<br />
<br />
* BCMA enhances tracking and understanding of medication delivery processes which can pinpoint opportunities for improvement in safety and efficiency.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* Better, more efficient systems can be built only on top of an EMR. Not much improvement can be made to a paper-based system.<br />
<br />
* 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. [http://www.msdc.com/EMR_Benefits.htm]<br />
<br />
* 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.<br />
<br />
* Automation of billing charges are typically included. This reduces error in submitting codes to insurance companies.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
* 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.]<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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. <br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* EMRs allow better integration to other operations such as billing, external departments and patient portals to manage, share, collect and protect the critical medical information. 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.<br />
<br />
* 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” [[http://www.chcf.org/documents/ihealth/PatientSafetyInPhysiciansOfficeACPOE.pdf]] <br />
[[User:MikeField|MikeField]] 17:54, 23 January 2010 (CST)<br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* 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<br />
<br />
*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.<br />
<br />
*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<br />
''<br />
<br />
* 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.<br />
* 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.<br />
<br />
* EMRs have significant potential to address impending workforce shortage in health care[http://www.hemonctoday.com/article.aspx?rid=67420 1][http://www.asco.org/ASCO/Downloads/Research%20Policy/Workforce%20Presentation%20at%202007%20Annual%20Meeting.pdf 2]<br />
<br />
* Greater EMR sophistication may be associated with emergency department (ED) efficiency. Relative to EDs with minimal or no EMR, fully functional EMR was associated with 22.4% lower ED length of stay and 13.1% lower diagnosis/treatment time. However, relationships varied by patient acuity level and diagnostic services provided. [http://mcr.sagepub.com/content/early/2010/06/07/1077558710372108.abstract (Medical Care and Research Review, 2010 Jun 16; Epub 2010 Jun 16)]<br />
<br />
<br />
* A 2007 article by Liang, titled ‘The Gap Between Evidence and Practice’, in Health Affairs, discusses the opportunities to improve healthcare by learning from the data available in electronic health record databases in order to bridge the gap between evidence and practice. The paper emphasizes the importance of the use of EHR data for comparative clinical effectiveness research. This potential benefit of EHRs is also addressed by the May 2008 Congressional Budget Office report - ‘Evidence on the Costs and Benefits of Health Information Technology’.<br />
<br />
* Software and hardware vendors are making things easier for doctors with cloud computing and secure web-based computing. These applications let doctors use the same laptops they’ve always used, but it gives them access to large volumes of clinical data, patient history and even 3D avatars that help doctors visualize medical records. The use of EMR as a standard way to exchange healthcare information will lower the costs of healthcare delivery and let physicians get back to the basics — thoughtful, holistic patient care. And it won’t stop there. Doctors will be able to take a proactive role in patient care, anticipating potential problems and dealing with them before they even arise, because they will have visibility into their patients’ complete medical records across the full range of doctors and healthcare providers.[http://classic.cnbc.com/id/38973121]<br />
<br />
* Software like Medical Dragon NaturallySpeaking with its ability to produce real-time language as enriched the lives of medical practitioners and their patients. It allows direct data entry by clinicians and staff by voice eliminates the need for transcription. Voice recognition software helps “voice writing” to document a verbatim record of medical examinations and surgeries saving approximately $10,000 per year. Dragon Naturally Speaking costs 80% less than manual medical transcription.[http://www.ehrdoctors.com/page/2/],[http://www.dragon-medical-transcription.com/]<br />
<br />
* Electronic claims processing is one of the many benefits of EMR software and service packages. With EMRs, electronic claims processing makes receiving payments faster, billing easier and more accurate.(http://hubpages.com/hub/The-Benefits-of-Electronic-Claims-Processing-with-EMR)<br />
<br />
* EMR allows fast access to patient’s medical record, update the record with changes in address or insurance carrier.(http://www.mayoclinic.org/emr/benefits.html)<br />
<br />
*EMR enables generation of report easily and instantly. Reports can be conveniently generated and programmed to automatic settings. Such reports can be used for assessment of various variables of performance, analysis, compliance and for research studies.<br />
<br />
== '''National''' ==<br />
<br />
* 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]<br />
<br />
* 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/<br />
<br />
*With the public and government demand for healthcare reform it is critical that health care technology structure be improved. 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''<br />
<br />
* 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.<br />
<br />
* Regional Health Information Organizations have the potential to revolutionize health care delivery. By connecting disparate providers, payers and other stakeholders, RHIOs are supposed to streamline and accelerate the flow of patient data. Medical records will move seamlessly from doctors’ offices to hospital to outpatient clinic. The ultimate goal is better care for patients, and billions of dollars in savings for the industry as a whole. But RHIOs are still very much in their infancy and are plagued by many unresolved issues, including a clear definition of what they are. [www.hhnmag.com, "A Primer for Building RHIOs", By Dagmara Scalise] [EarnValle9_11_10]<br />
<br />
* HIE and RHIO benefits can be measured along following key axis: <br />
•Quality of care improvement by way of greater access to data, newer data sources and technologies<br />
•Reduction in costs achieved either through efficiency and productivity gains or avoidance of redundant provider services<br />
•Improved patient experience with the system resulting in higher “customer satisfaction”<br />
•Compliance with legal, accreditation and standards of care practices<br />
•Ability to add new revenue stream due to new business opportunity the network creates [http://www.healthunity.com/handbook_hie_benefits.aspx] [EarnValle_9_12_10]<br />
<br />
* One feature of health IT that may qualify as a public good is the wealth of information that can be captured through EHR systems. (As discussed earlier, if researchers<br />
combined data from the EHRs of the population, they might be able to understand the spread and prevention of various diseases and injuries—and eventually develop cures and treatments; assess the effectiveness of various treatments; and more readily detect potential treatment hazards.) [http://www.cbo.gov/ftpdocs/91xx/doc9168/05-20-HealthIT.pdf] [EarnValle_9_12_10]<br />
<br />
* 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 [http://www.openclinical.org/emr.html 1], [http://www.bt.cdc.gov/episurv/ 2].<br />
<br />
<br />
<br />
• Provides complete and accurate access to patient information for providers and demonstrates time saved over paper record.<br />
• Expedites results reporting through customizable displays<br />
• Supports a common user interface for accessing patient information, usually through a workstation.<br />
• Supports monitoring and analysis of patient care outcomes<br />
<br />
• On a national and even international level, one benefit of EMR’s is to have potential research information readily available for multiple studies. The result would be not only more data but more immediate data. This allows for more studies to validate or eliminate new approved therapies and medications resulting in improved health care. <br />
<br />
• EMR’s systems that are linked nationally would allow for healthcare workers to identify and treat new outbreaks in infectious/communicable diseases in a specified region. Faster identification of the cause would allow for faster treatment and a decrease in illness and death.</div>RTompkinshttp://www.clinfowiki.org/wiki/index.php/EMR_Benefits_and_Return_on_Investment_CategoriesEMR Benefits and Return on Investment Categories2011-01-22T19:55:56Z<p>RTompkins: Minor edit under "National"</p>
<hr />
<div>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...<br />
<br />
= '''Common EMR Benefit Categories''' =<br />
<br />
== '''Security and Privacy''' ==<br />
<br />
* Though electronic systems facilitate audit trails, they are not immune to breaches. In just about any information system designed with commercial or security concerns, there are a handful of provisions that provide tracking and trending, tagging for storage (ex. CAS), history, billing (which is a form of data tagging for billing purposes, essentially providing financial audit trail), and numerous other forms and systematic ways of enhancing security by making it possible to trace back actions on important and private data.<br />
<br />
* Electronic objects can easily be tagged for conditional processing. This enhances privacy by providing different levels of security tags based on group policies, access control policies, government policies and other regulatory body public or private. However, it also lends itself to some false sense of security in that it doesn’t prevent humans from mislabeling, incorrectly tagging objects, or malicious tampering.<br />
<br />
* Digital data is, for better or for worse, immortal: once electronic data is created, it can be argued that it can never be destroyed providing everlasting durability and consistency.<br />
<br />
* Privacy and confidentiality remains a patient right! As digital data is permanent so are the trails of access to such data. There are news reports of staff being fired due to accessing 'celebrity-status' patient medical records. (http://www.nydailynews.com/news/national/2011/01/13/2011-01-13_staffers_at_tucson_university_medical_center_fired_after_staffers_violated_feder.html).<br />
<br />
* EMR's add an important layer of security by restricting unlimited access to confidential sections of a patient file to all healthcare works and support staff. By simply adding user name and password codes, access for employees is restricted to only the portions of the record needed to complete their work tasks.<br />
<br />
== '''Financial''' ==<br />
* EMR can prevent unnecessary duplication of diagnostic tests that might occur when a patient sees multiple healthcare providers. Reference: Evidence on the Costs and Benefits of Health Information Technology. http://www.cbo.gov/ftpdocs/91xx/doc9168/MainText.3.1.shtml#1096012<br />
<br />
* 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.<br />
<br />
* 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<br />
<br />
* 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.<br />
<br />
* 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. [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* Many ambulatory EMR systems are integrated with [http://www.drfirst.com/e-prescribing.jsp e-Prescribing]. For physicians who use this technology in 2009 and 2010 for at least 50% of their eligible patients, an addtional 2% will be added to their Medicare reimbursement. The amount drops to 1% for 2011 and 2012, and thereafter, non-use becomes a penalty. [http://www.cms.hhs.gov/PQRI/Downloads/PQRIEPrescribingFactSheet.pdf] <br />
<br />
* 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.]<br />
<br />
*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.<br />
<br />
* EMR systems can minimize coding errors, time delays in filing the claims and filing of an incomplete claim resulting in claim delay or denial.<br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
*Eliminating paper chart supplies and copying expense as well as costs associated with storing paper charts.<br />
<br />
* 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<br />
<br />
* Using an EMR can lead to reduced malpractice insurance rates for hospitals and clinical practices. Some insurance companies offer lower rates when clinicians use EMRs. Ref: http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm<br />
<br />
* 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.<br />
<br />
* 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 <br />
<br />
*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.<br />
<br />
* 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)<br />
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* Can improve billing by allowing improved medical staff documentation and lack of lost or misplaced charts.<br />
<br />
* 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<br />
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* With the use of the Eclipsys system, Lucile Packard Children’s Hospital identified $49 million in underpayments, collected $27 million of that amount, and saved $6.5 million in outsourcing costs. This was in between August 2002 and April 2006. Ref: http://www.eclipsys.com/ourclients/success_stories_details_LucilePackardChildrensHospital.asp<br />
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* 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)]<br />
<br />
* 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.<br />
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* One-third of the physicians/ nurses time is being spent responding to phone calls from pharmacies regarding prescriptions. Because of EMR system's features like e-prescribing and having potential implementation of interagency interoperability with pharmacy systems, clinics can save time, increase productivity (due to less interruptions in the workflow) and reduce the number of call backs from the pharmacies regarding wrong medicines prescribed, wrong dosages and illegibility of the prescription. Reference: http://www.emrconsultant.com/education/e-prescribing<br />
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* 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.<br />
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* 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<br />
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* 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)<br />
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* 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.<br />
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* EMR can provide clinicians information about a patient's financial status. Examples include:<br />
** 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.<br />
** EMR can indicate to a physician that Medicare does not cover a particular usage of a drug.<br />
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* 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.<br />
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* 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) [[http://www.chcf.org/documents/ihealth/PatientSafetyInPhysiciansOfficeACPOE.pdf]]<br />
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.<br />
[[User:MikeField|MikeField]] 15:59, 23 January 2010 (CST)<br />
<br />
* 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.<br />
[[User:MikeField|MikeField]] 20:11, 23 January 2010 (CST)<br />
<br />
* 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.<br />
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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.<br />
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<br />
* A technology evaluation study published in JAMIA in 2006 by Kaushal et al reported cumulative benefits for some clinical decision support systems' (CDSS) elements at Brigham’s and Women’s Hospital. The largest savings were from renal dosing guidance. Other savings were related to improvements in nursing time utilization, specific or expensive drug guidance, adverse drug event (ADE) prevention, laboratory charge display and redundant lab warnings. Some CDSS features were added to the system at a later time and were therefore not included in the analyses. The pilot studies related to these other features were also indicative of associated savings. These features included a transfusion guidance system, the appropriate ordering of Cl. Difficile toxin assays, and ordering of digoxin levels.<br />
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<br />
* More complete records helps clinicians and staff to avoid mistakes and to manage the cost of malpractice insurance. <br />
[http://www.msdc.com/EMR_Benefits.htm]<br />
<br />
== '''Clinical''' ==<br />
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* 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.<br />
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* 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. <br />
<br />
* According to Sanders and Miller, "decision support ordering screen helps to improve physician compliance with guidelines for use of brain MRI". Sanders D.L, Miller R.A, The effects on clinician ordering patterns of a computerized decision support system for neuroradiology imaging studies. Proc AMIA Symp, 2001:583-7. [PMID: 11825254]<br />
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* 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.<br />
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* 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. <br />
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* 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.<br />
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* Information on patient allergies and other medications, in combination with alerts and reminders, can decrease the number of medication-related adverse events and improve presribing practices of physicians and nurse practioners. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* 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.<br />
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<br />
* EMRs have the capability to dislay previous laboratory test results can significantly reduce the number of redundant tests ordered, not only saving money, but also the preventing the patient from undergoing unnecessary tests.[http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* 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.<br />
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* 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.<br />
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*Improved patient education through use of patient portal<br />
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* EMR data can be accessed by patients via web portals. Web portal usage increases patient satisfaction overall and increases patient communication with informational and psychosocial content. [http://www.pubmedcentral.nih.gov/articlerender.fcgi?pmid=16236699 Lin et al. An Internet-Based Patient-Provider Communication System: Randomized Controlled Trial. J Med Internet Res. 2005 Jul–Sep; 7(4): e47.]<br />
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*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<br />
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*EMR improves the patient safety by reducing medication discrepancies. Maimonides Medical Center, Brooklyn, New York, has published 58% decrease in medication orders and 55% decrease in medication discrepancies after EMR implementation. http://www.himss.org/content/files/davies_2002_maimonides.pdf<br />
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*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]<br />
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*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.<br />
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* 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.<br />
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PHR has appeal as it eliminates collaborative governance challenges, trades providers' high cost technology for patient managed lower cost technology, and places information of educational value directly in the hands patients.<br />
Ref: Tang PC, Ash JS, Bates DW, et al. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc 2006;13:121–6.<br />
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*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.<br />
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* Features such as remote access and electronic messaging were shown very usefull and successfull for primary care practice. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1839545&blobtype=pdf)<br />
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* 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<br />
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* Can improve critical medical decisions by providing the most up-to-date clinical information at point-of-care.<br />
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* 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<br />
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* 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<br />
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* 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)]<br />
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* Electronic order sets, as part of CPOE, will improve compliance with nationally reported quality indicators e.g. core measures.<br />
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* 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.<br />
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* EMRs systems generates reports like flowsheets, a specialty snap shot about progression of a patient status which are very useful in management of chronic illnesses like diabetes.<br />
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* 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.<br />
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* 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.) <br />
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* 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.) <br />
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*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.)<br />
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*The EHR will reduce the costs incurred by storing and keeping patient medical records. It also will ensure billing to patients.<br />
http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art<br />
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*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.<br />
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* 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<br />
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* 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<br />
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* Planning programs allow physicians to make and modify detailed treatment plans which can then be viewed by any other physician caring for the patient.<br />
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* EMR can be integrated with computer-based monitoring to store and display information gathered from a patient automatically, such as vital signs or ECG.<br />
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* 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.<br />
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* 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.<br />
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* 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. <br />
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* 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)<br />
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* 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)<br />
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* 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) <br />
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* 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).<br />
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* 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. [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]<br />
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* 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: [http://www.cbo.gov/ftpdocs/91xx/doc9168/healthITTOC.2.1.htm Evidence on the Costs and Benefits of Health Information Technology]<br />
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* 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.<br />
*<br />
* 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.<br />
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* 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" <br />
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* 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. <br />
<br />
* 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.<br />
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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.<br />
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* 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.<br />
http://patients.about.com/od/electronicpatientrecords/a/EMRbenefits.htm <br />
<br />
* Significant positive associations between specific objective quality indicators and CPOE implementation have been have been found. After controlling for confounders, CPOE hospitals outperformed comparison hospitals on 5 of 11 measures related to ordering medications and on 1 of 9 nonmedication-related quality measures. [http://ajm.sagepub.com/content/24/4/278.abstract (American Journal of Medical Quality 2009;24:278-286)]<br />
<br />
* Regarding abnormal cervical cytology results and follow-up care, in an at-risk urban population, an automated, EMR-based tracking system has been shown to reduce the time to resolution and increase the number of women who achieved diagnostic resolution. [http://www.springerlink.com/content/7t116l968n5u5167/ (Journal of General Internal Medicine 2010;25(6):575-580)]<br />
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<br />
* The May 2008 Congressional Budget Office report - ‘Evidence on the Costs and Benefits of Health Information Technology’ discusses evidence related to a multi-functional EHR (Jha and colleagues, 2006). The report discusses electronic referral communication between providers, among other EHR functions, that could have a significant impact on medical practice.<br />
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* Use of Computerized physician order entry (CPOE) with clinical decision support (CDS) has been shown to decrease Adverse Drug Events (ADE’s) in 5 studies. Wolfstadt JI, Gurwitz JH, Field TS, et al. The effect of computerized physician order entry with clinical decision support on the rates of adverse drug events: a systematic review. J Gen Intern Med. 2008;23:451-8.<br />
<br />
* Electronic prescribing of chemotherapy medications has been shown to ensure that safe chemotherapy practices were followed. Huertas, M. J., Baena-Cañada, J. M., Martínez, M. J., Arriola, E. & García, M. V. The impact of computerised chemotherapy prescriptions on the prevention of medication errors. Clin. Transl. Oncol. 8, 821–825 (2006).<br />
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* Prescribing accuracy has been shown to be greatly increased as the occurrence of missing or incomplete data in prescriptions dropped by a factor of 10 by implementing a CPOE. C Mir, A Gadri, GL Zelger, et al. Impact of a computerized physician order entry system on compliance with prescription accuracy requirements. Pharmacy World and Science, Oct 2009, vol. 31, no. 5, p. 596-602<br />
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* Reminders indicating that patient is eligible for preventive care measures. Dexter et al.<br />
<br />
* On-screen display of the charges for laboratory and radiologic tests at the time of computer ordering led to 4.5% fewer laboratory tests ordered in the intervention group (not statistically significant); minimal difference for radiologic tests. Bates et al.<br />
<br />
* A study performed by Bates et al., 55% reduction in serious medication errors (P = 0.01); decrease in preventable adverse drug events of 17% (P > 0.2). Bates et al.<br />
<br />
* Compliance with drug monitoring and preventive care guidelines. Overhage et al.<br />
<br />
* A CPOE system and an electronic medication administration record led to significant decreases in turnaround times, elimination of transcription errors, improvements in order countersignature, and decrease in length of stay. Mekhjian et al.<br />
<br />
* EMR helps healthcare providers to target patients with specific needs like immunization.<br />
<br />
* EMR allows various views of patient data to physicians. i.e, In a chronological order by report date- which helps the physicians to find the newest test results, they can highlight the changes etc. Edward H. Shortliffe, James J. Cimino. Biomedical Informatics Computer Applications in Health Care and Biomedicine. 3rd edition.<br />
<br />
* EMR is capable of generating reports. By generating reports healthcare providers can know the amount of vaccines used in the previous year and with that number they can plan for the coming years. Also they can know which patients are due for shots.(http://www.ama-assn.org/amednews/2008/05/05/bisa0505.html)<br />
<br />
* EMR allows researchers to efficiently search patient medical information by medical condition, date of treatment, physician name and test category. Researchers can use the EMR to analyze large amounts of patient information more efficiently, speeding the application of new research findings to improving patient care. (http://www.mayoclinic.org/emr/benefits.html)<br />
<br />
== '''Operational''' ==<br />
<br />
* With back-office management software packages integrated with the EMR software, it is easier than the paper record systems to produce statistical analysis reports for administrative purposes like scorecard reports for clinic performance, or individual physician contributions.<br />
<br />
* Joan Breuer, Ph.D. 01/22/2010 20:00 By building an EMR, there are opportunities for the IT staff to gain clinical knowledge.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* Protects patient data by preventing unauthorized individuals from accessing the clinical record. <br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* Documentation completed at conclusion of encounter.<br />
<br />
* 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.<br />
<br />
* Eliminates lost orders and ambiguities caused by illegible handwriting, generating realated orders automatically, monitoring for duplicate orders and reducing time to o fill orders. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System]<br />
<br />
* 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]<br />
<br />
* 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. <br />
[Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
* During the implementation phase of the EMR, was noted a closer cooperation between the clinical, and administrative setvices of hospitals. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2245928&blobtype=pdf)<br />
<br />
* Can allow for better appreciation of clinician performance for which can be used for employee bonuses.<br />
<br />
* 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)]<br />
<br />
* CPOE will automatically date and time physician orders, as recommended by regulatory organizations.<br />
<br />
* EMR user authentication can protect patient records from unauthorized access.<br />
<br />
* 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).<br />
<br />
*It reduces redundancy by eliminating duplicate testing. http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art<br />
<br />
*It increases patient privacy, by requiring secure login access. It also gives patients access to their records at any time. http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art<br />
<br />
* BCMA enhances tracking and understanding of medication delivery processes which can pinpoint opportunities for improvement in safety and efficiency.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* Better, more efficient systems can be built only on top of an EMR. Not much improvement can be made to a paper-based system.<br />
<br />
* 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. [http://www.msdc.com/EMR_Benefits.htm]<br />
<br />
* 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.<br />
<br />
* Automation of billing charges are typically included. This reduces error in submitting codes to insurance companies.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* 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]<br />
<br />
* 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.]<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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. <br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* 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.<br />
<br />
* EMRs allow better integration to other operations such as billing, external departments and patient portals to manage, share, collect and protect the critical medical information. 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.<br />
<br />
* 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” [[http://www.chcf.org/documents/ihealth/PatientSafetyInPhysiciansOfficeACPOE.pdf]] <br />
[[User:MikeField|MikeField]] 17:54, 23 January 2010 (CST)<br />
<br />
* 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.<br />
<br />
* 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]<br />
<br />
* 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<br />
<br />
*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.<br />
<br />
*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<br />
''<br />
<br />
* 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.<br />
* 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.<br />
<br />
* EMRs have significant potential to address impending workforce shortage in health care[http://www.hemonctoday.com/article.aspx?rid=67420 1][http://www.asco.org/ASCO/Downloads/Research%20Policy/Workforce%20Presentation%20at%202007%20Annual%20Meeting.pdf 2]<br />
<br />
* Greater EMR sophistication may be associated with emergency department (ED) efficiency. Relative to EDs with minimal or no EMR, fully functional EMR was associated with 22.4% lower ED length of stay and 13.1% lower diagnosis/treatment time. However, relationships varied by patient acuity level and diagnostic services provided. [http://mcr.sagepub.com/content/early/2010/06/07/1077558710372108.abstract (Medical Care and Research Review, 2010 Jun 16; Epub 2010 Jun 16)]<br />
<br />
<br />
* A 2007 article by Liang, titled ‘The Gap Between Evidence and Practice’, in Health Affairs, discusses the opportunities to improve healthcare by learning from the data available in electronic health record databases in order to bridge the gap between evidence and practice. The paper emphasizes the importance of the use of EHR data for comparative clinical effectiveness research. This potential benefit of EHRs is also addressed by the May 2008 Congressional Budget Office report - ‘Evidence on the Costs and Benefits of Health Information Technology’.<br />
<br />
* Software and hardware vendors are making things easier for doctors with cloud computing and secure web-based computing. These applications let doctors use the same laptops they’ve always used, but it gives them access to large volumes of clinical data, patient history and even 3D avatars that help doctors visualize medical records. The use of EMR as a standard way to exchange healthcare information will lower the costs of healthcare delivery and let physicians get back to the basics — thoughtful, holistic patient care. And it won’t stop there. Doctors will be able to take a proactive role in patient care, anticipating potential problems and dealing with them before they even arise, because they will have visibility into their patients’ complete medical records across the full range of doctors and healthcare providers.[http://classic.cnbc.com/id/38973121]<br />
<br />
* Software like Medical Dragon NaturallySpeaking with its ability to produce real-time language as enriched the lives of medical practitioners and their patients. It allows direct data entry by clinicians and staff by voice eliminates the need for transcription. Voice recognition software helps “voice writing” to document a verbatim record of medical examinations and surgeries saving approximately $10,000 per year. Dragon Naturally Speaking costs 80% less than manual medical transcription.[http://www.ehrdoctors.com/page/2/],[http://www.dragon-medical-transcription.com/]<br />
<br />
* Electronic claims processing is one of the many benefits of EMR software and service packages. With EMRs, electronic claims processing makes receiving payments faster, billing easier and more accurate.(http://hubpages.com/hub/The-Benefits-of-Electronic-Claims-Processing-with-EMR)<br />
<br />
* EMR allows fast access to patient’s medical record, update the record with changes in address or insurance carrier.(http://www.mayoclinic.org/emr/benefits.html)<br />
<br />
*EMR enables generation of report easily and instantly. Reports can be conveniently generated and programmed to automatic settings. Such reports can be used for assessment of various variables of performance, analysis, compliance and for research studies.<br />
<br />
== '''National''' ==<br />
<br />
* 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]<br />
<br />
* 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/<br />
<br />
*With the public and government demand for healthcare reform it is critical that health care technology structure be improved. 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''<br />
<br />
* 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.<br />
<br />
* Regional Health Information Organizations have the potential to revolutionize health care delivery. By connecting disparate providers, payers and other stakeholders, RHIOs are supposed to streamline and accelerate the flow of patient data. Medical records will move seamlessly from doctors’ offices to hospital to outpatient clinic. The ultimate goal is better care for patients, and billions of dollars in savings for the industry as a whole. But RHIOs are still very much in their infancy and are plagued by many unresolved issues, including a clear definition of what they are. [www.hhnmag.com, "A Primer for Building RHIOs", By Dagmara Scalise] [EarnValle9_11_10]<br />
<br />
* HIE and RHIO benefits can be measured along following key axis: <br />
•Quality of care improvement by way of greater access to data, newer data sources and technologies<br />
•Reduction in costs achieved either through efficiency and productivity gains or avoidance of redundant provider services<br />
•Improved patient experience with the system resulting in higher “customer satisfaction”<br />
•Compliance with legal, accreditation and standards of care practices<br />
•Ability to add new revenue stream due to new business opportunity the network creates [http://www.healthunity.com/handbook_hie_benefits.aspx] [EarnValle_9_12_10]<br />
<br />
* One feature of health IT that may qualify as a public good is the wealth of information that can be captured through EHR systems. (As discussed earlier, if researchers<br />
combined data from the EHRs of the population, they might be able to understand the spread and prevention of various diseases and injuries—and eventually develop cures and treatments; assess the effectiveness of various treatments; and more readily detect potential treatment hazards.) [http://www.cbo.gov/ftpdocs/91xx/doc9168/05-20-HealthIT.pdf] [EarnValle_9_12_10]<br />
<br />
* 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 [http://www.openclinical.org/emr.html 1], [http://www.bt.cdc.gov/episurv/ 2].<br />
<br />
<br />
<br />
• Provides complete and accurate access to patient information for providers and demonstrates time saved over paper record.<br />
• Expedites results reporting through customizable displays<br />
• Supports a common user interface for accessing patient information, usually through a workstation.<br />
• Supports monitoring and analysis of patient care outcomes<br />
<br />
• On a national and even international level, one benefit of EMR’s is to have potential research information readily available for multiple studies. The result would be not only more data but more immediate data. This allows for more studies to validate or eliminate new approved therapies and medications resulting in improved health care. <br />
<br />
• EMR’s systems that are linked nationally would allow for healthcare workers to identify and treat new outbreaks in infectious/communicable diseases in a specified region. Faster identification of the cause would allow for faster treatment and a decrease in illness and death.</div>RTompkinshttp://www.clinfowiki.org/wiki/index.php/Veterans_Health_Information_Systems_and_Technology_Architecture_(VistA)Veterans Health Information Systems and Technology Architecture (VistA)2011-01-17T06:14:41Z<p>RTompkins: Cleaning up "Future VistA Challenges" section</p>
<hr />
<div>VistA developed from DHCP (Decentralized Hospital Computer Program), the earlier version of the Veterans Health Administration’s clinical information system.(3) <br />
<br />
In the late 1970's, the Office of Data Management and Telecommunications (ODM&T) was given the job to computerize the VA nationwide [Brown, SH,2003]. It was developed using [http://en.wikipedia.org/wiki/MUMPS MUMPS (Massachusetts General Hospital Utility Multi-Programming System)], or alternatively, M programming language.<br />
<br />
In 1977, the Department of Medicine & Surgery, the predecessor of VHA, created the Computer-Assisted System Staff (CASS) Office. They involved clinical experts in the process of computerization of the medical centers, and avoided the lengthy traditional administrative process used by ODM&T. Their Decentralized Hospital Computer Program (DHCP) included programs for administration, mental health, radiology and dietetics. They also focused on re-usability and the adherence to an active data dictionary, two characteristics that were declared in a conference in December 1982.<br />
<br />
The ODM&T tried to shut down development, but DHCP developers continued their work. Eventually VA Administrator Robert Nimmo approved a policy giving facility directors the power to choose computer applications in 1982. A first group of 25 sites and 11 applications was in place by 1983. These were followed by up to 100 sites in year 1985 .<br />
<br />
Performance has always been an issue and continues to be so into the future. One of the chief reasons is that data has not only risen steady as more sites and locations have joined, but the VA is required to keep all data about a patient for 75 years after the last patient visit! This is even after the patient has died. Even if a patient has been inactive, data needs to be accessible immediately for whatever a physician might need it for. <br />
<br />
In 1995, DHCP was enshrined as a recipient of the Computerworld Smithsonian Award for best use of Information Technology in Medicine. A year later, the name VistA was officially given to the much improved system after the addition of a visual layer written using Delphi.<br />
<br />
By 1999, multimedia online patient records were provided in VistA. Images from specialties such as cardiology, pulmonary and gastronintestinal medicine, pathology , radiology, hematology and nuclear medicine were supported.<br />
<br />
As of 2001, it was the largest system in use in the US, with medical documentation and ordering available at every VA hospital in the country. In September 2002, 90.6% of all inpatient and outpatient pharmacy orders were entered by the provider. Today, the system is in use in hundreds of hospitals and clinics worldwide, not just in the VA Hospital System. <br />
<br />
By 2003, the VHA was the largest single medical system in the United States, providing care to over 4 million veterans, employing 180,000 medical personnel and operating 163 hospitals, over 800 clinics, and 135 nursing homes. About a quarter of the nation's population is potentially eligible for VA benefits and services because they are veterans, family members, or survivors of veterans.<br />
By providing electronic health records capability, VistA is thereby one of the most widely used EHRs in the world. Nearly half of all US hospitals that have a full implementation of an EMR are VA hospitals using VistA.<br />
<br />
As of 2009, VISTA incorporates all of the benefits of DHCP as well as including the rich array of other information resources that are becoming vital to the day-to-day operations at VA medical facilities. It represents the culmination of DHCP's evolution and metamorphosis into a new, open system, client-server based environment that takes full advantage of commercial solutions, including those provided by Internet technologies.<br />
<br />
VistA consists of nearly 100 applications. Two relatively new applications include Computertized Patient Record System (CPRS) and Barcode Medication Administration (BCMA). A complete description and list of all applications can be found at the [http://www.va.gov/vista Vista website]. <br />
<br />
<br />
'''CPRS'''<br />
<br />
VistA’s 1996 release of its Computerized Patient Record System (CPRS) aligns well with the current public emphasis in the U.S. on patient-centered health care.(1) CPRS provides electronic data entry, editing, and electronic signatures for provider-patient encounters as well as provider orders. Its computer-based provider order entry (CPOE) capability is an important enabler in the migration from paper-based charting to electronic medical records (EMRs). On the other hand, CPRS is now up to version 26, underscoring an ongoing reality: that EMR systems are continually evolving [[http://www1.va.gov/cprsdemo/ CPRS demo]]. This factor must be considered by providers who have a choice of hosting their own EMR system or going with a monthly fee-based ASP remote-hosting model in order to avoid the hassles of regular updates. Another observation from the VistA CPRS version 26 demo is that even after so many revisions, information density remains very low, a contributing factor to physician preference for paper charts. <br />
<br />
<br />
'''Master Patient Index'''<br />
<br />
There are approximately 140 Department of Veterans Affairs (VA) databases in use across the country in VA facilities that are accessible via VistA systems. Because of this wide distribution of information, there is great potential for individual patient data to be kept under more than one identification number.<br />
<br />
The Master Patient Index (MPI) has been created to support maintenance of a unique patient identifier and a single master index of all VA patients, and to allow messaging of patient information among systems of interest to the MPI [i.e., systems of interest are VA facilities where patients are seen for care, non-VistA systems that have a registered interest in a patient (e.g., Federal Health Information Exchange [FHIE], Home TeleHealth, Person Service Identity Management [PSIM], Health Data Repository [HDR], etc).].<br />
<br />
The ability to uniquely identify a patient and the facilities where that patient receives care is a key factor in the delivery of quality care. The ability to uniquely identify patients assists in the elimination of duplicate records throughout all VA systems and other agencies, and allows the systems to share information for patients that receive care from more than one facility/agency. (4)<br />
<br />
<br />
'''BCMA'''<br />
<br />
Nurses use this application at the bedside at the time of medication administration. Nurses scan the patient’s identification band using a hand-held device, scan the barcode on the medication container and then scan their ID badge at the time when medications are administered. This information is the sent directly to the medication administration record. The system identifies the patient and medication reducing the risk of errors. There is evidence showing a 70% decrease in medication errors after the implementation of this system at one of the VA sites (1).<br />
<br />
Being a system implemented somewhat uniformly across 128 sites, it is noteworthy in its site-specific flexibility. Individual user sites can adopt data dictionaries unique to that site. One important drawback of VistA is that site-specific data dictionaries prevents data summarization between sites, or on a system-wide level. Such data sharing and reporting limitations across sites can be overcome using a national dictionary acting as a cross-reference.<br />
<br />
The VA currently runs a majority of VistA systems on InterSystems Caché. VistA can also run on GT.M, an open source database engine for Linux and Unix computers. Although initially separate releases, publicly available VistA distributions are now often bundled with the database in an integrated package. This has considerably eased installation.<br />
<br />
"For more than 20 years, the FOIA has been used by nonprofit, commercial and foreign entities to obtain copies of the VistA source code. Through such FOIA requests, versions of VistA are in active use in Finland, Germany, Egypt and Latin America, as well as by a number of state and local health care systems in the United States. Examples of external VistA user organizations can be found in Hardhats.org (2003), Marshall (2003) and Medsphere (2003)." [West, Joel,2003]<br />
<br />
VistA and and AHLTA of the DoD, were the first two largest US Government EHR built on standardized base of interoperability of patient records.<br />
The project objective was to develop an interface between the DoD Clinical Data Repositiry (CDR), and the VA's Health Data Repository (HDR) that support a real time bi-directional exchange of computable health data.<br />
<br />
<br />
'''Future VistA Challenges'''[1]<br />
<br />
The VHA is addressing a number of future challenges with a strategy called HealtheVet. Overcoming these challenges will support development of its planned national health data repository (HDR) reducing the storage needs at each VistA implementation. First and foremost is separating data repositories from underlying applications. Secondly, standardization of formal reference terminologies facilitating organization computable and comparable data is required. The third challenge is to keep the current MUMPS database or migrate to a relational or object oriented database.<br />
<br />
Migration presents additional challenges. Local VistA implementations store data in MUMPS "globals" volume sets on pre-allocated disk sections. When volume sets exceed 16 GB, performance degrades. This is problematic due to three factors; accelerated data accumulation, 75 year record retention requirements, and the physician demand for availability of all records. The HDR is complicated by prior decisions to allow local implementations to determine data dictionaries for clinical data. This choice supported rapid growth of the VistA programs, but now complicates the national decision support system using data from local terminologies that are not recognized. One further complication is the variability of bandwidth and network reliability.<br />
<br />
The federal "HealthePeople strategy" to adopt common data, communications, architecture, security, technical, software standards in federal health information systems (HIS) along with shared software will result in full interoperability.<br />
<br />
<br />
More information on VistaA available at:<br />
<br />
http://en.wikipedia.org/wiki/VistA<br />
<br />
http://www4.va.gov/VISTA_MONOGRAPH/<br />
<br />
<br />
==References==<br />
1. Brown, SH, Lincoln MJ et al. [http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T7S-47CHD1B-1&_user=5674961&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000003838&_version=1&_urlVersion=0&_userid=5674961&md5=ff31f151f996d7eb51044546eb0fe2ec VistA - U.S. Department of Veterans Affairs national-scale HIS]. International Journal of Medical Informatics. 2003; 69:135-156.<br />
<br />
2. West, Joel and O’Mahony, Siobhán [http://www.joelwest.org/Papers/VistA-Community-12-2003.pdf]. 2003<br />
<br />
3. http://www.virec.research.va.gov/DataSourcesName/VISTA/VistA.htm<br />
<br />
4. 2008_2009_VistAHealtheVet_Monograph_FC_0309, http://www.va.gov/VISTA_MONOGRAPH/docs/2008_2009_VistAHealtheVet_Monograph_FC_0309.doc<br />
<br />
<br />
[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>RTompkinshttp://www.clinfowiki.org/wiki/index.php/Veterans_Health_Information_Systems_and_Technology_Architecture_(VistA)Veterans Health Information Systems and Technology Architecture (VistA)2011-01-17T06:12:11Z<p>RTompkins: Added Master Patient Index section</p>
<hr />
<div>VistA developed from DHCP (Decentralized Hospital Computer Program), the earlier version of the Veterans Health Administration’s clinical information system.(3) <br />
<br />
In the late 1970's, the Office of Data Management and Telecommunications (ODM&T) was given the job to computerize the VA nationwide [Brown, SH,2003]. It was developed using [http://en.wikipedia.org/wiki/MUMPS MUMPS (Massachusetts General Hospital Utility Multi-Programming System)], or alternatively, M programming language.<br />
<br />
In 1977, the Department of Medicine & Surgery, the predecessor of VHA, created the Computer-Assisted System Staff (CASS) Office. They involved clinical experts in the process of computerization of the medical centers, and avoided the lengthy traditional administrative process used by ODM&T. Their Decentralized Hospital Computer Program (DHCP) included programs for administration, mental health, radiology and dietetics. They also focused on re-usability and the adherence to an active data dictionary, two characteristics that were declared in a conference in December 1982.<br />
<br />
The ODM&T tried to shut down development, but DHCP developers continued their work. Eventually VA Administrator Robert Nimmo approved a policy giving facility directors the power to choose computer applications in 1982. A first group of 25 sites and 11 applications was in place by 1983. These were followed by up to 100 sites in year 1985 .<br />
<br />
Performance has always been an issue and continues to be so into the future. One of the chief reasons is that data has not only risen steady as more sites and locations have joined, but the VA is required to keep all data about a patient for 75 years after the last patient visit! This is even after the patient has died. Even if a patient has been inactive, data needs to be accessible immediately for whatever a physician might need it for. <br />
<br />
In 1995, DHCP was enshrined as a recipient of the Computerworld Smithsonian Award for best use of Information Technology in Medicine. A year later, the name VistA was officially given to the much improved system after the addition of a visual layer written using Delphi.<br />
<br />
By 1999, multimedia online patient records were provided in VistA. Images from specialties such as cardiology, pulmonary and gastronintestinal medicine, pathology , radiology, hematology and nuclear medicine were supported.<br />
<br />
As of 2001, it was the largest system in use in the US, with medical documentation and ordering available at every VA hospital in the country. In September 2002, 90.6% of all inpatient and outpatient pharmacy orders were entered by the provider. Today, the system is in use in hundreds of hospitals and clinics worldwide, not just in the VA Hospital System. <br />
<br />
By 2003, the VHA was the largest single medical system in the United States, providing care to over 4 million veterans, employing 180,000 medical personnel and operating 163 hospitals, over 800 clinics, and 135 nursing homes. About a quarter of the nation's population is potentially eligible for VA benefits and services because they are veterans, family members, or survivors of veterans.<br />
By providing electronic health records capability, VistA is thereby one of the most widely used EHRs in the world. Nearly half of all US hospitals that have a full implementation of an EMR are VA hospitals using VistA.<br />
<br />
As of 2009, VISTA incorporates all of the benefits of DHCP as well as including the rich array of other information resources that are becoming vital to the day-to-day operations at VA medical facilities. It represents the culmination of DHCP's evolution and metamorphosis into a new, open system, client-server based environment that takes full advantage of commercial solutions, including those provided by Internet technologies.<br />
<br />
VistA consists of nearly 100 applications. Two relatively new applications include Computertized Patient Record System (CPRS) and Barcode Medication Administration (BCMA). A complete description and list of all applications can be found at the [http://www.va.gov/vista Vista website]. <br />
<br />
<br />
'''CPRS'''<br />
<br />
VistA’s 1996 release of its Computerized Patient Record System (CPRS) aligns well with the current public emphasis in the U.S. on patient-centered health care.(1) CPRS provides electronic data entry, editing, and electronic signatures for provider-patient encounters as well as provider orders. Its computer-based provider order entry (CPOE) capability is an important enabler in the migration from paper-based charting to electronic medical records (EMRs). On the other hand, CPRS is now up to version 26, underscoring an ongoing reality: that EMR systems are continually evolving [[http://www1.va.gov/cprsdemo/ CPRS demo]]. This factor must be considered by providers who have a choice of hosting their own EMR system or going with a monthly fee-based ASP remote-hosting model in order to avoid the hassles of regular updates. Another observation from the VistA CPRS version 26 demo is that even after so many revisions, information density remains very low, a contributing factor to physician preference for paper charts. <br />
<br />
<br />
'''Master Patient Index'''<br />
<br />
There are approximately 140 Department of Veterans Affairs (VA) databases in use across the country in VA facilities that are accessible via VistA systems. Because of this wide distribution of information, there is great potential for individual patient data to be kept under more than one identification number.<br />
<br />
The Master Patient Index (MPI) has been created to support maintenance of a unique patient identifier and a single master index of all VA patients, and to allow messaging of patient information among systems of interest to the MPI [i.e., systems of interest are VA facilities where patients are seen for care, non-VistA systems that have a registered interest in a patient (e.g., Federal Health Information Exchange [FHIE], Home TeleHealth, Person Service Identity Management [PSIM], Health Data Repository [HDR], etc).].<br />
<br />
The ability to uniquely identify a patient and the facilities where that patient receives care is a key factor in the delivery of quality care. The ability to uniquely identify patients assists in the elimination of duplicate records throughout all VA systems and other agencies, and allows the systems to share information for patients that receive care from more than one facility/agency. (4)<br />
<br />
<br />
'''BCMA'''<br />
<br />
Nurses use this application at the bedside at the time of medication administration. Nurses scan the patient’s identification band using a hand-held device, scan the barcode on the medication container and then scan their ID badge at the time when medications are administered. This information is the sent directly to the medication administration record. The system identifies the patient and medication reducing the risk of errors. There is evidence showing a 70% decrease in medication errors after the implementation of this system at one of the VA sites (1).<br />
<br />
Being a system implemented somewhat uniformly across 128 sites, it is noteworthy in its site-specific flexibility. Individual user sites can adopt data dictionaries unique to that site. One important drawback of VistA is that site-specific data dictionaries prevents data summarization between sites, or on a system-wide level. Such data sharing and reporting limitations across sites can be overcome using a national dictionary acting as a cross-reference.<br />
<br />
The VA currently runs a majority of VistA systems on InterSystems Caché. VistA can also run on GT.M, an open source database engine for Linux and Unix computers. Although initially separate releases, publicly available VistA distributions are now often bundled with the database in an integrated package. This has considerably eased installation.<br />
<br />
"For more than 20 years, the FOIA has been used by nonprofit, commercial and foreign entities to obtain copies of the VistA source code. Through such FOIA requests, versions of VistA are in active use in Finland, Germany, Egypt and Latin America, as well as by a number of state and local health care systems in the United States. Examples of external VistA user organizations can be found in Hardhats.org (2003), Marshall (2003) and Medsphere (2003)." [West, Joel,2003]<br />
<br />
VistA and and AHLTA of the DoD, were the first two largest US Government EHR built on standardized base of interoperability of patient records.<br />
The project objective was to develop an interface between the DoD Clinical Data Repositiry (CDR), and the VA's Health Data Repository (HDR) that support a real time bi-directional exchange of computable health data.<br />
<br />
<br />
'''Future VistA Challenges'''[1]<br />
<br />
Using a strategy called HealtheVet VistA will be facing a number of challenges. Overcoming these challenges, will support development of it's planned national health data repository (HDR)reducing the storage needs at each VistA implementation. First and foremost is separating data repositories from underlying applications. Secondly, standardization of formal reference terminologies facilitating organization computable and comparable data is required. The third challenge is to keep the current MUMPS database or migrate to a relational or object oriented database. <br />
<br />
Migration presents additional challenges. Local VistA implementations store data in MUMPS "globals" volume sets on pre-allocated disk sections. When volume sets exceed 16 GB, performance degrades. This is problematic due to three factors; accelerated data accumulation, 75 year record retention requirements, and the physician demand for availability of all records. The HDR is complicated by prior decisions to allow local implementations to determine data dictionaries for clinical data. This choice supported rapid growth of the VistA programs, but now complicates the national decision support system using data from local terminologies that are not recognized. One further complication is the variability of bandwidth and network reliability.<br />
<br />
The federal "HealthePeople strategy" to adopt common data, communications, architecture, security, technical, software standards in federal health information systems (HIS) along with shared software will result in full interoperability.<br />
<br />
<br />
More information on VistaA available at:<br />
<br />
http://en.wikipedia.org/wiki/VistA<br />
<br />
http://www4.va.gov/VISTA_MONOGRAPH/<br />
<br />
<br />
==References==<br />
1. Brown, SH, Lincoln MJ et al. [http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T7S-47CHD1B-1&_user=5674961&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000003838&_version=1&_urlVersion=0&_userid=5674961&md5=ff31f151f996d7eb51044546eb0fe2ec VistA - U.S. Department of Veterans Affairs national-scale HIS]. International Journal of Medical Informatics. 2003; 69:135-156.<br />
<br />
2. West, Joel and O’Mahony, Siobhán [http://www.joelwest.org/Papers/VistA-Community-12-2003.pdf]. 2003<br />
<br />
3. http://www.virec.research.va.gov/DataSourcesName/VISTA/VistA.htm<br />
<br />
4. 2008_2009_VistAHealtheVet_Monograph_FC_0309, http://www.va.gov/VISTA_MONOGRAPH/docs/2008_2009_VistAHealtheVet_Monograph_FC_0309.doc<br />
<br />
<br />
[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>RTompkinshttp://www.clinfowiki.org/wiki/index.php/Alberta_NetcareAlberta Netcare2011-01-17T06:02:11Z<p>RTompkins: </p>
<hr />
<div>== '''Background''' ==<br />
<br />
<br />
[http://www.albertanetcare.ca Alberta Netcare] is a successfully deployed single province-wide [[EMR]] system in Canada. It was developed in order to be a central repository of clinical data that is produced anywhere within the province of Alberta. It holds a secure lifetime record of key health information, and is a critical reference tool for Albertan health care professionals. Thus, it is not a patient's full health or medical record, but a supplement to patient care. The Alberta Netcare system captures several key data elements from health service providers around Alberta for inclusion in a patient's provincial electronic health record. These key elements include:<br />
.personal demographic information as a unique identifier<br />
.prescribed dispensed drugs<br />
.known allergies and intolerances <br />
.immunizations<br />
.laboratory test results<br />
.diagnostic imaging reports<br />
.other medical reports<br />
<br />
== '''Information Management''' ==<br />
<br />
<br />
The information is then provided through Alberta Netcare EHR Portal for physicians, nurses, pharmacists and other authorized health service providers.<br />
It includes several decision support tools including:<br />
.drug to drug and drug to allergy interaction alerts to avoid prescriptions that conflict<br />
.a database of all available drugs and their common dosages<br />
.links to information support such as clinical guidelines from the [http://www.albertadoctors.org/ Alberta Medical Association]<br />
Information is maintained by two methods:<br />
.Primarily, information is automatically accessed and captured from the existing electronic data systems of pharmacies, <br />
labs, diagnostic services and [http://www.albertahealthservices.ca/facilities.asp?pid=facilities Alberta Health Services facilities]. This means that this information is not re-keyed or <br />
re-entered by anyone, it is gathered from source systems. <br />
.Additionally, some information can be entered directly into a record by an Alberta Netcare authorized health service provider.<br />
<br />
== '''Patient Identifier''' ==<br />
Electronic health records created and maintained by Alberta Netcare are indexed by a unique patient identifier, the Provincial Health Number. The PHN is assigned to a person who is eligible to receive services from Alberta Health and Wellness. This value is synonymous with the Unique Lifetime Identifier (ULI) assigned by Person Directory. (1)<br />
<br />
<br />
== '''Products''' ==<br />
<br />
<br />
<nowiki>Alberta Netcare EHR Portal is comprised of several EHR products that have been developed to meet regional needs and the requirements of health service providers. These products are linked together to comprise the province-wide Alberta Netcare EHR Portal.</nowiki><br />
<br />
<br />
The Alberta Netcare EHR product offerings are:<br />
<br />
'''Alberta Netcare EHR Portal'''<br />
Alberta Netcare EHR Portal is the enhanced version of Alberta Netcare Portal 2004. This release provides access to <br />
the full range of currently-available patient health information:<br />
.personal demographic information helps to uniquely identify each patient<br />
.prescribed dispensed drugs<br />
.known allergies and intolerances<br />
.immunizations<br />
.laboratory test results<br />
.diagnostic imaging reports<br />
.other medical reports<br />
<br />
'''System to System Version'''<br />
Alberta Netcare EHR Portal is also available in a "system to system" (S2S) version that integrates directly with <br />
some physician Electronic Medical Record (EMR) systems. S2S allows data to be seamlessly accessed and transferred <br />
between these local systems and the provincial electronic health record.<br />
<br />
'''Alberta Netcare Portal 2004'''<br />
Alberta Netcare Portal 2004 provides access to basic patient information:<br />
.personal demographics to make it easy to identify and find patients<br />
.prescribed dispensed drugs, as well as known allergies and intolerances<br />
.some laboratory results<br />
<br />
== '''References''' ==<br />
1. Pharmaceutical Information Network Data Set, http://www.health.alberta.ca/documents/HISCA-Pharmaceutical-Info.pdf<br />
<br />
<br />
== '''Future Directions''' ==<br />
<br />
<br />
Alberta Netcare EHR Portal continues to be developed and enhanced. Portal 2004 users are being encouraged, assisted <br />
and supported to migrate over to the new EHR Portal.<br />
<br />
<br />
----<br />
[http://www.albertanetcare.ca Alberta Netcare]<br />
<br />
[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>RTompkinshttp://www.clinfowiki.org/wiki/index.php/Alberta_NetcareAlberta Netcare2011-01-17T06:01:15Z<p>RTompkins: Added patient identifier section</p>
<hr />
<div>== '''Background''' ==<br />
<br />
<br />
[http://www.albertanetcare.ca Alberta Netcare] is a successfully deployed single province-wide [[EMR]] system in Canada. It was developed in order to be a central repository of clinical data that is produced anywhere within the province of Alberta. It holds a secure lifetime record of key health information, and is a critical reference tool for Albertan health care professionals. Thus, it is not a patient's full health or medical record, but a supplement to patient care. The Alberta Netcare system captures several key data elements from health service providers around Alberta for inclusion in a patient's provincial electronic health record. These key elements include:<br />
.personal demographic information as a unique identifier<br />
.prescribed dispensed drugs<br />
.known allergies and intolerances <br />
.immunizations<br />
.laboratory test results<br />
.diagnostic imaging reports<br />
.other medical reports<br />
<br />
== '''Information Management''' ==<br />
<br />
<br />
The information is then provided through Alberta Netcare EHR Portal for physicians, nurses, pharmacists and other authorized health service providers.<br />
It includes several decision support tools including:<br />
.drug to drug and drug to allergy interaction alerts to avoid prescriptions that conflict<br />
.a database of all available drugs and their common dosages<br />
.links to information support such as clinical guidelines from the [http://www.albertadoctors.org/ Alberta Medical Association]<br />
Information is maintained by two methods:<br />
.Primarily, information is automatically accessed and captured from the existing electronic data systems of pharmacies, <br />
labs, diagnostic services and [http://www.albertahealthservices.ca/facilities.asp?pid=facilities Alberta Health Services facilities]. This means that this information is not re-keyed or <br />
re-entered by anyone, it is gathered from source systems. <br />
.Additionally, some information can be entered directly into a record by an Alberta Netcare authorized health service provider.<br />
<br />
== '''Patient Identifier''' ==<br />
Electronic health records created and maintained by Alberta Netcare are indexed by a unique patient identifier, the Provincial Health Number. The PHN is assigned to a person who is eligible to receive services from Alberta Health and Wellness. This value is synonymous with the Unique Lifetime Identifier (ULI) assigned by Person Directory.<br />
<br />
<br />
== '''Products''' ==<br />
<br />
<br />
<nowiki>Alberta Netcare EHR Portal is comprised of several EHR products that have been developed to meet regional needs and the requirements of health service providers. These products are linked together to comprise the province-wide Alberta Netcare EHR Portal.</nowiki><br />
<br />
<br />
The Alberta Netcare EHR product offerings are:<br />
<br />
'''Alberta Netcare EHR Portal'''<br />
Alberta Netcare EHR Portal is the enhanced version of Alberta Netcare Portal 2004. This release provides access to <br />
the full range of currently-available patient health information:<br />
.personal demographic information helps to uniquely identify each patient<br />
.prescribed dispensed drugs<br />
.known allergies and intolerances<br />
.immunizations<br />
.laboratory test results<br />
.diagnostic imaging reports<br />
.other medical reports<br />
<br />
'''System to System Version'''<br />
Alberta Netcare EHR Portal is also available in a "system to system" (S2S) version that integrates directly with <br />
some physician Electronic Medical Record (EMR) systems. S2S allows data to be seamlessly accessed and transferred <br />
between these local systems and the provincial electronic health record.<br />
<br />
'''Alberta Netcare Portal 2004'''<br />
Alberta Netcare Portal 2004 provides access to basic patient information:<br />
.personal demographics to make it easy to identify and find patients<br />
.prescribed dispensed drugs, as well as known allergies and intolerances<br />
.some laboratory results<br />
<br />
== '''References''' ==<br />
1. Pharmaceutical Information Network Data Set, http://www.health.alberta.ca/documents/HISCA-Pharmaceutical-Info.pdf<br />
<br />
<br />
== '''Future Directions''' ==<br />
<br />
<br />
Alberta Netcare EHR Portal continues to be developed and enhanced. Portal 2004 users are being encouraged, assisted <br />
and supported to migrate over to the new EHR Portal.<br />
<br />
<br />
----<br />
[http://www.albertanetcare.ca Alberta Netcare]<br />
<br />
[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>RTompkinshttp://www.clinfowiki.org/wiki/index.php/Regenstrief_Medical_Record_System_(RMRS)Regenstrief Medical Record System (RMRS)2011-01-17T05:41:01Z<p>RTompkins: Adding patient identification section</p>
<hr />
<div>Orginally developed in 1972 by Clem Mcdonald, Regenstrief Medical Record System (RMRS) is a complex system that involves manipulation, transfer, and storage of data in and associated with electronic medical records. It is the first EMR to generate reminders to physicians about its own content. Using an internally-developed decision support language - CARE, providers could develop protocol-specific reminders to streamline clinical decision making. One study found that physician compliance with preventative care rose to 51% from 22% when RMRS suggestions were used. Physicians did not seem to have learned from the suggestions, because compliance dropped back down to baseline when the suggestions from RMRS was removed. This finding is particularly important because it indicates that physician knowledge is less important for patient care than providing the physician with the appropriate intellectual artifacts.<br />
<br />
The goal was to: <br />
<br />
* eliminate the logistic problems of the paper record by making clinical data immediately available to authorized users wherever they are—no more unavailable orundecipherable clinical records; <br />
* to reduce the work of clinical book keeping required to manage patients—no more missed diagnoses when laboratory evidence shouts its existence,no more forgetting about required preventive care; <br />
* to make the informational ‘gold’ in the medical record accessible to clinical, epidemiologic, outcomes and management research. The system was to complement, not replace, the paper medical record.<br />
<br />
It began in 1972 in a diabetes clinic with only 35 patients. Rule-based physican reminders were implemented in 1974. Physicans began entry of outpatient test orders in 1984, and in 1990, this was extended to outpatient test orders. In 1994, the Institute extended RMRS to the Indiana Network for Patient Care (INPC) in order to link Indianapolis' five major hospital systems. The majority of all hospital discharge notes have been entered by physicans since 1997.<br />
<br />
As of 1999, the RMRS carried 200 million separate coded observations,3.25 million narrative reports, 15 million prescriptions<br />
and 212,000 electrocardiographic (EKG) tracings. The RMRS carried records for 1.4 million patients in addition to all data generated from several thousand ambulatory and inpatient encounters per year, <br />
<br />
As of now, the RMRS is still operating, which carries 660 million distinct observation. This makes RMRS one of the longest operating EMRs in the world. The RMRS is being accessed more than 10 million times every year by Wishard Health Services and 20 million times per year at Clarian Health in Indianapolis.<br />
<br />
The RMRS has been best studies and it is well known nationally and internationally to be the model for a number of commercial and academic EMR systems.<br />
<br />
This system serves four hospitals on the Indiana University Medical Center campus and forty outreach practices in the city of Indianapolis.<br />
<br />
The systems success can be attributed to it's strong foundation in 3 areas. <br />
<br />
* Physician leadership in the informatics effort is vital. It is their intelligence, self-confidence, high energy, and clinical knowledge. <br />
* Commitment to the mission and vision of high quality and excellence in health care driven and believed in from the highest echelon within the hospital, and <br />
* Continuous quality improvement and incorporation of user feedback to guide this improvement.<br />
<br />
Quickly fixed mistakes are tolerated by Physicians, and this had driven an evolutionary approach. The software is updated incrementally and feedback from the users is sought early and often. Feature's are added based upon which is easiest to fix or implement. <br />
<br />
The data repository is the key component of the system. It originally called for no data entry for physicians' observations. Creator Clement McDonald, M.D. and his co-authors note that physicians were reluctant to perform data entry. The system developers first enlisted physicians for data entry with a physician orders system because orders are more easily structured for data input than observations.<br />
<br />
Significant effort is required to create mechanisms to capture clinical data. Universal or standardized codes such as LOINC and SNOMED through HL7 interfaces have eased the strain. <br />
What data to capture is an important decision. Multiple systems, types of data, formats, and the large number and variety of sources require a great deal of effort and thus the need for planning and prioritizing. <br />
<br />
Direct capture by electronic interface based on HL7 can be facilitated from beside electronic instruments, patient registration system, laboratory, pharmacy, appointment scheduling, dictation/transcription radiology, nurse telephone triage and billing systems.<br />
<br />
Clerk data entry is used to code the impressions of most diagnostic reports not already coded by the system. This allows the system can understand the diagnostic content for patient retrievals and reminders. They enter standardized phrases and abbreviations instead of numeric codes that would add to the training. The data entry clerks also enter the number values of predefined questions, such as blood pressure or finger stick glucose.<br />
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Physician workstation entry eliminates delays, costs and potential errors due to transcription. Direct entry by physicians also validates the person who is most knowledgeable of the information and is in the best position to act on “smart” computer feedback.<br />
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Today, most nursing home orders, as well as ED release and inpatient orders are entered directly into the computer system by physicians using the Medical Gopher CPOE workstation. Dictated discharge summaries have largely been replaced by physician-generated discharge notes entered directly into the computer. Similarly, most of the outpatient clinic notes are entered directly into the computer using the Medical Gopher system.<br />
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The Gopher workstation also allows the printing of personalized patient information handouts, permits doctors and nurses to communicate via confidential email and can even display satellite weather photos. Physicians can also access past issues of leading medical journals and the American Hospital Formulary drug monographs to research specific topics or learn more about a certain medication. <br />
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A 2001 study from Wishard Memorial Hospital demonstrated that computerized reminders significantly improved the use of preventative measures in eligible patients admitted to the hospital. Compared to a control group, those patients whose physicians received reminders received more influenza and pneumococcal vaccinations, subcutaneous heparin prophylaxis and aspirin at the time of discharge. However, even with the reminders, compliance with the recommendations was still far from being universally accepted by the physicians.<br />
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One of the keys behind the system is that the numerous forms and reports are not pre-generated. Instead, they have a generalized template ("schema") which deals with high-level components like "notes in this section" and "vitals in this section". And then based upon the data for a patient, the display is materialized. <br />
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The general layout of the system is with the problem list on the upper left side with a physician specified and chosen set of observation variables like vitals on the lower left portion of the screen. On the right side is a section for notes and below that is where orders are entered and reviewed. As far as reports, a great deal of them can be created and customized to the encounter. Such reports can be as wordy or succinct as the doctor desires and ready prior to the patient encounter. <br />
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===Data capture===<br />
* [https://www.himss.org/content/files/davies_1997_regenstrief.pdf Data capture] obviously is an important component in any electronic patient record system. Accuracy, security, portability, accessibility are just some of the important but extremely difficult aspects of it that need to be addressed in every design. Add to this the multitude of touch points a patient may interact with in their medical encounter and the many data acquisition devices each department use - ECG prods, MRI, etc. - that all interface and send data to a central repository for storage. Some of the data types and mechanisms used to capture them are shown in this figure:<br />
http://img16.imageshack.us/img16/3250/rmrs.png<br />
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===Patient Identification===<br />
Since the RMRS has developed the capacity to span multiple enterprises, it is necessary to use a global patient index to identify patients. This index relies on sophisticated matching algorithms to determine which registration records from the various enterprises represent the same patient. Once matching registry records are identified, virtual medical records about one patient from many enterprises can be produced at display time. This ‘cross enterprise’ access occurs at a very low level and allows most of the RMRS texts to function in this multiple enterprise environment with minimal modification.<br />
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==References==<br />
1. McDonald, C.J., Tierney, W.M., Overhage J.M., et al. (1997). [https://www.himss.org/content/files/davies_1997_regenstrief.pdf The three-legged stool: Regenstrief institute for health care.] In J.M. Teich (Ed.), The third annual Nicholas E. Davis award: Proceedings of the CPR recognition symposium: (pp. 131-158). Shaumburg, IL.<br />
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2. [http://www.medicine.indiana.edu/news_releases/archive_00/regenstrief_mrs_00.html Indiana School of Medicine]<br />
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3. [http://www.regenstrief.org/medinformatics/rmrs RMRS Introduction]<br />
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4. McDonald CJ. The Regenstrief Medical Record System: a quarter century experience. International Journal of Medical Informatics. 1999. 54(1999)225-53.<br />
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5. Dexter PR, et al. A Computerized Reminder System to Increase The Use of Preventative Care for Hospitalized Patients. NEJM 2001; 345 (13):965-70.<br />
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6. Friedlin J., et al. Details of a Successful Clinical Decision Support System. AMIA Annu Symp Proc 2007; 2007:254-258.<br />
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7. [http://www.regenstrief.org/medinformatics/inpc Indiana Network for Patient Care]<br />
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[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>RTompkinshttp://www.clinfowiki.org/wiki/index.php/Hospital_Italiano_EHR_SystemHospital Italiano EHR System2011-01-17T05:34:46Z<p>RTompkins: Editing description of Master Patient Index</p>
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<div>'''Introduction'''<br />
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''The Hospital''<br />
<!--Information added by Paula Otero - Department of Medical Informatics - Hospital Italiano de Buenos Aires--><br />
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The Hospital Italiano de Buenos Aires (HIBA) is a not for profit health care academic center founded in 1853 in Argentina, that has the latest technology applied to healthcare, with over 1,500 physicians and 3,500 employees. In the domain of healthcare delivery, HIBA has a network of 2 hospitals with 750 beds (200 for intensive care) 500 home care patients under care, and 23 clinics. It has an insurance plan that covers approximately 150,000 people and also coordinates insurance for another 1,500,000 people who are covered by affiliated insurers. Each year over 36,000 inpatients (pediatric and adult) are admitted to our hospitals that are located in the city of Buenos Aires and suburban area. More than 2,400,000 outpatient visits from patients from all over the country and Latin America.<br />
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<!--Information added and edited by Jorge Rodriguez - Department of Databases - Ministery of Health. Government of Buenos Aires--><br />
''Overview of Hospital Italiano CIS''<br />
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The system was created by the information department and started in 1998. The first step was to develop the ambulatory system. Professional involved in first design of the system were: Fernan Bernaldo de Quiroz, MD - Daniel Luna, MD - Paula Otero, MD between others.<br />
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The Hospital Information Department is working since more than 10 years in a Electronic Health Record system focused in the first step of development in the ambulatory care and then in the inpatient registry. The system is developed by open source tools like PHP language and JAVA, and works with Oracle databases in the backend. Up to now the system has the following modules: ADT, Outpatient management, Inpatient management, EMR, Pharmacy and Laboratory results on line. The EMR works with terminology server (matching with SNOMED), web based DRG's and their own medical thesaurus. For more information see [http://www.hospitalitaliano.org.ar/infomed/index.php?contenido=ver_seccion.php&id_seccion=56&p=1.1.1.1 History] (in spanish)<br />
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Up to now the Hospital Italiano has an intranet with more than 1,700 workstations and a fully integrated EHR system. <br />
The regional importance of this development is that it was the first integrated EMR in private hospitals in Argentina using terminology server and SNOMED, and one of the most rubust in Latin America.<br />
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<!--Information added by Paula Otero - Department of Medical Informatics - Hospital Italiano de Buenos Aires--><br />
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'''Building our Clinical Information System: Project ITALICA'''<br><br />
Until the 90’s HIBA was primarily focused on delivering acute care and the hospital information system had been developed for the automation of administrative, billing and reimbursement tasks. With the emergence of our own insurance plan and the growing need of the ambulatory care we were directed to expand our information systems beyond the administrative arena.<br> <br />
In the year 1998 HIBA decided to gradually implement a Healthcare Information System (HIS) by incorporating the clinical layer to the administrative applications that were already in use. It is an in-house project that currently handles all the information related to healthcare both clinical and administrative from capture to analysis. <br />
As part of the project that was called '''ITALICA''', the Department of Medical Informatics was created in 2001 involving over 110 people between clinicians, IT professionals and technicians. Our Department of Medical Informatics works on the development and maintenance of the hospital’s health information system. Before the decision of informatizing the clinical layer, all the administrative and financial areas were computerized in legacy systems that needed to be integrated in a HIS, and at the time the project started a patient could have up to 40 different ID´s depending on what area of the hospital they were being treated. There was an urgent need of the implementation of physical interoperability and the use of standards in order to achieve semantic interoperability.<br><br />
In order to achieve physical interoperability HL7 version 2.x was implemented so as to create fluent communication between three components that had been found: the administrative component that included not only financial and administrative issues but also took care of ADT (admission, discharge and transport), the ancillary services component that included Laboratory and Radiology that already had informatics applications working on their Departments and finally the clinical component that would be developed as had to be integrated with the other components. The focus was made on achieving all the data for a medical encounter or test and the patient characteristics were stored in patient centered health information system so the “medical encounter” would be the main axis of the information model.<br> <br />
Once the physical interoperability was solved, the creation of local Master Files mapped to standard terminologies and classifications were created in order to achieve semantic interoperability. The following Master Files were created:<br><br />
*''Master Patient Index (MPI)'' that allows the unequivocal identification of patients. The quality of the data included is guaranteed by correct identification of data from different centers of registration within the institution and a constant audit of data, process, and registration operators. The CORBAMed conceptual model was used to create this master file.<br />
*''Master File of Healthcare Professionals'' is a part of the MPI where all the healthcare professionals that work at the Hospital are assigned a role according to the specialty and type of work done. This master files also interacts with the Master Files of Professional Areas that identifies on what type of area a professional works. <br />
*''Master File of Payors and Insurers'': all the payors that have a contract for healthcare delivery with the Hospital are included in this application. <br />
*''Master File of Medical Tests'': includes all the tests that are carried out at the Hospital (lab, radiology, pathology, etc.) each test has its description, attributes for ordering and information for patients regarding preparation and additional information for the ordering of the test for healthcare professionals. <br />
*''Master File of Drugs and Medical Devices'': in this master file all the information for each drug that is needed to interact with the CPOE is included (8). <br />
*''Master File of Diagnosis'': includes all the information harvested from the EHR as a medical problem or healthcare encounter at different levels of care, this information is stored in a clinical data repository so it can be used for Clinical Decision Support Systems.<br />
The Master Files that include clinical terminology: diagnosis, medical tests, drugs and medical devices are stored in clinical terminology server that handles a local interface terminology and uses SNOMED CT as reference terminology. <br><br />
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'''Terminology Server'''<br><br />
The Terminology Server is a software composed of a local interface vocabulary (thesaurus) mapped to a reference vocabulary, SNOMED CT. The thesaurus is a list of terms created from almost 2 million free text inputs extracted from the clinical data repository. The terms included in the thesaurus are divided into concepts (real clinical entities) and descriptions (different ways of naming these clinical entities). The Terminology Server also has capabilities to reject invalid terms already flagged as not appropriate for the intended use The key objective of our Terminology Server project was to build a local Interface Terminology that allowed users to record clinical data choosing options from a list of familiar terms but storing information SNOMED CT compatible. The Interface Terminology provides adequate coverage for our reality. Users have the ability to refine terms, choosing a more specific option of a given term, and propose new terms to improve coverage. The system also provides the equivalence of a given local term in standard classifications. A “Terminology Team” is in charge of the maintenance of the Interface Terminology. The Terminology Server maps from our local Interface Terminology to standard classifications like ICD-9CM, ICD-10 or ICPC2 through the SNOMED CT standard cross-maps mechanism and concepts included in the local Interface Terminology that are not present in the original SNOMED CT distribution, are mapped through its super-types, the more general, standard concepts used for represent their meaning. The local Interface Terminology was implemented in our health information system on June 2006 using a set of Terminology Services. The first area was the inpatient structured discharge summary input. Subsets for Diagnosis and Procedures are used in a user interface that allows text input and search of related terms. The user interface uses the rules for dealing with invalid, ambiguous and refinement rules. We are also using a model for dynamic subset definitions, that are a set of rules that allow the definition of a subset in terms of their relationships with SNOMED CT concepts. In this way we can define in the local Interface Terminology a “Diabetes Subset” with all the terms related to the concept “Diabetes Mellitus” in SNOMED CT or any of its subtypes. <br><br />
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'''The Electronic Health Record'''<br><br />
Our EHR is patient centered and problem oriented and currently is working in the outpatient, inpatient and emergency care settings with different modalities of implementation. We have recently implemented a Picture Archive and Communication Systems (PACS) and a Signal Archive and Communication System (SACS) so as to have a multimedia EHR, meaning that there is full interoperability between images and the EHR, and the images and signals can be seen directly from the EHR application. A Chronic Disease Management Systems (CDMS) that uses clinical information from the EHR has been also implemented. This CDMS enable health care providers to surveillance and manage patient within our HMO that have diabetes and hypertension among other chronic conditions. This program was awarded with the “Best International Disease Management Program” prize, during the 5th Annual DMAA (Disease Management Association of America) Conference in 2003, Chicago, USA. A Personal Health Record was created that will help patients participate more actively and interact with different areas of our HIS. We are currently involved in a project with Duke University for the implementation of a clinical decision support system called “Sebastian” that works between institutions in two languages (English and Spanish).<br />
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Get more information [http://www.hospitalitaliano.org.ar offical web site], and in the [http://www.hospitalitaliano.org.ar/infomed Hospital Information Department] section.<br />
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For a list of publications of this professional team refer to [http://www.hospitalitaliano.org.ar/infomed/index.php?contenido=trabajos_general.php&p=1.1.1.1 Published work] section.<br />
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[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>RTompkins