Presentation for UP MSHI HI201 Health Informatics class under Dr. Iris Tan and Dr. Mike Muin. Check out my blog - http://jdonsoriano.wordpress.com/2014/10/09/fitting-the-pi…making-it-work/
2. Physician Adoption of Electronic Health Record Systems: United States, 2011
NCHS Data Brief
Number 98, July 2012
Key findings (Data from the 2011 Physician Workflow study)
• In 2011, 54% of physicians had adopted an electronic health record (EHR) system.
• About three-quarters of physicians who have adopted an EHR system reported that
their system meets federal "meaningful use" criteria.
• Eighty-five percent of physicians who have adopted an EHR system reported being
somewhat (47%) or very (38%) satisfied with their system.
• About three-quarters of adopters reported that using their EHR system resulted in
enhanced patient care.
• Nearly one-half of physicians currently without an EHR system plan to purchase or use
one already purchased within the next year.
3. Meaningful Use - financial incentive for the meaningful
use of certified EHR technology to improve patient care
• Stage 1 - EHR adoption and data gathering
• Stage 2 - Emphasizes care coordination and exchange
of patient information
• Stage 3 - Improves healthcare outcomes
7. Do Hospitals With Electronic Medical Records (EMRs) Provide Higher Quality
Care? An Examination of Three Clinical Conditions
Medical Care Research & Review August 2008 vol. 65 no. 4 496-513
This study investigates how hospital electronic medical record (EMR) use influences quality
performance. Data include nonfederal acute care hospitals in the United States. Sources of the
data include the American Hospital Association, Hospital Quality Alliance, the Healthcare
Information and Management Systems Society, and the Centers for Medicare and Medicaid.
The authors use a retrospective cross-sectional format with linear regression to assess the
relationship between hospital EMR use and quality performance. Quality performance is
measured using 10 process indicators related to 3 clinical conditions: acute myocardial infarction,
congestive heart failure, and pneumonia. The authors also use a propensity score adjustment to
control for possible selection bias. After this adjustment, the authors identify a positive significant
relationship between EMR use and 4 of the 10 quality indicators. They conclude that there is
limited evidence of the relationship between hospital EMR use and quality.
8. The Relationship between Electronic Health Record Use and Quality of Care over Time
Journal of the American Medical Informatics Association Volume 16 Number 4 July /
August 2009
The study linked two data sources: a statewide survey of physicians’ adoption and use of EHR
and claims data reflecting quality of care as indicated by physicians’ performance on widely used
quality measures. Using four years of measurement, we combined 18 quality measures into 6
clinical condition categories. While the survey of physicians was cross-sectional, respondents
indicated the year in which they adopted EHR. In an analysis accounting for duration of EHR use,
we examined the relationship between EHR adoption and quality of care.
!
The percent of physicians reporting adoption of EHR and availability of EHR core functions more
than doubled between 2000 and 2005. Among EHR users in 2005, the average duration of
EHR use was 4.8 years. For all 6 clinical conditions, there was no difference in performance
between EHR users and non-users. In addition, for these 6 clinical conditions, there was no
consistent pattern between length of time using an EHR and physicians performance on
quality measures in both bivariate and multivariate analyses.
!
In this cross-sectional study, we found no association between duration of using an EHR and
performance with respect to quality of care, although power was limited. Intensifying the use
of key EHR features, such as clinical decision support, may be needed to realize quality
improvement from EHRs. Future studies should examine the relationship between the extent
to which physicians use key EHR functions and their performance on quality measures over
time.
10. The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A
Systematic Review
Journal of the American Medical Informatics Association, Volume 12, Issue 5, Pages 505-516
The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and
23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care
systems increased documentation time of physicians by 17.5%. In comparison, the use of central
station desktops for computerised provider order entry (CPOE) was found to be inefficient,
increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted
average of CPOE-oriented studies, 238.4%).
Studies that conducted their evaluation process relatively soon after implementation of the EHR
tended to demonstrate a reduction in documentation time in comparison to the increases
observed with those that had a longer time period between implementation and the evaluation
process. This review highlighted that a goal of decreased documentation time in an EHR project is
not likely to be realized. It also identified how the selection of bedside or central station desktop
EHRs may influence documentation time for the two main user groups, physicians and nurses.
12. A cost-benefit analysis of electronic medical records in primary care
American Journal of Medicine 2003 Apr 1;114(5):397-403
Electronic medical record systems improve the quality of patient care and decrease medical
errors, but their financial effects have not been as well documented. The purpose of this
study was to estimate the net financial benefit or cost of implementing electronic medical
record systems in primary care. We performed a cost-benefit study to analyze the financial
effects of electronic medical record systems in ambulatory primary care settings from the
perspective of the health care organization.
!
Data were obtained from studies at our institution and from the published literature. The
reference strategy for comparisons was the traditional paper-based medical record. The
primary outcome measure was the net financial benefit or cost per primary care physician for
a 5- year period. The estimated net benefit from using an electronic medical record for a 5-
year period was 86,400 US dollars per provider. Benefits accrue primarily from savings in
drug expenditures, improved utilization of radiology tests, better capture of charges, and
decreased billing errors. In one-way sensitivity analyses, the model was most sensitive to the
proportion of patients whose care was capitated; the net benefit varied from a low of 8400
US dollars to a high of 140,100 US dollars . A five-way sensitivity analysis with the most
pessimistic and optimistic assumptions showed results ranging from a 2300 US dollars net
cost to a 330,900 US dollars net benefit. Implementation of an electronic medical record
system in primary care can result in a positive financial return on investment to the health care
organization. The magnitude of the return is sensitive to several key factors.
14. A review of methods to estimate the benefits of electronic medical records in hospitals and the
need for a national benefits database
Journal of Healthcare Information Management 2007 Winter;21(1):62-8.
Proponents of electronic medical record systems cite numerous benefits of their use; however
prospective electronic medical record (EMR) purchasers can find relatively little hard evidence these
systems will deliver promised or expected benefits. The lack of good information to help identify
EMR benefits, estimate and prioritize these benefits, and understand how the benefits are realized
is a serious problem for the healthcare industry. This paper describes the most useful current
approaches for hospitals to estimate the potential benefits of their EMR systems. Positive and
negative aspects of each approach are discussed, as is the question of determining whether a
hospital provider could use the approach. Based on this analysis, the article explains the necessity
of developing a standardized database of actual provider experience with clinical information
system (CIS) benefits, and it describes the initial efforts of the HIMSS CIS Benefits Task Force to
create such a database.
16. Impact of Health Information Technology Implementation on Diabetes
Process and Outcome Measures
Agency for Healthcare Research and Quality
The specific aims of this project were to:
• Estimate the impact of an EHR on diabetes outcomes, measured by the proportion of
patients meeting the Health Partners Optimal Diabetes Care measure.
• Estimate impact of an EHR on specific patient outcomes and compliance with
recommended process of care related to diabetes.
• Estimate the prevalence of physician use of the Diabetes Management Form, and the
effect of the Diabetes Management Form on patient outcomes related to diabetes as
measured by the Optimal Diabetes Care measure.
The project used an observational study design with primary care practices that underwent
a staggered implementation of a commercially available EHR. The primary outcome was
meeting diabetes “optimal care” target measures for HbA1c, LDL-cholesterol, blood
pressure, not smoking, and documented aspirin use. Compliance was compared between
patients exposed and not exposed to the EHR and in a subset of EHR-exposed patients in
patients for whom the DMF was used and those for whom it was not.