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.

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.

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.