EMR Benefits: Healthcare quality

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The primary goal of any electronic health record (EHR) system is to improve patient care. EHRs are basically designed to facilitate the exchange of medical information for purposes of improving clinical care. The real-time access of health records including radiology and laboratory results from inpatient or remote locations results in more coordinated and efficient patient care. In addition, the use of performance-improving tools such as clinical decision support systems, alerts, reminders, and electronic medical information, puts the provider in a better position and clinical environment to satisfactorily perform his or her duties more efficiently and patients get the best care they deserve.


Data access

When it comes to patient care, the more information that a doctor has at his or her fingertips, the better the results will be for everyone involved. If a notation made from a previous visit regarding a patient's drug allergies or condition cannot be read or goes missing from their paper medical file, a physician could be in the dark and make a grave decision with regards to treatment. With electronic medical records, a patient's entire healthcare history can be viewed with ease in order to help doctors make the best judgment calls.

In the 2014 HIMSS study, "EMR Effectiveness: The Positive Benefit Electronic Medical Record Adoption has on Mortality Rates", it was noted that a relationship exists between the level of EMR adoption as measured by the EMRAM score, and a hospital’s performance as measured by predicted, actual rates of mortality and associated z-scores. This study implications include that hospitals with advanced EMR capabilities are able to capture more information about the patient. This improved data capture involving the patient’s co-morbidities and other risks allow clinicians to better manage patients seen in the hospital, resulting in more positive predicted clinical outcomes. [63]

With the implementation of EMRs, patients' health information is available in one place and can be accessed when and where it is needed. Complete access to health information is essential for safe and effective care of patients which can lead to better patient outcomes and high quality care. In addition, it serves in achieving a higher form of personalized medicine and continuity of care, which are really important in the quality of patient care. Health care providers with busy practices and patients with busy lives can conveniently manage their health care transactions with EMRs. Besides, the 'clinical information distribution framework' (paper processes) is antiquated and does not support the modern practice of medicine as it migrates increasingly to evidence-based practice. Four signs that these outmoded processes need to change:

  • Paper based systems are not viable - patient care should be driven by point of care information available to clinicians when and where they need it. This is typically not available in paper based processes but is in the EHR.
  • Human memory is unreliable: so much research is being published that clinicians do not have time to read it all and the unaided mind is hard-pressed to recall all the detailed knowledge that current studies can impart. Computer based alerts, reminders and similar tools are needed!
  • Capturing clinical data is a new business imperative - clinically based information needs to be utilized for better responsiveness to unaffordable high costs of care and for use in disease management; EHRs are better adapted at these tasks than are paper based processes.
  • Rising consumer expectations - increasing numbers of consumers have high expectations of IT in various facets of their lives and this includes healthcare where they are increasingly responsible for managing their care [39]. Paper charts controlled by the provider do not meet consumer expectations for control of their information and convenient access.
  • EMR and EHR use enables health care facilities align the quality of their practice with the six aims of the Institute of Medicine (IOM) to provide patient care that is safe, effective, patient centered, timely, efficient and equitable[1]
  • EHR use can facilitate the collection and reporting of Quality informatics metrics / measures not only for compliance within a healthcare institution but also for external regulatory purposes. Ultimately the quality of patient care is enhanced as a result.
  • EMR use to support Patient Centered Care can be accomplished by the use of portable devices or accessing patient data via a portal at the patient bedside or in the exam room.

The ability to access data in a reliable and timely manner has become essential for all the care teams in a facility. EMR has facilitate access to information to the different departments that may be involved in a patient's visit. It has become imperative to have current information to enable ancillary departments to perform examinations and convey results to the rest of the care team for continuity of care.

Up-to-date information about patient at point of care

EMR can provide health information that is up-to-date with clinical information [2]. With an EMR, lab or radiology results can be retrieved much more rapidly. Test results and medical history are recorded directly into the EMR [3].

Access to information during urgent care

EMR systems have the potential to facilitate and enhance urgent care when the emergency room or urgent care physician has access to the patient’s EMR file as would occur when a patient seeks urgent care within the healthcare system where the patient receives routine care or when the patient’s EMR file is available in a ilocal, regional, national EMR system [19]. In such a scenario, the emergency room or urgent care physician could consult the patient’s EMR file to view the patient’s current medications, diagnoses, recent surgeries or procedures, and medical history, allowing the emergency physician to be better informed about the patient’s status and urgent needs [19]. In terms of specific chronic illnesses such as heart failure, an EHR may have the potential to be a valuable adjunct in the care of heart failure patients [28]. Information security and privacy concerns will have to be addressed, however, in order for shared EMRs to gain widespread public acceptance [19]

Improved access to Obstetric Outcome Data

  • Nielsen, Thomson, Kiley, Kosman and Jackson(2000) reported that the implementation of the Standard Obstetric Record Charting system (STORC) led improved rapid access to obstetric outcome data. [4]

Clinical Decision Support

Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and better health care. CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include:

  • Computerized alerts and reminders to care providers and patients based on patient specific data elements, including diagnosis, medication, and gender/age information as well as lab test results
  • Clinical guidelines/established best practices for managing patients with specific disease states
  • Condition-specific order sets
  • Focused patient data reports and summaries
  • Documentation templates
  • Diagnostic support [5]

Clinical Decision Support (CDS) can be used as an additional tool for performing potentially more accurate diagnoses in challenging situations, thus improving the quality of provided care. It has been shown to increase healthcare quality and patient safety, improve adherence to guidelines for prevention and treatment, avoid medication errors and reduce cost of care.

Reduce diagnostic errors

Diagnostic errors are defined as missed, delayed, or wrong diagnosis can lead to missed opportunity in patient care and increased cost. Example includes Failure to use an indicated diagnostic test, misinterpretation of test results pr failure to act on abnormal imaging results. Extensive adaptation of EHR along with clinical decision support tools will helps to reduce diagnostic errors and its percussion on patients, healthcare providers and healthcare organizations. Electronic clinical decision support alerts, red flags or triggers in the EHR will help providers to improve quality of patient care by reducing diagnostic and medication errors. For instance, for patients with abnormal test results, alerts in EHR will send notifications to providers to recommended follow up and appropriate management.[6].Medication alerts will send notifications to providers about possible drug interactions.For example, for patients with congestive heart failure that take the prescription medication Lasix, the EHR prompts providers to check potassium levels. Before the clinic used EHRs it was difficult to monitor for drug interactions. Now, the EHR alerts provide a safety net that helps reduce medication errors, improving overall patient care.Moreover, systematic reviews found that CDS can improve health care professional performance [8]. Therefore, there is increase evidence that CDS can be helpful in many ways. It is clear that CDSS will have significant effect on improving patient safety strategies.

Preventing adverse events

Physician surveys have attributed EMRs to alerting to allergic drug reactions and drug interactions that might have been missed. In addition, they reported more timely reporting of critical laboratory values.

A systematic review of the effectiveness of safety alerts in EMRs showed a reduction in medication errors in patients with renal insufficiency, pregnant women, elderly patients, drug-drug interactions and ADEs related to hyperkalemia.

This is an important benefit, since medication related adverse events, will not only cause patients harm but will increase the cost [7] and the use CPOE will eventually help to reduce the cost of medication related adverse events [3]. Although, some study suggested that is less likely to occur during the early implantation phase[4].EHRs act as a multilevel feedback system to report adverse events. Reporting can be facilitated at multiple levels such as physicians, nursing staff, patients , thus capturing adverse event related data more quickly and efficiently

Although many studies have shown CPOE can reduce the frequency of medication errors, there is no distinct association between CPOE and reduced harm for patients from medication. [8] For instance, there are certain antibiotics that work well with certain disease pathways, and selecting the wrong one may have null effects that may cause further harm for the patient. Developing EHR systems will provide additional data on the usage of certain medications with diseases and outcomes, which will expand our knowledge on selecting efficient medication for improving quality in patient care.

Degree of implementation of CPOE and CDS according to Leapfrog performance scores has shown to correlate with relative reduction in adverse drug events. One study found a 43% reduction in predicted adverse events for every 5% increase in Leapfrog performance score. [9]

EMRs makes information available to physicians at the time they enter an order. For example, the EMR systems can give warnings about potential interactions with a patient’s other drugs. [10]



In a study by Tisdale et al., the clinical decision support system was able to decrease the dispensing of drugs that would prolong the QT interval in at risk patients by alerting the pharmacist when he or she was entering a potentially offending drug into the computer system. The pharmacist could then discuss the issue with the prescribing doctor and resolve the problem; thus, preventing complications such as Torsades de pointes. [12]

Improved diagnostics and patient Outcomes

According to a national survey, physicians who were ready for meaningful use found 95% of clinical providers reported that their EHR system made records available to them at the point of care. The survey also found that 88% of the clinical produced benefits their practices. And there was a 75% improvement in patient care providers reported. It has been documented that HIV testing in the emergency department is time consuming and a tedious process requiring extra funding. In 2010 Arizona department of health services partnered with Maricopa integrated health system to initiate routine HIV screening system in the Emergency department. Based on a test, educate, support and treat Arizona (TESTAZ) program, the MIHS integrated a custom documentation specific to HIV screening into the existing EMR system and used its clinical decision support to help clinicians place an order for HIV test, get informed consent from patients and guidance for follow up orders and use electronic data collection and reporting. This modification increased HIV testing for eligible patients in the emergency department. In the first year 67% eligible subjects were tested which increased to 97% and 100% in second year and third year respectively. The high success rate of pushed the TESTAZ program expansion to include the Burn ED, Walk-in Clinic, and Whole Health Homes (providing integrated medical and behavioral healthcare to seriously mentally ill patients). TESTAZ is recognized as a national model for the implementation and maintenance of a routine, opt-out HIV screening program [13]

In addition, in a study a best practice alert (BPA), which is a clinical reminder in an EMR used to help providers adhere to certain guidelines, was developed to adhere to the antimicrobial stewardship. “Antimicrobial stewardship programs (ASPs) use a variety of methods to improve patient care and outcomes through judicious use of antimicrobial agents, including education and direct interaction and feedback to the prescriber.” The study focused on antimicrobial de-escalation using BPA by creating 1,285 stewardship BPAs, resulting in “significant decreases in total antibiotic use as well as in use of broad-spectrum (anti-methicillin-resistant Staphylococcus aureus and anti-pseudomonal) agents.” [14].

In the emergency department, Nguyen et al. were able to demonstrate how well a clinical decision tool was able to detect patients with sepsis. It provided a "true-positive sepsis alert of 91.0%, a false-positive alert of 83.0% and a no sepsis alert of 5.7%." [15]


Dxplain is part of the CDSS designed in 1984 at the Massachusetts General Hospital to assist physicians with a list of differential diagnosis based on the patient's symptoms. "The current DXplain knowledge base (KB) includes 2241 diseases and over 4800 clinical findings (symptoms, signs, epidemiologic data and laboratory and radiologic findings)."Hoffer, et al (2005) [16] The most common use of this program is to generate a list of diseases associated with the case problem. DXplain has the ability to produce a differential diagnosis list when a particular finding has been inputted into the program. In addition, “Disease Compare” allows the user to select two or more diseases and see a side-by-side table comparing the findings in each disease. Hoffer, et al (2005) This software is a web-based program and has potential to improve and assist physicians with differential diagnosis. Hoyt, et al( 2014) [17]


Hibbs et al, systematically reviewed the impact of Electronic Decision Support System (DSS) on Transfusion medicine. According to the article the study focuses specifically on the effect of DSS on blood product ordering. Different studies were collected from different medical databases from January 2000 up to April 2014. Up on finishing their review Hibbs et al reported that there was a substantial evidence that DSS improves the use of red blood cell usage. The article also added the introduction of DSS resulted in cost saving in studies with financial outcomes reported. [18]

Improved patient safety

CDSS affect patient safety by substantially reducing medication error rates, reducing risk of overdose or medication abuse, decreasing the occurrence of adverse drug reactions, and increasing adequate follow-up of critical test results such as abnor­mal biopsies, radiological studies, and laboratory tests Further, these systems utilize a variety of tools to enhance decision-making in clinical workflow, including computerized alerting systems, reminders, advice, critiques, and suggestions which can notify physicians about problems occurring asynchronously (clinical guidelines, condition-specific order sets, focused patient data report, summaries, etc.).

Furthermore, the system can reduce unnecessary prescription of antibiotics. There has been an increased prevalence of antibiotic resistant bacteria due to the widespread abuse of broad spectrum antibiotics. A study reported 73% of adults received antibiotic therapy from their primary care physicians when in reality only 5-17% of the cases warranted antibiotics.[19]. CDSS can help prevent the unnecessary use of antibiotics in addition to providing support regarding prescription medication. [19]

Inadvertent medical errors and ancillary procedural delays can prove costly in neonatal intensive care units (NICU). In one study, Computerized physician order entry (CPOE) showed almost complete elimination of medical errors (with the drugs studied that is gentamycin and caffeine), significant decrease in medication turn around time and radiology orders. This study was conducted using a commercial CPOE system and not on the institution specific CPOE. This gives the glimpse that even vendor specific EMRs can be helpful in small care units or community hospitals that cannot bear the cost of developing a custom CPOE. [20]

EMR systems provides mechanisms for identifying and eliminating errors. The EMR provides the information needed to redesign the order execution process so that errors become even harder to make.[21]

Safety with Colorectal cancer

A paper from Dr. Amy Schwartz and her team talks about how an electronic health record (EHR) based decision support systems (DSS) can affect situations about colorectal cancer. After testing the use of this kind of system, the team concluded that there is enough evidence to support the use of an EHR-based DSS for the use of determining what kind of treatment is good for a patient with colorectal cancer.[22] Through the analysis of “payoff time”—which, in this paper, is “defined as the minimum time until the benefits of screening exceed the harms”—three main points were concluded by the team.[22] The biggest point that the paper emphasizes is that “[e]lectronic medical record decision support may facilitate personalized benefit/harm assessment.”[22]

Length of stay in a hospital

An integration of a clinical decision support system in an EMR led to a decrease in the costs of anti-infective agents, a decrease in the length of stay in the hospital, and a decrease in the number of hospitalizations [23]. Along with CDS integration, CPOE integration can also decrease LOS in hospitals.

Adherence to clinical guidelines

The implementation of certified EMR was found to increase the adherence to clinical guidelines for management of diabetes. This improved quality of patient care by increasing the rate of appropriate and timely laboratory tests, and decreasing unnecessary retesting. [24].

Decrease in staff resources

A study reveals significant decrease in staff resources when a Computerized Decision Support was used for medication dosing for hemodialysis patients. CDS was associated with a nearly 50% reduction in nursing staff time spent on anemia management. It was concluded that computerized decision support maintains anemia management and reduces burden on dialysis staff. [25].

Safety Checklist

Living donor transplantation carries risks beyond those routinely associated with surgery. An EMR-based safety checklist was developed to reduce errors, which is easy to use and helps prevent LDKT 'never events' from occurring. Donor information is manually entered in to the tool directly from the source documentation, fostering critical review of each entry by the surgeon. It also enables source documentation information to be centralized in to a single location that is readily accessible to all transplant team members. The LDKT checklist presented was met with good utilization by the transplant surgeons and was deemed easy to use. It provided a final checkpoint prior to transplantation once all donor and recipient information was known. [26]


An HPV vaccination clinical decision support system was developed that informed both providers and patients' families about the benefits of obtaining the vaccination. Analysis of surveys determined that the mode and content of communication were acceptable to all parties involved. A study of the benefits of this model concludes that "a comprehensive decision support system directed at both clinicians and families" can have a positive impact on patient care. [27].


The implementation of a clinical decision support system for discharge referral positively impacted 30-day and 60-day readmissions at a hospital. The percentage of high and low risk 30-day readmissions dropped by 33% while 60-day readmissions dropped by 37%. [28] In a study standardized electronic discharge by Showalter using electronic discharge instructions did not lead to benefits in readmission and ED use.


Improved Medication Prescription

EMR systems allow for improved methods of prescription for patients and result in several benefits for patients, physicians and pharmacies alike. EMR provides a network by which prescriptions may be prescribed bypassing the traditional paper route, but instead utilizing facsimile or emailing prescription with digital signature. The electronic method allows for a record of any medications sent, while maintaining legibility. With this implementation, an accurate and up to date record is always on file, there is an increased ease of prescribing refills along with greater convenience to patients who may otherwise be handling paper prescriptions. [29]

Improved medication safety

Computer-based physician order entry systems prompted safe medication practices. Before the advent of automated order entry systems, physicians prescribed antibiotics commonly, which lead to an emergence of antibiotic resistant organisms. This not only promoted difficult-to-treat iatrogenic infections, but also increased the cost of healthcare in general. In addition, patients were inadvertently prescribed incorrect doses, especially in children and elderly, who needed dosage adjustments based on body mass, liver and kidney function. Incorrect dosing resulted in drug toxicities and organ failures. [30] Furthermore, drug-allergies, drug-drug interactions, and adverse drug events were commonplace due to the inaccessibility, inefficiency, and illegibility of paper-based systems and the unreliability of human memory. [31] The Computerized Physician Order Entry system sealed the holes in the traditional healthcare delivery system. According to Galanter, et al (2013), “Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry.” [32]

Pharmacy order entry

EHRs with alerts at the point of pharmacy order entry can help reduce medication errors and prevent potential clinical hazards.

EHR alerts has been beneficialin reduce medication errors in elder patient, pregenant patient and patient with compromised renal or liver functions. EHR alerts can help reduce drug-drug interactions and allergic and adverse events. [1]

Improved accuracy of diagnoses and health outcomes

EMRs provide reliable access to a patient's comprehensive health information which in turn helps diagnose patients' problems efficiently. EMRs can improve the ability to diagnose diseases, improve patient safety, support better patient outcomes and reduce or even prevent medical errors. Of the latter problem, medication errors are the most common cause of clinically induced injuries and CPOE has been shown to reduce these errors, by as much as 55% according to one study. Evidence shows that when combined with Clinical Decision Support, CPOE is particularly effective in reducing medication errors and also helps improve laboratory and imaging test utilization, among other benefits [42]. One study showed a 48% decrease in the likelihood of medication errors in an inpatient hospital setting. [8] Although it is unclear that CPOE can reduce the harm for patients from medication, the increasing amounts of data acquired such as particular medication for certain diseases and outcomes, may play a vital role in the efforts for improving public health.

More effective preventive care

EMR systems have the potential to enhance preventive care through integration of an automated alert system that reminds physicians and/or patients when preventive care procedures such as vaccinations, screening tests, or wellness/follow up visits are recommended [18].

Kuperman et al. (2003) conducted a review of studies discussing the benefits of CPOE. A randomized control trial of 6731 patients and 200 physicians in a General Medicine teaching institution where the computer application sent a reminder that the patient was eligible for preventive care yielded an increase number of orders for the flu and pneumococcal vaccine as well as aspirin for coronary artery disease. Another 4 week study conducted in medical and surgical units showed increased number of orders for H2 blockers and prophylactic Heparin when the EHR prompted physicians during CPOE. [11]

The use of EMRs has been shown to reduce ED visits and hospitalizations among diabetic patients in an integrated delivery network [37].

Computer-reminder systems, especially in outpatient settings, helped physicians adhere with evidence-based clinical practice guidelines. Tundia, et.al. (2012) reported superiority using computer reminders on women's preventive health and disease management. Based on the automated alert systems, more physicians ordered screening tests such as breast examinations, mammography, pelvic examinations, Pap tests, bone mineral density tests, cholesterol tests, and chlamydia tests. [33]

Care coordination among clinicians

The use of electronic medical records has allowed multiple healthcare providers across different specialties to access the patient's complete medical record. They help clinicians 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]

Improved Coordination of Care

  • As medical practices and technologies have advanced, the delivery of sophisticated, high-quality medical care has come to require teams of health care providers—primary care physicians, specialists, nurses, technicians, and other clinicians.
  • Each member of the team tends to have specific, limited interactions with the patient and, depending on the team member's area of expertise, a somewhat different view of the patient. In effect, the health care team's view of the patient can become fragmented into disconnected facts and clusters of symptoms. Health care providers need less fragmented views of patients.[34]
  • Tolomeo et al reported that the implementation of an EMR in a pediatric respiratory medicine practice has improved coordination of care with regard to asthma education. The article noted a 54% improvement in providing asthma action plan up on discharge to children who were treated for exacerbation of asthma. [35]
  • Electronic health record systems can decrease the fragmentation of care by improving care coordination. EMRs can integrate and organize patient health information and facilitate the immediate dissemination of information to authorized providers involved in a patient's care.[36]
  • By making data readily available during patient encounters electronic messaging,EMRs facilitate within-office care coordination.[37]
  • In the Imaging Services Department, EMR is an important and necessary part of daily operations. Clinicians will be able to access results from the system they originated the order from. In addition, Radiologist benefit as well by having access to the clinical information that will allow a more-informed interpretation which leads to improved patient outcomes. [38]

Patient Handoff

Patients can be safely handed off from one caregiver to the other. Especially CPOE reduces errors due to bad handwriting, verbal miscommunication etc. Implementing standardized, electronic patient hand off communication tools is known to have a positive effect on provider satisfaction and potentially patient safety. [39] Also, integrating sign off notes into EHR was found to improve physician workflow and improve physician satisfaction. [40]

Improved communication between clinicians and patients

When EHR is implemented, King et al found that direct communication between patients and clinicians were significantly improved either through email or secure messaging [41]. Further, this improvement is associated with longer EHR usage experienace and meeting the Meaningful Use criteria.


EMR can optimize workflow for trainees and training programs by reviewing reports of trainees’ clinical activity and notes. We can more easily and efficiency identify deficiencies of trainees and training program compared to paper-based system. Thus, EMR can provide a safer environment for patient.

Another area in which EMR has improved workflow is the Imaging department. Clinical information can be access by technologist, radiology nurses and radiologist from their areas. Radiology orders are clear and with appropriate reasons for performing them. Ordering physicians and care team have available contraindications, preparation and information pertaining to the exam ordered. Digital workflows enable greater transparency of given processes and enable process changes that can further improve imaging operations.[38]

Efficient utilization of health services

Healthcare quality is plagued by overuse, underuse, and misuse of Healthcare services. Reducing these plagues will invariably improve the quality of care. Kuperman and Gibson indicate that EMR such as Computer Physician Order Entry have been found to:

  • reduce overuse of health care services
  • reduce underuse of health care services
  • reduce misuse of health care services [17]

Furthermore, CPOE has been continuously shown to reduce the overuse of diagnostic procedures and antibiotics.[42].

Patient Safety Outcomes

EMRs increase patient safety and improve patient quality care by:

  1. Insuring practice of better evidence-based medicine
  2. Allowing flawless health information exchange between health care providers
  3. Decreasing cost due to changes in drug frequency, dose or route administration [43]
  4. Improving communication and engagement with patients and their health care providers
  5. Increasing patient medication compliance leading to improved overall health outcomes
  6. Promoting higher rates of reporting incidents and near incidents, ensuring greater numbers of completed reports and resulting in a more diverse pool of healthcare staff who report. [44]

EMRs insure the practice of better evidence-based medicine by developing evidence-based clinical and Good Clinical Practice guideline reminders that are prompted to health care providers during patient encounters.

The exchange of health information is greatly improved with EMRs because it can be delivered instantly and securely. Since the health care provider is entering the data into an EMR, medical errors are reduced from illegible handwriting.

The impact of computerized provider order entry (CPOE) on medication errors with the use of a basic CPOE system in an ambulatory setting was associated with a significant reduction in medication errors of most types and severity levels. [45]

EMRs help health care providers by alerting them to potential adverse drug events when entering new prescribed medications in the computerized provider entry forms (CPOE) for patients with allergies, incompatible medication interactions, and delivering medications to verified patients. CPOE systems address these problems, ensure patient safety and save associated costs and injuries. CPOE features that help to achieve this are patient-specific dosage suggestions, reminder to monitor drug levels, reminders to choose an appropriate drugs, checking for drug allergy and drug-drug interactions, standardized order sets, increased legibility, automated communication to ancillary departments and ease of access to patient data.[17]

EMRs allow pharmacists access to patient histories, past medication therapies, and current lab values. Clinical pharmacists have the responsibility of medication reconciliation, medication dose adjustments due to changes in liver/kidney function, transition of IV to oral therapies (in order to discharge the patient) and establishment of outpatient therapies. These areas of focus have shown to dramatically decrease length of hospital stay, increase beneficial patient outcomes, and decrease overall healthcare cost.

Use of traditional peer-reviewed approaches as a model for developing standardizations could serve as models for a foundation for new CPOE tools and as a benchmark for existing CPOE tools. For practically all major disease states, there are publicly accessible treatment guidelines that have been established by experts, undergone peer review, and are updated on a periodic basis. Using these review standards for development of protocols for drug-drug interactions, etc. improved accuracy and up-to-date information would be available and utilized to assist in protecting patients. [54]

Participants in the U.S. 2011 Physician Workflow study of office-based physicians responded that use of the EHR alerted them to potential medication errors (65%) and critical lab values (75%). This type of notification is a clinical decision support tool that many hospitals and providers use in their EHR. Clinical Decision Support is not limited to just alerts but can also inform a physician of immunizations needed for a certain age group or clinical guidelines. [46]

In other words, EMRs allow for Decision Support Systems (DSS) to be utilized. DSS detect critical values or errors in care and notify the clinician immediately. DSS may provide knowledge-based information and/or reminders to support or aid in finding a solution to a clinical problem (7). [45].

Using Data-Based Algorithms to Find Missed Opportunities

Data from EHRs can be used to determine if patients are lost to follow-up for certain types of cancer, thus allowing them to get treatment before their cancer progresses. Using a data-based "trigger" algorithm containing clinical inclusion and exclusion criteria, researchers have been able to mine EHR data repositories to determine patients that may be lost to follow-up for prostate, lung, and colorectal cancers. [47] [48]

Diagnostic Error Detection

Trigger algorithms can also be used to detect missed opportunities in the outpatient diagnostic process, thus leading to improved patient safety. By using triggers to identify cases where an error may have occurred, researchers are able to categorize and further study these errors so that in the future, they can be caught or prevented entirely. This sort of research would be impossible without the large repository of data that EHRs collect and store.[49]

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 one place from another. Records would be easily shared among the providers, which will reduce the process time and over all improve disease management. It will also improve the communication among the care providers and the administrative staff and administrative activities. The EMR can help the provider deliver the best quality of care because the EMR contains the complete patient‘s health history. In a crisis, the EMR provides immediate access to a patient's medical history, allergies, and medications. The retrieved information enables providers to make decisions sooner which otherwise they would have to wait for, like information from test results or other resources. This feature is very critical when a patient has a serious or chronic medical condition, such as diabetes. Also, the EMR information can be shared with patients and their family, so they can more fully take part in decisions about their health care. In addition, using decision support tools in EMRs help the provider to make efficient and effective decisions about patient care through clinical alerts and reminders.

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.

Pinsonneault and associates found that data from before and after EHR integration, from a matched set of 15,626 patients with electronic integration and 15, 626 patients in a control group, who visited over 95 physicians in a large North American health network, show that patients treated through the electronically integrated system had better quality of care in the follow-up period and a higher continuity of care, compared to the control group [29].

Another overview of an attempt to quantify quality outcomes and cost reporting measures benefits of EHRs was published by the Healthcare Information and Management Systems Society in 2010 and can be found here: http://www.himss.org/content/files/QPRWhitePaper.pdf

Natural Language Processing

Natural language processing (NLP) is a method of extracting information from free-text data and is becoming more frequently used in electronic health record related research.[50] Just as trigger algorithms can make EHR-related patient safety research more automated and efficient, NLP takes this sort of research a step further by turning data that was once incapable of being machine-read or unable to be categorized into a format where these steps are possible.[51]

Researchers can use NLP-driven algorithms to identify patient risk factors and post-operative complications and many other patient safety-related concerns. This technology has proven to be more efficient, more accurate, and less costly than the traditional administrative data chart review. [52]

In one example, Iqbal et al. were able to use GATE NLP software to "identify instances of a potential ADE from psychiatric EHRs." [53]

Reference Laboratories

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: [54]

  • Decreased costs as a result of transitioning to a paperless system.
  • Decreased order entry time.
  • Decreased lab result response time.

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)[55] 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.

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).

Personalizing Healthcare

After Visit summaries (AVS)

Stage 3 meaningful use recommends that patients or their authorized representative receive a clinical summary after each visit that is not just an abstract from the medical records, Most EHRs enable clinicians to supply patients with such information in the form of an After Visit Summary (AVS) that is generated from data entered into their medical records. The AVS should have relevant clinical information and instructions pertinent to the office visit. It should also be provided in a language other than English, when needed, within 3 business days of the clinic visit, and should contain more than 50% of the office visit clinical summary. Provision of the AVS is important, as physicians usually overestimate patient understanding of the treatment plan. Therefore, the AVS has the potential to improve patient engagement in their care and contribute to more personalized healthcare and share medical decisions.

Targeted cancer therapy

EHR with clinical decision support help process the genomic data in the context of individual patient and provide dosing recommendation in a timely manner.

EHR when intergrated into work flow can help realize personalized cancer treatment at the point of care. [www.ncbi.nlm.nih.gov/pubmed/21568680]

Improved Documentation of Advanced Care Planning

EMR can be utilized to screen patients in an outpatient setting and prompt the physician to have a discussion about Advanced Directives. A study conducted as a QI improvement project showed that EMR-based reminders on counseling were effective in improving documentation rates of Advanced Directives.[59]

Electronic Health Records and Quality of Diabetes Care

Sites with EHR systems implemented were associated with greater improvement in care. Regardless the insurance type, EHR sites were associated with higher achievement of care and outcome standards and higher improvement in diabetes care.[56]

Personalized Healthcare based on patient genotype information

Integration of genomic variation data in an EMR can help with disease risk prediction based on a patient’s genotype information. This can help providers and patients take action before a disease manifests itself. [57]

Patient Satisfaction

An EHR system reduces the need for patients to fill out the same forms at each office visit. The system enables providers to have reliable point-of-care information and reminders that notify them of important health interventions for their patients. This improves patient care and satisfaction. There is also the convenience of computerized physician order entry (CPOE) or e-prescribing. When integrated into an EHR system, CPOE electronically sends new prescriptions or refills to community pharmacies for outpatients. Patient portals including personal health records (PHRs) are now used for online interaction with providers. Access by electronic communication between providers and patients facilitates follow-up care for patients.

see EMR Benefits: PHR

Patient Involvement

Some EMRs enable patients to view their own medical records. They also lets patients renew prescriptions, make appointments and communicate with providers. Patient involvement is expanded to incorporate complaints and symptoms, monitor disease and response to therapy, and assess compliance and satisfaction with care. [58]

Population health

  • Improve Public Health Outcomes [59]

Use of EHR in a pediatric ambulatory setting can greatly improve compliance with immunization requirements. Computerized immunization registries, with or without CDSS and reporting capabilities, are important tools in tracking and improving immunization rates. [60]

  • Healthcare Quality and Convenience [61]

Patient monitoring

Monitors attached to the patient in a hospital bed emit a plethora of real-time physiological data, i.e. EKG signals, blood-oxygen saturation, etc. A CDSS driven by computer algorithms capable of pattern recognition by interpreting the data, ideally in real-time, will aid the physician in providing prompt, better quality care.

Universal Protocol

Universal protocols are developed by various disease monitoring agencies for accurate diagnosis, management and prevention of health related problems.For instance the universal protocol created by the joint commission to prevent wrong site, wrong procedure, and wrong surgery. [62].This ensures the same standard of care everywhere.

Healthcare Quality in Developing Countries

Although EMRs are mostly used in developed countries, they also have the potential to improve healthcare systems in developing countries. For example, a systematic review produced 23 studies which mostly supported the feasibility and benefits of implementing EMR systems in developing countries, with the help and resources of developed countries. [63].

Epidemiological Surveillance

The incorporation of Electronic Medical Record (EMR) data with epidemiological case detection methods is likely to enhance the relevance and effectiveness of epidemiologic monitoring and detection. For example, one study examined how EMR data could be used to augment epidemic surveillance for acute respiratory illness (ARI). Surveillance of potential epidemics based on EMR data may help improve response to serious outbreaks and provide timely information to the medical community and general public during an epidemic. Modular software and platforms are being developed in order to fully realize the benefits of integrating EMR data for use in epidemic surveillance. [64].

HIV Screening

Triage protocol ordering of HIV screening supported by a clinical decision support tool and an EMR demonstrated that routine, random, opt-out screening is both feasible and highly effective in maximizing the total number of patients tested; leading to fewer missed opportunities [65]

Medication administration

Increased Accuracy in Medication Administration [66]

EMAR can help increase accuracy in Medication Administration. There are about 700,000 reasons annually—the estimated U.S. number of adverse drug events—for the increasing use of the electronic medication administration record (EMAR) to support inpatient care. With paper and other non-digital records prone to being incomplete, misread, or even misplaced, nurses need a way to help ensure that medications are properly administered and tracked. With the help of EMAR functionality and bar coding/electronic verification during medication administration along with real-time alerts, there is very little room for errors thus accuracy in Medication Administration most like happen at all times. [66]


With physicians being able to electronically prescribe medications for patients, the patient's pharmacy is able to quickly and effeciently prepare the medications, while ensuring that there are no contraindications nor possible interactions for his patient to receive these medications. E-prescribing systems work with the pharmacy systems and verify correct dosage for the patient and their condition. With this there is also a reduction in adverse events regarding dosages. These benefits also reduce the chances for malpractice, and allow for multiple checkpoints throughout the process. [67] The article " Addition of electronic prescription transmission to computerized prescriber order entry: Effect on dispensing errors in community pharmacies " by Bates et al. found that e-prescribing where available can decrease medication errors by about 50%. [68]

Monitoring for medication toxicities

In the primary care setting, certain medications require regularly scheduled laboratory confirmation of potential toxicity in order to ensure that patients are not harmed. However, tracking patients who require this type of follow up and confirming that the necessary lab work is done in a timely fashion can prove challenging for providers. In a study published in the The Joint Commission Journal on Quality and Patient Safety, the authors found that "EHRs may be an important component of systems designed to improve medication monitoring...." [69]

Combating drug abuse

Electronic Medical Records may prove useful in the treatment of addiction in multiple clinics. With reporte incidents of substance abuse on the rise, this will prove very helpful in the treatment of these patients. [70]

Rural Health Care

Electronic Medical Records hold great promise to enhance access and improve the quality of care provided to patients in rural America. Numerous areas in the United States lack access to high-quality health care. Estimates reveal that nearly 65 million Americans live in communities with shortages of primary care providers. Implementation of EMRs is especially significant for rural areas, where increased provider productivity can inspire providers to help more patients in the same amount of time, and improved workplace satisfaction can motivate people to practice in high-need areas. For example, Columbia Basin Health Association (CBHA) was one of the first community health centers in the United States complete its transition to an electronic health record (EHR) system from paper-based charts. In January 2008 only 31% of patients had received a foot exam and only 37% had received an eye exam. Using their EHR system, CBHA began tracking 1,302 diabetic patients. CBHA also began to provide feedback to health care providers on their performance. By June, 86% of patients had received a foot exam and 63% had received an eye exam. [71]

In China, over 900 million people live in the rural areas where the healthcare system struggles to meet all the healthcare needs of the people. Lin, et al. (2014) conducted a study in a rural area of Mainland, China, to analyze and evaluate the impact of EHR system on preventive medicine and chronic disease management programs. The study concluded that sanctioning the cloud-based electronic record systems (EHR) not only improved the efficiency of the health care system, but also alerted the public health department about the contaminated water source. In general, the EHR system provided essential tools to monitor the public health, offer better preventive care, and enhance the quality of healthcare. [72]

Related articles


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