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== Informational ==

Commonly cited benefits of EMRs include:

* Lower number of doctor visits (from the payer's perspective)

* Communication, coding, efficiency, safety improvements

* Transformation of healthcare delivery

* Better Coordination of care

* Improved management of chronic conditions

* Increased revenue and decreased costs for healthcare organizations

* Increased use of preventive care <ref name="EMR Benefits">EMR Benefits, https://www.longwoods.com/articles/images/ABC_&_HIMSS_research-1.pdf</ref>

* Nursing staff time savings <ref name="EMR Benefits"></ref>

* Length of stay reduction <ref name="EMR Benefits"></ref>

* Clinical cost reduction <ref name="EMR Benefits"></ref>

* Pharmacist time savings <ref name="EMR Benefits"></ref>

* Reduced payment denials <ref name="EMR Benefits"></ref>

* Improved reimbursement inpatient or outpatient<ref name="EMR Benefits"></ref>

* HIM/Medical Records staffing reductions<ref name="EMR Benefits"></ref>

* Reduction in duplicate lab testing<ref name="EMR Benefits"></ref>

* Decreased cost of paper forms<ref name="EMR Benefits"></ref>

* Improved drug order to administration times<ref name="EMR Benefits"></ref>

* Reduction in order turnaround times<ref name="EMR Benefits"></ref>

* Data accessibility by multiple users <ref name="practical guide">Benefits of Switching to an Electronic Health Record. http://www.practicefusion.com/health-informatics-practical-guide/ </ref>

* Retrieval of prior encounters and medication history <ref name="practical guide"></ref>

* Improve legal and regulatory compliance <ref name="benefits & drawbacks"> Benefits and Drawbacks of Electronic Health Record System. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270933/#b55-rmhp-4-047. </ref>

* Up to date information about patient at point of care <ref name="benefits">Benefits of Electronic Medical Records (EMR), 2011 Physician Survey. http://blog.softwareadvice.com/articles/medical/benefits-of-emr-software-survey-1081611/ </ref>

* Improve Public Health Outcomes <ref name="Diagnostics and Outcomes">Improved Diagnostics & Patient Outcomes http://www.healthit.gov/providers-professionals/improved-diagnostics-patient-outcomes</ref>

* Healthcare Quality and Convenience <ref name="Patient Participation">Health Care Quality & Convenience http://www.healthit.gov/providers-professionals/health-care-quality-convenience</ref>

* Increased Accuracy in Medication Administration <ref name="Electronic Mediation Administration">Electronic Mediation Administration. http://www.fdbhealth.com/solutions/emar/ </ref>

* Improvement to patient appointment management

* Improved integration with pharmacy (e-prescribing)

* Advances in medical research <ref name="Enormous Benefits">How Epic EMR Implementations Bring Enormous Benefits to Human Health

. http://www.knowledgeanywhere.com/blog/news-and-events/post/how-epic-emr-implementations-bring-enormous-benefits-to-human-health </ref>

* Improved utilization of radiology tests <ref name="wang 2003"></ref>

* [http://clinfowiki.org/wiki/index.php/Department_of_Veterans_Affairs_Initiatives Special VA Benefits]

Veterans Transportation Service (VTS) provides Veterans with transportation to and from their VA health care appointments, which avails the service to care and continuity of care for many who would otherwise be limited in mobility.

Many other distinguished services such as VA Dental Insurance Program (VADIP),Minority Veterans Program (National Call Center for Homeless Veterans), Military Sexual Trauma, Family Caregivers Program,and many more. <ref name"Health Benefits"> http://www.va.gov/healthbenefits/resources/publications/IB10185_Health_Care_Overview_2014_Eng_V6_web.pdf</ref>

Further elaborate information is available at their website <ref> Health Benefits. http://www.va.gov/healthbenefits.html</ref>

However, quantifying these benefits is not a simple task. Issues that have hampered Return on Investment (ROI) studies and affected their validity include:

* Pressure to justify expense

* Shoddy collection of "before" comparison data after the implementation

* Application of multiple simple statistical tests (the more statistical tests you run, the more likely you are to find something significant)


=== Storage and retrieval ===

EMRs improve the storage and retrieval of patient information in the following ways:

# Reduces the amount of physical storage space required to house charts.

# Protected from fire, natural disaster, or theft.

# Records can be backed up to off-site facilities

# Instant access to records.

# More controlled access, including a record of who accessed the record.

# Eliminates “lost” or incomplete charts.

# More than one provider can access the record at one time. Ability to identify who modified the record.

# Ensures business continuity and uninterrupted medical service.

# EMRs store patient data, including but not limited to, patient medical history, medication history, vital signs, lab tests results, as well as other pertinent information in a single location, and is readily available to anyone directly involved in the patient’s care, regardless of location. It eliminates time and cost from paper chart pulls and transcription and re-file of paper charts <ref name="wang 2003"></ref>

# They reduce the likelihood that tests will be unnecessarily duplicated.

# Coordination of care is easier to achieve and eliminates steps that may lead to discrepancies in the sharing of data.

# EMRs can promote early intervention in disease processes because all the health data- vital signs, lab results, imaging, physician notes, nursing notes, etc.- of a patient are accessible in the same record (6).

# They are vital to improved quality of care at the bedside or point of care because less time is spent doing non-caring activities and more time spent actually caring for the patient (6).

# EMRs reduce the number of lost or missing reports.

# They reduce variability of care.

# Timely delivery of critical services

# Ensures business continuity and uninterrupted medical service.

# Facilitates patient self-service and increases patient's engagement with the help of Patient portal which is a secure online website that patients can access anywhere and anytime to view their medications, immunizations, lab reports, request prescription refills, schedule appointments, make payments and much more.

# Enforces data confidentiality and improves compliance.

# Ensures accurate patient identification: For example, there can be multiple Jon Does in the hospital even with same age. EMR ensure that they are uniquely identified with medical record numbers and also additional features like photograph etc.

# Increased ability to sanitize data for use in research studies

# Increased access for researchers both in-house and external

# The records provide proof to insurance companies that a patient was seen<ref name="Insight.com">www.insight.com/insighton/healthcare/emr-benefits-challenges-and-tips-for-integration/</ref>

Respondents from the 2011 U.S. Physician Workflow study of office-based physicians reported that the Electronic Health Record (EHR) helped them access patient records remotely (81%) and enhanced patient care overall (78%).

=== Workflow ===

EMR has tremendous effects on changing workflow by several ways such as reducing time spent in getting medical histories, ease of data retrieval, greater remote access, and providing auto-produced sign-out documents to support handoff workflow.

According to a study performed by Julia Driessen and ects. They estimated EMR assist an employee to reduce about 17 min per working day (28%) in transcription time. Although the volume of work initially required to achieve the goal of digitizing a healthcare office may seem overwhelming, the end result is well worth the effort.

Every medical office has its own "system" for organizing patient data, the majority of these facilities could use a little help in improving their processes. Searching through physical file folders for a specific patient's medical record and then being required to sift through paperwork to find the document(s) necessary for a certain task are time-consuming tasks that could be eliminated through the implementation of electronic medical records. A digitized records database can solve problems associated with human filing errors and misplaced documentation. Instead, all authorized medical staff will have immediate and accurate access to the exact information needed through just a few clicks of a mouse.

An EMR service that fully analyzes and streamlines the patient workflow, and works to support a lean practice operation, can actually improve efficiency, such as integrated billing. Providers can be more productive, spend more time with patients, and even enjoy increased patient visits.

=== Care coordination ===

EMRs can decrease the fragmentation of care by improving care co-ordination among clinical and administrative staff. Better care coordination can improve transparency among overall processes. EMRs have the potential to integrate and organize patient health information and communicate this information accurately among everyone that is involved in a patient's care. Better availability of patient information can reduce medical errors and redundancy in health care.

Improved care coordination increases with EHRs. Care coordination can be seen when every provider has the same access to a patients health information. This is important with patients who are receiving emergency setting treatment, seeing a few or many specialists and when transitioning care settings. EHRs can even provide the ability to set off alerts in a patients charts when they have been in the hospital. This allows providers to proactively follow up. <ref name="care coordination">Health IT: Improved Care Coordination http://www.healthit.gov/providers-professionals/improved-care-coordination</ref>

=== Integrated View of Patient Data ===

EHR systems can provide integrated access to all data about a patient from many visits and facilities such as laboratory tests, problems, diagnoses, medications, etc. from the database. This retrieval is made easy by data standards like HL7, LOINC, and SNOMED. Practitioners can also have multiple views of data through links provided in the user interfaces.

The capacity to integrate the way patient data can be viewed is one of the most important benefits of the EMR to healthcare providers. Being able to see flowcharts of a patients vital signs, lab results, intake and output, and medication administration, provide physicians a faster and better way to visualize and make decisions on the patient’s current condition without spending a considerable amount of time leafing through a patient’s paper chart searching for disjointed documentation. <ref name="MD satisfaction">Sittig, D. F., Kuperman, G. J., & Fiskio, J. (1999) .Evaluating physician satisfaction regarding user interactions with an electronic medical record system (1999). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2232602/</ref>

=== Tracking Patients’ Medical Data ===

By having the EMR save patient data (such as heart rate, blood pressure, eating habits, etc.) over, healthcare providers – or even the patients – can check parameters during a specific time frame when certain symptoms occur and correlate any relation. Having the constant patient data, allows the healthcare professional to go back in time and see any relationship to specific parameters and patient illness symptoms. [5]

=== Data Accessibility by Multiple Users ===

Electronic health records are accessible to multiple healthcare workers at the same time <ref name="paper chart">Benefits of EMR or EHR Over Paper Chart. http://www.emrandhipaa.com/benefits-of-emr-or-ehr-over-paper-charts/ </ref>, at multiple locations such as remote access from the office, hospital or home. <ref name="practical guide"></ref>. While a billing clerk is looking at the electronic chart, the primary care physician and a specialist can be analyzing clinical information simultaneously <ref name="practical guide"></ref>.

Electronic Health Records (EHRs) can improve health care quality. As opposed to paper record, it can also make health care more convenient for providers and patients. Below are some instances showing improved Health Care Quality and Convenience:

* For Providers

Quick access to patient records from inpatient and remote locations for more coordinated, efficient care, enhanced decision support, clinical alerts, reminders, and medical information performance-improving tools, real-time quality reporting. Legible, complete documentation that facilitates accurate coding and billing Interfaces with labs, registries, and other EHRs safer, more reliable prescribing.

* For Patients

Reduced need to fill out the same forms at each office visit, reliable point-of-care information and reminders notifying providers of important health interventions, convenience of e-prescriptions electronically sent to pharmacy, patient portals with online interaction for providers and electronic referrals allowing easier access to follow-up care with specialists <ref name="Health Care Quality & Convenience">http://www.healthit.gov/providers-professionals/health-care-quality-convenience</ref>

=== Retrieval of Prior Encounters and Medication History ===

One of the most attractive features of EMR is the ability to create and store a patient encounter electronically. In seconds one can view the last encounter and determine what treatment was rendered <ref name="practical guide"></ref>.

=== Improvement to Patient Appointment Management ===

EHRs improve the process of scheduling, changing, and cancelling patient appointments. Occasionally, patients will forget their appointment which may cause a delay in their care. EHR systems have the ability to reduce the number of missed appointments by sending out reminders to the patient via email, or even a text message. Alternatively, the system can also remind the staff to call the patient to follow up a missed appointment. EHR systems that also provide patient portals allow patients to directly schedule their appointments online and when the appointment reminder is received, they have the ability to confirm the appointment online or reschedule the appointment without having to pick up the phone.<ref>EHR Patient Portals. http://www.hbma.org/news/public-news/n_patient-portals-ehrs-and-third-party-billing</ref> Reducing the number of missed appointments can also help the organization see more patients.

=== Improved Integration with Pharmacy ===

EHRs are able to instantly look up the patient's pharmacy and send refill requests reducing the chances of a patient losing a paper prescription. Clinicians can also search for a patient's past and current medication, communicate with the pharmacy staff, and determine if there are any contraindications.

E-prescribing systems enable electronic transmissions of prescriptions to pharmacies from the provider's office. The promise of e-prescribing in regard to patient safety is reduction in the time gap between point of care and point of service, reduction in medication errors, and improved quality of care. There are 2 types of e-prescribing systems: stand alone e-prescribing systems and EHR (electronic health record) integrated e-prescribing systems.<ref name=" Kannry, J. (2011)"> Kannry, J. (2011), Effect of E-Prescribing Systems on Patient Safety. Mt Sinai J Med, 78: 827–833. doi: 10.1002/msj.20298</ref>

Records such as in-pharmacy immunizations in the past were sent to physicians by fax or traditional mail. By using EHRs, pharmacists and pharmacy healthcare providers contribute to the compilation of more complete medical histories for their patients. <ref name="immunizations">The impact of electronic health records on pharmacy practice.http://drugtopics.modernmedicine.com/drug-topics/news/clinical/community-pharmacy/impact-electronic-health-records-pharmacy-practice?id=&sk=&date=&&pageID=1</ref>

=== Data Legibility ===

Legibility is very important to reduce medical errors. For instance, patient information presented as typed text is much easier to read compared to human writings. They are also unified in structures and standards to prevent confusion. Misspelled words can be corrected with spell checks or autocorrect function. Clinicians will be required by computers to enter complete patient notes to avoid missing information.

When physicians use Computer Provider Order Entry (CPOE) systems within the EMR, fewer medication errors also occur because there are fewer legibility issues. Proper dosages are clearly entered into the computer by the ordering physician, thus reducing the need for nurses or other staff to “second guess” or question the order. [7]

In addition, with the use of electronic prescribing, the hand-written prescription is no longer applicable as a physician can electronically send a prescription directly to the pharmacy of the patient’s choice. This means there’s no question regarding which medication/dosage the provider prescribed and there are no complications with the physical prescription potentially being lost in transition [73].

=== Facilitated referral for multidisciplinary care ===

Electronic medical record (EMR) systems have the potential to facilitate referral of patients from one physician to another physician for provision of well-integrated multidisciplinary care [17]. Such an advantage of EMRs is best served when the referring physician and the physician(s) to whom the patient is referred have direct and full access to the EMR system containing the patient’s file. In such a scenario, viewing and modification of the patient’s EMR file by the physician to whom the patient is referred is immediate and secure [17]. In the absence of direct and full access, referral to other physicians can still be facilitated by EMRs if the relevant data contained within the patient’s EMR file can be transferred electronically, securely, and rapidly between physicians [17].

=== Better Integrated Care by Hospitals and Long-Term Facilities/Rehabilitation Centers ===

EHR plays an important role in improving the health care quality and safety; thus reducing the costs of providing care in long-term care facilities. <ref name="ford e 2010">Ford E. Electronic Health Records Hold Great Promise for Long-Term Care Facilities. http://www.ihealthbeat.org/perspectives/2010/electronic-health-records-hold-great-promise-for-longterm-care-facilities </ref> The relationship-building between the hospitals and long-term facilities is essential in reducing readmissions and improving patient satisfaction. EHR helps in '''improving the transition''' from one care setting to next and hence prevents any gaps in care provided to the patient.

According to Jenq (Program Director for the Greater New Haven Coalition for Safe Transitions and Readmission Reductions, or GNH CoSTARR)"Nursing facilities frequently do not receive the information they need to properly care for patients discharged from the hospital. From the hospital side, we presume that our paperwork makes it to the skilled-nursing facility and that they have all the material necessary," Jenq says. "But we're finding that our paperwork actually doesn't make it in a timely, efficient manner." Hospital clerical workers often do not recognize all the components of the discharge paperwork; historically, there has been no protocol for laboratory results, such as urine cultures, to be sent to nursing facilities. <ref name="hhnmag">Hospitals strengthen bonds with post-acute providers. http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Magazine/2013/Jan/0113HHN_Feature_strategy&domain=HHNMAG</ref>

Skilled nursing facilities (SNF) nurses do not know how to get information from the hospital. "Sometimes the nursing facility will call back to the hospital, but the hospital RN they reach will say, 'I don't know the patient,' and essentially end the conversation there," Jenq says. "We are going to have to lay out roles and responsibilities for all the people involved in the transition of care to make sure they are held accountable for this type of communication." When a problem arises, nursing facilities may not share the hospital's goal of keeping patients out of the hospital. "Right now, the skilled-nursing facilities don't get penalized for the readmission, so they are not affected if the patient goes to the emergency department and gets admitted," Jenq says. "In the future, when penalties apply to them as well, both the SNF and the emergency department will be forced to develop care plans that can work at an SNF." <ref name="hhnmag"></ref>

EHR also helps in Improving the communication between the hospital staff and assisted living or the long-term care facility staff when the patient is transferred from one setting to other. <ref name="hhnmag"></ref>

=== Minimize Repeating Diagnostic Imaging Studies ===

HIE can potentially eliminate unnecessary repetition of diagnostic testing, especially in the Emergency Department. Indeed as study found that HIE reduced imaging studies order by Emergency Department physicians for patients presenting with back pain, this is not only decrease the cost of expensive imaging studies but also decrease risk of unnecessary patients exposure to radiation[1]. This illustrate the importance of HIE and the potentially huge impact it will have on reducing cost and delivery an optimal health care.

Nitros et al reported that that a hospital that installed Picture Archiving and Communication System (PACS) as a part of EMR implementation has increased quality and efficiency of patient care in Radiology department. The article listed the benefits of installing PACS as follows.

• Hospital’s Radiology department productivity increased by 12%

• Department’s turnaround time improved above 60%

• Patient’s length of wait time reduced and workflow improved substantially.

• And, finally the article reported that there was $1.9 millions cost savings as a result of the implementation.

<ref name = “PubMed”> Nitrosi et al. A Filmless Radiology Department in a Full Digital Regional Hospital: Quantitative Evaluation of the Increased Quality and Efficiency http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC1896266/</ref>

=== Administrative and Management Benefits ===

By moving beyond the paper records, EMR can help Heath Care Providers do a better job at managing patient care. A vast amount of information can be easily used and shared. When fully functional and interoperable, EMRs can provide far more benefits than paper records such as "help providers improve productivity and work life balance." [68] At a higher level of EMR implementation and functionality, Computerized Provider Order Entry (CPOE) can help standardize the clinical practice and eliminate variation. Some benefits of CPOE are:

* The records can be used in court in the event of a malpractice claim<ref name="Insight.com"></ref>

* Help improve communication amongst care givers

* Expedite patient transfer to other levels of care

* Capture data for quality assurance and administrative purposes

* Aid practice and care in a complex care environment through the use of alerts and reminders

* Provides some level of assurance to patients that technology is being applied to their safety [38].

* Better strategic planning - The data generated from using electronic medical records can be used for strategic management by the administration. EMRs can help identify trends in utilization, identify bottlenecks in productivity for staff, and monitor patient needs and satisfaction. This would allow the management team to make better decisions on capital investments, staffing levels and workforce redeployment. They can use this data to implement process improvement projects. EMRs have the potential to help medical facilities design and reach their strategic vision.

=== Establishing a learning chance to improve healthcare system ===

EMR can assist people to review the outcomes of populations under care. Managers can find a more Meaningful Use criteria applied on quality improvement, research, outreach, and reduction of disparities.

=== Improved Documentation and Coding ===

With an EHR system a record can be captured within 12 to 24 after discharge, which can provide an accurate coding in a decreasing amount of time. Healthcare organizations are no longer limited to local coding resources and now healthcare facilities can provide coders with better expertise.

===Increase in Revenue===

The implementation of electronic health record (EHR) systems is generally believed to help avert operational costs and increase revenue for healthcare providers. Improved and more efficient financial records management with improved efficiency and more accurate coding functionality resulting from better capture of charges and decreased billing errors help providers with EHR systems more likely to realize increases in annual billable gains. Financial benefits will also occur as a result of improved care delivery from more efficient clinical decision support capabilities, increased patient flow and staff productivity. With the integration of efficient pharmacy systems, the use of EHRs also ensures that providers realize more savings and increased revenues from better controlled and well monitored drug inventory and utilization.

===Increase in Overall 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.

===Improvement in Clinical Care===

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 enhanced 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.

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.

<ref name= “PubMed “> Hibbs et al. The Impact of Electronic Decision Support On Transfusion Practice: A systematic review http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/25535095 </ref>

=== 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.

=== Improved Risk Management ===

* Prevention of adverse drug events

* Public health outcome improvements

* Prevention of liability actions

* Improvement with complete and legible health records

=== Customer Support ===

Some EHR provide help and support in the form of a medical billing specialist. This specialist gives both practices and patients customer support. The specialist also has access to medical codes (ICD-9), CPT code books and practice-related HIPAA information. Other EHRs provide onsite training and on-the-phone consulting for software and billing questions. http://www.advancedmd.com/medical-billing-services

== References ==



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