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

Revision as of 01:28, 7 September 2012

EMRs have many benefits and return on investments

Lower costs and better management of risks

By consolidating information across the entire spectrum of clinical operations, from admission to treatment to labs and beyond, it allows for the increase in the pace of information flow including service delivery, coding/billing accuracy, and better document patient encounters and work — all while reducing operating costs of the healthcare institution and ultimately the patient. Furthermore, the integration of EMR systems enables for more consistent application of medical protocols. As a result, the availability of information 24 hours a day, 7 days a week, helps to contribute significantly to reduced errors, better decision-making, lower malpractice risk and improved outcomes.

Better Sharing of integrated information

With better information integration capability, it allows for healthcare institutions to facilitate better quality care, contain costs, and better manage risks. Thus, by having healthcare organizations that incorporate an EMR, it enables for both clinical and business advantages by in turn creating a clinical healthcare system that helps to unite crucial patient information with various departments. As a result, this helps to create a central clinical information repository and resource used throughout the integrated delivery network of the institution. This in the long run allows for the different information of patients to be coalesced together in a timelier manner, which can reduce errors in diagnosis.

Patient Safety

By integrating an EMR in a healthcare environment, it allows for greater safety in terms of properly diagnosing the patient knowing all the history and details of the patient that otherwise would never be known to the healthcare provider. In the recent past, the way a doctor obtained a patient’s health history was by asking the patient himself. Each time the patient visited a new doctor's office, he or she would be required to fill out forms about their history, including previous surgeries, or the drugs he or she takes on a regular basis. Thus, if the patient forgot a piece of information, then your doctor didn't have that piece of the medical puzzle to work with. However, when doctors share records electronically, a new doctor only needs to ask for the patient’s name, birthdate, and possibly another piece of identifying information. As a result, the physician can then pull up your records from their electronic storage space. All of the information he needs to see will be there in full. In turn, when it comes time to diagnose the patient, it might be important to him to learn certain details that otherwise would not be known such as that you are taking a certain kind of medication, -- any information shared with a previous doctor. Thus, ultimate diagnosis and treatment decisions might be altered based on certain detailed information, which indeed is far more complete and thorough than what is written down on paper.

Investment Flexibility:

How much investment is available over a certain period of time? For example if a hospital considering to install a nursing system may conduct a pre- and post-implementation analysis of investment including maintenance cost, operating cost, nursing time and activities, determining the exact time spent on each patient activity.

Management Risk Disposition

Willingness to invest in experimental efforts.

Provide users with real time knowledge

Reducing non-clinical time

Increase patient doctor time:

Investment Motivation:

To reduce cost, position for capitation/managed care, and gain market share.

To enable providers to take advantage of financial incentives under the HITECH Act related to "Meaningful Use". https://www.cms.gov/EHRIncentivePrograms/01_Overview.asp#TopOfPage

--Sfjafari 22:21, 10 September 2011 (CDT)

--Sfjafari 22:29, 10 September 2011 (CDT)

Administrative and management benefits

• Overall transparency among the processes
• Improved communication among the clinical to clinical and clinical to administrative staff
• Reduction in drug and radiology usage in the outpatient setting

Return on Investment (ROI)

Quality Care

One could approach the ROI from the perspective of the Institute of Medicine Report, Crossing the Quality Chasm

1. Safe: Reducing adverse drug events, inappropriate testing
2. Effective: Reducing drug costs through appropriate prescribing
3. Efficient: Reducing drug, laborotory, or radiologic utilization
4. Timely: Reducing wait times
5. Patient-centered: Reducing length-of-stay while hospitalized
6. Equitable: Provides data to demonstrate equal delivery

Quantitative Benefits:

These are financial benefits that are clearly measurable and are attributable to the use of a particular technology. E.g., the use of EMR technology to submit claims has resulted in widely quantified cost savings for provider and payer organizations.

Qualitative Benefits:

The EMR will improve patient care by reducing medication error and wait time. Clinical processes will be standardized and there will be less variation in clinical care provided at place from another. Records would be easily shared among the providers, which will reduce the process time and over all improve the disease management.It will also improve the communication among the care providers and the administrative staff and administrative activities.

These are directly and indirectly attributed to the technology but are more difficult to quantify. E.g., implementation of a clinical nursing system may lead to increased case in recruiting efforts, better nurse retention, more rapid access to clinical nursing data, and decreased charting time. Quantification and measurement – of benefits usually is difficult because of the task complexity of the nursing function.

Strategic Benefits:

These offer substantial benefits to the organization, but at some future date. E.g., investments in networking and telecommunications offer significant future strategic benefits, positioning organizations to utilize enterprise-wide patient indexing and EMR or distributed case management technologies as they emerge.

--Sfjafari 22:29, 10 September 2011 (CDT)

Costs

The Medical Group Management Association (MGMA) says the average cost of an EMR per physician is $33,000. (http://www.physicianspractice.com/display/article/1462168/1591117)

Software License:: EMR license prices can easily range from $1,000 – $25,000. The average license for a FULL/TRUE EMR usually starts at $10,000, while a light/entry EMR usually starts at around $1,000, and these costs tend to recur. (http://www.phyaura.com/resources-2/open_source/)

Implementation: Implementation costs are usually billed hourly at a rate of $75-$150 per hour. Average implementation time per provider is 35 hours. Where 10 hours are used for customization, 25 hours for training and 10 hours for computer/network setup. This becomes exponentially lower as more physicians are added. (http://www.emrexperts.com/emr-roi/index.php)

Hardware: Network hardware and configuration, number and type of servers/workstations, hand-held devices, etc. is driven by the vendor's requirements and recommendations, as well as your organization's needs. Costs depend on quantity of equipment purchased or leased. For example, a tablet PC could cost $2,000, a workstation $1,500 and a server $5,000. (http://www.emrapproved.com/emr-hardware.php)

Support & Maintenance: Ongoing support costs will be incurred from both an annual support contract with the software vendor for updates and technical support and the increased need of hardware/network support through a local IT representative. (http://www.emrexperts.com/emr-roi/index.php)

Research

• EMR's increase the quality of medical data by recording coded rather than textual data. This, alongside the application of UMLS coding, will facilitate processes like data mining, data warehousing, in silico clinical trials, predictive modeling and any other mainstream research which requires data analysis. Also, by paving the way for automating data acquisition from other systems (like lab machines, imaging devices, barcode/RFID readers, bio-data sensors) error resulting from duplicate data entry procedures, manual file search and patient identification will decrease.
• While EMRs have shown an increase in the quality of medical data, research is still conflicting on the cost benefits and efficiency gains of EHRs. A study of HIMSS Analytics Database data from California medical-surgical units showed a decrease in cost efficiency for Stage 1 and Stage 2 EMR implementation, and no efficiency correlation for State 3 EMR implementations (http://www.ncbi.nlm.nih.gov/pubmed/20812460).
• EMRs contain large amounts of structured and free-text data which can be de-identified and used for research without disclosing patient information. Pantazos, K., Lauesen, S., Lippert, S. 2011. De-identifying an EHR Database - Anonymity, Correctness and Readability of the Medical Record. Stud Health Technol Inform. 2011, 169, 862-866.
• In addition to structured vocabulary searches of EMR databases, free-text search algorithms within and EMR can generate additional information critical to the identification of epidemics. Often, critical information is omitted by the clinical team when only structured vocabulary is analyzed. DeLisle S, South B, Anthony JA, Kalp E, Gundlapalli A, Curriero FC, Glass GE, Samore M, Perl TM. Combining Free Text and Structured Electronic Medical Record Entries to Detect Acute Respiratory Infections. PLoS One. 2010 Oct 14, 5(10):e13377

• Genome-wide association studies have become commonplace for the identification of risk and causative genetic variants. The power of these studies is highly dependent on accurate phenotypic classification of both control and test populations. Application of natural language processing algorithms to free-text clinical narrative, in addition to structured data, can significantly benefit these studies. Kullo IJ, Fan J, Pathak J, Savova GK, Ali Z, Chute CG. Leveraging informatics for genetic studies: use of the electronic medical record to enable a genome-wide association study of peripheral arterial disease. J Am Med Inform Assoc. 2010 September, 17(5): 568-574.

Barriers of EMR Implementation

• In order for an EMR to be truly successful, proper and timely training must be administered to all who will interact with the system.
• Conflicting research findings on the cost and efficiency benefits of EMR implementations will make it difficult, if not impossible, for administration staff to be confident in choosing an EMR for their facility. Until there is adequate research on multitudes of EMR systems that shows causal relationships between facility characteristics and the related EMR components there will not be a sufficient method of EMR selection and implantation.
• If it is true that implementations of EMRs cause a decrease in efficiency and an increase in quality of medical care then further research must take both of these repercussions into account and determine if there is an overall net benefit of EMR implementation.
• The 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.

EMR Cost Categories

References

Committee on Quality of Health Care in America, Institute of Medicine. "Front Matter." Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press, 2001. Full text