Beruflich Dokumente
Kultur Dokumente
Records:
Benefits, Drawbacks, and the Like
4/26/2011
MIS 290, 8-9:15 a.m. TR
Group 2:
Adam Kirby
Amy Moses
Kate Shamblin
Electronic Medical Records 201
1
EXECUTIVE SUMMARY:
2
Electronic Medical Records 201
1
BODY:
EMRs, or electronic medical records, are prevalent throughout the medical industry and
are used to easily store and access patients’ medical information. The world – very much
including the medical industry – is venturing from the paper medium toward a more
In our opinion, there are a majority of benefits; however, there are a few details about
EMRs that must be considered. A few of these draw-backs in regards to electronic medical
interoperability.
medical records. Some of the short-run benefits to implementing EMRs deal with space saving,
Our group shares an interest in this subject matter because it will affect every member of
society, from every class and creed. The implementation of electronic medical records is
3
Electronic Medical Records 201
1
advantageous both of in the short-run and the grand-scale of the progression of society. It will be
far more effective and efficient than maintaining previous paper filing methods, and will benefit
For years, hospitals have used countless pieces of physical paper, folders, and file
cabinets, to store a prolific amount of patient medical records. Advancements in the computing
world, however, now make it more logical to replace notepads with laptops, and file cabinets
with hard drives. The use of electronic medical records is actually improving patient care.
Patients are not the only ones to benefit; using electronic records makes it easier for nurses or
doctors to record what is being done for the patient. In addition to this, electronic records also
help to reduce operating costs. These three reasons are incentives worth taking advantage of.
Now we begin the in-depth discussion of these incentives. In many hospitals, the adopted
credo is that the patient is always right. This frame of mind is used so that the patient always
receives the best care possible. If sticking with this motto is important, then we must ask
ourselves if electronic medical records improve patient care. The answer is yes. By their nature
EMRs make it easier to care for patients, giving care providers more opportunity for positive
results. For example, programs like Vista, allow doctors to immediately pull up scanned
documents, or other images like x-rays, while in the patients room. Doctors are also able to
review formatted notes that list specific problems with their patient. Along with providing
information on a specific patient, EMRs are able to compile large amounts of data, which proves
extremely useful for showing certain trends – throughout the region, within demographics, or
4
Electronic Medical Records 201
1
The Veterans Health Administration, or VHA, is the first hospital to adopt EMRs on a
full scale. One example of success the VHA has had with the monitoring of cholesterol in
patients who have been victims of a heart attack. Monitoring a patient’s cholesterol is an
important part of keeping a patient healthy. However, even diligent hospitals sometimes neglect
to monitor this. In 2003, when the VHA was using EMR’s, 94% of patients were being
monitored for high cholesterol. Other hospitals though, only had 79% of patients being
The very essence of a hospital is to do good for others by helping them to live a healthy
life. Some hospitals even choose to be non–profit in order to accomplish this more fully.
However, this doesn’t mean that money isn’t important to them. With skyrocketing medical
costs, it is now more essential than ever for hospitals to be monetarily efficient. Though it may
seem insensible to implement an expensive EMR system when money is tight, it is a better
choice in the long-run for a medical provider. Studies show that over time EMRs end up saving
much more than they cost. A study in the American Journal of Medicine concludes that
providers saved on average $44,600 by switching to a medium level EMR system, and $84,600
by switching to a more comprehensive, full EMR system. So while EMRs may seem expensive,
they save on costs like billing errors, adverse drug effects, and charges for accessing other
medical databases. When it is all said and done, the switch to EMRs will reduce costs greatly
course, any time computer-based technology is used, there needs to be some sort of software that
5
Electronic Medical Records 201
1
goes with it. Needs can and most likely will determine what will be included in software. For
example at Meridian Health Systems in New Jersey, Becki Weber, the CIO, brought together all
the people whose jobs and duties mixed with one another. She did this to figure out everyone’s
specific needs, so that an EMR system could be built based on “varied roles and interactions.” In
fact, when developing the software, the developing team consisted of nurses, physicians, and
others, including those from finance and admissions. It is viable that the type of software needed
depends upon the needs and requirements of a hospital or family practice. The next question to
consider is why this is true. Weber sums it best when she said, “We found that nursing wasn’t
just about nurses” (Briggs). In other words, everything and everyone is connected, and that
Since this need based type of software is found in other places, let’s take a look at another
place where this type of software is used. Located in Washington, D.C., the Children’s National
Medical Center has also implemented a type of software that is based on what is needed, instead
of on something standard. In fact, they spent more than a year “researching electronic records
and assessing workflow needs.” With nearly thirty primary care facilities and remote clinics, this
specialty hospital has nearly 275 employed physicians, and the success of Children’s National is
the fact that the employed physicians participate with EMRs. To prove that claim, Kelly Styles,
the CIO at Children’s National said, “Our physician model is what makes the difference”
(Briggs). In other words, the specific type of EMR implemented there applies to what the
physicians need.
6
Electronic Medical Records 201
1
The software is important for EMRs, or else no one would probably use EMRs. However,
there was a case study of a family practice in the Province of Québec, Canada that has given
EMRs a shot. Those who had chosen to use EMRs in this study had a generally favorable
attitude after just one year of implementation, and they saw many benefits from its use. Among
these benefits were, “direct and quick access to complete information about a patient, available
from various sites (clinic, hospital and home), and information sharing between professionals
working in teams.” EMRs were also seen as being key to the follow-up of patients because
different human factors, including nurses and physicians, among others, could respond to the
patient. Time saving was also reported. On a negative note, however, EMRs seemed to increase
the workload and cause teams to reevaluate work processes (Duplantie et al.).
Along with the actual success of EMRs in a family practice, it has been found that EMRs
can truly help in diagnosing ailments and improving care. More specifically, we take a look at
how an EMT based intervention helped with care for gastro-esophageal reflux disease (GERD).
GERD is many times undiagnosed and untreated. Often times, GERD can be diagnosed by
recognizing common symptoms, such as heartburn, but atypical symptoms, such as asthma,
laryngitis, and a chronic cough, make GERD harder to diagnose. However, EMRs can readily
have guidelines and education available for doctors and give decision support at point of care. In
this particular study of EMRs, the Medical Quality Improvement Consortium (MQIC) and the
model of the Centricity® EMR were used. There was both an intervention group (the group that
had a certain tool to assist in GERD and symptoms that represent atypical GERD) and a control
group. The outcomes: diagnosis of GERD, diagnosis of GERD for those who had atypical
symptoms, and prescriptions for GERD. Due to the EMRs, the amount of diagnosis and
7
Electronic Medical Records 201
1
remember that there are certain limitations in this study, including notes put in EMRs that can be
underestimated. Even though the amount of improvements remained low, this study has shown
Some experts speculate that while the use of EMR’s may lead to more accurate records, it
causes disconnect with the way doctors think of individual patients. It is thought that if a doctor
is simply checking boxes and filling out standard questions, then he will not be able to form a
unique clinical thought process for that individual. M.D. Daniel Luchins sums this ideology up
when he says, “The more information that a clinician collects and records using these measures
(electronic recording); the less it is processed, tied to a specific individual and made part of a
narrative; the less that might be remembered by that clinician when they have to make a
decision.” Luchins goes on to insist that to fix this problem, emphasis needs to be placed on
finding out the quality of individual care rather than data and statistics. Most experts, like
Luchins, seem to agree that there are more benefits than drawbacks to EMR’s. As with any new
Various elements of human error can be found in the use of EMRs. The first thing you may
think of when considering human error, is simply entering something incorrectly into the system.
However, human errors can be made even in the software development of the EMR itself. These
human errors are very important to consider when human lives are at stake. One common
problem is that software designers may not fully understand the interaction that health providers
8
Electronic Medical Records 201
1
will expect to have with the computer, causing general confusion and misuse. Another example
of a common problem is the incorrect selection of medications that may be spelled similarly.
Once again, these problems can be worked out. There is a push for EMR software to be
authorized by some sort of government entity, ensuring that it is a quality product to use when
patient lives are involved. Other solutions simply involve being diligent, insisting that healthcare
workers are thoroughly involved in the process of developing EMR software (Harrington).
In the paper for GERD diagnosis previously discussed, the authors wrote, “Future
initiatives may need to focus on a better understanding of barriers and facilitators to this
diagnosis” (Chen et al.). Within Bill Briggs’s article Electronic Medical Records: A ‘Workflow’
in Progress, he quoted Lucy Molfetas, director of information systems at the Medical Center at
Princeton, New Jersey, as saying, “We’re continually looking at it, making literally weekly or
daily adjustments” (Briggs). What’s the point of saying all these things? The point is that EMRs
are constantly a part of change and innovation to help improve the workflow and patient care of
those who use them. Hal Teitelbaum, M.D., said it best, “Progress requires attention and
This leads us to pose the questions: where are EMRs going in the future and what more
will they offer? In a recent survey of Ontario doctors, it was found that doctors are becoming
more reliant on EMRs. If a doctor would have the EMR they need, they would adopt it and use
it. Within this survey it was found that 90% of doctors use EMRs regularly, 92% use them to
enter notes, 73% of doctors felt they are now mainly paperless, 53% use EMRs to remind them
of preventative or chronic care events, 83% use it as main source for information on patients,
9
Electronic Medical Records 201
1
65% think EMRs improve quality of care, 84% think EMRs improve or maintain revenue, 79%
report improved or maintained productivity, and 87% felt that privacy improved or was equal to
privacy provided by paper records (Webster). The future of EMRs will be greatly impacted by
Congress and President Obama’s American Recovery and Reinvestment Act of 2009. This act
will provide financial incentives to doctors who use EMRs properly, and it will also penalize
those who do not use EMRs. Doctors who have not begun using EMRs by 2014 will have their
It is crucial to consider the staff that will be using the new technology. While
implementing electronic medical records, the nurses, physicians, and technicians must be close
to mind. The software introduced must be flexible enough to span across the wide range of roles
it must fulfill; however it must be concise enough to keep costs as low as possible, as the costs
With EMRs, the quality control is drastically improved. With this software, come a
diagnosis assistant, which helps pinpoint the cause of seemingly unrelated systems, such as in the
facilitated diagnosis of GERD we highlighted earlier. The statistics, opinions, and general
momentum of the world all point to one inevitable fact: technology is encroaching at an
increasing rate with each passing day. What is left for society to determine is whether to
10
Electronic Medical Records 201
1
BIBLIOGRAPHY:
family practice: a case study." Informatics in Primary Care 18.1 (2010): 31-
11
Electronic Medical Records 201
1
20 Feb. 2011.
217-219.
and Electronic Medical Records -- Barrows and Clayton 3 (2): 139 -- Journal of
<http://jamia.bmjjournals.com/content/3/2/139.abstract>.
12
Electronic Medical Records 201
1
_ob=ArticleURL&_udi=B6TDC-
48D349C9&_user=504619&_coverDate=04/01/2003&_rdoc=1&_fmt=high&_
orig=gateway&_origin=gateway&_sort=d&_docanchor=&view=c&_searchStr
Id=1659524356&_rerunOrigin=scholar.google&_acct=C000024899&_version
=1&_urlVersion=0&_userid=504619&md5=f234e389ece789e6b547dbaa601
b12e2&searchtype=a>.
11. Bates, David W., Mark Ebell, Edward Gotieb, John Zapp, and HC Mullins. "A
Proposal for Electronic Medical Records in U.S. Primary Care." Jamia 10.1
<http://jamia.bmjjournals.com/content/10/1/1.full>.
12. Miller, Robert H., and Ida Sim. "Physicians' Use of Electronic Medical
Records: Barriers and Solutions." Health Affairs 23.2 (2004): 116-26. Print.
ProQuest Nursing & Allied Health Source, ProQuest. Web. 28 Feb. 2011.
13
Electronic Medical Records 201
1
14. Madduri, S. D. "Does your doctor spend more time with his computer than
implement, but they might help improve your care. OTHER VIEWS." St. Louis
verb=sr&csi=8422&sr=lni%2851R0-XHR1-DY37-34GP%29>.
2011.http://ezproxy.marshall.edu:2082/hottopics/lnacademic/?
verb=sr&csi=8406&sr=lni%2845Y1-J4F0-008G-601T%29.
16. Harrington, Linda, Donald Kennerly, and Constance Johnson. "Safety Issues
(2011): 31-43
17. The American Journal of Medicine - 1 April 2003 (Vol. 114, Issue 5, Pages
2011.<http://www.providersedge.com/ehdocs/ehr_presentations/Using_EMRs
_to_Improve_Patient_Care.pdf>
14
Electronic Medical Records 201
1
15