Finding value in EMRs (electronic medical records)

• HIT Description: Ambulatory electronic medical records More info...
  
• Purpose of Study: Describe the implementation and value of EMR
  
• Years of study: 1991-Not available
  
• Study Design: Time series
  
• Outcomes: Impact on efficiency, utilization, costs
  

• Settings: A large Health Maintenance Organization Ð Kaiser-Permanente of Ohio
• Evaluation Method: Qualitative description of the EMR implementation and its value including a ballpark prediction of its annual savings and expenses.
• Description: Automated medical record which collected and presented data at the time of an encounter. The system also generates physician reminders for guideline compliance and patient reminders for preventive services.
• Interoperability: Linked to digital data on the mainframe, such as lab results, radiology reports, emergency department notes, and hospital discharge summaries.
• Strategy: Used a turnaround document printed by the computer system, which contains a concise summary of individualized patient information. Charting is done directly on the document and crucial data elements are added to the system by physicians at charting or by medical coders or optical mark sensing/scanning afterwards. Clinical information that is not printed in the 5-page packet of essential information is available online.
• Financial Context: 200,000 member health maintenance organization with multiple buildings that used to require delivery of charts between buildings and affiliated hospitals.
• HIT System Sustainability: System development since 1989 and data collection since 1991, the system was fully implemented in 1997.
• Cost of HIT systems: Estimated the cost of system development to be $10 million, which involved the planning and building of an entire network from the group up. Annual expenses include $600,000 for personnel, $200,000 for printing, $150,000 for network expenses, $70,000 for memory, and $80,000 for license renewals, totaling $1,100,000/year.
• Quality of Care and Patient Safety Outcome: Examples given included increased compliance with guidelines for the use of medications in coronary artery disease patients, diabetes management, influenza immunization, and smoking cessation.
• Changes in efficiency and productivity: Expected savings include $2,800,000 for reduction of medical record room and support staff, $500,000 for elimination of clinical forms, and $400,000 for automatic collection of billing data, totaling $3,700,000/year.
• Time needed to accrue benefit: Expected the system to pay for itself 13 years from its initiation.