EMR Benefits and Return on Investment Categories

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

Financial

• EMR can prevent unnecessary duplication of diagnostic tests that might occur when a patient sees multiple healthcare providers. Reference: Evidence on the Costs and Benefits of Health Information Technology. http://www.cbo.gov/ftpdocs/91xx/doc9168/MainText.3.1.shtml#1096012

• Charges for laboratory tests were 8.8% lower in the intervention group (P < 0.05) from: Tierney WM, McDonald CJ, Hui SL, Martin DK. Computer predictions of abnormal test results. Effects on outpatient testing. JAMA. 1988;259:1194-8.

• With the use of EMR, record handling will be conducted in the office, records will not have to be sent to an outsource provider or to a transcriber for handling. This will ultimately help saving transcription cost. Reference: http://www.allscripts.com/casestudies/nffm.pdf

• EMR can facilitate the efficient creation and transmission of reports that support patient safety, quality improvement, public health, research, and other health care operations. All of those will reduce the cost of healthcare.

• EMRs can remove the middle man in different instances, cutting cost by eliminating the need for the middle man. For instance, automated dictation replaces the person that would type the dictation, thus reducing total cost.

• Financial benefits under pay for performance (P4P) accrue to the highest quality providers, both hospitals and physicians. EMR's which allow for real-time quality data can enable organizations to better meet targets to earn quality bonuses on Medicare and private insurance reimbursement.

• Many ambulatory EMR systems are integrated with e-Prescribing. For physicians who use this technology in 2009 and 2010 for at least 50% of their eligible patients, an addtional 2% will be added to their Medicare reimbursement. The amount drops to 1% for 2011 and 2012, and thereafter, non-use becomes a penalty. [1]

• A major component of all hospital operating budgets is the purchase of drugs with IV and IM doses generally being considerably more costly per dose versus oral. EMR's can support early transition from parenteral medications to oral, thus decreasing costs per admission and length of stay (LOS).[Reference: Fischer MA et al.Conversion from intravenous to oral medications. Arch Int Med 163(2003):2585-2589.]

• In a paper record, clinicians are not always thinking about optimizing charges. Omission of essential information makes it difficult to justify the charges. An EMR can help reduce billing errors and help prompt users to document fields that will be essential for billing. Wang et al, A Cost-Benefit Analysis of Electronic Medical Record.

• Effective EMRs and clinical decision support systems help notify clinical nurse specialists of patients with pressure ulcers or risk for developing pressure ulcers and avoid unnecessary costs for hospitals. Timm JA, Chick KL, Peterson JA, Epps SI, Bleimeyer RR, Harris M. Using expert rules to automate pressure ulcer alerts for the clinical nurse specialist. AMIA Annu Symp Proc. 2008 Nov 6:1154.

Clinical

• EMR systems have been proven to decrease the amount of time nursing staff spends on documentation. Reference: A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database. Journal of Healthcare Information Management- Vol. 21, No. 1 p 67.

• Alert and reminder programs in EMR's increase physician attentiveness to certain areas such as preventive medicine or more specifically drug level monitoring. Reference: Computer Physician Order EntryL Benefits, Costs, and Issues. Gilad Kuperman, M.D., P.h.D., Richard Gibson, M.D., P.h.D. Ann Intern Med. 2003; 139:31-39.

• Increased ordering rates for pneumococcal and influenza vaccine, prophylactic heparin, and aspirin at discharge. from: Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med. 2001;345:965-70.

• With the quality EMR, quick access to patients records can be lifesaving during the emergency situation by helping emergency decision-making process.

• EMR can help making medical history more efficient and accurate by providing templates that can decrease the time spent in documentation.

• EMR can reduce the number of errors associated with transcription.

• EMR will provide the integrated view of patient to clinician so that they can spent less time for getting patients’ history, lab and radiology results and medication information so that clinicians can make diagnosis more accurately and faster.

• By integrating guidelines and clinical information tools, EMRs improve the quality of outpatient care and safety of drug administration. Reference: Crane RM, Raymond B. Fulfilling the Potential of Clinical Information System. The Permanente Journal. 7.1 (2003). PP 63-64.

• An effective EMR system helps clinical nurse specialists notify patients with pressure ulcers or risk for developing pressure ulcers in time and therefore improve quality of care. Timm JA, Chick KL, Peterson JA, Epps SI, Bleimeyer RR, Harris M. Using expert rules to automate pressure ulcer alerts for the clinical nurse specialist. AMIA Annu Symp Proc. 2008 Nov 6:1154.

• In the intervention group, physicians ordered 14% fewer tests (P < 0.005) and charges for tests were 13% lower (both P < 0.05). Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl JMed. 1990;322:1499-504. [PMID: 2186274]

Operational

• Overall, 6.2% increase in time spent ordering (not statistically significant); experienced users were time neutral with paperbased ordering. from: Overhage JM, Perkins S, Tierney WM, McDonald CJ. Controlled trial of direct physician order entry: effects on physicians’ time utilization in ambulatory primary care internal medicine practices. J Am Med Inform Assoc. 2001;8:361-71.

• EMRs allow a physician to access multiple records at the touch of a button. Whether he or she is at a computer or in an exam room with a patient, the workflow is enhanced as less effort is required to retrieve information.

• Integrated communication and reporting support. EMR can facilitate the efficient creation and transmission of reports that relate to health care operations such as billing and charge information.

• EMRs improve interdisciplinary collaborations and efficent communications between physicians and nurses via nursing documentation with greater clarity and additional information. Green SD, Thomas JD. Interdisciplinary collaboration and the electronic medical record. PMID: 18649812 [PubMed - indexed for MEDLINE]