Sometimes when we think about EMR, I think we forget about the subtle nuances of paper charts that make them so undesirable. Check out this story which I got in response to my post called “Think About the Problems with Paper Charting.” It’s a a good illustration of some of the more simple things we often forget about:

I was recently visiting a relative at a major teaching hospital in the Midwest. While in the hall I noticed that they had charts in binders stored in boxes affixed to the wall. Just as I was wondering why such a prestigious institution relied on paper charts a nurse went to re-insert a chart into its box. She was in a hurry and missed, the chart dropped to the floor and binder opened and paper went all over the hall. What was even more surreal was the nurse did not at fist notice her mistake and was at leas 6 feet away before she noticed it and fixed her error.

Sometimes it’s not what you get from an EMR, but what you don’t get that matters.

Back in April, Evan Steele, CEO of SRSsoft, wrote an interesting post about EMR adoption and he asked the question, “Why Are You Still on the Fence?” It’s a very good question. Plus, he adds some value to the conversation by listing some of the problems with paper charts versus an EMR. Here’s a section of his post:

So why are these physicians, who have determined that government incentives are not relevant or achievable, still on the fence about adopting an EMR solution that will deliver measurable benefits? Staying with paper charts is not a good business strategy because there is nothing more inefficient!

• The costs associated with the excess staff needed to manage these medical records are massive and wasteful—these positions can be eliminated or the employees can be more effectively used in revenue-generating or patient-care roles.
• Paper charts hinder practice growth because adding physicians requires a proportional increase in support staff—medical records, billing, nurses, and medical assistants—and because physicians can’t see more patients without lengthening their work hours.
• Slow responsiveness to primary care physicians limits referral volume.
• Profitability is further affected by billing bottlenecks that delay revenue collection.
• The chaos associated with trying to manage paper charts has a damaging effect on staff morale and creates rampant frustration among patients, physicians, and staff.
• Paper charts are a malpractice nightmare—prescriptions are not consistently documented, orders are not easily tracked, and medical decisions are often made without complete clinical information.

So, why are doctors on the fence with EMR? The sad thing for me was the pre-EMR stimulus money, I felt a shift in the tone of conversation around EMR adoption. Doctors had mostly moved from wondering if they should implement an EMR to how they should implement an EMR and which EMR they should implement. They were off of the fence and I saw the tide shifting.

And then in one anti-stimulative swoop, the HITECH act rolled out and doctors decided to go back to the sidelines and see this government incentive play out. Now they’re waiting for meaningful use to be defined. While the HITECH act has increased EMR awareness 10 fold, it’s also done much damage on the short term EMR adoption. I’m not sure that the increased awareness will overcome the damage that it’s caused.

Of course, the damage is done and so we have to go forward from here. I suggest we go back to pre-EMR stimulus times and focus more effort back on the benefits of EMR and the costs of paper instead of the government handouts. If we do that, we’ll see a fantastic shift to more widespread EMR adoption.

One of my readers emailed me about a presentation he was looking at doing about EMR software and consumers. I was really intrigued by the idea of presenting on the benefits of an EMR to the consumer (Translation: Patients). I’d spent quite a bit of time thinking about the benefits of an EMR to doctors, but I hadn’t put as much thought and effort into the benefits of an EMR to patients.

Here’s our initial brainstorm on the benefits of an EMR to patients. Feel free to add to the list in the comments:
-Online Appt Scheduling
-Online Prescription Refills
-Online Patient Information
-Online Forms (possibly pulled in from a PHR)
-e-Visits (this is a controversial one)
-Secure communication with doctor
-Recall/Reminders Electronically
-Patient participation in health record (ie. diet journals)
-Better point of care
-Clinical decision support
-Better access to your health records
-Less errors
-Lower cost
-Better collaboration and communication between primary care and specialty Drs

No doubt some of these benefits should have a ? mark by them. Although, I like the idea of looking at the EMR from the patient perspective. I do after all think that consumers might be the key to “forcing” broad EMR adoption.

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.

In the press release I wrote about in my previous CCHIT certification post, they had a nice summary list of the meaningful use requirements as we know them today:
• Allow patients to access clinical information
• Comply with state and federal privacy, security and data sharing regulations
• Document patient progress and provide clinical summaries
• Exchange critical information with other care providers
• Implement drug interaction safeguards
• Send patient reminders about follow-up and preventive care
• Submit immunization and laboratory data to relevant public health registries
• Use computerized physician order entry systems to transmit prescription

Interestingly, this is what I think many doctors consider meaningful use of an EHR:
• Lower costs
• Increase revenue
• Lower charting time
• Oh yes, and better patient care

A bit of a generalization, but you get the point. The good news is that the benefits in my list are possible with an EMR. It’s just that the HITECH stimulus money may or may not promote those benefits.

“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.