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

From Clinfowiki
Jump to: navigation, search
Line 136: Line 136:
  
 
* 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.
 
* 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.
 +
 +
* Apart from Decision Support system, EHRs can be used in identification of postoperative adverse events using Natural Language Processing. Ref: Murff HJ, FitzHenry F, Matheny ME, et al. Automated identification of post-operative complications within an electronic medical record using natural language processing. JAMA. 2011;306(8):848–855
  
 
*Process Improvement. EMR implementations allows to review the clinical processes management, customizing it for a better quality and delivered health care. University of Illinois Chicago Medical Center has published 75% reduction in chart pull requests, expected to increase, 12 paper forms eliminated and 100% availability patient records (previously 40%). The Gemini Project  http://www.himss.org/content/files/davies_2001_uiccmc.pdf
 
*Process Improvement. EMR implementations allows to review the clinical processes management, customizing it for a better quality and delivered health care. University of Illinois Chicago Medical Center has published 75% reduction in chart pull requests, expected to increase, 12 paper forms eliminated and 100% availability patient records (previously 40%). The Gemini Project  http://www.himss.org/content/files/davies_2001_uiccmc.pdf

Revision as of 03:33, 12 September 2011

EMRs have many benefits and return on investments

Benefits

Reduces the underuse, overuse, and misuse of health care services:

Underuse: Increase in ordering rates for prophylactic medicine.

Overuse: Reduction in antibiotic prescription and unnecessary diagnostic tests.

Misuse: Reduction in medication errors due to drug-drug or drug-allergy interactions.

http://moodle.sbmi.uth.tmc.edu/pluginfile.php/7117/mod_resource/content/1/Computer_Physician_Order_Entry_Benefits_Costs_and_Issues.pdf

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

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.

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

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

Administrative and management benefits:

  • Reduce or eliminate the costly tasks of creating and managing paper charts
  • Decrease or eliminate labor-intensive chart pulls and re-files
  • Provide rapid access to comprehensive information when needed - fewer misplaced or duplicate charts
  • Fewer personnel are needed if clinicians enter some of the information - also save on transcription costs
  • Communicate key information better and with more accuracy
  • Provide rapid responses to chart/record requests and audits
  • Improve and track overall processes
  • Increase Return on Investment (ROI) (http://www.msdc.com/EMR_Benefits.htm)

Return on Investment

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:

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)


Emr systems with business intelligence functionality can measure organizational performance with the IT investment. This capability shows relationship with organizational metrics and the cost savings of the IT investment. --Zoker

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

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.

Communication

EMR's will enable health care personnel and patients to communicate and exchange data better and in a more accurate and efficient way.

Physician-Physician

  • Access to past records
  • Transitioning care
  • Collaboration in patient care (consultation)

Physician-Patient

  • Best practice guidelines
  • Directed advice
  • Continuity of care
  • Telemedicine

Better data quality and legibility due to:

  • aggregation of data
  • warnings of invalidated data
  • EMR data more legibile than handwritten data

Humpage, Sarah D., "Benefits and Costs of Electronic Medical Records: The Experience of Mexico’s Social Security Institute." Inter-American Development Bank. June 2010. www.iadb.org/document.cfm?id=35219845

Clinical

  • Generally speaking, EMR's can help physicians, patients, managers and other care-providers in many different ways. Benefits of having an EMR (including the CPOE) in place include lowering the health care costs, improving health care quality, prevention of errors and improving patient safety, improving health data communication and exchange, better education for care providers and patients and facilitating research.
  • In the long-term care environment, EHR implementation has been shown to increase charge captures, reduce pharmacy waste, lowered nursing overtime expenses and facilitate quality improvement through documentation of certified nurse aide activities related to patient care. Cherry BJ, Ford EW, Peterson LT. Experiences with electronic health records: early adopters in long-term care facilities. Health Care Manage Rev, Jul-Sep, 36(3): 265-74, 2011.
  • Properly designed and implemented EMRs may specifically address high-yield clinical problems, such as those identified by the Joint Commission in their annual National Patient Safety Goals advisory. For 2011, those goals include patient identification, staff communication, safe use of medications, infection prevention, medication reconciliation, and assessment of suicide risk. Radecki, R; Sittig, D. JAMA 2011. PubMed
  • An efficient Emr system also improves laboratory test utilization. No more redundant tests.

-Zoker Crane RM, Raymond B. Fulfilling the Potential of Clinical Information Systems. The Permanente 7:1,62-67; 2003��

  • The efficiency of the EMR system decreases time handling, transcription, and delays in transfer of the patients.

-Zoker Crane RM, Raymond B. Fulfilling the Potential of Clinical Information Systems. The Permanente 7:1,62-67; 2003��

  • Electronic surveillance has demonstrated the ability to identify patients at high risk for MRSA nasal colonization. Computerized alerts offered the ability to target testing to the highest yield group, rather than all hospitalized patients. No ROI calculation was performed for this intervention. Evans, R; Wallace, C. JAMIA 2008. PubMed
  • Error prevention is an important goal of CPOE systems. Drug-related events prevention by utilizing proper CDSS technology (eg: drug-drug, drug-alergy and drug-food alerts), renal dosage guidance, elderly dosage guidance and compliance with other known drug usage protocols are among the many benefits of such systems.
  • 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.
  • Apart from Decision Support system, EHRs can be used in identification of postoperative adverse events using Natural Language Processing. Ref: Murff HJ, FitzHenry F, Matheny ME, et al. Automated identification of post-operative complications within an electronic medical record using natural language processing. JAMA. 2011;306(8):848–855
  • Process Improvement. EMR implementations allows to review the clinical processes management, customizing it for a better quality and delivered health care. University of Illinois Chicago Medical Center has published 75% reduction in chart pull requests, expected to increase, 12 paper forms eliminated and 100% availability patient records (previously 40%). The Gemini Project http://www.himss.org/content/files/davies_2001_uiccmc.pdf
  • Overhage and colleagues demonstrated that compliance with the monitoring of drug levels doubled when automated ordering reminders were implemented. Ref: Overhage JM, Tierney WM, Zhou XH, McDonald CJ. A randomized trial of “corollary orders” to prevent errors of omission. J Am Med Inform Assoc.1997;4:364-75. [PMID: 9292842]
  • EMR can be instrumental in the connection to national disease registries allowing practices to compare their performance with that of others, which in turn, might improve the quality of care and facilitate research. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117.
  • PHR has appeal as it eliminates collaborative governance challenges, trades providers' high cost technology for patient managed lower cost technology, and places information of educational value directly in the hands patients.

Ref: Tang PC, Ash JS, Bates DW, et al. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc 2006;13:121–6.

  • Health information exchange can be easily and safely achieved for patients with multiple chronic illnesses who receive care from multiple providers in many settings. Ref: Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 1103-1117.
  • Secondary use of health data stored in EMR has potentials to protect and enhance public health, and facilitate health science research. Ref: American Medical Information Association. Secondary uses and re-uses of healthcare data: taxonomy and policy formulation and planning. 2007. http://www.amia.org/files/amiataxonomyncvhs.pdf
  • According to a study performed by Work, the use of bedside medication scanning with EMRs decreased medication administration error rates by 67% at a pilot unit in Beloit Memorial Hospital. BCMA was then implemented to other units and measured to have decreased error rates to an average of 93% in the first four months of study and not counting the first month. Work M. Improving Medication Safety with a Wireless, Mobile Barcode System in a Community Hospital. Patient Safety & Quality Healthcare. 2005. http://www.psqh.com/mayjun05/casestudy.html
  • According to an article by the president of the University of Texas M.D. Anderson Cancer Center in Houston, a standardized nation-wide electronic medical record will ensure quality care for patients who see multiple providers at multiple sites. A national EMR could provide enormous opportunities for reducing overhead costs, identifying factors contributing to many illnesses (including cancer), determining optimal treatment, and detecting uncommon side effects of treatment. Mendelsohn J. Ten pieces to the cancer puzzle. Jan 24, 2009. http://www.chron.com/disp/story.mpl/editorial/outlook/6228636.html
  • Genome-enabled EMR can integrate resources such as OMIM and PharmGKB to facilitate the diagnosis, long-term and family member management of molecular and cytogenetic diseases. [Hoffman. The genome-enabled electronic medical record. Journal of Biomedical Informatics (2007)]
  • Clinical decision support regarding culture results can improve antibiotic utilization, reduce costs of unnecessary medications, reduce bacterial resistance rates and lessen the incidence of Clostridium difficile and fungal infections. Computer-assisted drug prescribing in an ICU setting reduced potential allergy ADEs, excess drug dosages, an antibiotic/susceptibility mismatches. These improvements resulted in reductions in costs of anti-infectives prescribed, reductions in length of stay, and reduction in total hospital costs ($26,315 in the intevention-compliant cohort vs. $35,283 in the pre-intervention corhort). Evans, R; Pestotnik, S. NEJM 1998. PubMed
  • EMRs systems generates reports like flowsheets, a specialty snap shot about progression of a patient status which are very useful in management of chronic illnesses like diabetes.
  • Lists of patients receiving vesicant drugs can be generated and used to contact the appropriate physicians for those patients needing special IV access to decrease incidence of phlebitis.
  • EHRs also provide important information for purposes such as health policy planning. (Definition, structure, content, use and impacts of electronic health records: a review of the research literature. Häyrinen K, Saranto K, Nykänen P.Int J Med Inform. 2008 May;77(5):291-304. Epub 2007 Oct 22.)
  • EHRs integration to personal health records may improve home telehealth management of chronic illness. (Home telehealth electronic health information lessons learned. Charters K. Stud Health Technol Inform. 2009;146:719.)
  • Integration of EHRs with telehealth systems, particularly remote diagnostic systems, allows for rapid diagnosis, triage, and treatment of acute health conditions in physically remote areas. A telecardiology system proposed by the European EPI-MEDICS project using an intelligent web-enabled Personal ECG Monitor integrated with the patient’s EHR would allow for diagnosis and initial treatment of myocardial infarction in physically remote regions. [1]
  • EHR’s prescription profiles may facilitate resident education and improve resident competency in practice based learning, by enabling educators to determine the range of medications residents prescribe. (Utilizing VA information technology to develop psychiatric resident prescription profiles; Rohrbaugh R, Federman DG, Borysiuk L, Sernyak M; Acad Psychiatry. 2009 Jan-Feb;33(1):27-30.)
  • The EHR will reduce the costs incurred by storing and keeping patient medical records. It also will ensure billing to patients.

http://www.ehow.com/facts_4883387_benefits-electronic-health-records.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art

  • Integrating digital radiology studies into the EHR allows physicians to view images from their offices, homes, and multiple sites throughout the facility. Digital studies allow small rural hospitals access to prompt 24/7 radiology reading services through telemedicine contracts. Diagonosis can occur as soon as the image is captured.
  • By integrating decision support tools and standardized patient care letters, the EMR system can link patient care with an educational program. From a pediatric respiratory department’s experiences, more asthmatic patients (58%) received an asthma action plan upon discharge in an EMR system (as opposed to 4% before the EMR). http://www.ncbi.nlm.nih.gov/pubmed/18972308
  • Some EMR systems allow patients to access their own health records. This can strengthen the connectivity between doctors and patients. Also this can help patients to figure out their health condition. http://www.ncbi.nlm.nih.gov/pubmed/17901601
  • Planning programs allow physicians to make and modify detailed treatment plans which can then be viewed by any other physician caring for the patient.
  • EMR can be integrated with computer-based monitoring to store and display information gathered from a patient automatically, such as vital signs or ECG.
  • EMRs that incorporate dynamic knowledge bases will allow Clinicians to incorporate new research and new medical knowledge and developments into their practice faster than the traditional methods self study and reading journals. New research and new medical developments are happening at such a rapid rate that it has become challenging for practitioners to respond to the new information.
  • Patient waiting time and Triage times are significantly reduced with nurse-driven template charts and a vital sign interface that automatically drops the vital signs into the nursing note once the measurements are taken. The Financial Impact of an Emergency Department Information System - Michael Hocker, Health Care Technology Volume 2.
  • EHR system with its Clinical Decision Support system brings about a change in the decision making behavior of the clinicians, increasing their confidence, ability to identify solutions, increased interpretation accuracy and thereby, more efficient decision making.
  • An EMR can help optimize the choice of individual tests based on additional considerations. This includes considering cost-effectiveness and giving additional information to help clinicians make the best choice for the patient. Osheroff J, Pifer, E, Teich J, Sittig D, Jenders R. Improving outcomes with clinical decision support: An implementer’s guide. HIMSS: Chicago. 2005 (p. 48)
  • An EMR can help improve compliance with care guidelines. The compliance can help to improve a hospital’s scores in Core Measure guidelines. Osheroff J, Pifer, E, Teich J, Sittig D, Jenders R. Improving outcomes with clinical decision support: An implementer’s guide. HIMSS: Chicago. 2005 (p. 49)
  • An EMR can improve communication among caregivers. Automatic notifications and instant messaging can improve communications between caregivers and improve patient care. Osheroff J, Pifer, E, Teich J, Sittig D, Jenders R. Improving outcomes with clinical decision support: An implementer’s guide. HIMSS: Chicago. 2005 (p. 56)
  • Facilitates research by creating an enormous source of medical data that can be standardized and aggregated. Once analyze, this information can be used to: (1) Improve treatment methods, (2) Lower the cost of health care, and (3) Support the development of public health policies. Evidence on the Costs and Benefits of Health Information Technology
  • EHRs can help providers be more effective by: (1) reminding physicans about preventive care, (2) identifying allergic reactions to prescribed drugs and highlighting potentially harmful drug interactions, and (3) providing doctors with appropriate and timely information to support decision making. Ref: Evidence on the Costs and Benefits of Health Information Technology
  • EMR systems can integrate evidence-based recommendations for preventive services (such as screening exams) with patient data (such as age, sex, and family history) to identify patients needing specific services. The system can remind providers to offer the service during routine visits and remind patients to schedule care. Reminders to patients generated by EMR systems have been shown to increase patients’ compliance with preventive care recommendations when the reminders are merely interjected into traditional outpatient workflows. Ref:"Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs" - Richard Hillestad et al.
  • Mobile EMR can contribute to out patient follow-up for chronic conditions that require day to day monitoring for years and provide feedback for physicians and also for patients to avoid constly life-threating situations. Peter Boland, "Better Health Well in Hand"
  • With Mobile EMR medication levels can be adjusted based on the monitoring of patient physiological conditions, which some can be time sensitive, like distant monitoring of maternal contractions, fetal heart-rate, on high risk pregnancies.
  • EMRs can be integrated with any existing or future clinical information systems, which adhere to HL7 compatibility standards, thus enabling easy connection, communication,and collaboration of medical data of every patient.
  • EMRs can be used to ascertain phenocopies, phenotype heterogeneity, and relevant covariates to enable Genome Wide Association Studies (GWAS) of Peripherial Arterial Disease.Biorepositories linked to EMRs may provide a relatively efficient means of conducting GWAS. Kullo IJ, Fan J, Pathak J, Savova GK, Ali Z, Chute CG.Leveraging informatics for genetic studies: use of the electronic medical record to enable a genome-wide association study of peripheral arterial disease.Journal of American Medical Informatics Association.(2010);17(5):568-74.
  • Tragic events like 9/11, Hurricane Katrina, and the California fires have showcased the benefits of electronic record keeping. For those who had medical records available were easily treated then those whose medical records are not available. Large scale EMR systems replicate their stored records in several places across the country so that one tragic event won't destroy them.

http://patients.about.com/od/electronicpatientrecords/a/EMRbenefits.htm

  • Significant positive associations between specific objective quality indicators and CPOE implementation have been have been found. After controlling for confounders, CPOE hospitals outperformed comparison hospitals on 5 of 11 measures related to ordering medications and on 1 of 9 nonmedication-related quality measures. (American Journal of Medical Quality 2009;24:278-286)
  • Regarding abnormal cervical cytology results and follow-up care, in an at-risk urban population, an automated, EMR-based tracking system has been shown to reduce the time to resolution and increase the number of women who achieved diagnostic resolution. (Journal of General Internal Medicine 2010;25(6):575-580)
  • The May 2008 Congressional Budget Office report - ‘Evidence on the Costs and Benefits of Health Information Technology’ discusses evidence related to a multi-functional EHR (Jha and colleagues, 2006). The report discusses electronic referral communication between providers, among other EHR functions, that could have a significant impact on medical practice.
  • Use of Computerized physician order entry (CPOE) with clinical decision support (CDS) has been shown to decrease Adverse Drug Events (ADE’s) in 5 studies. Wolfstadt JI, Gurwitz JH, Field TS, et al. The effect of computerized physician order entry with clinical decision support on the rates of adverse drug events: a systematic review. J Gen Intern Med. 2008;23:451-8.
  • Electronic prescribing of chemotherapy medications has been shown to ensure that safe chemotherapy practices were followed. Huertas, M. J., Baena-Cañada, J. M., Martínez, M. J., Arriola, E. & García, M. V. The impact of computerised chemotherapy prescriptions on the prevention of medication errors. Clin. Transl. Oncol. 8, 821–825 (2006).
  • Prescribing accuracy has been shown to be greatly increased as the occurrence of missing or incomplete data in prescriptions dropped by a factor of 10 by implementing a CPOE. C Mir, A Gadri, GL Zelger, et al. Impact of a computerized physician order entry system on compliance with prescription accuracy requirements. Pharmacy World and Science, Oct 2009, vol. 31, no. 5, p. 596-602
  • Reminders indicating that patient is eligible for preventive care measures. Dexter et al.
  • On-screen display of the charges for laboratory and radiologic tests at the time of computer ordering led to 4.5% fewer laboratory tests ordered in the intervention group (not statistically significant); minimal difference for radiologic tests. Bates et al.
  • A study performed by Bates et al., 55% reduction in serious medication errors (P = 0.01); decrease in preventable adverse drug events of 17% (P > 0.2). Bates et al.
  • Compliance with drug monitoring and preventive care guidelines. Overhage et al.
  • A CPOE system and an electronic medication administration record led to significant decreases in turnaround times, elimination of transcription errors, improvements in order countersignature, and decrease in length of stay. Mekhjian et al.
  • EMR helps healthcare providers to target patients with specific needs like immunization.
  • EMR allows various views of patient data to physicians. i.e, In a chronological order by report date- which helps the physicians to find the newest test results, they can highlight the changes etc. Edward H. Shortliffe, James J. Cimino. Biomedical Informatics Computer Applications in Health Care and Biomedicine. 3rd edition.
  • EMR is capable of generating reports. By generating reports healthcare providers can know the amount of vaccines used in the previous year and with that number they can plan for the coming years. Also they can know which patients are due for shots.(http://www.ama-assn.org/amednews/2008/05/05/bisa0505.html)
  • An EMR Can Assist In Providing Preventive Care. Preventive care is important for patienars both on an individual level and a community level. On an individual patient level, the EMR can "enable a physician to provide other services for patients, such as helping them get appropriate preventive care, providing better education about their health, and assisting them in making choices from among an array of treatment options." This can be accoplished through physician reminders (for tests such as mammograms), and links to portals with patient information on diseases and teatments. On the community level, the information captured by the EMR could "help target public health effort." Public health agencies would be able to use the information not only for surveillance, but to determine if any the public health interventions are effective. REF: Evidence on the Costs and Benefits of Health Information Technology (http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm)
  • EMRS can provide clinicians answers to their information needs. "Studies of clinicians' information needs reveal that common questions that physicians ask concerning patient information (e.g., Is there evidence to support a specific patient diagnosis? Has a patient ever had a specific test? Has there been any follow up because of a particular laboratory test result?) are difficult to answer from the perusal of the paper-based chart (Tang et al., 1994b)." The EMR can assist the clinician by display the relevant contents of the patient's record in a useful format. REF: Edward H. Shortliffe Editor, James J. Cimino Associate Editor, Biomedical Informatics Computer Applications in Health Care and Biomedicine, Third Edition 471 pp.
  • Ready access to data helps nurses feel empowered in decision making. Robles, Jane (2009)
  • Computerized Provider Order Entry - Nurses spend less time tracking down providers, playing telephone tag, and performing actions that are outside their scope of practice. Robles, Jane (2009)
  • Patient care handoffs are times of high risk, when breakdowns in communication can cause significant harm to the patient. An EMR provides detailed patient information, easily accessible to everyone, in a consistent format. SBAR (Situation, Background, Assessment, Recommendation) offers a standardized approach for handoff communication, such as reporting at shift changes and during patient transfers. Robles, Jane (2009)
  • The use of EMRs allows more than one person in an organization to access a given patient’s data at one time. This increases productivity for everyone. The person performing a test does not have to wait on the physical chart to be available from the ordering doctor to load images from the exam. Just as the billing department does not need to wait for the radiologist to add exam reports before the patient is billed. This decreases the patient’s flow through time. REF: Osheroff Jerome, Pifer E, Telch J, Sittig D, Jenders R, Improving Outcomes with Clinical Decision Support: An implementers Guide. Chicago: Healthcare Information Systems Society; 2005.
  • Use of Electronic Medical Records (EMRs) as part of Immunization database and tracking systems or registries allows timely recall of patients for updates or missed immunizations. When used in conjunction with citywide or statewide systems such as the State of Texas' ImmTrac system, EMR allows the immunization records of participating families (which hopefully will reach 100% participation some day) who move frequently between practices, and who sometimes do not carry up to date immunization records, to be accessed and readily updated, thus avoiding duplications and omissions. There's a great potential in a national and ultimately, global immunzation registry when this can be attained. Combined with a standardized and well- laid out continuity of care record included as a module in the EMR, access to the data globally for immunization updates wii help maintain the gains in control of infectious diseases especially in an era of frequent global travel.
  • Intregration of available community referral resources and support into the EMR of na out-patient communiity health facility will allow timely access to these resources for patient care co-ordination and quality care.
  • Providers that have integrated a comprehensive Clinical Decision Support Systems (CDSS) into their EHR typically see a greater improvement in the quality of care of their patients. The most common of these improvements is the decrease in Adverse Drug Events (ADE). Incorporating CDSS into EHR can reduce these potential fatal errors up to 90% (Potts and others, 2004; Bates and others, 1999a, 1998a; Evans and others, 1998).
  • Improvement in supplemental treatment programs such as substance use treatment programs. EMR implementation can improve the efficacy of specialty substance use disorders (SUD) treatment programs. Harmonized EMR systems can allow a patient's mainstream health care to coordinate with the efforts of SUD treatment programs, improving their overall outcomes. [2]
  • EMR implementation allows patient records (individual and multiple) to be searched for temporal pattern, not immediately apparent to individuals examining traditional hard-copy records. Examples include examining adverse events (even those that occur remotely from the inciting event) such as renal injury to intravenous contrast administration for imaging studies. [3]
  • Zlebek(2011) was able to show that implementation of an inpatient EHR with CPOE can result in rapid improvement in measures of cost of care and safety, even in a already highly efficient healthcare delivery system. Properly implemented systems have the potential to decrease the cost of care and to improve the safety of our nation’s healthcare system. Zlabek, J. A., J. W. Wickus, and M. A. Mathiason. "Early Cost and Safety Benefits of an Inpatient Electronic Health Record." Journal of the American Medical Informatics Association 18.2 (2011): 169-72. Print.
  • EMRs can help eliminate false negatives by comparing previous and current test results. In a 2003 study, Kleit and Ruiz demonstrated that implementing an EMR reduced the number of false positives mammograms by over 50 percent by making previous mammograms available to clinicians at the time of diagnosis. Previous mammograms did not affect the number of false negatives. Kleit, N. A., Ruiz, J. F. 2003. False Positive Mammograms and Detection Controlled Estimation. Health Services Research, 38(4), 1207-1228.
  • EMR software is packed with many tools to help doctors make better decisions. These tools range from diagnosis to prescribing medications to treatment plan recommendations. Most EMR's have built in PDR-based medication dictionaries providing doctors with Adverse Drug Event (ADE) alerts, generic drug and dosage recommendations.(http://www.emrexperts.com/why-emr.php)
  • In one EMR pilot project to implement EHR in a developing nation (Cameroon), one of the significant benefit was increase in best practices. Boren, Suzanne and Williams, Faustine."The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review." Informatics in Primary Care 2008;16:143.

Operational

  • Integrated communication and reporting support. EMR can facilitate the efficient creation and transmission of reports that relate to health care operations such as billing and charge information. Coiera, E (2003) Guide to Health Informatics (2nd Edition), Arnold Publishers Shortliffe, EH (ed) (2006) Biomedical Informatics (3rd Edition), Springer. pg. 119.
  • 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]
  • Documentation completed at conclusion of encounter.
  • Preventing the missing patient paper medical records. Every time a paper chart gets stored, there is the chance it will be misplaced or maybe filed in a wrong place. This is very frequently is many hospitals, specially in those of the limited resources countries without EMR systems in where all paper medical records are located in a central repository room. EMR allows to prevents it by an unique electronic record and patient chart available in all time and stored into one central data repository server.
  • EMR is time savings for physicians and staffs by reducing in documenting the chart. According to the statistics, the average saving time is 5 minutes which can be done in real-time, point of encounter and no need for longer appointments. The total ROI per physician per year approximately is $78,000. [Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]
  • EMR is improvements in medical coding. The approximately annual loss per physician is $40,000 - $50,000 by under coding due to fear of audit and lack of time to sufficiently document the level of care. The ROI of improvement in coding per year is approximately $54,000.

[Joe Miller (2003).10 Benefits of an Electronic Medical Record: http://www.advancedMD.com]

  • The benefit of an electronic medical record can increase the numerators and decrease the denominators. In addition, efficiency takes all of the duties involved in medical record medical office management divided by time and money. [Douglas. Thompson, Neil Fleming. Finding the ROI in EMRs. http://www.hfma.org]
  • Part of the money-saving nature of electronic medical record technology is the elimination of IT infrastructure and the streamlining of multiple databases. The infrastructure is simplified into one online database, even for multiple offices.[Douglas. Thompson, Neil Fleming. Finding the ROI in EMRs. http://www.hfma.org]
  • Can allow for better appreciation of clinician performance for which can be used for employee bonuses.
  • The benefit of electronic medical record primarily accrued from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors. [Wang et al. A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine (2003)]
  • CPOE will automatically date and time physician orders, as recommended by regulatory organizations.
  • EMR user authentication can protect patient records from unauthorized access.
  • EMR user logging and auditing can provide assurance to patients that only authorized personnel have accessed their record (or proof that unauthorized personnel have accessed it).
  • BCMA enhances tracking and understanding of medication delivery processes which can pinpoint opportunities for improvement in safety and efficiency.
  • With EMR, disaster planning and recovery should be easier with today technologies, and should be similar to that of any organization with electronic systems. It’s almost not possible to move all paper-based data and patients’ records to another site when nature hits the current site.
  • With correctly designed EMR, an update should only need to be done in one place and will automatically synchronize with the rest of the system where the same data may resign. With paper-based system, same data can be in multiple places and updating can be much more challenging with making sure all places are updated accordingly.
  • Better, more efficient systems can be built only on top of an EMR. Not much improvement can be made to a paper-based system.
  • There are significant time gains that can be accomplished using an EMR. A study done shows that a 75% improvement was achieved in complex NICU discharges. [4]
  • Data recovery becomes more manageable using a digital system versus a paper system.--Kjbracey 15:10, 23 January 2011 (CST) Backups can be maintained for an EMR where as there are no disaster options for paper based systems.
  • Automation of billing charges are typically included. This reduces error in submitting codes to insurance companies.
  • With anytime, anywhere access to their own EMR, patients can edit their medical history from the comfort of their home, and whenever they have time. Quickly editing a medical history in a waiting room is too error-prone. Additionally, it needs to be created only one time and could easily be corrected.
  • Patient information cannot get lost or become inaccessible. This may happen with conventional records, for example when a practice is closed, or bad materials were used for paper or film material. The loss of electronic data is less probable due to highly evolved techniques for secure data storage.
  • An EMR is almost essential in a telehealth-like setting, where a practitioner would like to ask a colleague for advice about a specific case. Through an EMR, the other side could easily access all the patient information. Besides saving time, efficiency is improved since the other side gets all information - or just part of it for privacy protection - and can decide what information is most relevant for the specific case.
  • The use of a CPOE system in an ICU setting can cut down on errors [Potts AL, Barr FE, Gregory DF, Wright L, Patel NR. Computerized physician order entry and medication errors in a pediatric critical care unit. Pediatrics. 2004;113 :59 –63]
  • The use of CPOE systems can improve the turnaround time of laboratory and radiology test results. [Thompson, Willie B, Dodek PM, Norena M, Dodek, Jordana BSc. Computerized physician order entry of diagnostic tests in an intensive care unit is associated with improved timeliness of service. Crit Care Med. 2004;32 :1306 –1309]
  • Studies on "multifunctional systems" of HIT, found evidence that implementing a multifunctional EHR system could increase the delivery of care that would adhere to guidelines and protocols, enhance the capacity of the providers of health care to perform surveillance and monitoring for disease conditions and care delivery, reduce rates of medication errors, and decrease utilization of care. [B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006;144:742-752.]
  • Increased enrollment on clinical trials by using CDS to identify eligible patients. Ref: Embi PJ, Jain A, Clark J, Harris CM. Development of an electronic health record-based Clinical Trial Alert system to enhance recruitment at the point of care. AMIA Annual Symposium Proceedings, 2005: 231-5.
  • The ability to support patient mobility. When a patient moves, is on vacation, or simply seeing a specialist; it is currently very difficult to transfer the Medical Records between hospitals. With paper the records need to be pulled, faxed, and sent. Then they need to be retrieved, processed, and then read. With Integrated EMR, these steps can occur instantly.
  • Support of Bio-Surveillance. We live in a time when man made (terrorists) and natural (epidemics) are all around us. The advantage of the EMR is to eventually automatically, track outbreaks and health issues across regions, the country, or the world. This will enable rapid detection and prevention of wide-spread out break. The H1N1 outbreak is a prime example of how even a day or a few more hours of advanced notice could have helped contain the spread.
  • Re-purposing of data. There is a push these days to do more with less. Access to a hospital's patients data enables retrospective studies and data mining. It is a ready and accessible source (assuming proper anonymity can be obtained when required). Instead of spending millions of dollars to track how infusions affect patient outcome in the ER, that data could be mined from decades of patient information.
  • Helps in better adapting to HIPAA standards. HIPAA now requires stricter control over patients data, with better audit in general. EMR are better equipped to provide the combination of security from unauthorized access and the ease of access for authorized users. Moreover, an EMR is better suited to adapt to changes that might be enforced in the future.
  • Among the problems commonly faced in all clinical settings, is the problem of conflicting prescriptions. The inability of physician to account for other prescriptions by other physicians even within the same hospital leads to over-medicating, or conflicting medications.
  • Better supervision from physicians in charge. Within academic hospital, physicians may find it impossible to maintain a high standard of care along with all the responsibilities of teaching and supervising medical students. Physicians may find it much easier to follow students' notes across all the different records to grade and suggest any changes.
  • Facilitates the communication of patients' data and needs among different hospitals. With today's videoconferencing technologies, many hospitals opted to schedule weekly meetings to discuss difficult or interesting cases with other more specialized hospitals. EMRs allow both the ease of release/communication of data as required for these cases with the retention of unnecessary/private information about the patients.
  • EMRs allow better integration to other operations such as billing, external departments and patient portals to manage, share, collect and protect the critical medical information. Many EMRs are offered as services hosted over the Internet. This allows clinicians to access them from any location worldwide using cell phone technology or laptops with cellular connectivity. In an implementation like this, patient information can be accessed literally anywhere without having any kind of network connection to the medical facility.
  • EMR systems facilitate the automation of records necessary for audit compliance with federal, state, and accreditation organization regulations. See “EXTRA: Patient Safety in the Physician’s Office: Assessing the Value of Ambulatory CPOE” [[5]]

MikeField 17:54, 23 January 2010 (CST)

  • EHR System provides valuable administrative tools wherein daily reports can be generated. Also, data collected can be sent to a spreadsheet where further analysis, data manipulation, and interpretation can occur. The Financial Impact of an Emergency Department Information System - Michael Hocker, Health Care Technology Volume 2.
  • An 11 study meta-analysis comparing paper vs. electronic demonstrated nurses saved 24 percent of their documenting time when using electronic systems. The studies time savings ranged from 28 to 36 minutes per nurse per eight hour shift. For a 32 bed unit with 1:8 patient to nurse ratio, 36 minutes per shift saves 2 hours 24 minutes. This does not allow for savings by changes in staffing with 1 less nurse. Studies with a more broad perspective suggest savings ranging from 95 to 260 minutes per 12-hour shift for each nurse. This does allow for the possibility of staffing changes, only if nursing operations and cultures can adapt. “Incremental” overtime (OT) costs are incurred when nurses complete documentation at the end of their shifts. Work compiled from 8 hospitals found a range of incremental OT to be from 96 cents to $3.23 per admission (excluding newborns). Nursing leaders estimate potential OT cost reduction of 80 percent, or 77 cents to $2.30 to be expected for a typical 300 bed hospital per non-newborn admissions or a savings of $11,000 to $33,000 per year. A 28 to 38 minute reduction per nurse per shift could reduce or eliminate “incremental” overtime costs. [Thompson MBA, Douglas I, Osheroff MC, Jerry, Classen, MD, David, and Sittig PhD, Dean F. A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database. Journal of Healthcare Information Management Vol. 21, No.1:67-68]
  • CPOE implementation reduced the mean pharmacy order processing time from composition to verification by 97%. After CPOE implementation, a new medication order was verified as appropriate by a pharmacist in three minutes, on average. Ref: "Effects of computerized prescriber order entry on pharmacy order-processing time" - Jon Wietholter, Susan Sitterson, and Steven Allison
  • Radiological and Laboratory investigations reduced by 18% per week of inpatient hospital stay with implementation of both HER and CPOE. Ref: Zlabek JA, Wickus JW, Mathiason MA. Early cost and safety benefits of an inpatient electronic health record. JAMIA 2011;18:169-172
  • Implementing an EHR can increase reuse of data that is collected at point of care for many groups downstream in the health system. Many times data is recollected and re entered in to various systems which increases time and costs.
  • Having an EHR can facilitate the need for a national person identification number that can be used to identify individuals when seen at various locations. The national person identification number will promote the ability to integrate records from various institutions to give a complete picture of the person by providers.Diabetes information systems: a rapidly emerging support for diabetes surveillance and care. Joshy G, Simmons D.Waikato Clinical School, University of Auckland, Hamilton, New Zealand. joshyg@waikatodhb.govt.nz

  • Pay for performance linked to patient health outcomes are now a real possibility with electronic medical records, which integrate a patient’s medical history, health status and other health indicators in addition to medical visit encounters. Crane, R.M. & Raymond, B. (2003). Fulfilling the Potential of Clinical Information Systems. The Permanente Journal, 7(1), 62-67.
  • Patient portals integrated in electronic medical records, which offer appointment scheduling, retrieval of test results, and other services, make it possible for patients to participate in their health care with their providers. Most savvy healthcare consumers know that they must be active in their own care if they want to obtain the highest quality. Crane, R.M. & Raymond, B. (2003). Fulfilling the Potential of Clinical Information Systems. The Permanente Journal, 7(1), 62-67.
  • EMRs have significant potential to address impending workforce shortage in health care12
  • Greater EMR sophistication may be associated with emergency department (ED) efficiency. Relative to EDs with minimal or no EMR, fully functional EMR was associated with 22.4% lower ED length of stay and 13.1% lower diagnosis/treatment time. However, relationships varied by patient acuity level and diagnostic services provided. (Medical Care and Research Review, 2010 Jun 16; Epub 2010 Jun 16)


  • A 2007 article by Liang, titled ‘The Gap Between Evidence and Practice’, in Health Affairs, discusses the opportunities to improve healthcare by learning from the data available in electronic health record databases in order to bridge the gap between evidence and practice. The paper emphasizes the importance of the use of EHR data for comparative clinical effectiveness research. This potential benefit of EHRs is also addressed by the May 2008 Congressional Budget Office report - ‘Evidence on the Costs and Benefits of Health Information Technology’.
  • Software and hardware vendors are making things easier for doctors with cloud computing and secure web-based computing. These applications let doctors use the same laptops they’ve always used, but it gives them access to large volumes of clinical data, patient history and even 3D avatars that help doctors visualize medical records. The use of EMR as a standard way to exchange healthcare information will lower the costs of healthcare delivery and let physicians get back to the basics — thoughtful, holistic patient care. And it won’t stop there. Doctors will be able to take a proactive role in patient care, anticipating potential problems and dealing with them before they even arise, because they will have visibility into their patients’ complete medical records across the full range of doctors and healthcare providers.[6]
  • Software like Medical Dragon NaturallySpeaking with its ability to produce real-time language as enriched the lives of medical practitioners and their patients. It allows direct data entry by clinicians and staff by voice eliminates the need for transcription. Voice recognition software helps “voice writing” to document a verbatim record of medical examinations and surgeries saving approximately $10,000 per year. Dragon Naturally Speaking costs 80% less than manual medical transcription.[7],[8]
  • EMR allows researchers to efficiently search patient medical information by medical condition, date of treatment, physician name and test category. Researchers can more quickly focus their attention on medical information that supports their research efforts, develop databases to study patient outcomes, and cross-check complex medical information.(http://www.mayoclinic.org/emr/benefits.html)
  • EMR can increase the revenue by giving the ability to offer new services to patients. Many EMR vendors offer features for patients to view their medical information, schedule/cancel appointments and complete forms ahead of time via the organization’s website. This can help attract new business and reduce the load on the staff.(http://www.emrexperts.com/why-emr.php)
  • EMR enables generation of report easily and instantly. Reports can be conveniently generated and programmed to automatic settings. Such reports can be used for assessment of various variables of performance, analysis, compliance and for research studies.
  • Regionally integrated EMRs can help improve the safety of ar-risk patients, or narcotic addicted patients who may visit several emergency departments seeking treatment and medications for their habit. This can save time and cost since these patients may not have health insurance, and time that would have been spent on these patients can be extended to the care of emergency patients.
  • By combining clinical data from EHR with data from other sources such as OTC purchase, school absenteeism rate, it can be used for better monitor of disease outbreaks. Ref: Nir Menachemi, Taleah H Collum. Benefits and drawbacks of electronic health

record systems. Risk Management and Healthcare Policy 2011:4 47–55

EMRs can have a significant effect on patient care when successfully integrated with a fully featured Laboratory Information System (LIS) including:

  • Decrease in patient stays - a delay of a few hours through inefficient ordering processes can increase length-of-stay by up to 24 hours for some tests
  • Results in fewer diagnostic duplications, especially when coupled with a CDSS (which otherwise must be monitored by specially trained nursing or lab personnel
  • Can greatly reduce patient morbidity and mortality (once again especially when coupled with a CDSS) by quick reporting of critical values directly to involved providers.
  • Share integrated information - with better information integration capability, you can facilitate better quality care, contain costs, and better manage risks. MsdC's integrated solutions enable these clinical and business advantages by creating a clinical healthcare system that unites the crucial patient information with the varied departments. This creates a central clinical information repository and resource used throughout your integrated delivery network.[9]
  • Provide rapid access to comprehensive information when needed - fewer misplaced or duplicate charts[10]
  • Adapt to regulatory changes - Meet HIPAA and other legislative and regulatory challenges with organized, complete information. Our clinical information systems allow administrators and management to more easily document and conform to the changes in the regulatory environment. These systems allow auditors and regulators to rapidly assess compliance.[11]
  • Share integrated information - With better information integration capability, you can facilitate better quality care, contain costs, and better manage risks. MsdC's integrated solutions enable these clinical and business advantages by creating a clinical healthcare system that unites the crucial patient information with the varied departments. This creates a central clinical information repository and resource used throughout your integrated delivery network.[12]
  • Compared to paper records, utilizing an Electronic Medical Record (EMR) system is a rapid and efficient method to preserve critical medical information.[13]
  • Better manage risk and lower cost - By consolidating information across your clinical operations, from admission to treatment to labs and beyond, you increase the pace of information flow including service delivery, coding/billing accuracy, and better document patient encounters and work — all while reducing your operating costs. Further, EMR systems provide for more consistent application of medicine protocols. The rapid availability of information 24x7 contributes significantly to better decision making, reduced errors, improved outcomes, and lower malpractice risk.[14]
  • LTAC facility employees who work with EHR systems on a daily basis were positive about their experiences. In particular, operational improvements were achieved through increased access to resident information, cost avoidance, increased documentation accuracy, and implementation of evidence-based practices.

Health_Care_Manage_Rev. 2011 Jul-Sep;36(3):264-74.

  • EHR-based, triggered ADE reporting is efficient and acceptable to clinicians, provides detailed clinical information, and has the potential to greatly increase the number and quality of spontaneous reports submitted to the FDA. Pharmacoepidemiol Drug Saf. 2010 Dec;19(12):1211-5
  • A study performed by Rosen et al. (2011) showed that transitioning a rheumatology practice for children to an EMR resulted in an increase in family satisfaction with an office visit. Kudler, N.R., Pantanowitz, L. (2010). Overview of laboratory data tools available in a single electronic medical record. J Pathol Inform, 3.
  • In 2011, Furukawa concluded that EMRs “may improve provider productivity, especially during visits for a new problem and routine chronic care”. Furukawa, M.F., (2011). Electronic medical records and efficiency and productivity during office visits. Am J Manag Care, 17, 296-303.
  • According to Kudler and Pantanowitz (2010), there are many advantages to having flexible electronic laboratory data in an EMR. For example, laboratory data can be viewed, sorted and pooled to support and determine trend analyses, used for clinical decision making and charting (3). In addition, flexible laboratory data in an EMR has that capacity to help further the development of better clinical decision support tools (Kudler & Pantanowitz, 2010). Rosen, P., Spalding, S.J., Hannon, M.J., Boudreau, R.M., Kwoh, C.K. (2011). Parent satisfaction with the electronic medical record in an academic pediatric rheumatology practice. Journal of Medical Internet Research, 13, 40.
  • Electronic Medical Records (EMR) are beneficial to all parties involved in the managing, receiving and the financial aspect of healthcare which includes the healthcare facility, the patient and the payor of services 1. Reduced offline and in house storage cost of paper based records. Paper records for legal reasons must be kept for several years. When records are not accessed for a certain period of time, they are taken off line and warehoused. Storage of these records is very expensive and time consuming when having to retrieve the document for use. 2. Enhanced Patient care. Patient care improves by having their health information readily available to their clinician for viewing and updating. By having the medical records available to the clinician, the patient can receive timely diagnosis and treatment in addition to reduced healthcare cost from additional test and procedures. 3. Payors such as insurance companies and the government will save from eliminating the cost for additional procedures and possible hospital stay for patients due to lack of correct diagnosis from limited information.

National

  • The American healthcare industry needs a national database of actual EMR implementation results to meet the absence of a low-cost, easy-to-use method for a typical hospital to reasonably estimate the potential benefits of an EMR purchase. This database should include EMR implementation results using 1.common or standardized terms, 2.definitions, and 3.calculation metrics,4.--Kjbracey 14:50, 23 January 2011 (CST) as well as information about the actual EMR implementation environment for truer apples to apples comparison. HIMSS CIS Benefits Taskforce has an initial framework to begin addressing this need. The framework consists of: 1. Hospital Demographic Information 2. Measures to describe the technology infrastructure of the organization 3. Descriptive measures of how the technology is being used by clinicians 4. Benefit categories that are defined 5. System components defined and associated with each benefit 6. Quantitative metrics for each benefit category 7. Entry of above framework data into a web-based data collection tool by hospitals expanding the database and allowing others to find similar hospitals to estimate their own costs [Thompson MBA, Douglas I, Osheroff MC, Jerry, Classen, MD, David, and Sittig PhD, Dean F. A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database. Journal of Healthcare Information Management Vol. 21, No.1: 66-67]
  • To broadly examine the potential health and financial benefits of health information technology (HIT), this paper compares health care with the use of IT in other industries. It estimates potential savings and costs of widespread adoption of electronic medical record (EMR) systems, models important health and safety benefits, and concludes that effective EMR implementation and networking could eventually save more than $81 billion annually—by improving health care efficiency and safety—and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits(http://content.healthaffairs.org/content/24/5/1103.full)
  • Sound public policy recommendations worthy of serious consideration have been identified by Crane, Raymond [1] to enable widespread clinical IT systems implementation. 1. Leadership in the development of standard clinical vocabulary, standards for exchange of clinical information, and interoperability standards. 2. Barriers to legitimate development and use of clinical information supporting a balance between public privacy right’s and a clinician’s ability, within an uncoordinated delivery system, to manage care and perform research that benefits society. 3. Costs of health information technology (HIT) should be shared among those that benefit. 4. Promotion of and focused study on research and development focused on HIT implementations. The Stimulus Act of 2009 is providing clear movement in this direction[2]. The American Recovery and Reinvestment Act (ARRA), has many implications on health information issues. AHIMA is actively monitoring, participating and developing resources to assist in understanding the key components of this law and the impact on the industry and practice. Information on healthcare reform will be continually evolving. Important HIM issues include: 1. Incentives for adoption of EHRs, 2. Health information exchange (HIE), 3. New privacy regulations for both HIPAA and non-HIPAA entities, and 4. HIM workforce opportunities. [1] Crane MPA, Robert; Raymond MPH, Brian. Fulfilling the Potential of Clinical Information Systems. The Permanente Journal Winter 2003, Vol. 7, No. 1: 66 [2] http://www.ahima.org/arra/
  • With the public and government demand for healthcare reform it is critical that health care technology structure be improved. Implementing EMR will help achieve that success but uptake by the US has been slow with only 7% of the providers using them. Taking the Pulse: Physicians and the Internet(1). (1) New York:Deloitte and Touche 2000. Other industries have improvement in quality, security and productivity using IT infrastructure and it seems this could also translate to the healthcare Industry to slow down the rising healthcare costs while improving quality.(2) A Review of Methods to Estimate the Benefits of Electronic Medical Records in Hospitals and the Need for a National Benefits Database. (2)Thompson, MBA; Osheroff, MD; Classen, MD; Sittig, PhD. Journal of Healthcare Information Management Vol 21.1 pp 63
  • To realize the plan to create a National Health Information Network for providers, hospitals and public health systems an EHR system is needed to facilitate data exchange. The implementation of an EHR system for national use will improve the health of the population which is a goal of the Department of Health and Human Services. An Electronic Health Record - Public Health (EHR-PH) System Prototype for Interoperability in 21st Century Healthcare Systems Anna O. Orlova, PhD,Mark Dunnagan, Terese Finitzo, PhD, Michael Higgins, PhD, Todd Watkins, Allen Tien, MD, MHS, and Steven Beales AMIA Annu Symp Proc. 2005; 2005: 575–579.
  • Regional Health Information Organizations have the potential to revolutionize health care delivery. By connecting disparate providers, payers and other stakeholders, RHIOs are supposed to streamline and accelerate the flow of patient data. Medical records will move seamlessly from doctors’ offices to hospital to outpatient clinic. The ultimate goal is better care for patients, and billions of dollars in savings for the industry as a whole. But RHIOs are still very much in their infancy and are plagued by many unresolved issues, including a clear definition of what they are. [www.hhnmag.com, "A Primer for Building RHIOs", By Dagmara Scalise] [EarnValle9_11_10]
  • HIE and RHIO benefits can be measured along following key axis:
    •Quality of care improvement by way of greater access to data, newer data sources and technologies
    •Reduction in costs achieved either through efficiency and productivity gains or avoidance of redundant provider services
    •Improved patient experience with the system resulting in higher “customer satisfaction”
    •Compliance with legal, accreditation and standards of care practices
    •Ability to add new revenue stream due to new business opportunity the network creates [15] [EarnValle_9_12_10]
  • One feature of health IT that may qualify as a public good is the wealth of information that can be captured through EHR systems. (As discussed earlier, if researchers

combined data from the EHRs of the population, they might be able to understand the spread and prevention of various diseases and injuries—and eventually develop cures and treatments; assess the effectiveness of various treatments; and more readily detect potential treatment hazards.) [16] [EarnValle_9_12_10]

  • EMRs can support federal and state mandatory reporting requirements. Electronic data storage that employs uniform data standards will enable health care organizations to respond more quickly, thus improving disease surveillance and there by promoting early detection of fatal infectious diseases 1, 2.

• Provides complete and accurate access to patient information for providers and demonstrates time saved over paper record. • Expedites results reporting through customizable displays • Supports a common user interfnace for accessing patient information, usually through a workstation. • Supports monitoring and analysis of patient care outcomes

  • On a national and even international level, one benefit of EMR’s is to have potential research information readily available for multiple studies. The result would be not only more data but more immediate data. This allows for more studies to validate or eliminate new approved therapies and medications resulting in improved health care.
  • EMR’s systems that are linked nationally would allow for healthcare workers to identify and treat new outbreaks in infectious/communicable diseases in a specified region. Faster identification of the cause would allow for faster treatment and a decrease in illness and death.
  • Federal government agencies such as the CDC, FDA, VA, HHS will better be able to allocate resources around the country based on data that is collected from an EHR. Such data will allow for improved risk management and planning for disasters such as an epidemic or biological attack.
  • According to Hilstead, et al, massive national adoption of Health IT initiatives may inhibit estimated average savings of "more than $77 billion per year (an average annual savings of S42 billion during the adoption period)". Hillestad et al. Can Electronic Medical Record Systems Transform Health Care? Health Affairs, 24, no. 5 (2005): 107.


EMR Cost Categories