Running head: THE IMPACT OF EHR ON EFFCIENCY AND PATIENT OUTCOMES 1

The Impact of EHR on Efficiency and Patient Outcomes

Diego Emestica Montenegro

University of San Diego

THE IMPACT OF EHR ON EFFCIENCY AND PATIENT OUTCOMES 2

Abstract

This paper examines the impact of electronic health records (EHR) implementation and

utilization has on patient care and patient outcomes. Periodical and health sources were utilized

to highlight both positive impacts and complications of EHR implementation. Multiple studies

indicated that the initial investment of time and capital in the adoption of EHR are far surpassed

long-term while demonstrating that issues in the relationship of information technology (IT) and

EHR use can be addressed through different sectors of the healthcare infrastructure. Continuous

research is necessary for healthcare to determine the impacts of EHR use on patient care and

outcomes.

Keywords: EHR, patient care, barriers, IT, healthcare

THE IMPACT OF EHR ON EFFCIENCY AND PATIENT OUTCOMES 3

The Impact of EHR on Efficiency and Patient Outcomes

Since its humble beginning as a paper-based system, EHR’s have evolved and its impact

on the healthcare industry has been a revolutionary one that gave dawn to a fully digital age of

record keeping. This paper examines the literature available on EHRs and the effects it has in the

healthcare industry, highlighting the factors surrounding EHR adoption, implementation and the

results on patient outcomes and entity efficiency. It is thought that health information

technology, particularly EHRs, will improve quality and efficiency of healthcare organizations,

from small practices to larger health groups (Yanamadala, Morrison, Curtin, & McDonald,

2016). As Kutney-Lee and Kelly (2011) describe, the widespread adoption of EHRs is a national

priority in attempts to showcase the potential of information systems to assist in addressing the

overuse, underuse, and misuse of healthcare services. O’Neil (2015) emphasizes EHRs high

valued cost can be justified with several benefits in predictable, preventative and treatment

adherence medicine to name a few. Concurrently, EHR, being one of the powering batteries of

healthcare and the positive impacts previously mentioned, also come with their negative

counterparts. The evidence regarding the impact of EHRs on quality of patient outcomes is

undeniably mixed despite estimates that these technologies could save the US healthcare system

more than 81 billion dollars a year (Kutney-Lee et al., 2011). Kutney-Lee et al. (2011) observe

an increasing body of evidence highlighting the unintended and unanticipated consequences on

quality of care after EHR introduction, including increased nursing staffing levels.

From its paper-based foundation, the rise of the EHR system began in the 1990’s when

computers were used to keep simple record files in the commercialization era of EHRs (Tripathy,

2012). As noted by Tripathy (2012), “As homegrown systems in academic medical centers

matured, the technologies began to commercialize, some as outgrowths of these homegrown

THE IMPACT OF EHR ON EFFCIENCY AND PATIENT OUTCOMES 4

provider-designed systems and others that were designed commercial from the start”. The impact

of EHR was small, in comparison to today’s standards, yet significant for it was this record

keeping capability that demonstrated the potential the digital record system had (Tripathy, 2012).

In the journey to improving quality metrics and steering toward more efficient patient outcomes,

the need for a more robust “Physician-specific workflow” became more apparent (Tripathy,

2012). Concurrent features were necessary that would allow inpatient and outpatient settings to

show worth on their investment while effectively having the capacity to connect with clinical

equipment. Tripathy (2012) describes that at the turn of the millennium, Medicare and MediCal

brought light to the lack of capability from the EHRs and incentives were provided to empower

health entities, providers to become EHR savvy, and in doing so identifying what the system

lacked. Furthermore, Tripathy (2012) expresses the result was the HITECH meaningful use

requirements that included uniform features that would be utilized in healthcare settings. The

EHR features that were developed in the early 2000’s exists in a more optimized and efficient

form in today’s EHR systems.

Today EHRs have a greater challenge in meeting the expectations of a more demanding,

quality driven field. The challenges are apparent in a field where the system that was originally

built for another purpose needs to be redesigned and implemented. Yanamadala, et al. (2016)

emphasized that “Electronic health records were originally built for billing purposes, not for

research and quality improvement efforts.” Quality metrics vary among the different health

entities yet all face similar barriers when integrating an EHR. Burt, Hing, and Woodwell (2006)

explain that as the processes evolve with the adoption of EHR so must the need to identify the

barriers, by all invested parties, to remove them. Such barriers only reinforce the pushback given

by the users of EHR resulting in a delay of care. Ford et al. (2009) said it best “Resistance is
THE IMPACT OF EHR ON EFFCIENCY AND PATIENT OUTCOMES 5

futile: but it is slowing the pace of EHR adoption nonetheless”. Even with its set of challenges,

EHR can provide immediate impacts when given the opportunity.

Positive impacts on efficiency and EHR operations can result in faster prescription

filling, financial benefits i.e. reduction in paper cost, data security, speedy lab results, an increase

in patient visits and overall patient satisfaction (Jamoom, Patel, King, & Furukawa, 2012).

Jamoom et al. (2012) noted an organization can utilize these positive impacts on efficiency as a

selling point to attract physicians. Blijleven, Koelemeijer, Wetzels and Jaspers (2017) expressed,

this can be accomplished with improvements made through policy review, technology, personal

training and effectiveness of care and by following a “walkaround” model. Blijleven et al. (2017)

explained that “Workarounds are defined as informal temporary practices for handling

exceptions to normal workflow that do not follow explicit or implicit rules, assumptions,

workflow regulations, or intentions of systems designers”. Blijleven et al. (2017) added the

workaround model was created and highly utilized by physicians to become more efficient at

completing tasks. Adler-Milstein, Everson, Lee (2015) affirmed, similar models saw clear

evidence that EHR adoption and proper operation resulting in improved adherence and patient

satisfaction.

Proper implementation of EHR is just as important as the plug and play equipment that is

necessary to collect health data. Complications during the implementation process of EHR can

take many forms especially when user customization is necessary to fulfill the health entities

needs. Some researchers have gone to the lengths of analyzing EHR and the change processes

that occur during implementation and have applied Kübler-Ross's five stages of grief model.

McAlearney, Hefner, Sieck, and Huerta (2015) described that interventions were provided during

each stage of grief and treated each “loss” as an opportunity to strategically conceptualize, frame
THE IMPACT OF EHR ON EFFCIENCY AND PATIENT OUTCOMES 6

and develop management tools for the organization and physicians. McAlearney et al. (2015)

claim a more apparent sensation is usually seen in more seasoned physicians when no longer

having the ability to delegate work to nurses or other clinical staff. Relevant interventions and

management tools are crucial to addressing a significant function of EHR that requires proper

data entry and coding. Tang and Quan (2017) emphasize, “the pivotal need to implement

interventions that improve physician documentation, for its illegibility, unreliability, and

incompleteness at times present challenges to the precise coding of conditions and procedures

essential to achieving high-quality health data.”

A significant impact has been made by EHR in healthcare. Continuously attempting to

improve the quality of patient care and redefining the meaning of efficiency of small and large

organizations alike while providing a more secure & optimal tool for providers and health

workers. The research demonstrated that EHRs continue to face abrupt challenges as the

healthcare system evolves and that a recurring investment is inevitable by all involved entities, to

fully unearth the potential the system has. The research also broadens the perspective of the

scope EHRs must cover in healthcare in attempts to prevent delays in care, meeting the demands

of EHR users. It was found that it is necessary to gather quality and structured information to

develop more actualized privacy protection policies towards the true dissemination and exchange

of health data and to enhance the dynamic of the patient-provider relationships. Furthermore, the

research proved that efficiency and positive patient outcomes can be achievable with a structured

and well-established support system. EHRs far surpass its initial investment and continue to

over deliver in areas where both the patient and care team benefit simultaneously.
THE IMPACT OF EHR ON EFFCIENCY AND PATIENT OUTCOMES 7

References

Adler‐Milstein, J., Everson, J., & Lee, S. D. (2015). EHR adoption and hospital performance:

time‐related effects. Health Services Research, 50(6), 1751–1771.

http://doi.org/10.1111/1475-6773.12406

Blijleven, V., Koelemeijer, K., Wetzels, M., & Jaspers, M. (2017). Workarounds emerging from

electronic

health record system usage: consequences for patient safety, effectiveness of care, and efficiency

of care. JMIR Human Factors, 4(4), e27. Retrieved from

http://doi.org/10.2196/humanfactors.7978

Burt CW, Hing E. Woodwell D. (2006). Electronic medical record use by office-based

physicians: United States, 2005. NCHS Health E-stat.

Retrieved from https://www.cdc.gov/nchs/data/hestat/electronic/electronic.htm

O’Neil Hayes, T. (2015, August 6). Are electronic medical records worth the costs of

implementation? Retrieved from https://www.americanactionforum.org/research/are-

electronic-medical-records-worth-the-costs-of-implementation/

DesRoches CM, Campbell EG, Rao SR, Donelan K, Ferris TG, Jha A. Shields AE. (2008, July

3) Electronic health records in ambulatory care—a national survey of physicians. New

England Journal of Medicine. 2008;359(1):50–60. doi: 10.1056/NEJMsa0802005

Ford, E. W., Menachemi, N., Peterson, L. T., & Huerta, T. R. (2009). Resistance Is Futile: But It

Is Slowing the Pace of EHR Adoption Nonetheless. Journal of the American Medical

Informatics Association: JAMIA, 16(3), 274–281. http://doi.org/10.1197/jamia.M3042

Jamoom, E., Patel, V., King, J., & Furukawa, M. (2012, August). National perceptions of ehr

adoption: Barriers, impacts, and federal policies. National conference on health statistics.
THE IMPACT OF EHR ON EFFCIENCY AND PATIENT OUTCOMES 8

Retrieved from https://www.cdc.gov/nchs/ppt/nchs2012/ss-03_jamoom.pdf

Kutney-Lee, A., & Kelly, D. (2011). The effect of hospital electronic health record adoption

on nurse-assessed quality of care and patient safety. The Journal of Nursing

Administration, 41(11), 466–472. http://doi.org/10.1097/NNA.0b013e3182346e4b

Lucyk, K., Tang, K., & Quan, H. (2017). Barriers to data quality resulting from the process of

coding health information to administrative data: a qualitative study. BMC Health

Services Research, 17, 766. http://doi.org/10.1186/s12913-017-2697-y

Mathai N, Shiratudin MF, Sohel F (2017) Electronic Health Record Management: Expectations,

Issues, and Challenges. J Health Med Informat, 8, 1-5. doi: 10.4172/2157-7420.1000265

McAlearney, A. S., Hefner, J. L., Sieck, C. J., & Huerta, T. R. (2015). The journey through

grief: insights from a qualitative study of electronic health record implementation. Health

Services Research, 50(2), 462–488. http://doi.org/10.1111/1475-6773.12227

Tripathi, Micky. (2012) EHR evolution: policy and legislation forces changing the ehr.

Journal of AHIMA, 83, 24-29. Retrieved from

http://library.ahima.org/doc?oid=105689#.WpekhOdG2Uk

Yanamadala, S., Morrison, D., Curtin, C., McDonald, K., & Hernandez-Boussard, T. (2016).

Electronic health records and quality of care: an observational study modeling

impact on mortality, readmissions, and complications. Medicine, 95(19), e3332.

http://doi.org/10.1097/MD.0000000000003332