Delving Deeper into the Historic Origins of Debate
By Richard J. Mata MD, CIS, CMP™
According to Wager, Ornstein, and Jenkins, in 2005, the perceived advantages of an EHR system include the following:
- Quality of the patient records (legible, complete, organized) — 86%
- Better access to patient records (available, convenient, fast) — 86%
- Improved documentation for patient care purposes — 93%
- Improved documentation of preventive services — 82%
- Improved documentation for quality improvement activities — 82%
Items viewed as an advantage by fewer respondents include the following:
- Administrative cost savings — 38%
- Improved efficiency — 61%
- Security of patient records — 64%
Nothing directly was said about cost savings or increased medical care quality. These topics have become more contentious issues during the past few years.
The Gurley Opinion
According to HIT expert Lori Gurley, in 2006, of the American Academy of Medical Administrators:
“The EHR provides the essential infrastructure required to enable the adoption and effective use of new healthcare modalities and information management tools such as integrated care, evidenced-based medicine, computer-based decision support, care planning and pathways, and outcomes analysis” (Schloefell et al). Although the benefits that support implementation of an EHR are clear, there are still barriers too, therefore the concept is still not accepted. “However, this could also be said of almost every other area of positive change and improvement within healthcare systems […]” (Schloefell et al). There must be more involvement by the government and the private sector “to make changes where possible to instigate, motivate, and provide incentives to accelerate the development of solutions to overcome the barriers” (Young).
THINK: ARRA and HITECH, today. Of course, there are obviously advantages and disadvantages to both the paper medical record and the EHR.
Multi-Factorial Issues
Many factors must be considered before any healthcare organization or medical practice should implement an EHR. The organization must first obtain as much information as possible about this new concept, and then the information must be carefully reviewed and the pros and cons discussed. Only then should the organization make their decision about this very important issue.
“The [EHR] as a part of a Clinical Information System (CIS) is a powerful tool which ties together documentation of the patient visit (clinical information), coding (diagnosis, and treatment procedures), which then translates into more accurate billing processes, reduces reprocessing of medical claims, and that translates into increased customer satisfaction with a provider” (Koeller). Although the technology is available, progress towards an EHR has been slower than expected. “Widespread use of [EHRs] would serve both private-and public-sector objectives to transform healthcare delivery in the United States” […] EHRs would also “enhance the health of citizens and reduce the costs of care” (Dick, Steen, and Detmer).
The MRI Study
According to a 2005-07 survey by the Medical Records Institute, the following factors are driving the push towards EHR systems within medical organizations:
| Motivating Factors | 2005 | Ambulatory |
| The need to improve clinical processes or workflow efficiency. | 89.3% | 91.2% |
| The need to improve quality of care. | 85.0% | 85.3% |
| The need to share patient record information among healthcare practitioners and professionals. | 81.1% | 66.9% |
| The need to reduce medical errors (improve patient safety). | 76.1% | 69.1% |
| The need to provide access to patient records at remote locations. | 67.9% | 65.4% |
| The need to improve clinical documentation to support appropriate billing service levels. | 67.1% | 76.5% |
| The need to improve clinical data capture. | 64.6% | 61.0% |
| The need to facilitate clinical decision support. | 60.7% | 50.7% |
| The requirement to contain or reduce healthcare delivery costs. | 54.6% | 61.8% |
| The need to establish a more efficient and effective information infrastructure as a competitive advantage. | 53.6% | 53.7% |
| The need to meet the requirements of legal, regulatory, or accreditation standards. | 50.0% | 44.1% |
| Other | 5.7% | 5.1% |
| Totals | 280 | 136 |
| Margin of Error | +/- 5.8% | +/- 8.4% |
Now, compare this with the results of the 2007 survey that focused on the factors driving hospitals to expand their use of EHR.
| Driving Factors in a Hospital | 2007 |
| Efficiency and convenience, e.g., better networking to the medical community and patients and remote access | 57.8% |
| Satisfaction of physicians and clinician employees | 42.2% |
| The need to survive and thrive in a much more competitive, interconnected world. | 41.0% |
| Regulatory requirements of JCAHO or NCQA. | 35.6% |
| Savings in the Medical Record Department and elsewhere, including transcription. | 24.0% |
| Value-based purchasing/pay for performance | 17.7% |
| Pressure from payer groups, such as Leapfrog Group | 15.2% |
| Possibility of subsidized purchase of HER, e-prescribing systems, etc. by purchasers/payers/large health systems. | 8.8% |
| Totals | 329 |
| Margin of Error | +/- 5.4% |
Assessment
How have these motivating and driving factors changed today; have they really changed in 2010?
Does this deeper dive reveal any other truths; political, social, business or economic? Is this historical review helpful in understanding the reluctance or eagerness for EMR acceptance, or not?
Conclusion
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