Can electronic medical record systems transform health care? Potential health benefits, savings, and costs

To broadly examine the potential health and financial benefits of health information technology (HIT), this paper compares health care with the use of IT in other industries. It estimates potential savings and costs of widespread adoption of electronic medical record (EMR) systems, models important health and safety benefits, and concludes that effective EMR implementation and networking could eventually save more than $81 billion annually--by improving health care efficiency and safety--and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits. However, this is unlikely to be realized without related changes to the health care system.     

Assessing the information management requirements for behavioral health providers

Behavioral health agencies will soon implement automated information-management systems to support their administrative, financial, and clinical care functions. Assessing current information-management capabilities and delineating future needs are prerequisite to recommending a specific information technology solution. Quantifying the discrepancy between current information-management capabilities and future requirements highlights the areas of greatest unmet need for information management. Selecting an information system that addresses the most critical areas of unmet need is a prudent purchase decision. This article describes the results of a process to assess the information-management requirements for agencies that were considering implementation of an integrated behavioral health information-management system. The assessment revealed that these agencies already employed automated systems to manage most financial functions and many administrative functions. Few agencies, however, utilized automated systems to manage clinical care functions. Selection of a behavioral health electronic medical record (EMR) effectively addressed clinical care information-management needs without duplicating existing financial and administrative management functions. Also, the EMR included features that addressed some administrative functions for which a discrepancy between current capabilities and future needs was found. Selecting an EMR instead of an integrated behavioral health information system was associated with a significant reduction in information system acquisition costs.     

“Meaningful Use” of ambulatory EMR: Does it improve the quality and efficiency of health care?

The US government has initiated incentive programs to encourage the adoption of Electronic Medical Records (EMR). To qualify for the incentive payment, healthcare providers need to demonstrate “meaningful use” of EMR systems, which requires the use of certified EMRs and the implementation of a set of standard functionalities. In this paper, we examine how the meaningful use of EMRs would affect health care outcomes in outpatient settings. Our results show that the use of core functionalities required by “meaningful use” criteria and the use of certified EMRs have a positive impact on the quality and efficiency of health care. In addition, we find the relationship between the meaningful use and quality of care is moderated by the length of use. The implications of this study are also discussed.     

提高电子病历规范化应用水平——电子病历及其应用概述

电子病历（EMR）指医疗机构采集和保存的个人健康资料的数字化记录。EMR的实施需要在医疗机构内建立基于计算机和信息网络的个人电子健康信息储存和检索系统,实现以患者为中心的数据集成和访问。通过EMR系统与临床决策支持工具的整合,EMR可成为促进循证医疗、改善医疗质量的有力工具;通过提供完整、准确的临床数据,EMR也是医疗质量评价和持续改进的必要手段;在EMR基础上构建的、可以跨机构、跨时段、跨地域共享的电子健康记录（EHR）支持区域协同的医疗服务新模式,是提高医疗资源利用效率、改善卫生服务体系整体绩效的有效途径。EMR／EHR的实现在技术上依赖信息的标准化和信息系统的互操作性,也受法律、制度、政策、资金、观念等环境因素的制约。     

The adoption and use of health information technology in rural areas: results of a national survey

Context: Health information technology (HIT) is a national policy priority. Knowledge about the special needs, if any, of rural health care providers should be taken into account as policy is put into action. Little is known, however, about rural‐urban differences in HIT adoption at the national level. Purpose: To conduct the first national assessment of HIT in rural primary care offices, with particular attention to electronic medical record (EMR) adoption, range of capabilities in use, and plans for adoption. Methods: A national mail survey of 5,200 primary care offices, stratified by rurality using Rural‐Urban Commuting Area categories, was conducted in 2007‐2008. Regression analyses were used to assess the relationship between office characteristics and EMR adoption, capabilities used, and future adoption plans. Results: A commercial EMR system was present in 31% of offices, with no significant differences by rurality. Of offices with EMRs, 12% reported using a full range of EMR capabilities, with 51% using a basic range and 37% using less than the basic range. Large Rural (adjusted OR = 3.71, P= .022) and Small Rural (aOR = 3.75, P= .049) offices were more likely than Urban offices to use a broader range of EMR capabilities. Among offices without EMRs, those in Isolated areas were less likely to have more immediate plans to adopt (aOR = 0.19, P= .02). Conclusions: HIT adoption and use in rural primary care offices does not appear to be lower than in urban offices. The situation, however, is dynamic and warrants further monitoring.     

U.S. hospital efficiency and adoption of health information technology

This study empirically examines the association between hospital inefficiency and the decision to introduce electronic medical records (EMR) and computerized physician order entry (CPOE) in a national sample of U.S. general hospitals in urban areas in 2006. The main research question is whether the presence of hospital cost inefficiency or other factors driving inefficiency in the production process of a hospital explain low adoption rates of health information technology (HIT) in a hospital setting. We estimated a logistic regression of HIT adoption as a function of hospital cost inefficiency scores obtained using a stochastic frontier analysis. The results demonstrate that hospitals with a greater degree of cost inefficiency were more likely to introduce EMR, suggesting that the benefits of EMR implementation in terms of improved efficiency were likely to outweigh the costs of adoption compared to hospitals that are more efficient. The results showed no association between cost inefficiency and the CPOE adoption decision.     

Promoting health information technology: is there a case for more-aggressive government action?

Health information technology (HIT) could save $81-$162 billion or more annually while greatly reducing morbidity and mortality. However, gaining these benefits requires broad adoption, effective implementation, and associated changes in health care processes and structures. The policy options that could speed the adoption of HIT and the realization of these benefits include incentives to promote standard-based electronic medical record (EMR) system adoption; subsidies to develop information-exchange networks; and programs to measure, report, and reward performance. Investments in these and other identified policy options should pay for themselves while also laying the foundation for needed transformation of the U.S. health care system.     

Public attitudes about health information technology, and its relationship to health care quality, costs, and privacy

Objective. To understand Americans' attitudes concerning health information technology's (IT's) potential to improve health care and differences in those attitudes based on demographics and technological affinity. Data Sources/Study Setting. A random‐digit‐dial sample with known probability of selection for every household in the United States with a telephone, plus a supplemental sample of cell phone users. Telephone interviews were conducted from August 2009 through November 2009. Study Design. Data were analyzed to present univariate estimates of Americans' opinions of health IT, as well as multivariate logistic regressions to assess hypotheses relating individuals' characteristics to their opinions. Characteristics used in our model include age, race, ethnicity, gender, income, and affinity to technology. Findings. A large majority (78 percent) favor use of electronic medical records (EMRs); believe EMRs could improve care and reduce costs (78 percent and 59 percent, respectively); believe benefits of EMR use outweigh privacy risks (64 percent); and support health care information sharing among providers (72 percent). Regression analyses show more positive attitudes among those with higher incomes and greater comfort using electronic technologies. Conclusion. The findings suggest that American's believe that health IT adoption is an effective means to improve the quality and safety of health care.     

Immunization registries in the EMR Era

Background: The CDC established a national objective to create population-based tracking of immunizations through regional and statewide registries nearly 2 decades ago, and these registries have increased coverage rates and reduced duplicate immunizations. With increased adoption of commercial electronic medical records (EMR), some institutions have used unidirectional links to send immunization data to designated registries. However, access to these registries within a vendor EMR has not been previously reported.Purpose: To develop a visually integrated interface between an EMR and a statewide immunization registry at a previously non-reporting hospital, and to assess subsequent changes in provider use and satisfaction.Methods: A group of healthcare providers were surveyed before and after implementation of the new interface. The surveys addressed access of the California Immunization Registry (CAIR), and satisfaction with the availability of immunization information. Information Technology (IT) teams developed a “smart-link” within the electronic patient chart that provides a single-click interface for visual integration of data within the CAIR database.Results: Use of the tool has increased in the months since its initiation, and over 20,000 new immunizations have been exported successfully to CAIR since the hospital began sharing data with the registry. Survey data suggest that providers find this tool improves workflow and overall satisfaction with availability of immunization data. (p=0.009).Conclusions: Visual integration of external registries into a vendor EMR system is feasible and improves provider satisfaction and registry reporting.Key Words: Electronic Medical Records, Immunization Registries, EMR integration, HITECH, Meaningful Use     

Advancing practice: Using nutrition information and technology to improve health—the nutrition informatics global challenge

Aims: The unique combination of technology, information and nutrition has been utilised in health care for decades. As technology and effective use of health data evolve, the field of ‘nutrition informatics’ is positioned to advance best practices of nutrition care delivered by registered dietitians and dietetic technicians registered. The present paper reviews the opportunities. Methods: A narrative review was constructed with reference to the literature. Results: Evolution of the use of digital health care in the USA is on an aggressive timeline because of regulations, which provide financial incentives to eligible professionals and hospitals who can prove ‘meaningful use’ of certified health‐care technology. While adoption and use of electronic health records has occurred at the international level for decades, only recently have American adoption rates increased. Health‐care providers are adjusting to rapid cultural changes, which support the interoperability of health data. The dietetics profession must move in tandem with this transition to digital care. This requires implementation and development of nutrition standards, vocabularies and quality measures, which support exchange of pertinent nutrition data critical to patient care and wellbeing. All dietetic professionals need to appreciate the paradigm shift in health care. Conclusions: Dietitians who are involved with informatics will help with this transition through their work with systems implementations, understanding competencies necessary for successful integration of digital nutrition and using electronic nutrition data for research.     

Toward a model of successful electronic health record adoption

The Canadian healthcare landscape abounds with pressures to address wait times, chronic disease management, aging at home, information and service integration, health human resource shortages, pandemic planning and most importantly health outcomes of individuals receiving care in our system. Investment in clinical information technologies is often touted as significant to the successful resolution of most if not all of these issues. For example, Baker and Norton (2001) uncovered an alarming rate of preventable adverse events occurring within Canadian hospitals. A particularly high error rate associated with the administration of fluids and medications suggests that there is a dire need to introduce processes and tools to reduce human error in healthcare facilities. The implementation of clinical applications such as computerized physician order entry (CPOE) with integrated electronic medication administration records (MAR) has been identified as a key step to safer care (Bates and Gawande 2003; Leape et al. 2002; Leatt et al. 2006). It has been suggested that the full value of electronic health records (EHR) will only be realized with the implementation of CPOE and that its use (by physicians) is a reasonable proxy for adoption (Ash and Bates 2005). Considering recent surveys of Canadian and American hospitals, those that have fully implemented CPOE remain in the minority (Ash et al. 2004; Davis 2007; Gudbranson 2007); most have yet to tackle the challenges of the change imperative and adoption issues associated with the use of a complete EHR     

Hospitals ineligible for federal meaningful-use incentives have dismally low rates of adoption of electronic health records

The US government has dedicated substantial resources to help certain providers, such as short-term acute care hospitals and physicians, adopt and meaningfully use electronic health record (EHR) systems. We used national data to determine adoption rates of EHR systems among all types of inpatient providers that were ineligible for these same federal meaningful-use incentives: long-term acute care hospitals, rehabilitation hospitals, and psychiatric hospitals. Adoption rates for these institutions were dismally low: less than half of the rate among short-term acute care hospitals. Specifically, 12 percent of short-term acute care hospitals have at least a basic EHR system, compared with 6 percent of long-term acute care hospitals, 4 percent of rehabilitation hospitals, and 2 percent of psychiatric hospitals. To advance the creation of a nationwide health information technology infrastructure, federal and state policy makers should consider additional measures, such as adopting health information technology standards and EHR system certification criteria appropriate for these ineligible hospitals; including such hospitals in state health information exchange programs; and establishing low-interest loan programs for the acquisition and use of certified EHR systems by ineligible providers.     

The role of clinical information systems in health care quality improvement

This article addresses the increasing use of electronic medical records and supporting clinical information systems in US hospitals. It also addresses the current barriers to implementation of digital technology, which include cost, cultural factors, and the reluctance to embrace new technology. However, despite the barriers, there is evidence from the Veteran's Administration, Partners' HealthCare, Kaiser Permanente, and other organizations that electronic medical records and clinical information systems are a worthwhile investment. The benefits of the electronic medical records include the reduction of errors, improvement in clinical decision making during patient encounters, and universal access to information in real time. From a managerial perspective, health care organizations should adopt such systems to improve quality of care and to stay competitive in the marketplace. From a policy perspective, the electronic medical record provides an opportunity for integration of patient information and improves efficiency and quality of care across a wide range of patient populations.     

The need to incorporate health information technology into physicians' education and professional development

Nationwide, as physicians and health care systems adopt electronic health records, health information technology is becoming integral to the practice of medicine. But current medical education and professional development curricula do not systematically prepare physicians to use electronic health records and the data these systems collect. We detail how training in meaningful use of electronic health records could be incorporated into physician training, from medical school, through licensure and board certification, to continuing medical education and the maintenance of licensure and board certification. We identify six near-term opportunities for professional organizations to accelerate the integration of health information technology into their requirements.     

Cardiovascular disease documentation and counseling in electronic medical records

The purpose of this paper is to explore the relationship between clinical reminders generated by electronic medical record (EMR) systems and providers giving prevention counseling to patients at-risk for cardiovascular disease (CVD). Data were extracted from the 2012 National Ambulatory Medical Care Survey (NAMCS). Results indicate that the providers routinely using clinical reminders are significantly more likely to document height and weight data to determine risk and provide the recommended counseling to patients that merit the intervention. The findings are important for policymakers and managers that have been promoting the adoption of more sophisticated EMR decision support functionalities across the care delivery spectrum. In particular, the ability to intervene prior to negative health events is an important feature of the movement to improve care quality and reduce costs.     

Information technology in health care: Addressing promises and pitfalls

Health information technology (HIT) and electronic medical records systems are receiving much attention in health care though only a relatively small number of health care organizations and providers have embraced the technology. This article introduces important concepts and definitions and provides the risk manager with key elements to consider when incorporating HIT principles into a proactive risk management program. A checklist is offered to assist in the assessment of electronic records systems.     

Savings in electronic medical record systems? Do it for the quality

National policymakers are considering whether to make major long-term investments in electronic medical record (EMR) systems. The matter of rising health care costs is never far from any health care debate, and the prospect for EMR systems to decrease costs is a potential selling point. The paper by Richard Hillestad and colleagues presents a well-documented analysis of the potential costs, savings, and other benefits of widespread adoption of interoperable EMR systems. It focuses on the potential savings such systems could yield. Here I examine the main components of their argument and question whether such savings could ever be realized.     

Electronic medical record systems as a basis for computer-based patient records

In summation, some document imaging systems offer the capability to form what may be called electronic medical record (EMR) systems. These systems are adaptations of current paper-based record management systems into the digital environment, but they offer far more capabilities than strictly archival, historical functions. Some of the capabilities that create EMR systems will also be necessary for development of CPRs, these capabilities are listed as follows: mass storage and image management; direct capture, storage, and retrieval of digital information (native format); large volume, high-speed, client-server networks; multi-media information management; high-power, flexible database tools; workflow process software; flexible, full function security; user customizable features; and alerts and reminders. Selection and implementation of document imaging systems should, at present, be undertaken with great care to insure that the platform may be utilized to form an electronic medical record with a clear migration path to the CPR.     

Initiatives and Barriers to Adopting Health Information Technology

In recent years, US healthcare experts have increasingly agreed that the effective application of information technology (IT) can enable the industry to address its three most pressing concerns: an increase in medical errors, rising costs, and the fragmentation of care delivery. While other industries have fully adopted and capitalized on IT to optimize operational efficiencies and customer service delivery, healthcare systems in the US have generally been slow to make a full transition.Presently, one of the quickest and most efficient ways health systems can begin to benefit from IT is through the implementation of the electronic health record (EHR). This dynamic resource provides key healthcare stakeholders (patients, payers, and providers) with a comprehensive view of current and historical patient data compiled from various sources. It holds tremendous potential for better management of chronic diseases, improving outcomes, and streamlining expenses.While the EHR has been shown to generate positive results in its limited use so far, its widespread implementation faces several hurdles, most notably cost. Additionally, primary EHR users (payers and providers) often experience initial infrastructure and personnel burdens, along with potential workflow disruptions. Despite this, considerable support for the EHR as an entry point for full-scale IT adoption is mounting in the US with a number of high-level government initiatives.This article examines the current state of health IT efforts in the US, the barriers to further adoption, and how technology can be, and is being, used to meet major challenges in the US healthcare industry. Although this article exclusively examines the US healthcare system, the author believes that many of the issues and scenarios described herein are universal among healthcare systems worldwide. At the same time, the author acknowledges that, to a great degree, each nation’s healthcare system faces its own unique considerations that may or may not be reflected in or relevant to the information in this article.