Journal Review: Benefits of EMR

J. Don M. Soriano, MD MBA

Physician Adoption of Electronic Health Record Systems: United States, 2011 NCHS Data Brief Number 98, July 2012

• In 2011, 54% of physicians had adopted an electronic health record (EHR) system.

• About three-quarters of physicians who have adopted an EHR system reported that their system meets federal "meaningful use" criteria.

• Eighty-five percent of physicians who have adopted an EHR system reported being somewhat (47%) or very (38%) satisfied with their system.

• About three-quarters of adopters reported that using their EHR system resulted in enhanced patient care.

• Nearly one-half of physicians currently without an EHR system plan to purchase or use one already purchased within the next year.

Key findings (Data from the 2011 Physician Workflow study)

Meaningful Use - financial incentive for the meaningful use of certified EHR technology to improve patient care

• Stage 1 - EHR adoption and data gathering

• Stage 2 - Emphasizes care coordination and exchange of patient information

• Stage 3 - Improves healthcare outcomes

Quality of care Clinical outcome

Do Hospitals With Electronic Medical Records (EMRs) Provide Higher Quality Care? An Examination of Three Clinical Conditions Medical Care Research & Review August 2008 vol. 65 no. 4 496-513

This study investigates how hospital electronic medical record (EMR) use influences quality performance. Data include nonfederal acute care hospitals in the United States. Sources of the data include the American Hospital Association, Hospital Quality Alliance, the Healthcare Information and Management Systems Society, and the Centers for Medicare and Medicaid.

The authors use a retrospective cross-sectional format with linear regression to assess the relationship between hospital EMR use and quality performance. Quality performance is measured using 10 process indicators related to 3 clinical conditions: acute myocardial infarction, congestive heart failure, and pneumonia. The authors also use a propensity score adjustment to control for possible selection bias. After this adjustment, the authors identify a positive significant relationship between EMR use and 4 of the 10 quality indicators. They conclude that there is limited evidence of the relationship between hospital EMR use and quality.

The Relationship between Electronic Health Record Use and Quality of Care over Time Journal of the American Medical Informatics Association Volume 16 Number 4 July / August 2009

The study linked two data sources: a statewide survey of physicians’ adoption and use of EHR and claims data reflecting quality of care as indicated by physicians’ performance on widely used quality measures. Using four years of measurement, we combined 18 quality measures into 6 clinical condition categories. While the survey of physicians was cross-sectional, respondents indicated the year in which they adopted EHR. In an analysis accounting for duration of EHR use, we examined the relationship between EHR adoption and quality of care. !The percent of physicians reporting adoption of EHR and availability of EHR core functions more than doubled between 2000 and 2005. Among EHR users in 2005, the average duration of EHR use was 4.8 years. For all 6 clinical conditions, there was no difference in performance between EHR users and non-users. In addition, for these 6 clinical conditions, there was no consistent pattern between length of time using an EHR and physicians performance on quality measures in both bivariate and multivariate analyses. !In this cross-sectional study, we found no association between duration of using an EHR and performance with respect to quality of care, although power was limited. Intensifying the use of key EHR features, such as clinical decision support, may be needed to realize quality improvement from EHRs. Future studies should examine the relationship between the extent to which physicians use key EHR functions and their performance on quality measures over time.

Workflow Process

The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review Journal of the American Medical Informatics Association, Volume 12, Issue 5, Pages 505-516

The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and 23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerised provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted average of CPOE-oriented studies, 238.4%).

Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process. This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized. It also identified how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups, physicians and nurses.

Cost vs. benefit

A cost-benefit analysis of electronic medical records in primary care American Journal of Medicine 2003 Apr 1;114(5):397-403

Electronic medical record systems improve the quality of patient care and decrease medical errors, but their financial effects have not been as well documented. The purpose of this study was to estimate the net financial benefit or cost of implementing electronic medical record systems in primary care. We performed a cost-benefit study to analyze the financial effects of electronic medical record systems in ambulatory primary care settings from the perspective of the health care organization. !Data were obtained from studies at our institution and from the published literature. The reference strategy for comparisons was the traditional paper-based medical record. The primary outcome measure was the net financial benefit or cost per primary care physician for a 5- year period. The estimated net benefit from using an electronic medical record for a 5-year period was 86,400 US dollars per provider. Benefits accrue primarily from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors. In one-way sensitivity analyses, the model was most sensitive to the proportion of patients whose care was capitated; the net benefit varied from a low of 8400 US dollars to a high of 140,100 US dollars . A five-way sensitivity analysis with the most pessimistic and optimistic assumptions showed results ranging from a 2300 US dollars net cost to a 330,900 US dollars net benefit. Implementation of an electronic medical record system in primary care can result in a positive financial return on investment to the health care organization. The magnitude of the return is sensitive to several key factors.

Need for standards

A review of methods to estimate the benefits of electronic medical records in hospitals and the need for a national benefits database Journal of Healthcare Information Management 2007 Winter;21(1):62-8.

Proponents of electronic medical record systems cite numerous benefits of their use; however prospective electronic medical record (EMR) purchasers can find relatively little hard evidence these systems will deliver promised or expected benefits. The lack of good information to help identify EMR benefits, estimate and prioritize these benefits, and understand how the benefits are realized is a serious problem for the healthcare industry. This paper describes the most useful current approaches for hospitals to estimate the potential benefits of their EMR systems. Positive and negative aspects of each approach are discussed, as is the question of determining whether a hospital provider could use the approach. Based on this analysis, the article explains the necessity of developing a standardized database of actual provider experience with clinical information system (CIS) benefits, and it describes the initial efforts of the HIMSS CIS Benefits Task Force to create such a database.

Studies designed to compare EHR & Non-EHR use

Impact of Health Information Technology Implementation on Diabetes Process and Outcome Measures Agency for Healthcare Research and Quality

The specific aims of this project were to:

• Estimate the impact of an EHR on diabetes outcomes, measured by the proportion of patients meeting the Health Partners Optimal Diabetes Care measure.

• Estimate impact of an EHR on specific patient outcomes and compliance with recommended process of care related to diabetes.

• Estimate the prevalence of physician use of the Diabetes Management Form, and the effect of the Diabetes Management Form on patient outcomes related to diabetes as measured by the Optimal Diabetes Care measure.

The project used an observational study design with primary care practices that underwent a staggered implementation of a commercially available EHR. The primary outcome was meeting diabetes “optimal care” target measures for HbA1c, LDL-cholesterol, blood pressure, not smoking, and documented aspirin use. Compliance was compared between patients exposed and not exposed to the EHR and in a subset of EHR-exposed patients in patients for whom the DMF was used and those for whom it was not.

Thank You!