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The [[EMR|Electronic Medical Record]] may consist of computer order entry, decision support, electronic medication administration, documentation, and so much more. Commonly cited benefits of EMRs include:
The [[EMR|Electronic Medical Record]] may consist of computer order entry, decision support, electronic medication administration, documentation, and so much more. Commonly cited benefits of EMRs include:
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*
lower
number of doctor visits (from the payer's perspective)
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*
Lower
number of doctor visits (from the payer's perspective)
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*
communication
, coding, efficiency, safety improvements
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*
Communication
, coding, efficiency, safety improvements
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*
transformation
of healthcare delivery
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*
Transformation
of healthcare delivery
* Better Coordination of care
* Better Coordination of care
* Improved management of chronic conditions
* Improved management of chronic conditions
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However, quantifying these benefits is not a simple task. Issues that have hampered Return on Investment (ROI) studies and affected their validity include:
However, quantifying these benefits is not a simple task. Issues that have hampered Return on Investment (ROI) studies and affected their validity include:
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*
pressure
to justify expense
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*
Pressure
to justify expense
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*
shoddy
collection of "before" comparison data after the implementation
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*
Shoddy
collection of "before" comparison data after the implementation
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*
application
of multiple simple statistical tests (the more statistical tests you run, the more likely you are to find something significant)
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*
Application
of multiple simple statistical tests (the more statistical tests you run, the more likely you are to find something significant)
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The sections below detail the benefits, costs,
barriers to
and
evaluation of
EMR implementations.
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The sections below detail the benefits, costs, and
barriers in evaluating
EMR implementations.
== Informational ==
== Informational ==
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EMRs improve the storage and retrieval of patient information in the following ways:
EMRs improve the storage and retrieval of patient information in the following ways:
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# Reduces the amount of physical storage space required to house charts.
# Reduces the amount of physical storage space required to house charts.
# Protected from fire, natural disaster, or theft.
# Protected from fire, natural disaster, or theft.
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With better information integration capability, it allows for healthcare institutions to facilitate better quality care, contain costs, and better manage risks. Thus, by having healthcare organizations that incorporate an EMR, it enables for both clinical and business advantages by in turn creating a clinical healthcare system that helps to unite crucial patient information with various departments. As a result, this helps to create a central clinical information repository and resource used throughout the integrated delivery network of the institution. This in the long run allows for the different information of patients to be coalesced together in a timelier manner, which can reduce errors in diagnosis. EMRs allow for interoperability such that multiple clinicians and facilities may use or add to a patient’s record, even at the same time.
With better information integration capability, it allows for healthcare institutions to facilitate better quality care, contain costs, and better manage risks. Thus, by having healthcare organizations that incorporate an EMR, it enables for both clinical and business advantages by in turn creating a clinical healthcare system that helps to unite crucial patient information with various departments. As a result, this helps to create a central clinical information repository and resource used throughout the integrated delivery network of the institution. This in the long run allows for the different information of patients to be coalesced together in a timelier manner, which can reduce errors in diagnosis. EMRs allow for interoperability such that multiple clinicians and facilities may use or add to a patient’s record, even at the same time.
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The advent of the [[HIE|Health Information Exchange (HIE)]] allows for sharing of patient information electronically within an organization, system, community, region or state. This helps in monitoring not just a patient's health but health in certain subsets of populations, whether for a certain diagnosis group or within a social demographic or a geographic region. Stratifying the data to look for trends over areas, ethnicities or over time has helped in development of software models which help in predicting the health of not only a patient but also patient populations over time.
The advent of the [[HIE|Health Information Exchange (HIE)]] allows for sharing of patient information electronically within an organization, system, community, region or state. This helps in monitoring not just a patient's health but health in certain subsets of populations, whether for a certain diagnosis group or within a social demographic or a geographic region. Stratifying the data to look for trends over areas, ethnicities or over time has helped in development of software models which help in predicting the health of not only a patient but also patient populations over time.
Metrics such as 30 day readmission are used commonly in healthcare to gauge the quality of care of a patient and is an example of where predictive modeling is being used. EMR has allowed for transparency, and the analysis of data has helped to establish trends and patterns. Big Data is another commonly used term in healthcare and refers to the availability of large amounts of data available from the collection of patient EMR records.
Metrics such as 30 day readmission are used commonly in healthcare to gauge the quality of care of a patient and is an example of where predictive modeling is being used. EMR has allowed for transparency, and the analysis of data has helped to establish trends and patterns. Big Data is another commonly used term in healthcare and refers to the availability of large amounts of data available from the collection of patient EMR records.
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=== Better Integrated Care by Hospitals and Long-Term Facilities/Rehabilitation Centers ===
=== Better Integrated Care by Hospitals and Long-Term Facilities/Rehabilitation Centers ===
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EHR plays an important role in improving the health care quality and safety
and
reducing the costs of providing care in long-term care facilities.[http://www.ihealthbeat.org/perspectives/2010/electronic-health-records-hold-great-promise-for-longterm-care-facilities] 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.
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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.[http://www.ihealthbeat.org/perspectives/2010/electronic-health-records-hold-great-promise-for-longterm-care-facilities] 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.[http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/01JAN2013/0113HHN_Feature_strategy&domain=HHNMAG]
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.[http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/01JAN2013/0113HHN_Feature_strategy&domain=HHNMAG]
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One financial benefit of improving care through the use of Health IT might be to lower malpractice insurance costs for providers. A number of firms that sell liability insurance for physicians are offering discounted premiums to practices that use EHRs.(Congress of the United States Congressional Budget Office. (2008). Evidence on the costs & benefits of health information technology (). Washington, DC: Government Printing Office.) P. 13
One financial benefit of improving care through the use of Health IT might be to lower malpractice insurance costs for providers. A number of firms that sell liability insurance for physicians are offering discounted premiums to practices that use EHRs.(Congress of the United States Congressional Budget Office. (2008). Evidence on the costs & benefits of health information technology (). Washington, DC: Government Printing Office.) P. 13
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Financial benefits include averted costs and increased revenues, which can be divided into three categories: payer-independent benefits, benefits under capitated reimbursement, and benefits under fee-for-service reimbursement [58].
=== Quantitative Benefits ===
=== Quantitative Benefits ===
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* The reported barriers to adoption and MU of EHRs were not associated with serving a predominately Medicaid-insured population, and were consistent with barriers that health care professionals in other studies had previously reported. In fact, barriers to adopting and using EHRs that could be associated with Medicaid providers were issues specific to provider types who were eligible for the Medicaid EHR Incentive Program but not the Medicare EHR Incentive Program, specifically, dentists and pediatricians. However, all findings were useful in generating a set of recommendations that are specific to promoting MU of EHRs among health care professionals eligible for the Medicaid EHR Incentive Program. [http://healthit.ahrq.gov/portal/server.pt/document/958478/barriers_to_meaningful_use_in_medicaid_final_report_pdf?qid=82968838&rank=5]
* The reported barriers to adoption and MU of EHRs were not associated with serving a predominately Medicaid-insured population, and were consistent with barriers that health care professionals in other studies had previously reported. In fact, barriers to adopting and using EHRs that could be associated with Medicaid providers were issues specific to provider types who were eligible for the Medicaid EHR Incentive Program but not the Medicare EHR Incentive Program, specifically, dentists and pediatricians. However, all findings were useful in generating a set of recommendations that are specific to promoting MU of EHRs among health care professionals eligible for the Medicaid EHR Incentive Program. [http://healthit.ahrq.gov/portal/server.pt/document/958478/barriers_to_meaningful_use_in_medicaid_final_report_pdf?qid=82968838&rank=5]
* 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.
* 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.
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*The high cost of basic infrastructure of clinical information technology
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*The high cost of basic infrastructure of clinical information technology is a substantial hurdle for many health care organizations, many of whose income margins have deteriorated after years of decreasing reimbursement (from Medicare and other sources) and whose access to capital for new medical technology is extremely scarce. Financial instability and scarce capital resources for IT infrastructure similarly affect small to mid-sized independent practice associations (IPAs) and independent physician offices, the practice venues for most physicians in the United States.
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is a substantial hurdle for many health care organizations, many of whose income margins have deteriorated after years of decreasing reimbursement (from Medicare and other sources) and whose access to capital for new medical technology is extremely scarce. Financial instability and scarce capital resources for IT infrastructure similarly affect small to mid-sized
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independent practice associations (IPAs) and independent physician offices, the practice venues for most physicians in the United States.
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*Diversity of products as well as lack of standards for common architecture of basic infrastructure of clinical information technology constitutes a barrier and further complicates EMR Implementation.
*Diversity of products as well as lack of standards for common architecture of basic infrastructure of clinical information technology constitutes a barrier and further complicates EMR Implementation.
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=== Challenges to Identifying a Return on Investment (ROI) ===
=== Challenges to Identifying a Return on Investment (ROI) ===
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Evidence of a strong ROI business case for EHR implementation is confounded by anecdotal evidence in peer reviewed research and trade journals. Furthermore, environmental differences across provider settings make it challenging to replicate information system strategies and dependence on disparate legacy applications [48].
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Evidence of a strong ROI business case for EHR implementation is confounded by anecdotal evidence in peer reviewed research and trade journals. Furthermore, environmental differences across provider settings make it challenging to replicate information system strategies and dependence on disparate legacy applications [48
]. For organizational stakeholders to embrace EHR adoption, they need assurance that adopting an EHR system would positively impact business performance [58
].
Additional barriers include:
Additional barriers include:
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# http://www.healthit.gov/providers-professionals/2-install-and-enable-encryption
# http://www.healthit.gov/providers-professionals/2-install-and-enable-encryption
# http://www.dialogmedical.com/informed-consent-2-3/
# http://www.dialogmedical.com/informed-consent-2-3/
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# http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047866.hcsp?dDocName=bok1_047866