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

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The [[EMR|Electronic Medical Record]] may consist of computer order entry, decision support, electronic medication administration, documentation, and so much more.  <ref name="what is an emr">What Is an Electronic Medical Record (EMR)? http://www.healthit.gov/providers-professionals/electronic-medical-records-emr</ref>
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The sections below detail the benefits, costs, and barriers in evaluating EMR implementations. Selecting, financing, and launching an EHR system is difficult.
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The sections below detail the benefits, costs, and barriers in evaluating EMR implementations. Selecting, financing, and launching an EHR system is difficult. Product certification seeks to make the first step a little easier. <ref name=" Heubusch. (2008)"> Heubusch, K. (2008). Certified EHRs. Journal of AHIMA, 79(8), 34-36. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/212569443?accountid=7034</ref>
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== Informational ==
 
== Informational ==
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== Security ==
 
== Security ==
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[[EMR Benefits: Security]]
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[[EMR Benefits: Security]] is an advantageous attribute which comes with EMR systems. Centers for Medicare and Medicaid Services (CMS) published a privacy, security & [[Meaningful Use|meaningful use]] guidelines which computer systems that store patient information need to conform to imply to [[Health Insurance Portability and Accountability Act (HIPAA)|HIPAA]] privacy guidelines. <ref name="Privacy-Standards-CMS">Centers for Medicare & Medicaid Services. Privacy and Security Standards. http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/HIPAAGenInfo/PrivacyandSecurityStandards.html</ref>
  
 
== Environmental ==
 
== Environmental ==
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[[EMR Benefits: Environmental]]
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[[EMR Benefits: Environmental]] positive impact through Electronic Health Records has the potential to improve the environmental footprint left by the health care industry. <ref name="turley 2011">Turley, M., Porter, C., Garrido, T., Gerwig, K., Young, S., Radler, L., & Shaber, R. (2011). Use of electronic health records can improve the health care industry’s environmental footprint. Health affairs, 30(5), 938-946.</ref>
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== Quality Outcomes ==
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EHR’s can be utilized to generate reports on quality measures in the effort to improve quality and patient satisfaction. With the ability to produce reports from EHR’s, clinicians can easily compare data to baseline data and quickly identify areas in need of improvement. Once areas in need of improvement have been identified, clinicians can compare data to manual reports and similar data to validate the reported information.  Once an area of improvement has been identified it can be delivered to the performance improvement department where informatics professionals can perform gap analysis and identify methods to improve overall quality. , <ref name="Stefan 2011">Stefan, Susan (2011). Using clinical EHR metrics to demonstrate quality outcomes.http://ovidsp.tx.ovid.com.ezproxyhost.library.tmc.edu/sp-3.16.0b/ovidweb.cgi?QS2=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
  
 
== Medical Education ==
 
== Medical Education ==
 
[[EMR Benefits: Medical education]]
 
[[EMR Benefits: Medical education]]
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In a teaching facility EMRs can be a very useful tool for medical education and training.  EMRs can be used to monitor how much time each trainee spends with patients and therefore their clinical experience in terms of patient diagnosis and procedures can be tracked and reported to enable optimization of workflow for both trainee and training programs. <ref name= "Tierney 2013">Tierney et al, Medical Education in the Electronic Medical Record (EMR) Era: Benefits, Challenges, and Future Directions http://tmclibrary.summon.serialssolutions.com/search?s.q=tierney+m+j#!/search?ho=t&l=en&q=Medical%20education%20in%20the%20electronic%20medical%20record%20(EMR)%20era:%20Benefits,%20challenges,%20and%20future%20directions.%20Academic%20Medicine</ref>
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In addition the use of EMRs in a teaching environment allows trainees access to the most up to date information. “Point-of-care education accessed via CDS allows for easy access to relevant and up-to-date medical literature from which students and residents can draw to formulate diagnosis and management plans".<ref name= "Tierney 2013">Tierney et al, Medical Education in the Electronic Medical Record (EMR) Era: Benefits, Challenges, and Future Directions http://tmclibrary.summon.serialssolutions.com/search?s.q=tierney+m+j#!/search?ho=t&l=en&q=Medical%20education%20in%20the%20electronic%20medical%20record%20(EMR)%20era:%20Benefits,%20challenges,%20and%20future%20directions.%20Academic%20Medicine</ref>
  
 
== Financial ==
 
== Financial ==
 
[[EMR Benefits: Financial]]
 
[[EMR Benefits: Financial]]
  
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== Improving patient care ==
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"Implementing an EMR system could cost a single physician approximately $163,765. As of May
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[[EMR Benefits: Healthcare quality]]
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2015, the Centers for Medicare and Medicaid Services (CMS) had paid more than $30 billion in
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financial incentives to more than 468,000 Medicare and Medicaid providers for implementing
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EMR systems. With a majority of Americans now having at least one if not multiple EMRs
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generated on their behalf, data breaches and security threats are becoming more common and are
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estimated by the American Action Forum (AAF) to have cost the health care industry as much as
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$50.6 billion since 2009." <ref name="O'Neill"> O'Neill, T. (2015, August). Are Electronic Medical Records Worth the Cost of Implementation.</ref>
  
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== Research ==
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Some of the ways that EMR systems can cut healthcare costs are due to savings based on "time-consuming paper-driven and labor-intensive tasks":<ref name="Medical Cost"> Kumar, S., & Bauer, K. (2011). Medical Practice Efficiencies & Cost Savings.http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings</ref>
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[[EMR Benefits: Research]]
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== Health Information Exchange (HIE) ==
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* Reduced transcription costs<ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
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[[EMR Benefits: HIE]]
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* Reduced chart pull, storage, and re-filing costs <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
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* Improved and more accurate reimbursement coding with improved documentation for highly compensated codes <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
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* Reduced medical errors through better access to patient data and error prevention alerts <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
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* Improved patient health/quality of care through better disease management and patient education <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
  
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== Personal Health Records ==
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There are few comprehensive estimates of savings from Health Information Technology (HIT) at the national level. At 90 percent adoption, it is estimated that the potential HIT – enabled efficiency savings for both inpatient and outpatient care could average more than 77 billion per year.<ref name=”Hillestad 2005”> </ref> <ref name=”Hillestad 2005”> Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. Health Affairs, 24(5), 1103-1117.</ref>
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[[EMR Benefits: PHR]]
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==Telehealth==
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Although the full extent of EMR advantages may not become apparent until further implementation and research is carried out, a clear benefit is the reduction of cost. Major administrative costs can be eliminated or reduced. Providers can do away with the costs of “chart pulls,” while substantially reducing dictation costs through the use of EMRs. Healthcare providers can also receive decision support regarding selection and costs of medications, radiographic studies, and laboratory tests.<ref name="Bates 2003"> Bates, D. W., Ebell, M., Gotlieb, E., Zapp, J., & Mullins, H. C. (2003). A proposal for electronic medical records in US primary care. Journal of the American Medical Informatics Association, 10(1), 1-10.</ref>
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[[EMR Benefits: Telehealth]]
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== Mobile EMRs ==
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===Billing Accuracy===
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[[EMR_Benefits: mHealth]]
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== Physicians ==
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The benefits for small to medium private practices that have implemented EMR systems integrated with the practices' billing and prescription systems, can be increased efficiency and accuracy thanks to automatic coding leading to improved profitability. "Since installing the EMR, Medicare has audited only one of my charts. I had billed out as a level four and Medicare said it should have been billed as a level five, which, in essence, said that we should have been paid more. My EMR system gave the chart a level four and I believe it was right.” "Since adopting an EMR system, my practice receipts have increased about $4,000 per month."<ref name="Sonnenberg 2007">EMR ROI: A Pennsylvania family practice's investment in an EMR pays off three-fold.  http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?p=HRCA&u=txshracd2509&id=GALE|A163469720&v=2.1&it=r&sid=summon&userGroup=txshracd2509</ref>
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[[EMR Benefits: Physicians]]
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A nuanced view is appropriate here, however; improved billing can coincide with fewer patients seen. "EHR implementation ... increased reimbursements but reduced long-term practice productivity across all specialties"<ref name="Howley 2015">Howley et al, 2015. "The long-term financial impact of electronic health record implementation" http://jamia.oxfordjournals.org/content/22/2/443</ref> according to one study. This may be a net financial positive for the practice: "an EHR should greatly enhance physician effectiveness even if fewer patients are seen by the physician"<ref name="Howley 2015"></ref> due to gains in billing efficiency, but this also represents an artificial reduction in the supply of services.
  
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=== Improve Legal and Regulatory Compliance ===
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=== An EMR Cost Benefit Analysis ===
  
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EMRs can facilitate and improve legal and regulatory compliance in terms of increased security of data and enhanced patient confidentiality through controlled and auditable provider access
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Samsung Medical Center (SMC) performed a cost benefit analysis (CBA) on the cost benefits of implementing an electronic medical record (EMR) system.  Costs of implementing the EMR system involved both '''direct costs''' to build the system infrastructure and '''induced costs''' to make a smooth transition to the new system.  Benefits of implementing the EMR system include both cost reductions and increased revenue. Five types of cost reductions, mentioned by the authors, include:
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<ref name="benefits & drawbacks"></ref>. In a study by Bhattacherjee et al, Florida hospitals with a greater adoption of health information technology had higher operational performance, as measured by outcomes of Joint Commission on Accreditation of Healthcare Organizations (JCAHO) site visits <ref name="benefits & drawbacks"></ref>
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# Reduction of supplies for paper charts
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# Disposal of storage facilities used for paper chart storage
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# Reduction of full-time equivalent (FTE) employees for the paper chart management
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# Reduction in staff for outpatient clinics
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# Decreased supplies for medical devices
  
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=== EMRs Help Manage Transactions ===
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The FTE's responsible for paper management were greatly reduced from 28 FTE's (2007) to 1 FTE (2009).
  
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EMRs help better manage the “large number of transactions and handoffs” which can include: billing, physicians’ orders, prescriptions, nurses’ orders insurance information, and more.  Having this information all in one place makes it easier for any staff member – from administrators/front office to pharmacists to physical therapists – to gain access to the patient’s records and read and notes that may apply to them. [6]
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This CBA was based on an eight year period post EMR implementation.  SMC determined the EMR system became cost effective shortly after 6 years.  The outcomes of the CBA were calculated using the following formulas:
  
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* The primary outcome is the Net Present Value (NPV)
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** '''NPV = Present Value (PV) of benefit for the eight year period - PV of cost'''
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* The second outcome is the Benefit Cost Ratio (BCR)
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** '''BCR = PV of the benefit / PV of the cost'''
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* The third outcome is the Discounted Payback Period (DPP). 
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**'''This is the time to reach the breakeven point'''.
  
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=== Patient Handoff ===
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This CBA does not include clinical benefits of the EMR implementation such as decreased medication errors, improved workflow, and reduced length of stay.<ref name="Choi 2013">Choi, J., Lee, W., Rhee, P. (2013). Cost-Benefit Analysis of Electronic Medical Record System at a Tertiary Care Hospital, Health Informatics Research;19(3):205-214. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3810528/</ref>
  
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Patients can be safely handed off from one caregiver to the other. Especially CPOE reduces errors due to bad handwriting, verbal miscommunication etc.
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== Improving Patient Care ==
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Implementing standardized, electronic patient hand off communication tools is known to have a positive effect on provider satisfaction and potentially patient safety. <ref name="Dyches, 2004">Implementation of a Standardized, Electronic Patient Hand Off Communication Tool in a Level III NICU. Source: OJNI Volume 18, Number 2 June 1, 2014</ref> Also, integrating sign off notes into EHR was found to improve physician workflow and improve physician satisfaction. <ref name="Bernstein 2010">Bernstein, Jonathan A.; Imler, Daniel L.; Sharek, Paul; Longhurst, Christopher A. Improved Physician Work Flow After Integrating Sign-out Notes into the Electronic Medical Record Source: Joint Commission Journal on Quality and Patient Safety, Volume 36, Number 2, February 2010, pp. 72-78(7) </ref>
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[[EMR Benefits: Healthcare quality]]
  
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Many EMRs have alert systems that ensure physicians do not forget to request important tests.  As well as the legal benefits that this provides, EMR alerts remind physicians of the "preventive care needs for patients, which helps improve quality of care and office income by reminding us to do appropriate testing and provide vaccinations" recommended for some patient conditions e.g. asthma, emphysema or diabetes. <ref name= Block 2008">How We Improved Our Practice and Our Bottom Line With a New EMR System.Fam Pract Manag, 15(7), 25. http://www.aafp.org/fpm/2008/0700/p25.html</ref>
  
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===Improve efficiency and patient throughput===
 
  
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The Institute of Medicine estimates that $17-29 billion is spent annually on unnecessary or inaccurate patient care due to misdiagnosis. If clinicians can rapidly determine the correct dose, calculation or diagnosis, they can order relevant tests and make appropriate referrals, saving time and eliminating unnecessary costs for the patients and the ED. Of course, CDS is most effective when it is built into the clinician’s workflow, which minimizes interruptions and dangerous distractions. It is also important for CDS to be incorporated into providers’ workflow in such a way that minimizes alert fatigue.<ref name=”Robert Hitchcock”> Top 5 Benefits of Clinical Decision Support in the ED http://www.govhealthit.com/blog/top-5-benefits-clinical-decision-support-ed</ref>.
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[[EMR Benefits: Reduction in no shows]]
  
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EMR system was used to improve on automated calls made to patients to remind them of their appointment which reduced the number of no call shows and improved patient satisfaction.
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<ref name= Block 2008">How We Improved Our Practice and Our Bottom Line With a New EMR System.Fam Pract Manag, 15(7), 25. http://www.aafp.org/fpm/2008/0700/p25.html</ref>
  
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[[EMR Benefits: Medication Management]]
  
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"Rational antibiotic use resulted in a lower mortality of 0.0644 % during the post-implementation period compared to 0.179 % during the pre-implementation period (p = 0.018). The comprehensive EMR system contributed to a significant reduction in antibiotic consumption and an improvement in rational antibiotic use."<ref name= journal of medical systems">The Meaningful Use of EMR in Chinese Hospitals: A Case Study on Curbing Antibiotic Abuse 15(7),</ref>
  
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EMR systems have the ability to make evidence-based suggestions regarding patient care. With these suggestions, EMRs are able to use a patient’s information to identify preventative services that specific patient may need. The system is able to remind doctors that the patient is due for certain screening exams or other services which allows the doctor to discuss it with the patient and also allows the patient to decide whether or not they would like to schedule an appointment for that specific exam. This reminder has proven to benefit patient care by increasing compliance with preventative care.
  
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EMRs also benefit patient care by assisting in long-term chronic disease prevention and management. Case management systems in EMRs allow patients to communicate with a variety of specialists, which better enables them to manage their care. This system also allows healthcare providers to keep track of patient data, such as vital signs, and allows case management nurses to quickly respond to any issues that may occur. The system benefits the patient because it allows the patient’s acute issues to be handled promptly before they become bigger issues that may lead to a hospital admission.
  
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== Barriers to EMR Implementation ==
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EMRs have the ability to eliminate up to 200,000 adverse drug events with the use of CPOE.  Using reminders and alerts CPOEs are able to notify physicians about possible drug interactions that may occur when a new medication order is placed.
  
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===  System Selection ===
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EMRs have a direct correlation with the quality of healthcare offered to a patient. Problems in healthcare quality fell into three categories as stipulated by the National Roundtable on Health Care Quality. These three categories are the underuse, overuse, and misuse of healthcare services. Reducing overuse and misuse of healthcare services, as noted by the Roundtable, leads to an increase in health care quality while simultaneously lowering costs. In addition, reducing the underuse of healthcare services increases quality, but may in turn increase costs. “Computerized physician order [CPOE] entry may affect all three categories of health care quality problems, as well as inefficiencies in the health care system.” <ref name="Kuperman 2003">Kuperman, G. J., & Gibson, R. F. (2003). Computer physician order entry: benefits, costs, and issues. Annals of internal medicine, 139(1), 31-39.</ref>
  
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Based on the application the type of system selected will vary based on current research, size of practice, institution, academic affiliation, vendors and their ability to demonstrate compliance with current research “by identifying funded and published research(Kannry  Mukani& Myers , 2006)” and ultimately the assessment and analysis of the total cost of ownership.
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== Research ==
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[[EMR Benefits: Research]]
  
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ONE CONSISTENT THEME emerges from EHR implementations in physician practices: almost everyone underestimates the complexity, time, and effort required. <ref name="Gaudreau (2009)">Gaudreau, E., & Palermo, D. (2009). EHR fast track. Journal of AHIMA, 80(8), 40-43. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/212610540?accountid=703</ref>
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Researchers can use EHRs to retrieve up-to-date data from various sources around the country to advance their studies. EHRs can compute a report to show researchers certain trends in the population or common side effects of medications. <ref name="Enormous Benefits"></ref>
  
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According to Kannry  Mukani& Myers in their 2006 article Using an Evidence-based Approach for System Selection at a Large Academic Medical Center: Lessons Learned in Selecting an Ambulatory EMR at Mount Sinai Hospital . The authors note the technology requirements of educational institutions vary greatly from the needs of the private sector.  Although both the private sector and academia have concerns with accurate documentation, patient safety and patient care, educational institutions focus on “education, training and research, (Kannry  Mukani& Myers, 2006).  The need of residents and compliance with regulatory requirements is significant and cannot be minimized. [13] According to Ajami and Chadegani, despite of the potential benefits of electronic health records, implement of this project facing with barriers and restriction, that the most of these limitations are cost constraints, technical limitations, standardization limits, attitudinal constraints–behavior of individuals and organizational constraints.[71]
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== Health Information Exchange (HIE) ==
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The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of time and workload. Each user group also identified factors specific to their professional and individual priorities [30].
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[[EMR Benefits: HIE]]
  
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* In order for an EMR to be truly successful, proper and timely training must be administered to all who will interact with the system.
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== Personal Health Records ==
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* Conflicting research findings on the cost and efficiency benefits of EMR implementations will make it difficult, if not impossible, for administration staff to be confident in choosing an EMR for their facility. Until there is adequate research on multitudes of EMR systems that shows causal relationships between facility characteristics and the related EMR components there will not be a sufficient method of EMR selection and implantation.
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[[EMR Benefits: PHR]]
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* If it is true that implementations of EMRs cause a decrease in efficiency and an increase in quality of medical care then further research must take both of these repercussions into account and determine if there is an overall net benefit of EMR implementation.
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*The use of EMR and the afforded efficiencies may not provide immediate cost savings to some office-based physicians. These physicians may not be able to reduce their office expenses sufficiently to offset the revenue decreases they may see as a result of increasing efficiency. For example, a physician who is paid, as many laboratory or treatment centers are, per service rendered would see a direct decrease in revenue were they to reduce the number of duplicated diagnostic tests.[http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/91xx/doc9168/05-20-healthit.pdf ]
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* The reported barriers to adoption and MU of EHRs were not associated with serving a predominately Medicaid-insured population, and were consistent with barriers that health care professionals in other studies had previously reported. In fact, barriers to adopting and using EHRs that could be associated with Medicaid providers were issues specific to provider types who were eligible for the Medicaid EHR Incentive Program but not the Medicare EHR Incentive Program, specifically, dentists and pediatricians. However, all findings were useful in generating a set of recommendations that are specific to promoting MU of EHRs among health care professionals eligible for the Medicaid EHR Incentive Program. [http://healthit.ahrq.gov/portal/server.pt/document/958478/barriers_to_meaningful_use_in_medicaid_final_report_pdf?qid=82968838&rank=5]
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* The variability of results of similar studies on the monetary and efficiency benefits of EHRs indicates that there is no single approach to EMR implementation that will fit all settings. Variables such as hospital size, setting, specialty, prior computer integration, etc will determine the effectiveness of an EMR dramatically and must be considered in all cases.
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* The high cost of basic infrastructure of clinical information technology is a substantial hurdle for many health care organizations, many of whose income margins have deteriorated after years of decreasing reimbursement (from Medicare and other sources) and whose access to capital for new medical technology is extremely scarce. Financial instability and scarce capital resources for IT infrastructure similarly affect small to mid-sized independent practice associations (IPAs) and independent physician offices, the practice venues for most physicians in the United States.
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* Diversity of products as well as lack of standards for common architecture of basic infrastructure of clinical information technology constitutes a barrier and further complicates EMR Implementation.
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== Costs ==
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===Patient Participation===
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Patients can use personal health record (PHR) to keep track of information from doctor visits, record health-related information, and link to health-related resources. PHR, is an electronic application used by patients to maintain and manage their own health information.  Connected PHRs are linked to a specific health care organization's EMR system that can increase patient and family participation in their own care.                <ref name="PHR">http://www.healthit.gov/providers-professionals/patient-participation</ref>
  
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Cost benefit analysis is categorized into 3 fields [70]:
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== Electronic Dental Records ==
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# Direct, one-time costs
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[[EMR Benefits: EDR]]
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## Hardware & Peripherals
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## Packaged and customized software
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## Network, peripherals, supplies, equipment
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## Initial data collection and conversion of archival data
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## Facilities upgrades, including site preparation and renovation
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## End-user project management
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## Project planning, contract negotiation, procurement
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## Application development and deployment
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## Configuration management
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## Office accommodations, furniture, related items
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## Initial user training
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## Workforce adjustment for affected employees
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## Transition costs (parallel systems, converting legacy systems)
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## Quality assurance and post implementation reviews
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# Direct, ongoing costs
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==Telehealth==
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## Salaries for IT and assigned end user staff
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[[EMR Benefits: Telehealth]]
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## Software maintenance, subscriptions, upgrades,
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## Equipment leases
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## Facilities rental and utilities
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## Professional services, Ongoing training and
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## Reviews and audits
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# Indirect, ongoing costs.
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== E-Prescribing ==
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## Data integrity
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[[EMR Benefits: E-Prescribing]]
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## Security
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## Privacy
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## IT policy management
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## Help Desk
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The financial commitment of implementing a CPOE system varies amongst facilities and depends on the facility's current hardware and software systems. The institution's current system needs to have a strong infrastructure in order to be able to enhance it's capabilities. The license for the software is but a small portion of the total cost. The larger expenses incurred will be a result of training healthcare professionals and support activities.  Customer service and technical support should be available everyday 24 hours a day.   
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E-Prescribing has many benefits, some of them include: <ref name="E-Prescribing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
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* reduce illegibility <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
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* providing warning and alert systems, which reduce medication errors <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
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* access to patient's medical history <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
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* reduces or eliminates phone calls and call-backs to pharmacies  <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
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*eliminates faxes to pharmacies <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
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*streamlines the refill and authorization processess  <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
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* increases patient compliance <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref>
  
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For more information, see [[EMR Cost Categories]].
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== Mobile EMRs ==
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[[EMR Benefits: mHealth]]
  
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=== Challenges to Identifying a Return on Investment (ROI) ===
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== Physicians ==
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[[EMR Benefits: Physicians]]
  
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Evidence of a strong ROI business case for EHR implementation is confounded by anecdotal evidence in peer reviewed research and trade journals. Furthermore, environmental differences across provider settings make it challenging to replicate information system strategies and dependence on disparate legacy applications [48]. For organizational stakeholders to embrace EHR adoption, they need assurance that adopting an EHR system would positively impact business performance [58].
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===Physicians Benefit===
  
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Additional barriers include:
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EMRs can greatly improve communication between physicians by allowing each full access to the patient’s medical record and by making it easier for physicians to follow up with patients. The electronic record provides up to the minute information on the patient allowing more efficient collaboration between disciplines.  EMRs allow multiple providers to simultaneously access a patient’s record from any authorized computer.<ref name="MD">http://www.usfhealthonline.com/resources/healthcare/benefits-of-ehr/#.VfjJDXktDmQ
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</ref>
  
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*Vendor supplied benefits data may not be objective
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== Nurses ==
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*Few vendors maintain a structured database of benefits information
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[[EMR Benefits: Nurses]]
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*Peer reviewed studies are difficult to compare due to the complexity of health services delivery and variety of provider settings.
+
−
*Differences in system architecture
+
−
*Trade journals tend to focus on anecdotal evidence rather then empirical evidence
+
−
*No standardized domain method exists to measure the ROI of electronic health records
+
−
*Lack of information regarding maintenance and optimization costs [48]
+
  
−
Consequently, providers frequently lack the necessary information to make sound financial decisions regarding Health IT capital investments. Uncovering the true cost and benefit of EHR adoption will require a national effort to standardize and centralize evidence in a national database. [48]
+
Nurses use the EMR to identify newly admitted patients, track their location, and document admission information. The nursing SWAT team harnessed the power of EMR technology, and successfully re-organized nursing workflow to expedite the admission process, while maintaining patient and family centered care.<ref name="Journal of pediatric nursing ">http://www.sciencedirect.com.ezproxyhost.library.tmc.edu/science/article/pii/S0882596314002413
 +
</ref>
  
−
== Return on Investment (ROI) Estimates ==
+
== Versatile capabilities of EHRs in healthcare settings ==
 +
There are many studies showed that EHRs are capable to integrate with various standards systems such as billing codes, clinical notes, ICD diagnose codes, and medications, which essentially enhances effectiveness and efficiency of care and results in superior phenotyping performance compared with paper-based medical record systems.  <ref name=" Wei 2015"> Wei, W.Q., Teixeira, P. L., Mo, H., Cronin, R. M., Warner, J. L., & Denny, J. C. Combining billing codes, clinical notes, and medications from electronic health records provides superior phenotyping performance. Journal of the American Medical Informatics Association: JAMIA. http://doi.org/10.1093/jamia/ocv130 </ref>.
  
−
While barriers of determining actual ROI for EMR implementations exist, companies such as Dr. Cloud EMR are providing EMR and EHR ROI estimates based on each practice's details. This however does not suggest that it is entirely accurate and is only an estimate. DrCloudEMR is built by DrCloud Healthcare Solutions Inc, a wholly owned EnSoftek, Inc. subsidiary. [65]
+
==  Improvement of Spontaneous Reporting System for drug post-marketing safety surveillance ==
−
There are 2 main postulates for ROI which KOSH’s postulate and Sir Austin Bradford Hill’s criteria for Causation.  
+
In the healthcare settings, Spontaneous Reporting Systems (SRSs) are critical systems for monitoring drug post-marking safety and adverse drug reactions (ADRs). Although widespread utilization of SRSs has played a fundamental role in drug safety monitoring, there are certain limitations that hinder their efficacy and accuracy in practices. For example, multiple sources of data are needed for confirmation and validation; the nature of passive reactions to ADR events makes SRSs perform poorly in terms of pharmacovigilance. The integration of an SRS system into EHRs could have potential to improve efficiency and effectiveness of detection for ADR events. The combination of an SRS with EHRs could help collect data and information related to ADRs dynamically while avoiding the need of data validation from multiple sources and potentially reducing the costs. <ref name=" Pacurariu  2015"> Pacurariu, A. C. Useful Interplay Between Spontaneous ADR Reports and Electronic Healthcare Records in Signal Detection. Drug Safety. http://doi.org/10.1007/s40264-015-0341-5. </ref>
−
Kosh’s postulate for CIS is
+
−
i. The system or feature must be present in every case in which the benefit is observed.
+
−
ii. The system must be isolated from the organization.  
+
−
iii. The benefit must be reproduced when the system is implemented in a new organization.
+
−
iv. We must demonstrate that the system was used in the new organization.
+
−
Hill’s Criteria for Causation includes (a) Strength of Association (b) Consistency of findings (c) Specificity of Association (d) Temporality (e) Dose-response (f) Plausibility (g) Coherence (h) Experimental Evidence and Analogy.
+
  
−
(a) Strength of Association tells us that the greater the change observed, the more likely the association is to be causal (e.g. If a EHR system is implemented and the CPOE feature greatly reduces medication errors, we could say that the implementation of the system had a causal effect on the reduction of medication errors and the strength of association is great).  
+
==  Improvement of healthcare outcomes through interactive collaboration among stakeholders ==
 +
It has been reported that the integration of a Network-Based Learning Health System with EHRs can potentially improve a variety of healthcare outcomes. For example, integrating chronical care management, quality improvement, patients and their family engagement, and comparative research.  <ref name=" Marsolo  2015"> Marsolo, K., Margolis, P. A., Forrest, C. B., Colletti, R. B., & Hutton, J. J. A Digital Architecture for a Network-Based Learning Health System: Integrating Chronic Care Management, Quality Improvement, and Research. EGEMS (Washington, DC), 3(1), 1168. </ref>.  Therefore, EHRs can serve as an effective platform and infrastructure that fascinates online learning for all stakeholders, and patient-centered quality care and evidence-based medical research.
  
−
(b) Consistency of Findings explains that if a change has been observed by different groups in different places with different circumstances and systems, the change is valid, so to speak. For example, if Company A (London, England, UK) implements System A , Company B (Houston, TX, USA) implements System B, and Company C (Guadalajara, Jalisco, Mexico) implements System C, and all three companies reduce medication errors using their respective systems, we can, again say that the CPOE feature of EHR systems can help reduce medication errors. It is important to note that the more consistent findings amongst different groups in different places, the better.
 
  
−
(c) Specificity of Association requires us to ask if there are any other factors which may have affected the change that we've observed. In regards to medication errors being reduced, one would have to ask if CPOE was the only factor involved. If errors could have been reduced due to other mechanisms in place besides CPOE alerts (e.g. better workflow in departments, new policies, etc.), the specificity of association could be considered weak. Weak does not imply wrong, but it does mean that more research has to be initiated.
+
== Costs ==
  
−
(d) Temporality addresses the evaluation after an EHR system is implemented. Temporality asks us "were there any changes AFTER the system was implemented?" Usually this is harder to prove due to lack of data prior to EHR implementation, however, Sittig rates temporality as "strong."
+
[[Return on investment]]
  
−
(e) Dose-Response asks if the size of changes are directly correlated with the increase of system use (e.g. were medication errors greatly reduced due to the use of many medication alerts in the EHR system?). Usually, there is a strong and direct correlation between system use and the reduction of medication errors, as one example of a dose response in an EHR system.  
+
It is estimated that purchasing and installing an EMR can cost a provider anywhere from $15,000 to $70,000. There are several things to consider when looking for an EMR for your organization or practice.  The prices vary based on number of providers using the EMR and whether it is a select on-site EHR deployment or web-based EHR deployment.  Other factors to take into consideration of what costs you will incur include these 5 components of implementation: <ref name="How much is this going to cost me?">HealthcareIT.gov http://www.healthit.gov/providers-professionals/faqs/how-much-going-cost-me http://www.healthit.gov/providers-professionals/faqs/how-much-going-cost-me </ref>
  
−
(f) Plausibility must be shown; There must be some way to demonstrate that the EHR system was used the way it was intended to deliver certain results (e.g. Physicians must have used clinical support decisions the way the EHR system intended to reduce medication errors, in order to demonstrate plausibility.)
+
*Hardware: Hardware costs may include database servers, desktop computers, tablets/laptops, printers, and scanners. <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
  
−
(g) Coherence simply states that changes caused by EHR systems should be caused by other EHR systems elsewhere. So, if medication errors are reduced by the use of one EHR system and that happens with the use of many other EHR systems, coherence exists.  
+
*EHR Software: Potential software costs include an EHR application, interface modules and upgrades to your EHR application. Remember, software costs vary depending on whether you select an on-site EHR deployment or a SaaS EHR deployment. <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
  
−
(h) Experimental Evidence and Analogy is proving that when the system is not used properly or at all, that certain changes stop. So, if an EHR system is not being used properly or at all (after initial proper use), does a rise in medication errors resume? Experimental evidence is hard to obtain after EHR implementation because it requires not using the system for quite some time (which many would view as wasted money).  
+
*Implementation Assistance: Potential implementation assistance costs include IT contractor, attorney, electrician, and/or consultant support; chart conversion; hardware/network installation; and workflow redesign support. <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
  
 +
*Training: Your organization will need to train your physicians, nurses, and office staff before and during EHR implementation.  <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
  
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== Reference Laboratories ==
+
*Ongoing Network Fees and Maintenance: Potential ongoing costs include hardware and software license maintenance agreements, ongoing staff education, telecom fees, and IT support fees. <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref>
  
−
Reference Labs benefit greatly from interfacing with the various EMR's of the Hospitals, Clinics, and Physician Practices which utilize their services. Benefits include, but are not limited to: <ref name="Reference Lab Benefits">Making Reference Labs More Competitive and Profitable with an HL7 Interface Engine, http://www.corepointhealth.com/sites/default/files/whitepapers/reference-labs-hl7-engine-advantages.pdf</ref>
+
*Although the initial cost of an EMR may (and typically does) result in an immediate increase in administrative cost, through the reduction of other “removable and or defunct items or process the implementation of the EMR showed a positive improvement in the BCR and NPV. <ref name= "Removable or defunct"> Removable or Defunct http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810528/ </ref>
 +
    examples: remodeling of paper-chart storage areas, medical transcriptions, shorter chain of communication, reduction of administrative material
  
−
* Decreased costs as a result of transitioning to a paperless system.
+
==Cost vs Time == (A reduction of time spent on a common process can lead to reduced cost and better efficiency)
−
* Decreased order entry time.
+
*EMRs can greatly reduce or make more efficient use of time.  
−
* Decreased lab result response time.
+
A recent study (July-2015)EMR decision support systems where proven to have reduced and or made more efficient use of the time needed for “Colorectal cancer screening where the immediate harms are balanced with longer-term benefits.” By providing a “personalized benefit/harm assessment”. <ref name="Cost vs Time"> Cost vs Time http://www.ajmc.com/journals/issue/2015/2015-vol21-n7/Pilot-of-Decision-Support-to-Individualize-Colorectal-Cancer-Screening-Recommendations/</ref>
  
−
Through the use of EMRs a physician is able to place a lab order for their patients in their EMR and have that information be conveyed electronically through the use of Health Level 7 (HL7)<ref name="HL7">Health Level 7, http://www.hl7.org/about/index.cfm?ref=nav</ref> messages to the system utilized by the reference lab.  This saves time as the order will automatically populate within the reference lab's system and will not have to be manually entered. 
 
  
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Once the lab work is complete the results can be transmitted in a similar manner as the initial order to have the results populate in the ordering provider's EMR.  This increases the precision of the results, and decreases the time required for the patient and physician to receive the results as the result would no longer require to wait until someone in the physician's office manually enters the results into the EMR (risking the possibility of errors).
 
  
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== Misc, to sort later ==
 
  
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* [[E-prescribing]] will reduce number of physician office visit and phone call. phone calls and visits, Test results and appointments alert will be implemented and patients are automatically notified of test results and appointment times. [http://www.cms.hhs.gov/PQRI/Downloads/PQRIEPrescribingFactSheet.pdf] [http://www.drfirst.com/e-prescribing.jsp] [http://www.emrconsultant.com/education/e-prescribing]
+
==Implementaion==
−
* Updates are done faster and files can be synchronized.
+
For a proper return on investment a proper implementation of EHR is needed.
−
* Duplicate orders and illegible handwriting will no longer be an issue is less of a problem <ref name="iom ehr key">IOM Key Capabilities of an Electronic Health Record System http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf</ref>
+
lots of things have to be kept in mind for a successful implementation of an EHR.  
−
* Hard drives take up less space. Shared databases reduces the need for paper [http://www.allscripts.com/casestudies/nffm.pdf]
+
−
* Billing is easier as the formatted documentation may improve the accuracy of charge capture.
+
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* Billing edits, including National and Local Coverage Determinations, can be alerted in real-time.
+
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* Patients arecan be informed of generic drugs, doctors can know if insurances do not cover patients, and formulary requirements can be identified.
+
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* Insurance and malpractice premiums can also be lowered. [http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm]) [http://www.msdc.com/EMR_Benefits.htm]
+
−
* Different drugs can save hospitals money Hospitals will save money over various drugs [http://www.kpinstituteforhealthpolicy.org/kpihp/CMS/Files/fulfilling_potential.pdf].
+
−
* Dictation is automatic
+
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* HIM staff may be reduced or staffing requirements changed [http://library.ahima.org]
+
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* Nurses will be more productive and more efficient [http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm]
+
−
* Reduces medication errors and checks for [[adverse drug event|drug-drug interactions]]Adverse drug event (ADE), drug-drug interactions(DDI)will be detected thereby reducing errors in medication. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf] [http://www.chcf.org/publications/2004/04/patient-safety-in-the-physicians-office--assessing-the-value-of-ambulatory-cpoe] [http://www.himss.org/content/files/davies_2002_maimonides.pdf] [http://www.ncbi.nlm.nih.gov/pubmed/19590335]
+
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* Reduces redundant lab tests [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf] [http://www.cbo.gov/ftpdocs/91xx/doc9168/MainText.3.1.shtml]
+
−
* Reminders increase underused preventative measures [http://www.nejm.org/doi/full/10.1056/NEJMsa010181]
+
−
* deduce infections from a list of symptoms and help make doctors make good clinical decisions. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954790/] [http://www.annals.org/content/139/1/31.abstract] [http://www.ncbi.nlm.nih.gov/pubmed/18999073] [http://www.ncbi.nlm.nih.gov/pubmed/11025783] The patient internet portal allows patients to know the most up to date information about healthcare. [http://www.pubmedcentral.nih.gov/articlerender.fcgi?pmid=16236699]
+
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* [[Telemedicine]]
+
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* Large scale data exchange and [[HIE|information integration]] [http://xnet.kp.org/permanentejournal/winter03/cis.html] [http://content.healthaffairs.org/content/24/5/1103.abstract]
+
−
* Surveillance and reporting of diseases [http://www.bt.cdc.gov/episurv/]
+
−
* Research information in the database [http://www.cbo.gov/ftpdocs/91xx/doc9168/05-20-HealthIT.pdf]
+
−
Academic EHRs are functional systems that makes training for nursing staff more efficient. Student nurses apply their learnt skills to plan patient care in a simulated setup. This allows student nurses to develop their acquired knowledge in a practical setting and transition into a familiar working environment after their academic careers.(<ref name="Gardner 2012">Gardner, C. and Jones, S.  (June 2012). Utilization of academic electronic medical records in undergraduate nursing education. Online Journal of Nursing Informatics (OJNI), vol. 16 (2) </ref>.
+
  
−
=== Sources of Funding ===  
+
*Benefits and risks of the EHR.
 +
*cost
 +
*specifications of our needs and what we want and what the EHR have.
 +
*vendor certifications.
 +
*preparations for implementation and after.
 +
The journal of Emergency medicine titled with "computers in Emergency medicine" talks about all aspects of EHR implementation. <ref name="implementation"> IMPLEMENTING ELECTRONIC HEALTH RECORDS IN THE
 +
EMERGENCY DEPARTMENT. http://www.jem-journal.com/article/S0736-4679(08)00321-1.</ref>
  
−
# Organizational Reserves – provider organization make investments in affiliated organizations
 
−
# Bank and other financial service – short term loans
 
−
# Capital leases – used for large equipment acquisitions but can be negotiated for a major IT investment
 
−
# Vendor discounts and incentives – requires something in return
 
−
# Joint venture or partnership – tighter relationship
 
−
# Health plans and plan sponsors – contractual arrangement
 
−
# Private philanthropy – fellowships or university chairs
 
−
# Pharmaceutical companies – willing to conduct clinical trials
 
−
# Public grants – government initiatives
 
−
# State legislative initiatives – local and state initiatives
 
  
−
60. Interviews with John Kansky, Laura Adams (2014, 8) by Mark Braunstein, GA Tech.
 
−
61. What is the DIRECT project (2010, 10) by The Direct Project. http://wiki.directproject.org/file/view/DirectProjectOverview.pdf
 
  
−
== References (old, to edit) ==
 
−
<references/>
 
  
 +
=== Neonatal Informatics and CPOE ===
 +
 +
Computerized physician order entry (CPOE) can be considered one of the major contributions to patient safety and health care quality from an EMR system implementation. CPOE and clinical decision support (CDS) systems have the potential to impact care of the critically ill neonatal patients to an even greater extent than other patient groups.  Implementation of CPOE with CDS has been shown to specifically benefit Neonatal care intensive care units (NICU) with improved medication turnaround times, decreased medication errors, reduced adverse drug effects, and improved radiology turnaround times.<ref>Corder, L., Kuehn, L., Kumar R.R., Mekhjian, H.S. Impact of computerized physican order entry on clinical practice in a newborn intensive care unit. J Perinatol. 2004;24:88-93. [Pubmed: 14872207].</ref>
 +
 +
While studies have shown these benefits to be consistent with CPOE and CDS equipped institutions, the effects of these systems on morbidity and mortality have been ambiguous.  A 2005 article reported an increase in mortality rate with the implementation of an EMR system with CPOE in a pediatric intensive care unit (PICU).<ref>Han, Y.Y., Carcillo, J.A., Venkataraman, S.T., et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system.  Pediatrics. 2005;116:1506-1512. [PubMed: 16322178].</ref>  The informaticists and hospital administration, determined that errors with the implementation process of the CPOE system resulted in these negative results.  They stressed that a change in the workflow design was essential for a safer CPOE implementation.  A more recent 2010 article reported a decrease in neonatal mortality rate using the exact same CPOE system.<ref>Longhurst, C.A., Parast, L., Sandborg, C.I. et al. Decrease in hospital-wide mortality rate after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2010;126:14-21. [PubMed: 20439590].</ref>These findings indicate that the implementation of the CPOE system needs to include careful consideration of workflow analysis.  However, even with the utmost attention being given to ensure the safety of a new CPOE system, inadvertent issues may still arise with human error. An example of such would be a physician order entry on the wrong patient.<ref name="Palma 2011">Palma, J.P., Sharek, P.J., Classen, D.C., & Longhurst, C.A. (2011). Neonatal Informatics: Computerized Physician Order Entry. Neoreviews. 12:393-396. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3146345/</ref>
  
−
Committee on Quality of Health Care in America, Institute of Medicine. "Front Matter." ''Crossing the Quality Chasm: A New Health System for the 21st Century''. Washington, DC: The National Academies Press, 2001.  [http://www.nap.edu/openbook.php?isbn=0309072808 Full text]
 
  
−
# msdc benefits of emr
+
== Specialty clinics ==
−
# about ehrs
+
−
# malpractice 2008
+
−
# http://www.cdc.gov/about/grand-rounds/archives/2011/july2011.htm
+
−
# http://www.mayoclinic.org/emr/benefits.html
+
−
# Integrated Centre for Care Advancement through Research (iCARE); Canada Health Infoway (Infoway); Canadian Patient Safety Institute (CPSI). (2007). The Relationship Between Electronic Health Records and Patient Safety: A Joint Report On Future Directions For Canada. 1-31.
+
−
# Crane, R. M., Raymond, B., (Winter 2003). Fulfilling the Potential of Clinical Information Systems. The Permanente Journal. 7 (1), pp.62-67
+
−
# Hersh, W. R., (2002). Medical Informatics: Improving Health Care Through Information. Journal of American Medical Association. 288 (16), pp.1955-1958
+
−
# http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_046429.hcsp?dDocName=bok1_046429
+
−
# http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/56_DataAndReports.asp
+
−
# http://www.ischool.drexel.edu/faculty/ssilverstein/AJM-Himmelstein-Hospital-Computing.pdf
+
−
# http://www.himss.org/content/files/jhim/20-2/16_original_evidence.pdf
+
−
# http://www.markle.org/publications/403-achieving-health-it-objectives-american-recovery-and-reinvestment-act
+
−
# http://www.cdc.gov/ehrmeaningfuluse/
+
−
# http://healthit.ahrq.gov/portal/server.pt/document/958478/barriers_to_meaningful_use_in_medicaid_final_report_pdf?qid=82968838&rank=5
+
−
# Evidence on the Costs and Benefits of Health Information Technology. A Congressional Budget Office Paper. Congress of the United States. Congressional Budget Office. Available at: http://www.cbo.gov/publication/41690. Acessed September 30, 2013.
+
−
# Kuperman GJ, Gibson RF. Computer Physician Order Entry: Benefits, Costs and Issues. Ann Intern Med. 2003;139:31-39.
+
−
# Shapiro JS, Kannry J, et al. Approaches to patient health information exchange and their impact on emergency medicine. Ann Emerg Med. 2006 Oct;48(4):426-432.
+
−
#Kaushal R, Jha AK, Franz C, Glaser J, Shetty KD, Jaggi T, Middleton B, Kuperman GJ, Khorasani R, Tanasijevic M, Bates DW; Brigham and Women's Hospital CPOE Working Group. (2006). Return on investment for a computerized physician order entry system. J Am Med Inform Assoc. 13(3):261-6.
+
−
# tierney 2013
+
−
# http://www.hhs.gov/news/press/2013pres/08/20130805a.html
+
−
# http://www.fierceemr.com/story/new-york-looks-ehrs-enhance-public-health-surveillance/2013-08-27
+
−
# http://ehrintelligence.com/2012/12/10/engaging-patients-through-ehr-access-open-notes/
+
−
# The effect of electronic medical record-based clinical decision support on HIV care in resource-constrained settings: A systematic review Tom Oluocha,*,Xenophon Santasb, Daniel Kwaroc, Martin Wered, Paul    Biondichd,
+
−
# Driessen J,CioffiM, Alide N,et al. J Am Med Inform Assoc 2013;20:743–748.
+
−
# Overcoming barriers to electronic medical record (EMR) implementation in the US healthcare system: A comparative study Sameer Kumar, Krista Aldrich
+
−
# http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Basics.html
+
−
# http://www.ncbi.nlm.nih.gov/pubmed/9576410
+
−
# Study of the factors that promoted the implementation of electronic medical record on iPads at two emergency departments. Rao AS, Adam TJ, Gensinger R, Westra BL. AMIA Annu Symp Proc. 2012;2012:744-52. Epub 2012 Nov 3.
+
−
# Connelly, D. P., Park, Y. T., Du, J., Theera-Ampornpunt, N., Gordon,B. D., Bershow, B. A., ... & Speedie, S. M. (2012). The impact of electronic health records on care of heart failure patients in the emergency room. Journal of the American Medical Informatics Association, 19(3), 334-340.
+
−
# Pinsonneault, A., Dakshinamoorthy, V., Reidel, K., & Tamblyn, R. (2012, January). The impact of IT on quality of care: Evaluation of an integrated chronic disease management system. In System Science (HICSS), 2012 45th Hawaii International Conference on (pp. 2947-2956). IEEE.
+
−
# McGinn, C. A., Grenier, S., Duplantie, J., Shaw, N., Sicotte, C., Mathieu, L., ... & Gagnon, M. P. (2011). Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC medicine, 9(1), 46.
+
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# Mintz, MD, M., Narvarte, MD, H. J., OBrien, MD, K. E., Papp, PhD, K. K., Thomas, MD, M., & Durning, MD, S. J. (2009). Use of electronic medical records by physicians and students in academic internal medicine settings. Academic Medicine, 84(12), 1698-1704.
+
−
# http://www.practicefusion.com/ehrbloggers/2010/10/return-on-investment-for-emrs.html
+
−
# http://jama.jamanetwork.com/article.aspx?articleid=1737043#ArticleInformation
+
−
# Kuperman, G.J. and Gibson, R.F. (2003) “Computer Physician Order Entry: Benefits, Costs & Issues” Am Intern Med 2003; 139:31-39
+
−
# Crane, R.M. and Raymond, B. (2003) “Fulfilling the Potential of Clinical Information Systems: The Permanente Journal Winter/2003/Vol.7No1
+
−
# Kaushal, R.; Jha, A.K.; Franz, C. et al. (2006) J Am Med Inform Assoc 2006;13:261-266 doi 10.1197/jamia.J1984
+
−
# http://www.nejm.org/doi/full/10.1056/NEJMp1211315#t=article
+
−
# Menachemi N, Collum H.T. Benefits and drawbacks of electronic health record systems.Risk Manag Healthc Policy. 2011; 4: 47–55.
+
−
# http://www.healthit.gov/sites/default/files/pdf/privacy/privacy-and-security-guide-chapter-2.pdf
+
−
# http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978883/
+
−
# Thompson, D., Osheroff, J., Classen, D., & Sittig, D. (2007). A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database. Journal of Healthcare Information Management, 21 (1), 62-68.
+
−
# Butcher L. Hospitals strengthen bonds with post-acute providers. http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/01JAN2013/0113HHN_Feature_strategy&domain=HHNMAG
+
−
# Voigt, C. & Torzewski, S. (2011). Direct results: An HIE simple information exchange using the direct project.  Journal of AHIMA, 38-41.
+
−
# Kohn, L. T., Corrigan, J. M., & Donaldson, M. S., eds. (2000).  To err is human.  ''Institute of Medicine Committee on Quality of Health Care in America''.  Washington, DC:  National Academic Press.
+
−
# McGeath, J. (2012). The Team Dynamics of Connecting Medical Devices with EMR Systems. 24X7, 17(10), 34-41
+
−
# Mulherin, D. P., Zimmerman, C. R., & Chaffee, B. W. (2013). National standards for computerized prescriber order entry and clinical decision support: The case of drug interactions. American Journal Of Health-System Pharmacy, 70(1), 59-64. doi:10.2146/ajhp120217
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# Otte-Trojel, T., de Bont, A., Rundall, T. G., & van de Klundert, J. (2014). How outcomes are achieved through patient portals: a realist review. Journal of the American Medical Informatics Association, amiajnl-2013.
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# http://www.healthit.gov/providers-professionals/2-install-and-enable-encryption
+
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# http://www.dialogmedical.com/informed-consent-2-3/
+
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# http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047866.hcsp?dDocName=bok1_047866
+
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# Hayek S1 et al. End-of-Life Care Planning: Improving Documentation of Advance Directives in the Outpatient Clinic using Electronic Medical Records.  J Palliat Med. 2014 Jul 2.
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# Gummadi S1.  Electronic medical record: a balancing act of patient safety, privacy and health care delivery.  Am J Med Sci. 2014 Sep;348(3):238-43.
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# Ojeleye O1 et al.  The evidence for the effectiveness of safety alerts in electronic patient medication record systems at the point of pharmacy order entry: a systematic review. BMC Med Inform Decis Mak. 2013 Jul 1;13:69.
+
−
# https://www.drchrono.com/meaningful-use-ehr/
+
−
# EMR Effectiveness: The Positive Benefit Electronic Medical Record Adoption has on Mortality Rates. http://apps.himss.org/content/files/HAHealthgradesEMRStudyWhitePaper.pdf
+
−
# Integrating Clinical Practice and Public Health Surveillance Using Electronic Medical Record Systems. http://www.ajpmonline.org/article/S0749-3797(12)00249-8/fulltext
+
−
# EMR ROI / EHR ROI Calculator. http://www.drcloudemr.com/roi/
+
−
# http://www.academia.edu/4083826/An_Adaptive_Evidence_Based_Medicine_System_Based_on_a_Clinical_Decision_Support_System
+
−
# http://www.cdc.gov/ehrmeaningfuluse/introduction.html
+
−
# http://www.healthit.gov/providers-professionals/faqs/how-can-electronic-health-records-improve-public-and-population-health-
+
−
# http://www.esi-bethesda.com/ncrrworkshops/clinicalresearch/pdf/MichaelKahnPaper.pdf
+
−
# http://www.forbes.com/sites/hbsworkingknowledge/2014/03/26/how-electronic-patient-records-can-slow-doctor-productivity/
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# Bhargava, Hemant K., and Abhay Mishra. "Electronic Medical Records and Physicians Productivity: Insights from Panel Data Analysis and Design Implications." 2nd round at Management Science (2011).
+
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# http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1855&pageaction=displayproduct
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# Shortliffe, E. H., & Cimino, J. J. (2006). ''Biomedical informatics''. Springer Science+ Business Media, LLC.
+
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# http://www.healthit.gov/providers-professionals/faqs/what-are-advantages-electronic-health-records
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# Kim, Y., Kim, S. S., Kang, S., Kim, K., & Jun Kim. (2014). Development of Mobile Platform Integrated with Existing Electronic Medical Records. Health Infrormatics Research.
+
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# Zaroukian, M. (n.d.). EMR Cost-Benefit Analysis: Managing ROI into Reality. Retrieved from http://www.himss.org/files/HIMSSorg/content/files/EMRCost-BenefitReality.pdf
+
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# Ajami, S., & Arabchadegani, R. (n.d.). Barriers to implement Electronic Health Records (EHRs). Materia Socio Medica, 213-213. Retrieved September 10, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3804410/
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# http://hitconsultant.net/2014/08/19/patient-portal-features-which-is-the-most-beneficial-frustrating/
+
−
# http://www.cms.gov/Medicare/E-Health/Eprescribing/index.html?redirect=/EPrescribing
+
−
# https://www.drchrono.com
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# turley 2011
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# Menachemi N, Powers TL, Brooks RG. The role of information technology usage in physician practice satisfaction. Health Care Manage Rev. 2009;34(4):364–371.
+
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# Elder KT, Wiltshire JC, Rooks RN, et al. Health information technology and physician career satisfaction. Perspect Health Inf Manag. 2010;7:1d.
+
−
# http://www.himss.org/ResourceLibrary/ResourceDetail.aspx?ItemNumber=17246
+
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# http://www.ihealthbeat.org/insight/2013/physicians-divided-on-cloudbased-ehrs
+
  
 +
EHR’s can significantly improve the productivity for specialty physician clinics such as for ophthalmology. Incorporating an EHR, a clinic can reduce process and time spent on recording patient data, as most diagnostic equipment can communicate with EHR’s.  With medical and diagnostic equipment communicating with EHR’s, staff and technicians can focus more on the patient.  <Ref name== "Misch, 2012"> Misch, D.M. Specialty-specific EHR system benefits both practice, patients: technologic innovation: how using EHR, practice management platform can improve standard of care and efficiency. http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?p=HRCA&u=txshracd2509&id=GALE|A312290264&v=2.1&it=r&sid=summon&userGroup=txshracd2509</ref>
  
 +
== Benefits Database ==
 +
[[EMR Benefits: Benefits Database]]
  
 +
A national repository of EMR benefits data is needed to help stakeholders make more informed decisions about EMR implementation and to facilitate monitoring and corrective redesign of existing EMR implementations.  A framework for reporting data should be developed that will enable meaningful comparisons, provide uniform benefit categories and standardized methods of measurement and evaluation.<ref name=”Thompson 2006”>Thompson, D. I., Osheroff, J., Classen, D., & Sittig, D. F. (2006). 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: JHIM, 21(1), 62-68.</ref>
  
 +
==Compliance==
 +
[[EMR Benefits: Compliance]]
  
  
−
6. Harrington, L., Porch, L., Acosta, K., & Wilkens, K. (2011). Realizing electronic medical record benefits: an easy-to-do usability study. The Journal of Nursing Administration, 41(7-8), 331–5. doi:10.1097/NNA.0b013e3182250b23
+
18. Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings,      And Costs. Health Affairs, 1103-1117. doi:10.1377/hlthaff.24.5.1103 Health Aff September 2005 vol. 24 no. 5 1103-1117
  
−
7. Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Affairs (Project Hope), 24(5), 1103–17. doi:10.1377/hlthaff.24.5.1103
 
  
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== References ==
 
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# Bailey JE, Pope RA, Elliott EC, Wan JY, Waters TM, Frisse ME. Health Information Exchange Reduces Repeated Diagnostic Imaging for Back Pain. Annals of Emergency Medicine 2013 Jul;62(1):16-24.
 
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# bates 1997
 
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# Johnston D, Pan E, Walker J. The value of CPOE in ambulatory settings. J Healthc Inf Manag 2004;18(1):5-8.
 
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# Berger RG, Kichak JP. Computerized physician order entry: helpful or harmful? J Am Med Inform Assoc 2004 Mar;11(2):100-3.
 
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# Stage DRMU. 3; Meaningful Use Work Group; Paul Tang, chair and George Hripcsak, co-chair.  2013.  August.
 
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# Singh H. Editorial: Helping Health Care Organizations to Define Diagnostic Errors as Missed Opportunities in Diagnosis. Joint Commission Journal on Quality and Patient Safety 2014 Mar;40(3):99-101.
 
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# Bogua¡eviaius A, Maleckas A, Pundzius J, Skaudickas D. Prospective randomised trial of computer‐aided diagnosis and contrast radiography in acute small bowel obstruction. European Journal of Surgery 2002;168(2):78-83.
 
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# Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 2005;293(10):1223-38.
 
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# McDonald KM, Matesic B, Contopoulos-Ioannidis DG, Lonhart J, Schmidt E, Pineda N, et al. Patient safety strategies targeted at diagnostic errors: a        systematic review. Ann Intern Med 2013 Mar 5;158(5 Pt 2):381-9.
 
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# Radley, D. C., Wasserman, M. R., Olsho, L. E., Shoemaker, S. J., Spranca, M. D., & Bradshaw, B. ( 2013). Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. Journal of the American Medical Informatics Association : Jamia, 20, 3, 470-6.
 
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11. Kuperman,G.J.,Gibson,R.F. (2003)Computer Order Physician Entry: Benefits, Costs, and Issues. ''Annals of Internal Medicine,139,31-19''
 
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# Sittig, D. (2014, September). Return on Investment Calculations. Lecture conducted from University of Texas Health Science Center at Houston, Houston, TX.
 
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#The American Journal of Medicine , Volume 114 , Issue 5 , 397 - 403
 
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#Jamoom E, Beatty P, Bercovitz A, et al. (2012) Physician adoption of electronic health record systems: United States, 2011. NCHS data brief, no 98. Hyattsville, MD: National Center for Health Statistics.
 
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# http://www.healthit.gov/providers-professionals/patient-participation
 
−
# AHRQ  Daignostic errors”http://psnet.ahrq.gov/primer.aspx?primerID=12.
 
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# EHRS and other technology can reduce diagnostic errors http://www.exscribe.com/orthopedic-e-news/ehremr/ehrs-and-other-technology-can-reduce-diagnostic-errors.
 
−
# McGregor JC, Weekes E, Forrest GN, et al. Impact of a Computerized Clinical Decision Support System on Reducing Inappropriate Antimicrobial Use: A Randomized Controlled Trial.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513678/.
 
−
# Top 5 Benefits of Clinical Decision Support in the ED http://www.govhealthit.com/blog/top-5-benefits-clinical-decision-support-ed.
 
−
<references />
 
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# Hoyt, R., & Yoshihashi, A. (2014). Health Informatics: Practical guide for healthcare and information technology professionals.(6th ed.). Informatics Education.
 
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# Hibbs, SP, Nielsen, ND, Brunskill, S, Doree, C, Yazer , MH Kufman RM, Murphy MF.
 
−
  (Jan 2015). The Impact of Electronic Decision Support on Transfusion Practice: A systemic Review [Abstruct]. Transfusion Medicine Review, 29(1),14-23 doi: 10.1016/j.tmrv.2014.10.002
 
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# Nitrosi, A, Borasi, G, Nicoli, F, Modigliani, G,  Botti, A, Bertolini, M, Notari, P.
 
−
  (June, 2007). A Filmless Radiology Department in a Full Digital Regional Hospital: Quantitative Evaluation of the Increased Quality and Efficiency [Abstract]. Journal of Digital Imaging, 20(2), 140-148. doi:  10.1007/s10278-007-9006-y
 
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# Tolomeo, C, Shiffman, R, Bazzy-Asaad, A (Nov, 2008). Electronic medical records in a sub-specialty practice: one asthma center’s [Abstract]. Journal of Asthma, 45
 
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  (9), 849-51 doi: 10.1080/02770900802380803
 
  
  
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== References ==
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<references/>
  
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[[Category:EHR]]
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[[Category: EHR]]
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[[Category: EMR]]

Latest revision as of 18:33, 22 September 2015

The sections below detail the benefits, costs, and barriers in evaluating EMR implementations. Selecting, financing, and launching an EHR system is difficult.

Informational

EMR Benefits: Informational

Security

EMR Benefits: Security is an advantageous attribute which comes with EMR systems. Centers for Medicare and Medicaid Services (CMS) published a privacy, security & meaningful use guidelines which computer systems that store patient information need to conform to imply to HIPAA privacy guidelines. [1]

Environmental

EMR Benefits: Environmental positive impact through Electronic Health Records has the potential to improve the environmental footprint left by the health care industry. [2]

Quality Outcomes

EHR’s can be utilized to generate reports on quality measures in the effort to improve quality and patient satisfaction. With the ability to produce reports from EHR’s, clinicians can easily compare data to baseline data and quickly identify areas in need of improvement. Once areas in need of improvement have been identified, clinicians can compare data to manual reports and similar data to validate the reported information. Once an area of improvement has been identified it can be delivered to the performance improvement department where informatics professionals can perform gap analysis and identify methods to improve overall quality. , Cite error: Closing </ref> missing for <ref> tag

In addition the use of EMRs in a teaching environment allows trainees access to the most up to date information. “Point-of-care education accessed via CDS allows for easy access to relevant and up-to-date medical literature from which students and residents can draw to formulate diagnosis and management plans".[3]

Financial

EMR Benefits: Financial

"Implementing an EMR system could cost a single physician approximately $163,765. As of May 2015, the Centers for Medicare and Medicaid Services (CMS) had paid more than $30 billion in financial incentives to more than 468,000 Medicare and Medicaid providers for implementing EMR systems. With a majority of Americans now having at least one if not multiple EMRs generated on their behalf, data breaches and security threats are becoming more common and are estimated by the American Action Forum (AAF) to have cost the health care industry as much as $50.6 billion since 2009." [4]

Some of the ways that EMR systems can cut healthcare costs are due to savings based on "time-consuming paper-driven and labor-intensive tasks":[5]

  • Reduced transcription costs[5]
  • Reduced chart pull, storage, and re-filing costs [5]
  • Improved and more accurate reimbursement coding with improved documentation for highly compensated codes [5]
  • Reduced medical errors through better access to patient data and error prevention alerts [5]
  • Improved patient health/quality of care through better disease management and patient education [5]

There are few comprehensive estimates of savings from Health Information Technology (HIT) at the national level. At 90 percent adoption, it is estimated that the potential HIT – enabled efficiency savings for both inpatient and outpatient care could average more than 77 billion per year.[6] [7]

Although the full extent of EMR advantages may not become apparent until further implementation and research is carried out, a clear benefit is the reduction of cost. Major administrative costs can be eliminated or reduced. Providers can do away with the costs of “chart pulls,” while substantially reducing dictation costs through the use of EMRs. Healthcare providers can also receive decision support regarding selection and costs of medications, radiographic studies, and laboratory tests.[8]

Billing Accuracy

The benefits for small to medium private practices that have implemented EMR systems integrated with the practices' billing and prescription systems, can be increased efficiency and accuracy thanks to automatic coding leading to improved profitability. "Since installing the EMR, Medicare has audited only one of my charts. I had billed out as a level four and Medicare said it should have been billed as a level five, which, in essence, said that we should have been paid more. My EMR system gave the chart a level four and I believe it was right.” "Since adopting an EMR system, my practice receipts have increased about $4,000 per month."[9]

A nuanced view is appropriate here, however; improved billing can coincide with fewer patients seen. "EHR implementation ... increased reimbursements but reduced long-term practice productivity across all specialties"[10] according to one study. This may be a net financial positive for the practice: "an EHR should greatly enhance physician effectiveness even if fewer patients are seen by the physician"[10] due to gains in billing efficiency, but this also represents an artificial reduction in the supply of services.

An EMR Cost Benefit Analysis

Samsung Medical Center (SMC) performed a cost benefit analysis (CBA) on the cost benefits of implementing an electronic medical record (EMR) system. Costs of implementing the EMR system involved both direct costs to build the system infrastructure and induced costs to make a smooth transition to the new system. Benefits of implementing the EMR system include both cost reductions and increased revenue. Five types of cost reductions, mentioned by the authors, include:

  1. Reduction of supplies for paper charts
  2. Disposal of storage facilities used for paper chart storage
  3. Reduction of full-time equivalent (FTE) employees for the paper chart management
  4. Reduction in staff for outpatient clinics
  5. Decreased supplies for medical devices

The FTE's responsible for paper management were greatly reduced from 28 FTE's (2007) to 1 FTE (2009).

This CBA was based on an eight year period post EMR implementation. SMC determined the EMR system became cost effective shortly after 6 years. The outcomes of the CBA were calculated using the following formulas:

  • The primary outcome is the Net Present Value (NPV)
    • NPV = Present Value (PV) of benefit for the eight year period - PV of cost
  • The second outcome is the Benefit Cost Ratio (BCR)
    • BCR = PV of the benefit / PV of the cost
  • The third outcome is the Discounted Payback Period (DPP).
    • This is the time to reach the breakeven point.

This CBA does not include clinical benefits of the EMR implementation such as decreased medication errors, improved workflow, and reduced length of stay.[11]

Improving Patient Care

EMR Benefits: Healthcare quality

Many EMRs have alert systems that ensure physicians do not forget to request important tests. As well as the legal benefits that this provides, EMR alerts remind physicians of the "preventive care needs for patients, which helps improve quality of care and office income by reminding us to do appropriate testing and provide vaccinations" recommended for some patient conditions e.g. asthma, emphysema or diabetes. [12]


EMR Benefits: Reduction in no shows

EMR system was used to improve on automated calls made to patients to remind them of their appointment which reduced the number of no call shows and improved patient satisfaction. [12]

EMR Benefits: Medication Management

"Rational antibiotic use resulted in a lower mortality of 0.0644 % during the post-implementation period compared to 0.179 % during the pre-implementation period (p = 0.018). The comprehensive EMR system contributed to a significant reduction in antibiotic consumption and an improvement in rational antibiotic use."[13]

EMR systems have the ability to make evidence-based suggestions regarding patient care. With these suggestions, EMRs are able to use a patient’s information to identify preventative services that specific patient may need. The system is able to remind doctors that the patient is due for certain screening exams or other services which allows the doctor to discuss it with the patient and also allows the patient to decide whether or not they would like to schedule an appointment for that specific exam. This reminder has proven to benefit patient care by increasing compliance with preventative care.

EMRs also benefit patient care by assisting in long-term chronic disease prevention and management. Case management systems in EMRs allow patients to communicate with a variety of specialists, which better enables them to manage their care. This system also allows healthcare providers to keep track of patient data, such as vital signs, and allows case management nurses to quickly respond to any issues that may occur. The system benefits the patient because it allows the patient’s acute issues to be handled promptly before they become bigger issues that may lead to a hospital admission.

EMRs have the ability to eliminate up to 200,000 adverse drug events with the use of CPOE. Using reminders and alerts CPOEs are able to notify physicians about possible drug interactions that may occur when a new medication order is placed.

EMRs have a direct correlation with the quality of healthcare offered to a patient. Problems in healthcare quality fell into three categories as stipulated by the National Roundtable on Health Care Quality. These three categories are the underuse, overuse, and misuse of healthcare services. Reducing overuse and misuse of healthcare services, as noted by the Roundtable, leads to an increase in health care quality while simultaneously lowering costs. In addition, reducing the underuse of healthcare services increases quality, but may in turn increase costs. “Computerized physician order [CPOE] entry may affect all three categories of health care quality problems, as well as inefficiencies in the health care system.” [14]

Research

EMR Benefits: Research

Researchers can use EHRs to retrieve up-to-date data from various sources around the country to advance their studies. EHRs can compute a report to show researchers certain trends in the population or common side effects of medications. [15]

Health Information Exchange (HIE)

EMR Benefits: HIE

Personal Health Records

EMR Benefits: PHR

Patient Participation

Patients can use personal health record (PHR) to keep track of information from doctor visits, record health-related information, and link to health-related resources. PHR, is an electronic application used by patients to maintain and manage their own health information. Connected PHRs are linked to a specific health care organization's EMR system that can increase patient and family participation in their own care. [16]

Electronic Dental Records

EMR Benefits: EDR

Telehealth

EMR Benefits: Telehealth

E-Prescribing

EMR Benefits: E-Prescribing

E-Prescribing has many benefits, some of them include: [17]

  • reduce illegibility [18]
  • providing warning and alert systems, which reduce medication errors [18]
  • access to patient's medical history [18]
  • reduces or eliminates phone calls and call-backs to pharmacies [18]
  • eliminates faxes to pharmacies [18]
  • streamlines the refill and authorization processess [18]
  • increases patient compliance [18]

Mobile EMRs

EMR Benefits: mHealth

Physicians

EMR Benefits: Physicians

Physicians Benefit

EMRs can greatly improve communication between physicians by allowing each full access to the patient’s medical record and by making it easier for physicians to follow up with patients. The electronic record provides up to the minute information on the patient allowing more efficient collaboration between disciplines. EMRs allow multiple providers to simultaneously access a patient’s record from any authorized computer.[19]

Nurses

EMR Benefits: Nurses

Nurses use the EMR to identify newly admitted patients, track their location, and document admission information. The nursing SWAT team harnessed the power of EMR technology, and successfully re-organized nursing workflow to expedite the admission process, while maintaining patient and family centered care.[20]

Versatile capabilities of EHRs in healthcare settings

There are many studies showed that EHRs are capable to integrate with various standards systems such as billing codes, clinical notes, ICD diagnose codes, and medications, which essentially enhances effectiveness and efficiency of care and results in superior phenotyping performance compared with paper-based medical record systems. [21].

Improvement of Spontaneous Reporting System for drug post-marketing safety surveillance

In the healthcare settings, Spontaneous Reporting Systems (SRSs) are critical systems for monitoring drug post-marking safety and adverse drug reactions (ADRs). Although widespread utilization of SRSs has played a fundamental role in drug safety monitoring, there are certain limitations that hinder their efficacy and accuracy in practices. For example, multiple sources of data are needed for confirmation and validation; the nature of passive reactions to ADR events makes SRSs perform poorly in terms of pharmacovigilance. The integration of an SRS system into EHRs could have potential to improve efficiency and effectiveness of detection for ADR events. The combination of an SRS with EHRs could help collect data and information related to ADRs dynamically while avoiding the need of data validation from multiple sources and potentially reducing the costs. [22]

Improvement of healthcare outcomes through interactive collaboration among stakeholders

It has been reported that the integration of a Network-Based Learning Health System with EHRs can potentially improve a variety of healthcare outcomes. For example, integrating chronical care management, quality improvement, patients and their family engagement, and comparative research. [23]. Therefore, EHRs can serve as an effective platform and infrastructure that fascinates online learning for all stakeholders, and patient-centered quality care and evidence-based medical research.


Costs

Return on investment

It is estimated that purchasing and installing an EMR can cost a provider anywhere from $15,000 to $70,000. There are several things to consider when looking for an EMR for your organization or practice. The prices vary based on number of providers using the EMR and whether it is a select on-site EHR deployment or web-based EHR deployment. Other factors to take into consideration of what costs you will incur include these 5 components of implementation: [24]

  • Hardware: Hardware costs may include database servers, desktop computers, tablets/laptops, printers, and scanners. [5]
  • EHR Software: Potential software costs include an EHR application, interface modules and upgrades to your EHR application. Remember, software costs vary depending on whether you select an on-site EHR deployment or a SaaS EHR deployment. [5]
  • Implementation Assistance: Potential implementation assistance costs include IT contractor, attorney, electrician, and/or consultant support; chart conversion; hardware/network installation; and workflow redesign support. [5]
  • Training: Your organization will need to train your physicians, nurses, and office staff before and during EHR implementation. [5]
  • Ongoing Network Fees and Maintenance: Potential ongoing costs include hardware and software license maintenance agreements, ongoing staff education, telecom fees, and IT support fees. [5]
  • Although the initial cost of an EMR may (and typically does) result in an immediate increase in administrative cost, through the reduction of other “removable and or defunct items or process the implementation of the EMR showed a positive improvement in the BCR and NPV. [25] 
   examples: remodeling of paper-chart storage areas, medical transcriptions, shorter chain of communication, reduction of administrative material

==Cost vs Time == (A reduction of time spent on a common process can lead to reduced cost and better efficiency)

  • EMRs can greatly reduce or make more efficient use of time.

A recent study (July-2015)EMR decision support systems where proven to have reduced and or made more efficient use of the time needed for “Colorectal cancer screening where the immediate harms are balanced with longer-term benefits.” By providing a “personalized benefit/harm assessment”. [26]



Implementaion

For a proper return on investment a proper implementation of EHR is needed. lots of things have to be kept in mind for a successful implementation of an EHR.

  • Benefits and risks of the EHR.
  • cost
  • specifications of our needs and what we want and what the EHR have.
  • vendor certifications.
  • preparations for implementation and after.

The journal of Emergency medicine titled with "computers in Emergency medicine" talks about all aspects of EHR implementation. [27]



Neonatal Informatics and CPOE

Computerized physician order entry (CPOE) can be considered one of the major contributions to patient safety and health care quality from an EMR system implementation. CPOE and clinical decision support (CDS) systems have the potential to impact care of the critically ill neonatal patients to an even greater extent than other patient groups. Implementation of CPOE with CDS has been shown to specifically benefit Neonatal care intensive care units (NICU) with improved medication turnaround times, decreased medication errors, reduced adverse drug effects, and improved radiology turnaround times.[28]

While studies have shown these benefits to be consistent with CPOE and CDS equipped institutions, the effects of these systems on morbidity and mortality have been ambiguous. A 2005 article reported an increase in mortality rate with the implementation of an EMR system with CPOE in a pediatric intensive care unit (PICU).[29] The informaticists and hospital administration, determined that errors with the implementation process of the CPOE system resulted in these negative results. They stressed that a change in the workflow design was essential for a safer CPOE implementation. A more recent 2010 article reported a decrease in neonatal mortality rate using the exact same CPOE system.[30]These findings indicate that the implementation of the CPOE system needs to include careful consideration of workflow analysis. However, even with the utmost attention being given to ensure the safety of a new CPOE system, inadvertent issues may still arise with human error. An example of such would be a physician order entry on the wrong patient.[31]


Specialty clinics

EHR’s can significantly improve the productivity for specialty physician clinics such as for ophthalmology. Incorporating an EHR, a clinic can reduce process and time spent on recording patient data, as most diagnostic equipment can communicate with EHR’s. With medical and diagnostic equipment communicating with EHR’s, staff and technicians can focus more on the patient. [32]

Benefits Database

EMR Benefits: Benefits Database

A national repository of EMR benefits data is needed to help stakeholders make more informed decisions about EMR implementation and to facilitate monitoring and corrective redesign of existing EMR implementations. A framework for reporting data should be developed that will enable meaningful comparisons, provide uniform benefit categories and standardized methods of measurement and evaluation.[33]

Compliance

EMR Benefits: Compliance


18. Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs. Health Affairs, 1103-1117. doi:10.1377/hlthaff.24.5.1103 Health Aff September 2005 vol. 24 no. 5 1103-1117



References

  1. ↑ Centers for Medicare & Medicaid Services. Privacy and Security Standards. http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/HIPAAGenInfo/PrivacyandSecurityStandards.html
  2. ↑ Turley, M., Porter, C., Garrido, T., Gerwig, K., Young, S., Radler, L., & Shaber, R. (2011). Use of electronic health records can improve the health care industry’s environmental footprint. Health affairs, 30(5), 938-946.
  3. ↑ Tierney et al, Medical Education in the Electronic Medical Record (EMR) Era: Benefits, Challenges, and Future Directions http://tmclibrary.summon.serialssolutions.com/search?s.q=tierney+m+j#!/search?ho=t&l=en&q=Medical%20education%20in%20the%20electronic%20medical%20record%20(EMR)%20era:%20Benefits,%20challenges,%20and%20future%20directions.%20Academic%20Medicine
  4. ↑ O'Neill, T. (2015, August). Are Electronic Medical Records Worth the Cost of Implementation.
  5. ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 Kumar, S., & Bauer, K. (2011). Medical Practice Efficiencies & Cost Savings.http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings
  6. ↑
  7. ↑ Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. Health Affairs, 24(5), 1103-1117.
  8. ↑ Bates, D. W., Ebell, M., Gotlieb, E., Zapp, J., & Mullins, H. C. (2003). A proposal for electronic medical records in US primary care. Journal of the American Medical Informatics Association, 10(1), 1-10.
  9. ↑ EMR ROI: A Pennsylvania family practice's investment in an EMR pays off three-fold. http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?p=HRCA&u=txshracd2509&id=GALE%7CA163469720&v=2.1&it=r&sid=summon&userGroup=txshracd2509
  10. ↑ 10.0 10.1 Howley et al, 2015. "The long-term financial impact of electronic health record implementation" http://jamia.oxfordjournals.org/content/22/2/443
  11. ↑ Choi, J., Lee, W., Rhee, P. (2013). Cost-Benefit Analysis of Electronic Medical Record System at a Tertiary Care Hospital, Health Informatics Research;19(3):205-214. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3810528/
  12. ↑ 12.0 12.1 How We Improved Our Practice and Our Bottom Line With a New EMR System.Fam Pract Manag, 15(7), 25. http://www.aafp.org/fpm/2008/0700/p25.html
  13. ↑ The Meaningful Use of EMR in Chinese Hospitals: A Case Study on Curbing Antibiotic Abuse 15(7),
  14. ↑ Kuperman, G. J., & Gibson, R. F. (2003). Computer physician order entry: benefits, costs, and issues. Annals of internal medicine, 139(1), 31-39.
  15. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Enormous_Benefits
  16. ↑ http://www.healthit.gov/providers-professionals/patient-participation
  17. ↑ Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing
  18. ↑ 18.0 18.1 18.2 18.3 18.4 18.5 18.6 Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing
  19. ↑ http://www.usfhealthonline.com/resources/healthcare/benefits-of-ehr/#.VfjJDXktDmQ
  20. ↑ http://www.sciencedirect.com.ezproxyhost.library.tmc.edu/science/article/pii/S0882596314002413
  21. ↑ Wei, W.Q., Teixeira, P. L., Mo, H., Cronin, R. M., Warner, J. L., & Denny, J. C. Combining billing codes, clinical notes, and medications from electronic health records provides superior phenotyping performance. Journal of the American Medical Informatics Association: JAMIA. http://doi.org/10.1093/jamia/ocv130
  22. ↑ Pacurariu, A. C. Useful Interplay Between Spontaneous ADR Reports and Electronic Healthcare Records in Signal Detection. Drug Safety. http://doi.org/10.1007/s40264-015-0341-5.
  23. ↑ Marsolo, K., Margolis, P. A., Forrest, C. B., Colletti, R. B., & Hutton, J. J. A Digital Architecture for a Network-Based Learning Health System: Integrating Chronic Care Management, Quality Improvement, and Research. EGEMS (Washington, DC), 3(1), 1168.
  24. ↑ HealthcareIT.gov http://www.healthit.gov/providers-professionals/faqs/how-much-going-cost-me http://www.healthit.gov/providers-professionals/faqs/how-much-going-cost-me
  25. ↑ Removable or Defunct http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810528/
  26. ↑ Cost vs Time http://www.ajmc.com/journals/issue/2015/2015-vol21-n7/Pilot-of-Decision-Support-to-Individualize-Colorectal-Cancer-Screening-Recommendations/
  27. ↑ IMPLEMENTING ELECTRONIC HEALTH RECORDS IN THE EMERGENCY DEPARTMENT. http://www.jem-journal.com/article/S0736-4679(08)00321-1.
  28. ↑ Corder, L., Kuehn, L., Kumar R.R., Mekhjian, H.S. Impact of computerized physican order entry on clinical practice in a newborn intensive care unit. J Perinatol. 2004;24:88-93. [Pubmed: 14872207].
  29. ↑ Han, Y.Y., Carcillo, J.A., Venkataraman, S.T., et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2005;116:1506-1512. [PubMed: 16322178].
  30. ↑ Longhurst, C.A., Parast, L., Sandborg, C.I. et al. Decrease in hospital-wide mortality rate after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2010;126:14-21. [PubMed: 20439590].
  31. ↑ Palma, J.P., Sharek, P.J., Classen, D.C., & Longhurst, C.A. (2011). Neonatal Informatics: Computerized Physician Order Entry. Neoreviews. 12:393-396. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3146345/
  32. ↑ Misch, D.M. Specialty-specific EHR system benefits both practice, patients: technologic innovation: how using EHR, practice management platform can improve standard of care and efficiency. http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?p=HRCA&u=txshracd2509&id=GALE%7CA312290264&v=2.1&it=r&sid=summon&userGroup=txshracd2509
  33. ↑ Thompson, D. I., Osheroff, J., Classen, D., & Sittig, D. F. (2006). 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: JHIM, 21(1), 62-68.
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