Benefits of Switching to an Electronic Health Record (EHR) | practical fusion (2023)

practical fusion Benefit of Switching to an EHR, Health Informatics: A Practical Guide

The following content is from Dr. Robert E. Hoyt, Health Informatics: A Practical Guide (Sixth Edition). Dr. Hoyt is an internal medicine physician with extensive experience in health informatics and clinical research. He is the director of the Medical Informatics program at the University of West Florida.

Need for Electronic Health Records (EHRs)

The following are the most important reasons why our healthcare system would benefit from a broad transition from paper to electronic medical records.

Paper records are severely limited

Much of what can be said about handwritten recipes can also be said about handwritten office notes. Figure 4.2 illustrates the problems with a paper record. Although this doctor used a template, the handwriting is illegible and the document cannot be shared or stored electronically. It is not structured data that is computable and therefore shareable with other computers and systems. Other shortcomings of paper: expensive to copy, transport and store; easy to destroy; difficult to analyze and determine who saw it; and the negative impact on the environment. Electronic patient encounters represent a breakthrough in readability and the ability to quickly retrieve information. Almost all industries are now computerized and digitized for fast data retrieval and trend analysis. Look at the stock market or companies like Walmart or Federal Express. Why not the medical field?

With the relatively recent pay-for-performance health care models, the patient-centric home care model, and accountable care organizations, there are new reasons to embrace technology to aggregate and report results for reimbursement. It is much easier to retrieve and track patient data using an EHR and patient records than using labor intensive paper chart analysis. EHRs are much better organized than paper charts, allowing faster retrieval of X-ray or lab results. An EHR is likely to also have an electronic problem summary list that outlines a patient's major illnesses, surgeries, allergies, and medications. How many times has a physician opened a large paper chart and released the lab results? How many times does a doctor reorder an exam because the result or the medical record is missing? It's important to note that paper graphics are lost up to 25% of the time, according to one study.¹⁰Even though the chart is available; Details are missing in 13.6% of patient encounters, according to another study.¹¹Table 4.1 shows the types of missing information and their frequency. According to the President's Information Technology Advisory Committee, 20% of lab tests are reordered because previous studies are not accessible.¹²This statistic has enormous patient safety, productivity, and financial implications.Table 4.1: Types and frequencies of missing information

EHRs allow for easy navigation throughout a patient's medical history. Instead of pulling volume 1 of 3 from the paper chart to look up a lab result, it only takes a few mouse clicks. Another key advantage is that the log is available 24/7 and does not require an employee to extract the chart or additional space to store it. The adoption of electronic medical records has saved money by reducing full-time equivalents (FTEs) and transforming registration rooms into more productive spaces like exam rooms. It is important to note that electronic health records are accessible to multiple healthcare professionals at the same time in multiple locations. While a billing clerk views the electronic medical record, the GP and a specialist can simultaneously review the clinical information. Additionally, patient information must be available to physicians on call so they can review patient records that are not on their dashboard. In addition, electronic health records are believed to improve the level of coding. Do physicians routinely send a lower level of care for billing purposes because they know that patients' handwritten notes are short and incomplete? Templates can help remind clinicians to add more detail to the history or physical exam, ensuring a higher level of coding (templates are disease-specific electronic forms that essentially allow a user to point and click on a history and exam physicist). A study of the impact of an EHR on the integrity of medical records in a labor and delivery unit demonstrated better documentation compared to previous paper records.¹³Finally, an EHR provides clinical decision support such as alerts and reminders, which are discussed later in this chapter.

Need to improve efficiency and productivity

The goal is to have patient information available to whoever needs it, when they need it, and where they need it. With an EHR, lab results can be retrieved much faster, saving time and money. However, it should be noted that reducing duplicate testing benefits payers and patients rather than physicians, so there is a misalignment of incentives. Furthermore, a previous study using computerized order entry showed that simply displaying past results reduced duplication and testing cost by only 13%.¹⁴If lab results or x-rays are frequently missing, the implication is that they need to be repeated, adding to this country's staggering healthcare bill. The same can be said for duplicate recipes. An estimated 31% of the US$2.3 trillion health care bill goes to the administration.¹⁵EHRs are more efficient because they reduce redundant paperwork and have the ability to interface with a billing program that files claims electronically. Consider what it takes to simply return lab test results to a patient using the old system. This could involve a receptionist, a nurse and a doctor. The end result is usually putting the patient on hold or playing phone tag. With an EHR, lab results can be forwarded via secure messaging or made available for viewing via a portal. Electronic health records can help with productivity if the templates are used wisely. As noted, they enable point-and-click histories and physics that can, in some cases, save time. Integrated clinical decision support is one of the newest features of a complete EHR. Clinical practice guidelines, linked educational content, and patient brochures can form part of the EHR. This can make it possible to find the answer to a medical question while the patient is still in the exam room. Several EHR companies also offer a centralized area for all medical approvals and signatures for lab work, prescriptions, etc. This should improve your workflow, avoiding the need to extract multiple charts or insert multiple EHR modules. While EHRs appear to improve overall office productivity, they often increase physicians' workload, particularly when it comes to data entry. We'll discuss this later in the Productivity Loss section.

Quality of care and patient safety

As suggested above, an EHR should improve patient safety through several mechanisms: (1) Better readability of clinical notes, (2) Better anytime, anywhere access, (3) Reduced duplication, (4) ) Reminders of overdue preventive exams or services, (5) Clinical decision support that reminds physicians of patients' allergies, correct medication dosage, etc. (6) Electronic issue summary lists provide quick diagnosis, allergies, and surgery. Despite the aforementioned benefits, a study by Garrido of process quality measures before and after the implementation of a widespread EHR in the Kaiser Permanente system showed no improvement.^sixteenTo date, only one study has been published of which the authors are aware that the suggested use of an EHR reduced mortality. This particular EHR had a disease management module designed specifically for kidney dialysis patients that could provide more specific medical guidance and better data mining to potentially improve healthcare. The study suggested that mortality was lower compared to a pre-implementation period and compared to a national renal dialysis registry.¹⁷Healthcare is likely just beginning to see the impact of EHRs on quality. Based on internal data, Kaiser Permanente determined that the drug Vioxx had an increased risk of cardiovascular events before this information was released based on its own internal data.¹⁸Likewise, 90 minutes after learning of the withdrawal of Vioxx from the market, the Cleveland Clinic checked its EHR to see which patients were taking the drug. Within seven hours, they disabled the prescriptions and notified the doctors via email.¹⁹Quality reports are much easier to generate with an EHR compared to a paper chart which requires chart review. Quality reports can also be generated from a data warehouse or health information organization that receives data from an EHR and other sources.²⁰Quality reporting is the backbone of health system reform, which will be discussed further in another chapter.

public expectations

According to a 2006 Harris Interactive Survey for the Wall Street Journal Online, 55% of adults thought an EHR would reduce medical errors; 60% felt that an EHR would reduce healthcare costs and 54% felt that using an EHR would influence their decision about selecting a personal physician.²¹The Center for Health Information Technology would argue that EHR adoption results in better customer satisfaction through fewer lost records, faster refills, and better delivery of patient education material.²²Patient portals that are part of EHRs are likely to be a source of patient satisfaction as they allow patients to access their records with many other functionalities like online consultations, medication refills, etc.

Government expectations

The federal government sees EHRs as transformative and essential to health care reform. As a result, EHR reimbursement is an important focal point of the HITECH Act. The US government's goal is to have an interoperable electronic health record by 2014. In addition to federal government support, states and taxpayers have initiatives to encourage the adoption of the EHR. Many organizations say that health care must move from the cow trail to the information highway. CMS is very aware of the potential benefits of EHRs to help coordinate and improve disease management in elderly patients.

financial savings

The Center for Information Technology Leadership (CITL) suggested that ambulatory EHRs would save $44 billion per year and eliminate more than $10 in rejected orders per patient per outpatient visit. This organization concluded that not only would savings be made by eliminating map rooms and registration staff; there would be a reduction in the need for transcription. There would also be fewer callbacks from pharmacists with electronic prescriptions. Copying, faxing, mailing, graphics extraction, and labor costs are likely to be reduced with EHRs, thereby saving full-time equivalents (FTEs). Faster retrieval of radiographs and lab reports saves time and effort, as does the use of templates. It appears that part of the savings is due to improved coding. More efficient patient encounters mean more patients can be seen each day. Savings for drug management payers can be enhanced with reminders to use your drug of choice and generics. It should be noted that this optimistic financial projection assumed widespread EHR adoption, health information sharing, interoperability, and change in workflow.²³EHRs should reduce the cost of transcription if clinicians switch to speech recognition and/or use of templates. Due to the template-structured documentation, they can also improve claims coding and billing. It is not known whether adopting the EHR will decrease malpractice and thus save medical and hospital costs. A 2007 Medical Records Institute survey of 115 practices involving 27 specialties showed that 20% of malpractice firms offered a discount for having an EHR in place. Of physicians who had a malpractice case where the documentation was based on an EHR, 55% said the EHR was helpful.²⁴

Technological advancements

The time seems right for electronic records, in part because technology has evolved. The Internet and the World Wide Web enable the concept of an application service provider (ASP) for an electronic health record. An ASP option means that the EHR software and patient data reside on a remote Web server that users can access over the Internet at the office, hospital or home. Computer speed, memory, and bandwidth have advanced so much that digital imaging is also a reality, so imaging can form part of an EHR system. Personal computers (PCs), laptops and tablets continue to add features and improve speed and memory while lowering purchase costs. Wireless and mobile technologies allow access to hospital information systems, electronic health records and the Internet using a variety of mobile technologies. The chapter on health information exchange will note that health information organizations can link EHRs through a web-based exchange to share information and services.

Need for aggregated data

To make evidence-based decisions, clinicians need high-quality data that must be derived from multiple sources: inpatient and outpatient care, acute and chronic care settings, urban and rural care, and at-risk populations. This can only be achieved with electronic health records and discrete structured data. In addition, healthcare data must be combined or aggregated to achieve statistical significance. Although most primary care is provided by small practices, it is difficult to study due to relatively small patient populations, making aggregation necessary.²⁵For large healthcare organizations, there will be a deluge of data generated from the widespread adoption of EHR, resulting in "big data" that will require new data analysis tools.

Need for integrated data

Paper health records are stand-alone and cannot be integrated with other paper forms or information. The ability to integrate health records with a variety of other services and information and to share information is critical to the future of health care reform. Digital information, unlike that found on paper, can be integrated with multiple internal and external applications:

• Integration capability to share health information with organizations (another chapter)
• Ability to integrate with analytical software for data mining to examine optimal treatments, etc.
• Ability to integrate with genomic data as part of the electronic record. Many organizations have started this journey. There is more information in the bioinformatics chapter²⁶
• Ability to integrate with local, state and federal governments for quality reporting and public health issues
• Ability to integrate with algorithms and artificial intelligence. Mayo Clinic researchers were able to extract Charlson's comorbidity determinations from the EHRs, rather than performing manual chart reviews.²⁷

EHR is a transformation tool

There is widespread agreement that the American health care system needs reform in several areas. To modernize its infrastructure, healthcare would need widespread adoption of EHRs. Large organizations like the Veterans Health Administration and Kaiser Permanente use robust EHRs (VistA and Epic) that generate enough data to change the practice of medicine. In 2009, Kaiser Permanente reported on two studies, one related to the treatment of bone diseases (osteoporosis) and the other to chronic kidney disease. They were able to demonstrate that, with their EHR, they could reach patients at risk and use all available tools to improve disease management and population health.^28-29In another study published in 2009, Kaiser-Permanente reported that electronic visits as part of the electronic medical record system were likely responsible for a 26.2% reduction in office visits over a four-year period. They posited that this was good news for a system that aligns incentives with quality, regardless of whether the visit is virtual or in-person.³⁰Other pay-for-service organizations may find it alarming if office visits are declined and electronic visits are not reimbursed. Kaiser also features a pooled total registry of over 100,000 patients with data generated from its universal EHR. As a result of their comprehensive EHR (KP HealthConnect) and visionary leadership, they have seen improvements in standardization of care, coordination of care, and population health. They were also able to experience the advanced data analysis of the EHR with its virtual data storage, the use of artificial intelligence and the use of computer simulation models (Archimedes). In addition, they began the process of collecting genomic information for future linkage to their electronic records.^31-32

Need for coordinated care

According to Gallup research, it is very common for elderly patients to have more than one physician: no physician (3%), one physician (16%), two physicians (26%), three physicians (23%), four physicians (15% ), five physicians (6%) and six or more physicians (11%).³³Having more than one physician requires good communication between the primary care physician, the specialist and the patient. This becomes an even bigger problem when different health systems are involved. O'Malley et al. surveyed 12 medical practices and found that EHRs improved coordination in the office, but the technology was not mature enough to improve coordination of care with external physicians.³⁴Electronic health records are being integrated with health information organizations (HIOs) so that inpatient and outpatient related information can be accessed and shared, thereby improving communication between different healthcare entities. Home monitoring (telehomecare) can transmit patient data from home to an EHR in the office, which also assists in coordinating care. It will be noted in a later section that coordinating care across various medical transitions is part of meaningful use.

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