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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%.<ref name='Bowles_readmissions"> Bowles, K. H., Chittams, J., Heil, E., Topaz, M., Rickard, K., Bhasker, M., … Hanlon, A. L. (2015). Successful electronic implementation of discharge referral decision support has a positive impact on 30- and 60-day readmissions. Research in Nursing & Health, 38(2), 102–114. http://doi.org/10.1002/nur.21643</ref>
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%.<ref name='Bowles_readmissions"> Bowles, K. H., Chittams, J., Heil, E., Topaz, M., Rickard, K., Bhasker, M., … Hanlon, A. L. (2015). Successful electronic implementation of discharge referral decision support has a positive impact on 30- and 60-day readmissions. Research in Nursing & Health, 38(2), 102–114. http://doi.org/10.1002/nur.21643</ref>
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== CPOE ==
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== CPOE
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== Improved Medication Prescription
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== 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.
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.
<ref name="Rhoades, Charles E">The more you use EMR, the more you benefit. http://www.aaos.org/news/aaosnow/feb09/managing6.asp</ref>
<ref name="Rhoades, Charles E">The more you use EMR, the more you benefit. http://www.aaos.org/news/aaosnow/feb09/managing6.asp</ref>
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== Improved medication safety
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== 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. <ref name="Kuperman"> Kuperman et al. (2003). Computer Physician Order Entry: Benefits, Costs, and Issues. http://www.ncbi.nlm.nih.gov/pubmed/12834316.</ref> 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. <ref name="Crane"> Crane, M.R., & Raymond, B. (2003) The Permanente Journal. Fulfilling the Potential of Clinical Information Systems https://www.thepermanentejournal.org/files/Winter2003/cis.pdf.</ref> 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.” <ref name="Galanter"> Galenter, et al (2013). J Am Med Inform Assoc. Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry. http://www.ncbi.nlm.nih.gov/pubmed/23396543. </ref>
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. <ref name="Kuperman"> Kuperman et al. (2003). Computer Physician Order Entry: Benefits, Costs, and Issues. http://www.ncbi.nlm.nih.gov/pubmed/12834316.</ref> 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. <ref name="Crane"> Crane, M.R., & Raymond, B. (2003) The Permanente Journal. Fulfilling the Potential of Clinical Information Systems https://www.thepermanentejournal.org/files/Winter2003/cis.pdf.</ref> 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.” <ref name="Galanter"> Galenter, et al (2013). J Am Med Inform Assoc. Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry. http://www.ncbi.nlm.nih.gov/pubmed/23396543. </ref>
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== Pharmacy order entry
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== Pharmacy order entry ==
EHRs with alerts at the point of pharmacy order entry can help reduce medication errors and prevent potential clinical hazards.
EHRs with alerts at the point of pharmacy order entry can help reduce medication errors and prevent potential clinical hazards.
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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. [http://www.ncbi.nlm.nih.gov/pubmed/23816138]
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. [http://www.ncbi.nlm.nih.gov/pubmed/23816138]
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== Improved accuracy of diagnoses and health outcomes
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== 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. <ref name="Radley"></ref> 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.
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. <ref name="Radley"></ref> 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.
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== More effective preventive care
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== 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].
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].
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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. <ref name="Tundia"> Tundia, et.al. (2012). The effect of EMRS sophistication on preventive healthcare for women. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638189/.</ref>
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. <ref name="Tundia"> Tundia, et.al. (2012). The effect of EMRS sophistication on preventive healthcare for women. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638189/.</ref>
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== Care coordination among clinicians
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== 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]
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]
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== Improved Coordination of Care ==
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== Improved Coordination of Care ==
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* 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.
* 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.
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* 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.
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* 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.<ref name="ImprovedCareCoordination"> Improved Care Coordination http://www.healthit.gov/providers-professionals/improved-care-coordination</ref>
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<ref name="ImprovedCareCoordination"> Improved Care Coordination http://www.healthit.gov/providers-professionals/improved-care-coordination</ref>
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* 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. <ref name = “PubMed”> Tolomeo et al. Electronic medical records in a sub-specialty practice: One asthma center’s experience http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/18972308 </ref>
* 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. <ref name = “PubMed”> Tolomeo et al. Electronic medical records in a sub-specialty practice: One asthma center’s experience http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/18972308 </ref>
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* By making data readily available during patient encounters electronic messaging,EMRs facilitate within-office care coordination.<ref name="Within-Office Care"> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839331/pdf/11606_2009_Article_1195.pdf</ref>
* By making data readily available during patient encounters electronic messaging,EMRs facilitate within-office care coordination.<ref name="Within-Office Care"> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839331/pdf/11606_2009_Article_1195.pdf</ref>
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* 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. <ref name= "rad">Kevin W. McEnery, MD Coordinating Patient Care Within Radiology and Across the Enterprise http://ca3cx5qj7w.search.serialssolutions.com/OpenURL_local?sid=Entrez:PubMed&id=pmid:25467898</ref>
== Patient Handoff ==
== Patient Handoff ==