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The Pros and Cons of eMRs

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Delving Deeper into the Historic Origins of Debate

Dr. Mata

[By Richard J. Mata MD, CIS, CMP™]

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According to Wager, Ornstein, and Jenkins, in 2005, the perceived advantages of an EHR system include the following:

  •  Quality of the patient records (legible, complete, organized) — 86%
  •  Better access to patient records (available, convenient, fast) — 86%
  •  Improved documentation for patient care purposes — 93%
  •  Improved documentation of preventive services — 82%
  •  Improved documentation for quality improvement activities — 82%

Items viewed as an advantage by fewer respondents include the following:

  •  Administrative cost savings — 38%
  •  Improved efficiency — 61%
  •  Security of patient records — 64%

Nothing directly was said about cost savings or increased medical care quality. These topics have become more contentious issues during the past few years.

The Gurley Opinion

According to HIT expert Lori Gurley, in 2006, of the American Academy of Medical Administrators:

“The EHR provides the essential infrastructure required to enable the adoption and effective use of new healthcare modalities and information management tools such as integrated care,  evidenced-based medicine, computer-based decision support, care planning and pathways, and outcomes analysis” (Schloefell et al).  Although the benefits that support implementation of an EHR are clear, there are still barriers too, therefore the concept is still not accepted. “However, this could also be said of almost every other area of positive change and improvement within healthcare systems […]” (Schloefell et al).  There must be more involvement by the government and the private sector “to make changes where possible to instigate, motivate, and provide incentives to accelerate the development of solutions to overcome the barriers” (Young).

THINK: ARRA and HITECH, today. Of course, there are obviously advantages and disadvantages to both the paper medical record and the EHR.

Multi-Factorial Issues

Many factors must be considered before any healthcare organization or medical practice should implement an EHR.  The organization must first obtain as much information as possible about this new concept, and then the information must be carefully reviewed and the pros and cons discussed. Only then should the organization make their decision about this very important issue.

“The [EHR] as a part of a Clinical Information System (CIS) is a powerful tool which ties together documentation of the patient visit (clinical information), coding (diagnosis, and treatment procedures), which then translates into more accurate billing processes, reduces reprocessing of medical claims, and that translates into increased customer satisfaction with a provider” (Koeller). Although the technology is available, progress towards an EHR has been slower than expected. “Widespread use of [EHRs] would serve both private-and public-sector objectives to transform healthcare delivery in the United States” […] EHRs would also “enhance the health of citizens and reduce the costs of care” (Dick, Steen, and Detmer).

The MRI Study

According to a 2005-07 survey by the Medical Records Institute, the following factors are driving the push towards EHR systems within medical organizations:

Motivating Factors 2005 Ambulatory
The need to improve clinical processes or workflow efficiency. 89.3% 91.2%
The need to improve quality of care. 85.0% 85.3%
The need to share patient record information among healthcare practitioners and professionals. 81.1% 66.9%
The need to reduce medical errors (improve patient safety). 76.1% 69.1%
The need to provide access to patient records at remote locations. 67.9% 65.4%
The need to improve clinical documentation to support appropriate billing service levels. 67.1% 76.5%
The need to improve clinical data capture. 64.6% 61.0%
The need to facilitate clinical decision support. 60.7% 50.7%
The requirement to contain or reduce healthcare delivery costs. 54.6% 61.8%
The need to establish a more efficient and effective information infrastructure as a competitive advantage. 53.6% 53.7%
The need to meet the requirements of legal, regulatory, or accreditation standards. 50.0% 44.1%
Other 5.7% 5.1%
Totals 280 136
Margin of Error +/- 5.8% +/- 8.4%

Now, compare this with the results of the 2007 survey that focused on the factors driving hospitals to expand their use of EHR.

Driving Factors in a Hospital 2007
Efficiency and convenience, e.g., better networking to the medical community and patients and remote access 57.8%
Satisfaction of physicians and clinician employees 42.2%
The need to survive and thrive in a much more competitive, interconnected world. 41.0%
Regulatory requirements of JCAHO or NCQA. 35.6%
Savings in the Medical Record Department and elsewhere, including transcription. 24.0%
Value-based purchasing/pay for performance 17.7%
Pressure from payer groups, such as Leapfrog Group 15.2%
Possibility of subsidized purchase of HER, e-prescribing systems, etc. by purchasers/payers/large health systems. 8.8%
Totals 329
Margin of Error +/- 5.4%

Assessment

How have these motivating and driving factors changed today; have they really changed in 2010?

Does this deeper dive reveal any other truths; political, social, business or economic? Is this historical review helpful in understanding the reluctance or eagerness for EMR acceptance, or not?

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Understanding Clinical and Financial Features of Medical Practice eMRs & Hospital IT Systems

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[A Three Part CD Primer for the Practicing Physician, CXO or Nurse-Executive]

Are You in Medical Practice or Healthcare Administration? – Buy this CD-ROM!

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PART I: Understanding Hospital Information Systems

For the last 30 years, hospital information systems (HISs) have steadily grown in popularity. At present, nearly every acute care hospital in the United States has at least some form of HIS – at a minimum – performing administrative tasks such as patient billing, payor accounting, and employee payroll tracking. Depending on the size of the hospital, an information system may initially cost from several hundred thousand dollars to tens of millions of dollars. In 2005, about $25.8 billion was spent on hospital information technology (IT) in the United States.

By 2010-11 and beyond, it has become critical that such a system produce a positive return on investment (ROI) through patient care quality improvements, increases in organizational efficiency, or enhanced negotiating power with third-party payors and other stakeholders. Some HIS projects, especially more complex undertakings, have been clear failures to the extent that the organization had to abandon the new HIS in favor of the previous manual system. The goal of Part I is to illustrate how hospitals can maximize the chances for successful implementations of HIS while at the same time providing a positive ROI.

PART II: eMRs for the Independent Medical Practice

Many large organizations have a Chief Information Officer (CIO), a Chief Technology Officer (CTO), perhaps a Chief Medical Information Officer (CMIO), or Chief Medical Officer (CMO) that is tasked to do things like figure out the information technology (IT) and computer systems that support clinical and business goals within a healthcare organization. Smaller groups and practices don’t have enough resources to have dedicated staff for such a purpose so the selection, launch and implementation of eMRs will fall onto the physician staff or other senior leadership at a practice … Are you ready?

PART III: Health Information Technology Risks

Your clinical and business data and how it is used is vital to your medical organization.  Information technology (IT) and its infrastructure must therefore be protected through careful security policies.  These policies are guided in part by the risk inherent in your health organization’s IT infrastructure, its competitive strategy, and its asset and risk management policies.  It is important, however, not to over focus on security implementation so that you overlook the clinical operation management and patient-centered care in your healthcare facility.

There are two parts to the security equation: the first involves meticulous inventory of hardware, accessories, and software and the other involves establishing secure IT policies and procedures.  Management systems like those developed by the International Standards Organization (ISO) and the National Institute of Standards and Technology (NIST) serve as very functional models that can be applied in the clinical setting.

Part III of this CD-ROM  reviews the model codes that offer templates on how to put protections in place and the regulations that have been designed to ensure information security.  It also discusses the business continuity and risk management systems you need to keep your organization functioning in case of security and/or privacy breaches. It also offers interpretation and recommendations in making choices as they relate to the IT systems and discusses good healthcare security and privacy practices.  For example, the use of role-based access in an electronic health record (EHR) is not mandatory, but that does not mean that it cannot be implemented. In fact, it is usually desirable.  Many organizations will used a modified role-based system to limit the amount of protected health information (PHI) that one needs to access.

Special Added Bonus

We also include the following valuable resources for your office staff:

1. Glossary of managed care terms

2. Glossary of health information technology

3. Glossary of medical management abbreviations and practice business acronyms. 

Table of Contents: CD-TOC

Now, be among the first-adopters to use this CD for the vital HIT, eMR and IT administration aspects of your medical office, hospital or clinic. You will be glad you did.

Testimonial:

“I am finally beginning to understand HIT and eMRs” [Dr. Sarah Jane Fergson] 

And, the handsome, sturdy package makes the checklist CD an ideal gift for the recent graduate, mid-career doctor or mature medical practitioner.

Product Specifications:

Compatible with any PC or Mac computer; Adobe Acrobat Reader® required.

Price: Only $99 USD, includes SPH and tax.

TO ORDER: Please send your check or money order [for CD-ROM] to: iMBA Inc, Suite #5901 Wilbanks Drive, Norcross, GA 30092-1141 [770.448.0769] or MarcinkoAdvisors@msn.com

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