EMR and Providers’ Productivity
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[[EMR_Benefits: mHealth]]
[[EMR_Benefits: mHealth]]
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Qualitative
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Physicians
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[[EMR
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The EMR will improve patient care by reducing medication error and wait time. Clinical processes will be standardized and there will be less variation in clinical care provided at one place from another. Records would be easily shared among the providers, which will reduce the process time and over all improve disease management. It will also improve the communication among the care providers and the administrative staff and administrative activities. The EMR can help the provider deliver the best quality of care because the EMR contains the complete patient‘s health history. In a crisis, the EMR provides immediate access to a patient's medical history, allergies, and medications. The retrieved information enables providers to make decisions sooner which otherwise they would have to wait for, like information from test results or other resources. This feature is very critical when a patient has a serious or chronic medical condition, such as diabetes. Also, the EMR information can be shared with patients and their family, so they can more fully take part in decisions about their health care. In addition, using decision support tools in EMRs help the provider to make efficient and effective decisions about patient care through clinical alerts and reminders.
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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.
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Pinsonneault and associates found that data from before and after EHR integration, from a matched set of 15,626 patients with electronic integration and 15, 626 patients in a control group, who visited over 95 physicians in a large North American health network, show that patients treated through the electronically integrated system had better quality of care in the follow-up period and a higher continuity of care, compared to the control group [29].
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Another overview of an attempt to quantify quality outcomes and cost reporting measures benefits of EHRs was published by the Healthcare Information and Management Systems Society in 2010 and can be found here: http://www.himss.org/content/files/QPRWhitePaper.pdf
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=== Up To Date Information About Patient at Point of Care ===
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EMR can provide health information that is up-to-date with clinical information <ref name="health news">The Era of Electronic Medical Records. http://health.usnews.com/health-news/most-connected-hospitals/articles/2011/07/18/most-connected-hospitals </ref>. With an EMR, lab or radiology results can be retrieved much more rapidly. Test results and medical history are recorded directly into the EMR <ref name="practical guide"></ref>.
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=== Increased Accuracy in Medication Administration ===
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EMAR can help increase accuracy in Medication Administration. There are about 700,000 reasons annually—the estimated U.S. number of adverse drug events—for the increasing use of the electronic medication administration record (EMAR) to support inpatient care. With paper and other non-digital records prone to being incomplete, misread, or even misplaced, nurses need a way to help ensure that medications are properly administered and tracked. With the help of EMAR functionality and bar coding/electronic verification during medication administration along with real-time alerts, there is very little room for errors thus accuracy in Medication Administration most like happen at all times.
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<ref name="Electronic Mediation Administration">Electronic Mediation Administration. http://www.fdbhealth.com/solutions/emar/ </ref>
=== Improve Legal and Regulatory Compliance ===
=== Improve Legal and Regulatory Compliance ===
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<ref name="benefits & drawbacks"></ref>. In a study by Bhattacherjee et al, Florida hospitals with a greater adoption of health information technology had higher operational performance, as measured by outcomes of Joint Commission on Accreditation of Healthcare Organizations (JCAHO) site visits <ref name="benefits & drawbacks"></ref>
<ref name="benefits & drawbacks"></ref>. In a study by Bhattacherjee et al, Florida hospitals with a greater adoption of health information technology had higher operational performance, as measured by outcomes of Joint Commission on Accreditation of Healthcare Organizations (JCAHO) site visits <ref name="benefits & drawbacks"></ref>
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===Increased practice efficiencies, cost savings, and reimbursement===
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EMRs help improve medical practice management by increasing practice efficiencies and cost savings. A practice can be made more efficient by using integrated EMR systems that can be used for scheduling, automated coding, and managing claims which save time as well. As one example, a clinic or physician practice can expect to increase revenue and decrease costs by converting the encounter form to digital format to reduce billing errors and revenue loss. Prompts for fields that need to be completed will reduce errors by an average of 78% according to one study [40]. Communication is enhanced among clinicians, labs and health plans as information can be accessed from anywhere. EMRs save money by reducing redundancies in medical care, by eliminating costly tasks of creating paper charts and labor intensive management of paper charts. Very simply, the EHR eliminates paper chart pulls and staffing expenses can be reduced as a result. One study estimated that an average of $5 per pull would be saved considering the time and cost of medical records staff to retrieve and then re-file the paper chart. The clinic studied expected it would reduce paper chart pulls by approximately 600 annually and transcription costs would be reduced by 28% [41].
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There is significant evidence to show that while initial costs remain an issue, switching from paper records to EHR systems will ultimately reduce overall health care expenses. Documenting electronically is much less time consuming than documenting on paper allowing physicians more time with their patients and the ability to see more patients. <ref name="see more patients">5 simple ways to realize ROI from your EHR.http://www.healthcareitnews.com/news/5-simple-ways-realize-roi-your-ehr/ </ref> Historically, it has been difficult to identify and achieve a solid, measurable Return on Investment (ROI) following Electronic Health Records (EHR) or other clinical system implementation initiatives. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 has motivated system implementations, and the associated incentive dollars have offered a simple measure of ROI on the revenue side of the ledger, but this represents only one aspect of the substantial benefits clinical systems can yield. A proper optimization program, with broader consideration for the projects comprising it, can bring a truly positive ROI to healthcare organizations over a 10-15 year period if properly considered and executed. (Cumberland Consulting Group, 2013) Research indicates that Medicare and private payers could save tens of billions of dollars every year. To incentivize EMR adoption, the federal government has established a plan to provide $44.7 billion during 2010-2019 to financially assist health care providers in the EMR implementation process [4]. However according to Himmelstein, Wright & Woolhandler, as currently implemented, the use of Electronic Medical Records could moderately advance metrics related to quality measures, it does however not reduce the cost of administration of ‘overall’ costs. “Hospitals on the ‘Most Wired’ list performed no better than others on quality, costs, or administrative costs” (Himmelstein, Wright & Woolhandler, 2009). Forecasts of potential improvements in efficiency and cost-savings from implementation of computerized health care and the use of Electronic Medical Records seem premature at the time the authors published their data in 2009 [12]. According to DRCRHONO, physicians qualify to get $24,000 or more as part of the economic stimulus incentive offered by the HITECH act if they adopt a certified EMR. Incentives are given to providers who qualify. The stimulus includes $24,000 in Medicare Incentives or $63,750 in Medicaid Incentives. The government is putting in $19.2 billion dollars to help move all doctors off paper records onto electronic systems [62].
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EMR implementations could affect physician and health system reimbursement in a number of ways. Some have argued that increased clinical documentation as a result of using an EMR will lead to increased billing and therefore reimbursement. Having an electronic health record can mean less time with filing claims or searching for documentation. If a physician works in many different locations accessing a patients electronic record from a different location is very easy. <ref name="see more patients"></ref> An increase in emergency department billing among Medicare patients has been attributed to more complete documentation that allows for higher levels of billing [43]. However, given the pay-for-service model present in many facets of the American healthcare system, some of the cost savings possibly generated by the introduction of an EMR – such as eliminating unnecessary and duplicated tests and ineffective procedures – could lead to decreased reimbursement for the physicians and health systems.
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According to a survey performed by the National Center for Health Statistics, in collaboration with the Office of the National Coordinator for HIT, it was found that 82% of providers report time savings when sending prescriptions electronically and that 79% of providers see increased efficiency when using an electronic health record. <ref name="Jamoom">Jamoom, E., Patel, V., King, J., & Furukawa, M. (2012, August). National perceptions of ehr adoption: Barriers, impacts, and federal policies. National conference on health statistics.</ref>
=== EMRs Help Manage Transactions ===
=== EMRs Help Manage Transactions ===
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EMRs help better 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]
EMRs help better 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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=== Physician Recruitment ===
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68% of physicians surveyed by the National Center for Health Statistics report that the implementation and use of electronic health records is seen as an asset when recruiting physicians to their practice.<ref name="Jamoom"></ref>
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=== Physician Satisfaction ===
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An association has been shown to exist between EMR use and physician satisfaction with their current practice[76], as well as with their career satisfaction [77].
=== Patient Handoff ===
=== Patient Handoff ===
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The Institute of Medicine estimates that $17-29 billion is spent annually on unnecessary or inaccurate patient care due to misdiagnosis. If clinicians can rapidly determine the correct dose, calculation or diagnosis, they can order relevant tests and make appropriate referrals, saving time and eliminating unnecessary costs for the patients and the ED. Of course, CDS is most effective when it is built into the clinician’s workflow, which minimizes interruptions and dangerous distractions. It is also important for CDS to be incorporated into providers’ workflow in such a way that minimizes alert fatigue.<ref name=”Robert Hitchcock”> Top 5 Benefits of Clinical Decision Support in the ED http://www.govhealthit.com/blog/top-5-benefits-clinical-decision-support-ed</ref>.
The Institute of Medicine estimates that $17-29 billion is spent annually on unnecessary or inaccurate patient care due to misdiagnosis. If clinicians can rapidly determine the correct dose, calculation or diagnosis, they can order relevant tests and make appropriate referrals, saving time and eliminating unnecessary costs for the patients and the ED. Of course, CDS is most effective when it is built into the clinician’s workflow, which minimizes interruptions and dangerous distractions. It is also important for CDS to be incorporated into providers’ workflow in such a way that minimizes alert fatigue.<ref name=”Robert Hitchcock”> Top 5 Benefits of Clinical Decision Support in the ED http://www.govhealthit.com/blog/top-5-benefits-clinical-decision-support-ed</ref>.
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===Standardization of Practice===
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Although publication of evidence-based medicine abounds, it has been noted that physicians do not practice according to proven guidelines.<ref name="Morris develop"> Morris, A. H. (2000). Developing and implementing computerized protocols for standardization of clinical decisions. Retrieved from http://www.sciencedirect.com/science/article/pii/S1532046407001049</ref> The reasons are numerous. One of them is that busy physicians do not have the time to read publications that have increased exponentially. <ref name="Sackett need"> Sackett, D. L., & Rosenberg, W. M. (1995). The need for evidence-based medicine. J R Soc Med, 88(11), 620-624. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1295384/?tool=pmcentrez</ref> Another is the innate human limitation in the capacity to integrate information during decision-making.<ref name="Morris develop"></ref> This has led to a decline in patient care standards.<ref name="Sackett need"></ref>
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CDDS can increase compliance with evidence-based practice by presenting the needed information to the clinician at the point of care.<ref name="Morris develop"></ref> And while there is resistance to its use from physicians who view CDSS as an out of the box practice that is not tailored to their clinical workflow, it has been noted that incorporating factors such as patient-specific information, consideration of comorbid conditions, and organized and explicit presentation, might result in increased CDSS utilization. <ref name="Sittig Grand"> Sittig, D. F., Wright, A., Osheroff, J. A., Middleton, B., Teich, J. M., Ash, J. S., . . . Bates, D. W. (2008). Grand challenges in clinical decision support. J Biomed Inform, 41(2), 387-392. doi: 10.1016/j.jbi.2007.09.003. Retrieved from http://www.sciencedirect.com/science/article/pii/S1532046407001049</ref>
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=== Universal Protocol ===
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Universal protocols are developed by various disease monitoring agencies for accurate diagnosis, management and prevention of health related problems.For instance the universal protocol created by the joint commission to prevent wrong site,wrong procedure,and wrong surgery. <ref name=”Universal protocol”> Chapter 4. Determining the Target Patient Safety Practices.http://archive.ahrq.gov/research/findings/finalreports/contextsensitive/context4.html</ref>.This ensures the same standard of care everywhere.
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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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== Costs
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== Costs ==
Cost benefit analysis is categorized into 3 fields [70]:
Cost benefit analysis is categorized into 3 fields [70]:
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Consequently, providers frequently lack the necessary information to make sound financial decisions regarding Health IT capital investments. Uncovering the true cost and benefit of EHR adoption will require a national effort to standardize and centralize evidence in a national database. [48]
Consequently, providers frequently lack the necessary information to make sound financial decisions regarding Health IT capital investments. Uncovering the true cost and benefit of EHR adoption will require a national effort to standardize and centralize evidence in a national database. [48]
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=== EMR and Providers’ Productivity ===
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Health care providers are adopting electronic medical records, but some doctors report a disturbing side effect. Instead of becoming more efficient, some practices, especially smaller ones are becoming less. As with all new systems, there will be a temporary reduction in productivity as the healthcare staff become familiar with the new system. A study by Menachemi and Brooks (2006) estimated a 20% loss of productivity for the first month, 10% loss in the second month, and 5% loss in the third month and finally productivity returning to baseline in the subsequent months. <ref name="Brooks 2006">Menachemi, N. & Brooksm R. (2006). Reviewing the Benefits and Costs of Electronic Health Records and Associated Patient Safety Technologies.http://download.springer.com.ezproxyhost.library.tmc.edu/static/pdf/470/art%253A10.1007%252Fs10916-005-7988-x.pdf?auth66=1411967145_1fbceb4fa2c5cea1c67867e88dd78695&ext=.pdf</ref>. Several studies indicated that when physicians spent extra time entering data themselves, it cut down time spent with patients and stretched out their workday. [70]
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In a study by Bhargava et al. which examines productivity impacts of electronic medical records (EMR) implementation in a large academic hospital in California. Bhargava et al. also investigate the dynamics through which EMRs may impact productivity. The study employ random effects model on panel data comprising 3,189 physician-month observations for productivity data collected on 87 physicians specializing in internal medicine, pediatrics and family practice. The total duration of data collection was 39 months. Bhargava et al. find that the productivity of physicians dropped immediately after EMR implementation, but began to recover in a few months and finally leveled-off. Additionally, Bhargava et al. find that productivity impacts of EMR are contingent upon physician specialty. Bhargava et al postulate that the fit provided by an EMR to the task requirements of physicians of various specialties is key to entangling the productivity dynamics. [71]
== Return on Investment (ROI) Estimates ==
== Return on Investment (ROI) Estimates ==