I’ve now had two people send me links to a study coming out of Stanford University that says that EHR software doesn’t improve patient care in the US (Here’s one story about it from Reuters). So I figure that it must be a topic that my readers would enjoy me discussing. Here’s a portion of their summary:

A team from Stanford University in California analyzed nationwide survey data from more than 250,000 visits to physicians’ offices and other outpatient settings between 2005 and 2007.

They found electronic health records did little to improve quality, even when there was “decision support” software that gives doctors tips on how best to treat individual patients.

I’ve always found it a bit off to talk about EMR software as a means to improve the quality of care that a doctor provides. For the vast majority of healthcare, more information, clinical decision support, drug to drug interaction checking, drug to allergy checking, etc aren’t going to improve the care a doctor provides. First, because the doctors have been well trained to do many of these things already. Second, because if I come in as a generally healthy patient with a common cold, then of course the doctor doesn’t need any of these advanced EMR functionality.

Now in more advanced and complicated cases, there is potential that an EMR software could offer some benefit. I remember a doctor commenting back in 2009 on my blog about how the Body of Medical Knowledge could become to complex for the human mind to process it all. Whether we’re there or yet, is open for debate, but the concept is interesting. Although, this still only applies to the outlier cases.

I remember one time hearing a clinician tell me about how the Drug to Drug interaction alerts informed her of some medical knowledge that she hadn’t known previously. So, there are instances where various parts of an EMR software can provide better patient care, but is it dramatic enough difference to really improve the quality of care? I think that’s a hard argument to really make. At least with the current iteration of EMR software.

Other EMR Benefits
Quality of Care aside, I think the thing that studies like this (and their related headlines) miss is the other benefits of having an EMR system (see also my list of EMR benefits in my EMR Selection e-Book).

I can’t tell you how many times I’ve heard doctors talk about how they love the legibility and accessibility of patient charts in the EMR. No difficult to read handwriting (others or their own). No waiting for chart pulls. These are guaranteed benefits to having an EMR system. Sure, it’s hard to quantify them when it comes to dollar signs or improved quality of care. However, they’re a real tangible benefit to having an EMR. Not to mention that I still think there’s long term benefits to widespread adoption of EMR that we can’t even imagine yet.

I could go on about many of the other benefits. It’s just unfortunate that studies and those who report on these studies don’t take into account these other benefits of EMR software.

UPDATE: Over at HIStalk, Mr. H also points out that the study only focuses on a couple quality measures. So, it doesn’t actually say that EHR doesn’t improve quality of care, but instead it says that it doesn’t improve quality of care when it comes to the couple simple measures that the study used to measure it. There could be many other quality measures where EHR does improve the quality of care. We just don’t know.

A source just told me that an insurance company that does only professional liability insurance for doctors is providing a 5% discount to all doctors who implement EHR and use it in a meaningful manner.

This is really interesting news for me since I’ve seen a number of really interesting debates about whether use of an EHR would actually raise liability insurance for doctors or lower it. This is the first confirmed company I’ve found that has actually acted on a doctors use of an EMR in their liability insurance premiums (of course, maybe there are more I don’t know about).

Of course, there are a lot of details missing in the statement posted above. For example, how does the liability insurance company plan to measure if the doctor is using an EMR in a “meaningful manner”? Will they discriminate (not in a bad way, but in a good business way) against EMR software which isn’t up to snuff?

Lots of other issues that could be talked about, but I’m heading to the Digital Health Summit at CES. So, this should start a really interesting discussion and I’m sure I’ll do some follow up posts on this subject since I have plenty to say about it.

Also, looks like I’ll have to add liability insurance savings to my list of EMR benefits. I’m thinking it’s about time to do a series of posts on the “EMR Benefits.” One EMR benefit post a day would start a really interesting set of discussions I think.

An EMR vendor saw my question, “Has EMR helped?” and they sent it to one of their EMR users to get some feedback. Here’s their response:

I am absolutely in the camp where this transition to EMR has been helpful. Long and steep learning curve but the benefits of accessing readable notes and histories and helping patients off hours has all been great. I believe I am writing better notes and noticing HCM issues more, and I hope the drug interactiion piece will be helpful down the road also.

SO, yes, this has been great.

I’d love to hear more people’s response to the question: “Has EMR helped?”

I’m still a little bit partial to my list of EMR benefits which is pretty specific in its description of the possible benefits of an EMR. However, today in an EMR stimulus webinar they listed the following reasons for adopting an EHR:

• Financial
• Quality
• Patient Satisfaction
• Clinical Research
• Community Leadership

Not a bad list of reasons to consider for those people on the fence about adopting an EMR.

Today, I decided that I’d ask people to share a benefit they’ve received from an EMR (or seen received if you’re an EMR vendor) that you didn’t expect to happen when you implemented an EMR.

I’ll start off with one unexpected benefit of an EMR: audit logs.

There’s so many things you can do with audit logs. It resolves so many issues with accountability for a record. You just run a quick report on the audit logs and you know exactly when someone did something in the EMR. This is also true for patients when we check to see for things like when a patient checked in and when they were seen. The audit logs can tell you a lot about your clinic. Plus, it just feels so much more secure knowing that everything that’s being done in the EMR is being audited.

Not really relevant, but I got free breakfast thanks to the audit logs. HIM found a mistake in the EMR that needed to be corrected. One of our Directors went on and on about the breakfast this person would have to bring for making this mistake. She started listing off what she wanted for breakfast. I pull up the audit logs to identify the offending party: sure enough it was the Director who was going on and on that made the mistake. She corrected the mistake and brought a full breakfast.

Ok, now lets hear what EMR benefits surprised you.

“Physician order entry and decision support I believe offer the most chance of improving healthcare delivery. There are a lot of information systems with bells and whistles that don’t focus on physicians’ real needs.” – Neil R. Powe, MD, MPH, MBA, Chief of Medical Services, San Francisco General Hospital source

I previously posted about the benefits of EMR interoperability. The above quote touts Physician order entry and clinical decision support as the most likely to improve healthcare. Are these the three most promising features of an EMR or is there something they’re missing? What’s the killer feature of an EMR that will make every doctor implement an EMR whether they like it or not?

“Looking for savings in hospitals that use EMRs is short-sighted. The real payday for use of EMRs will come with interoperability. Measurable savings will be realized as middleware is installed that will allow for the electronic transmission and translation of patient records across different proprietary systems between delivery networks.” – Jim Lott, Executive Vice President, Hospital Council of Southern California, Los Angeles source

“EMRs don’t save money in standalone situations. However, EMRs will absolutely save significant money (and improve care and safety) when connected and sharing clinical information.” Johnny Walker, MBA, CPA, Founder and past CEO of Patient Safety Institute, Plano, Texas source

These two quote remind me a lot of my previous post about the real long term benefits of EMR. Interoperability is one of those benefits that we won’t see right away. In fact, we’ll see little benefit from them until we hit a critical mass of EMR implementations that it’s almost futile to share information between EMR software. Kaiser and the VA are always held up as examples of successful EMR implementations and one of the main reasons for that is that they have such broad EMR adoption that they can share the clinical information across all of their clinics.

So, YES! there is a real benefit to EMR adoption long term and it comes dressed in the name “EMR data sharing.” However, it’s worth pointing out that this doesn’t diminish the very important more quickly seen EMR benefits.

HIMSS has been collecting stories of EMR success. One of my readers asked for more of these stories as well. So, I figured I’d highlight one that I found that was an interesting look at the ROI he received from implementing an EMR. Here’s an excerpt of the ROI they Glynn Medical Associates out of Georgia saw:

The first three months of going paperless were stressful. However, returns have proven the transition well worth it, with the practice saving approximately/conservatively $200,000/year. Also, one physician in the practice is seeing 33 percent more patients daily with use of the EMR system helping to increase patient satisfaction.

Glynn described that the above benefits came from:

• Transcription Cost Savings
• Reduced Medical Records personnel (through natural attrition)
• Reduced Billing personnel (through natural attrition)
• Rent Savings (moved into smaller office space)

Stories like this reinforce my belief that there’s a great case to be made for EMR software regardless of EMR stimulus money. Along with the above benefits, check out this list of potential EMR benefits.

I’ve been discussing the case for EMR implementation recently both on my blog and in emails with various people. In fact, someone even recently commented that the cost of an EMR was less than the EMR stimulus money and so it was a negative return on investment. I quickly responded that maybe he was looking at the wrong EMR companies and also that there were other benefits to implementing an EMR beyond just the EMR Stimulus money.

One example of these benefits is those people who have multiple locations. I was recently talking with someone about how they managed paper charts between multiple offices. What a mess. I’m sure those who read this blog who have done this know about all the challenges. The most important of which is that sometimes you’re left without the chart from the other office when giving care or at a minimum it takes time to get the info from the chart in the other office.

The beauty of an EMR is that as long as you have an internet connection in each location, you can access the full electronic medical record no matter where you see the patient. That’s just one example. Having an EMR solves a number of problems with having multiple locations.

In fact, most EMR are available to you as long as you have an internet connection. Now that mobile broadband internet has become so prevalent, that’s almost anywhere you’d want to access the chart.

Just one more reason to implement an EMR that doesn’t have anything to do with ARRA EMR stimulus money.

1. Quickly locate a chart, never look for a chart
2. Access to chart from multiple locations by multiple users
3. Legible Charts
4. EMR Data: chart it, graph it, flag it and organize it

Oh wait, none of those are financial are they? Try these potential EMR financial benefits.

1. Transcription cost savings
2. Space Savings
3. Eliminate Staff
4. Paper Chart Costs
5. Improved Charge Capture

Oh wait, why not just hope you get $44k in stimulus money? That might work.

See the full list of EMR Benefits.