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.

One of the things that has bothered me most about the $36.3 billion which is estimated to be spent by the government in EMR stimulus money is the affect it’s had on the decision to implement an EMR. The doctors looking at the stimulus money remind of of Scrooge McDuck from my favorite cartoon ever Ducktales. Yes, Scrooge was the one who had so much money he’d go and swim in it. That part of the story is fictional. The part of Scrooge that’s not fictional is the trance that he’d go into when there was the possibility of more MONEY!! That same look seems to have come over far too many people looking at selecting an electronic medical record.

Certainly there are exceptions, but with the announcement of ARRA’s EHR stimulus money it seems like all of the previous benefits of an EMR have been thrown out the window. All people care to think about is “How do I get that EMR stimulus MONEY from the government?” I think this is a huge mistake and will most certainly lead to major problems in the future.

I’ll continue to argue inform people that an EMR should be implemented on its own merits and not with the hopes of a government windfall of cash.

Let’s step back a second and look at a study done in 2003 about the ROI of an EMR system. Here’s a summary of their findings:

The estimated net benefit from using an electronic medical record for a 5-year period was $86,400 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 to a high of $140,100. A five-way sensitivity analysis with the most pessimistic and optimistic assumptions showed results ranging from a $2300 net cost to a $330,900 net benefit.

Certainly we could discuss the details of this study, but I think the important point is that there’s an argument that can be made for implementing an EMR that doesn’t include EMR stimulus money. We can’t let the EMR stimulus money put us in a trance where we make stupid decisions. If we do, there will be a huge price to pay years later.

I’m always sad when I come across an EMR implementation that doesn’t have an interface between their EMR and their lab. I can appreciate someone having just implemented an EMR not having a lab interface. However, it should be one of the first things on your list to implement. It’s such a great compliment to your EMR software.

First thing I must suggest is that you get a bi-directional lab interface if at all possible. One way lab interfaces can work, but do take more management to make it work right.

Why Get a Lab Interface with Your EMR?
Lab interfaces are so seamless. The order is made in the EMR and it’s automatically is sent to the lab. Talk about removing a lot of the possibilities for error. In our case, we have an in house lab and so this saves a ton of time for the lab rat tech as well. No more data entry into the Lab’s LIS system. As a side note, we also use the lab order in our EMR to print out the labels for the specimen. This is an unbelievable time saver and much more accurate. Small things like this are just another hard to calculate benefit to an EMR.

The largest benefit to a lab interface is receiving the results back electronically. Compare this to receiving a paper copy of the lab results. Often this paper copy is sent to a fax machine and then the hunt begins to get that result to the right paper chart/person. The time savings here are apparent. With a lab interface, you no longer have to file the lab results in the paper chart (or scan them into your EMR). The results are automatically available in the EMR and routed to the ordering provider. They can be signed electronically and no one has to then go back and refile the chart.

What’s even more important is that with the lab interface all of those lab results are now stored in discrete values. Storing the lab results this way means that you can graph lab results over time, do studies on lab results across your patient population, and eventually may be needed to satisfy the government and insurance reporting requirements.

Cost of a Lab Interface
Many people are often surprised to find out that there’s sometimes a cost associated with implementing a lab interface. In fact, there could be multiple costs involved.

The costs depend a lot upon your EMR vendor and the lab with which you’d like to interface. Some EMR vendors will offer a lab interface for free (or part of the standard cost of the EMR) while others will charge. The same is true for labs. However, more labs are willing to offer their interface for free. Often that just requires the right negotiating skills. If you’re a large customer of that lab, then if you talk to the right people you can usually get the interface for free. Labs are easier to negotiate with since a lab interface benefits the lab as well. $5,000 seems like the standard charge (from what I’ve seen) for most interfaces. Yes, that’s possibly $5,000 to your EMR vendor and another $5,000 to your lab.

The question every doctor wants to ask is, will the EHR save me time?

The answer is an obvious: depends.

Here’s a nice little way to break it down into an EHR’s functions (started by gchiu on EMR Update with a few of my own changes):
Takes Less Time

• Finding and Retrieving Notes (milliseconds)
• Doing Refills (minutes)
• Faxing Off Prescriptions (seconds)
• Making Appointments (seconds)
• Looking Up Results (milliseconds)
• Doing Calculations (DAS28, Framingham) (seconds)
• Drug Interactions (seconds)
• Reporting to Recall Patients (minutes)
• Reprinting Letters (seconds)
• Looking Up ICD9s (seconds)

Takes More Time

• Documenting an Encounter (Level of Documentation Is Now Higher than Before?)
• Entering Initial Diagnosis List
• Writing Prescriptions

Please feel free to add to this list in the comments and I’ll update the post. I also started a page on the EMR and EHR wiki of the above EMR and EHR time savings and also started the list of EHR benefits and costs. I certainly encourage more people to contribute there as well.

I’ve posted previously the best video I’ve seen promoting EHR use. Today I came across another video that talks about some of the benefits and challenges associated with electronic health records. It’s a little bit dry compared to that other video, but for someone just wanting to learn more about electronic health record or those considering the benefits and challenges of an EHR, it’s worth a watch. Those experts in the field of EMR can carry on.

In a recent comment, Steven suggested that an EMR and HIT in general might be necessary because the volume of medical knowledge is so large and complex that it’s too complex for the human mind. Here’s a short section of his comment:

Another set of reasons to adopt EMR, and sooner rather than later, are the reasons that are beyond the horizon. With the rate of change continuing to accelerate in the health care industry, along with our body of medical knowledge, I see a day where a person’s care plan is simply going to be too complex for a human brain alone to work out all the contributing factors. Sometimes I think we’ve already reached that point and haven’t quite realized it yet.

I absolutely love this concept of the body of medical knowledge being “too complex” for us to work it all out on our own. The idea that we need good clinical decision support systems, EMR and other technology we might not have even developed is really intriguing to me. Reminds me of my previous post about not knowing the true benefits of EMR.

The basic concept being that we won’t know the real benefits of EHR adoption until we have a platform for smart people to be really creative. Think about the Apple iPhone. If you look at the creativity that’s come out of the iPhone platform, it’s amazing. However, we would have never seen all this creativity until the platform was adopted in a broad way.

I believe that being able to managing and delivering all the medical knowledge out there is going to be one of those long term benefits we can’t realize until we have broad EMR adoption.

I previously posted about the Guaranteed EMR benefit of legible charts. I told you this would be a series on the benefits of EMR and so here’s a link that will constantly update with the benefits of an EMR.

The second guaranteed benefit of an EMR is the accessibility of charts. This really encompasses a number of issues with paper charts.

Issue 1: Chart stored in Medical Records
I must admit that I’m always amazed at how quickly medical records staff can find a paper chart. However, just the fact that you have to call medical records to have them pull the patient chart takes time. Depending on your clinic, you probably have appointments and can pull the chart the day before and have it ready. However, this is much more difficult for those clinics that allow for patient walk ins. Not to mention when medical records staff are out sick or on vacation.

Plus, let’s not forget phone calls. How nice is it to be able to just pull up a patient’s record in the EMR while you’re on the phone with them. Try doing that in the paper world. Certainly is possible, but definitely takes more time to get the chart.

Issue 2: Where’s the chart?
Let me bargain to say that even the most organized practices have often had a paper chart go missing. I’m not talking about missing missing. I’m talking about a nurse, doctor, or medical records staff running around the clinic to see where the patients chart was placed last. Let me just list off a few possibilities: doctor’s desk, in the room (on the door), nurses station, unread lab results box, etc etc etc. Certainly there are ways to mitigate this problem, but it’s still a challenge.

Of course, the beauty of an EMR is that you never have to send out a search party to find a chart again. Just type in the patients name and you can pull up their chart. Another major time saver.

Issue 3: Multiple Users
I’m sure the nurses reading this will really appreciate this benefit. How many times a day does the nurse and the doctor both want to do their charting at the same time. Or maybe they just want to have that chart available so that when they have a free second they can do some charting. Most EMR support at least some ability for multiple people to view, access and add to the chart note at the same time.

Issue 4: Taking Charts Home
Maybe some doctors just really liked taking a stack of paper charts home. They love the smell of the paper chart and the print between their fingers. For everyone else, remote access to an EMR is so much nicer than having to run around with a stack of paper charts. Not only is it awkward to carry the charts, but misplacing the paper chart is a real possibility.

Broadband wireless connections are getting really cheap these days and provide a real benefit to be able to access your full chart electronically from almost anywhere. The time savings of figuring which charts to take with you is also a nice benefit. Not to mention the unplanned visit or call.

At the end of the day, EMR software really excels at making the chart easily accessible and can be a huge time saver for those utilizing an EMR.

There are some absolute guaranteed benefits to implementing an EMR. These aren’t things that some will get. These EMR benefits don’t come from the government. They aren’t based on some certification. They are just absolute benefits to implementing an EMR system.

The crazy part about these absolute benefits of an EMR system is that most of these absolute benefits to using an EMR just get quickly swept under the rug. They are easily forgotten and never get the credit they deserve (like a good medical biller). People just begin to take them for granted once they have them that they forget what it was like before the implemented an EMR.

For those who haven’t implemented an EMR, most of the absolute benefits aren’t financial and so they don’t even make it on your list of reasons to implement an EMR. Well, I’m here to give these EMR benefits the proper acknowledgment they deserve in a multi part series highlighting each of these benefits of a doctor going electronic.

First EMR benefit….*drum roll*…

Legibility of Charts

I know it’s a generalization that all doctors can’t write legibly. However, why do you think that it became a generalization? Possibly because generally it’s true. The crazy thing is that this is going to get progressively worse. The next generation of clinical providers have used the computer so much, they don’t even know what the term penmanship is. I’m willing to admit that I don’t even really know how to write in cursive anymore (outside of signing my name).

Needless to say, being able to read what’s been written in a patient chart is extremely valuable. This becomes even more true when we’re talking about information sent through those high quality (sarcasm) fax machines in every doctors office. The legibility found on typed documents that are faxed is so much better. Of course, I don’t even really need to step out of the office to see the benefits of a nicely typed, legible note. The doctor reading the nurse note is more accurate. The doctor reading past notes is more accurate. In a group practice, the doctor reading other doctors’ notes. The list goes on and on.

Legibility of EMR notes is valuable. Difficult to measure, but incredibly valuable. Don’t discount this benefit of an EMR.

Today, I decided to start a new web page that I believe will really grow over time. It’s basically a list of the possible benefits a doctor or clinic can receive from using an EMR or EHR rather than paper charts.

I haven’t take much time to make the list at all, but I think it’s better to start it and then as ideas come to my head I can add to it as time permits. I already have a number of other ideas (like quality of medical care), but I need some more free time to put all the details down. Now that I’m thinking about it a little bit more, maybe each benefit of an EMR should have it’s very own blog post describing the benefit that’s received by using EMR. We’ll see how that works. Seems like a worthwhile series of posts to me.

Also, in all fairness I’m certain that I’ll also soon be creating a list of problems associated with EMR. I think it’s important to keep the discussion well rounded and that people are well aware of both the benefits and challenges associated with using an EMR.

Finally, I certainly welcome comments from people on benefits or challenges associated with use of an EMR. I look forward to hearing ideas from other people’s experience to help me round out the list of benefits and challenges that many have already experienced first hand. Might as well try to pass on that knowledge to those who are still implementing or looking to implement.