Thursday, March 26, 2009

Electronic Health Record - Don't Hold Your Breath

The New England Journal of Medicine study that shows less than 2% of U.S. hospitals have a comprehensive electronic record is being discussed all over the news.

The benefits of going electronic, getting rid of wasteful paper, and providing all caregivers with the right information to care for patients has been proven time and time again. We can go to the moon. We can log onto Amazon and be recognized personally for our reading habits. We can have 6000 friends on Facebook. We can share our every thought on Twitter. So why are we stuck doing medicine like we did in 1950?

Here are some reasons why this is so damn hard.

Electronic health records, where physicians and caregivers can document, write notes, see information real time, do assessments and orders for patients, require millions of dollars in capital to develop and install. Seventy four percent of hospitals reported inadequate capital and 44% couldn't afford the maintenance costs.

Another barrier is the fact that electronic records systems are not interoperable. Imagine installing a $100 million dollar system that doesn't talk to anyone outside of the hospital. Patients are mobile. They go from physicians office to hospital to clinic to lab...and that is just within their own town. If the electronics cannot communicate, information is incomplete and possibly even dangerous.

One cannot underestimate the training and maintenance costs that accompany "going electronic". Think how you feel when your computer crashes or freezes or slows down. Hospitals need to build fire walls, redundancies, back-ups, plan for disasters. Systems need continual upgrades and all staff needs to have training and support. You can't shut down patient care while this is going on so you need to bring in extra staff for weeks while you are transitioning from paper to computers. Training and "help desk" expertise is an ongoing expense. Hospitals that do not have Information Technology specialists on staff will need to develop an entire department of hundreds of new experts.

Hospitals develop business plans for capital expenditures and look for a ROI. A third of hospitals surveyed did not believe they would recoup their investment in eHR.

These findings are sobering. We absolutely have to join the digital age and use technology and decision tools to improve quality, reduce error and become more efficient.


Quiact said...

Electronic Medical Records (EMRs) are essentially digital treatment platforms that contain significant patient variables specific to their health. EMRs are clinical systems with several components and specific functions to create a secure and complete patient profile.
Data and information on the patient includes the patient’s medical history and past or existing medical conditions. This data as well as other relevant information provided by the EMR assures a higher degree of treatment success that is reasonable and necessary. That is, if the EMR functions as it should.
Patient care providers are clearly pleased by the potential ability of EMRs, and for the benefit of their patients. Patients can keep track of the medical records of relatives from a distance. Patients can also access their own diagnostic testing results without having to call a particular ancillary department to obtain them.
The first large demonstration of the effectiveness of EMRs was with the VA Hospital’s Vista System years ago. The code was written by doctors for doctors, and has about 18000 pages integrated into Vista. Author Phillip Longman wrote a book about this system and the quality it allowed for superior health care, which was entitled, “Best Care Anywhere.” The Vista remains the largest EMR in the United States.
EMRs have the potential to prevent unfortunate medical errors that occur, which cause around 100 thousand deaths a year. For many other reasons beneficial for patients, EMRs are encouraged to be utilized within medical facilities now more than ever.
In fact, the U.S. government, starting in 2011, will pay doctors about 10 grand a year for 5 years to place an EMR in their clinic. Meanwhile, many are attempting to receive refundable federal tax credits for EMRs that they may purchase.
Present medical records on paper documents are digitized and integrated into the EMR easily. And EMRs are desirable in the medical community for a number of reasons because they potentially fill unmet needs to restore the health of others. These health care provider assets within EMRs provide evidence-based clinical information contained in this knowledge system.
In addition, EMRs provide additional patient safety in general, as well as regulatory and reporting needs. These needs, as well as confirming reimbursement requirements, provide a strong ROI for those medical facilities that have quality EMRs at their location. Wal Mart appears to see strong revenues with EMRs as well.
Their Sam’s club will soon offer their doctor members package deal EMR systems- partnering with two other companies. The first EMR package will cost 25 thousand for the first doctor in a practice, and 10 thousand for each additional doctor. The computer maker will be Dell, and the EMR vendor will be eclinicalworks. With the Wal Mart venture, EMR customization may have limitations, and this may be a concerning issue for some doctors.
In addition to EMRs storing patients’ medical history and present treatment regimens, EMRs make others aware when ordering ancillary testing for patients. The awareness is to make sure the testing ordered is not repeated, or does not already exist. In addition, and of particular importance to the health care provider, the need for transcription of patient notes is eliminated, as the notes are stored in the EMR.
With some debate, there seems to be a good possibility for the development of increased profits for both health care providers and medical institutions. This is due to EMRs offering the most appropriate and accurate codes. These are diagnostic and procedural codes allowable for a particular patient as they are determined to be needed for this patient. These codes are used to seek reimbursement from health care payers, and are required for reimbursement from third party payers for certain patients.
The continuity of patient care improves the care of patients and reduces the need of additional patient staff that was needed before EMRs arrived at the medical facility. Historically, there is often a lack of needed staff at medical institutions due to the shortages of professions that exist in the health care field, such as nurses.
The EMR provides flexibility of architecture to meet individual workflow requirements at each location. Preventative medicine and compliance with treatment regimens are more assured with EMR utilization as well. Yet one does not have to begin with a complete EMR for their medical location.
Many small offices acquire some automation that provides functionality that is beneficial, yet limited. This costs only 5 grand, instead of the full EMR package at over 40 grand per health care provider, on average. Such lightweight EMR versions include document management systems and electronic patient records.
Yet perhaps the essential stand-alone technology a medical clinic should acquire is e-prescribing. When selecting e-prescribing for your medical facility, assure that staff will be well-trained, any technological problems will be rapidly resolved, and that workflow remains adequate when selecting a vendor.
Again, evidence-based medicine as well as a higher degree of patient-centered healthcare is now possible and improved by EMRs. The many benefits perceived by others that are based on fact that has resulted in the utilization of EMRs by various managed care companies and pharmacy benefit management companies.
However, health care providers who are in solo practice are understandably reluctant to acquire EMRs because of this high cost without a guaranteed return on their investment. The cost of an EMR may not only approach 40 thousand dollars per provider, but also several thousands of dollars paid annually to maintain the EMR. A complete EMR package would include hardware, software, installation, maintenance, and training. The EMR hardware is typically replaced every 5 years.
One of the primary functions of EMRs often includes electronic prescribing, which is more reliable in reducing prescription errors. Prescribing errors are believed to cause over 5 thousand deaths a year. Electronic prescribing also lets the health care provider know if there is a generic version of the drug available, and if the patient’s pharmacy insurance benefit covers the drug chosen by the health care provider.
Additional functions of EMRs would include the ordering diagnostic tests, and retaining the results of these tests. Also, the documentation from the health care provider about the health and well-being of their patient after a visit with such a provider is placed directly upon direction from the provider into the EMR. This thankfully improves patient data availability for other health care professionals may have a need to retrieve regarding these patients.
Aside from having great ability to store information and data, as well as the EMR having user-friendly navigation, the EMR should have the following core functionalities: Health information and data about disease states and patients that have been treated, the, ability to manage results, the features to allow order entry, the ability to provide decision support, and the EMR should have good communication with other devices.
As far as the plan of implementing EMRs within a medical facility, this would involve the EMR’s hardware, software, EMR installation, maintenance of the EMRs as determined, and training of the medical staff. The EMR should have the ability to access the patient’s full medical history, and improve the quality and treatment regimens of those with various medical conditions. Also, the EMR should provide cost savings, and have the ability to promote research due to the data content of the EMR.
Selecting an EMR is a difficult decision at times. Tools to assist you with your decision are available at the Center for HIT website, as well as the American College of Physicians ( The EMR format should have the ability to include critical data, and omissions due to interoperability should be limited. The EMR should be certified by the Certification Commission for HIT (
Finally, many doctors and medical institutions are visiting locations with successful EMR implementation before they purchase this for themselves. Also, when you have chosen a vendor for your medical facility, make sure in the contract with the vendor contains a remedy if the vendor happens to go out of business, as such contracts may be for periods of 10 years or so.
Additional patient benefits because of the ability and function of EMRs is the reduction in mortality, according to some studies. Mortality has been concluded to be reduced by around 40 percent. Equally impressive is that the EMR makes patient care much more efficient, including where efficiency may be needed the most.
That would be those many patients who have at least one chronic disease. Chronic diseases consume around 80 percent of health care spending. The EMR facilitates a medical home for those patients who are chronically ill.
Surveys have shown that most people surveyed favor EMRs more than they do a health care provider visit. The EMRs allow and encourage written dialogue between the health care provider and their patients. When this is done, visits between these patients and their providers are significantly decreased.
Presently, those who have access to EMRs range in ages of those in their late teens, to those in their early 90s. Utilization of EMRs by others is not limited because these records are very user-friendly for most people. And utilizing EMRs may also be used to enhance one’s medical knowledge regarding a particular topic or disease state. With those who are with medical problems, this knowledge often will improve their health and their medical issues because the patient is now an advocate in their own treatment of their medical problem.
EMRs are certainly not flawless, and there are those that oppose the integration of this digital advance into the U.S. Health Care System. There are privacy concerns, as well as more valid concerns about EMRs becoming dysfunctional without notice.
Presently, those who make EMRs in this 20 billion dollar a year industry are not regulated, and no uniform standards regarding their durability have been established. About 75 percent of the U.S. population supports the implementation of EMRs for their health, and should be aware that this system is not free of potential flaws.
There are legal concerns as well regarding who owns the patient information stored within electronic medical records. Aside from privacy concerns, this information is encouraged by others to be used for research purposes. So EMRs are not without their issues.
Some believe, for example, that EMRs should be classified as class III medical devices under the FDA’s 510k, as they potentially can be life-altering if not functioning properly. This would require EMRs to be evaluated by the FDA before they are marketed, which presently is not the case.
One particular issue of concern is the fact that EMR vendors are void of responsibility of their system malfunctions, regardless of intent. This is due to a legal element beneficial to EMR companies called ‘learned intermediaries.’
Basically, this means that the staff members of the medical institution are ultimately responsible for health information technology at their institution, and are the ones who should remedy dysfunctions with this technology if it occurs. The EMR vendor who provided their system to the institution are exonerated from any liability of something should occur.
So likely, these issues will be resolved, as they need to be resolved, and the EMRs that are the best for patients will eventually be identified,

Dan Abshear

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electronic health records said...

Hi Toni! Most technologies that we have today, pose certain amount of risk. The advent of electronic medical records primarily aims to increase the efficiency of hospitals through a comprehensive system of handling data. You raised a number of very salient points, when you discussed the causes of apprehension on the part of some practitioners. I like the response coming from Quianct though, because he mentioned the safety nets of EMRs in his comment.

I really hope that effective regulation would be utilized during and after the transition period. That way, the quality of health care would be improved throughout the country.

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This is totally truth because people spend the time on twitter, traveling around the word and other things but no one care about "Electronic Health Record" people should paid attention to that to become better.m10m

electronic medical records said...

Nice post! According to research, "electronic medical records would improve the quality of medical care in general, as well as for themselves and their families. They also believe these records would prevent unnecessary care and medical errors." Anyway, i enjoyed reading your post. Thanks for sharing.

-mel- said...

So, I don't actually believe this will have effect.

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