Jun 23, 2014
A thorough look into the advantages of electronic health records – an essential step towards transformed healthcare.
It is now 2014 and technology has firmly planted its foot in the healthcare industry, springing a variety of opinions in regards to the degree of influence we should allow it to have. There are still a handful of old-fashioned healthcare professionals who prefer their hands-on, pen-and-paper methods. This isn’t typically a result of negative experiences with incapable technology, but rather a reluctance to change the way they have learned and practiced for years. The fact is that correctly utilized technology should and will continue to have a lasting effect on the industry. Like it or not, many more technological footprints will continue to imprint the world of healthcare – and we should embrace them.
One major healthcare service made possible by technology is electronic health records (EHRs). For years, EHRs have continued to gain steam among the industry to the point where 78% of office-based doctors were using some form of EHRs. They have quickly become a staple component in the argument for technological integration in healthcare. As HealthIT.gov puts it:
“Medicine is an information-rich enterprise. A greater and more seamless flow of information within a digital health care infrastructure, created by electronic health records, encompasses and leverages digital progress and can transform the way care is delivered and compensated. With EHRs, information is available whenever and wherever it is needed.”
We’ve seen the promising potential of technology radically alter the future of other industries. Smartphones changed the communication industry. MP3s and digital music changed the music industry. The Internet changed the entire digital infrastructure. Electronic health records are capable of having a similar impact on the healthcare industry. While the fragmental advantages of EHRs stretch far and wide, the fundamental purpose behind each individual advantage remains constant. A domino effect of sorts occurs as each specific benefit leads to a larger benefit, and another. Eventually, all of the pieces fall in place in support of the overarching objective – better healthcare.
To help grasp this concept, I like to picture the benefits of EHRs as a funneling system of individual advantages that lead to this objective, as is shown here:
In short, EHR implementation leads to lower costs. Lower costs allow for increased efficiency and accessibility. Increased efficiency and accessibility creates the ability to make more accurate decisions. More accurate decisions improve the quality of healthcare we are able to deliver to patients. These are the four general phases of the “Funnel of EHR Benefits.” There are a handful of distinctive advantages EHRs offer, but all of them can find their place in one of these four stages.
To better explain this model, let’s dig deeper into each level of the pyramid by starting at the bottom and working our way up.
Most arguments supporting electronic health records ability to save money revolve around practical matters. More specifically, EHRs reduce office supply and paper-based expenses. However, the truth is that this only accounts for a small portion of their financial advantages. There are many factors that play a significant role in determining how much money, if any, can be saved. To be clear, implementing an EHR system does not guarantee lower costs. However, Medscape journalist Rob Lowes indicates in this article that while there are physicians who lose money with EHRs, those that achieve a positive ROI did so by properly using their EHRs to significantly boost revenue. In simple terms, the reason some do not save money with EHRs is likely due to the fact that they are not fully exploiting EHRs capabilities to the point that allows them to reach their potential. A fully functional EHR system leads to lower costs and long-term saving in multiple areas.
An increase in savings allows for more money that can be spent on other areas in need. That having been said, more money does not invariably lead to better healthcare. There is no better example of this than the United States - take these spending figures for example:
- Health expenditure per capita: $8,508: Ranked 1st in the world (source)
- Health expenditure as total % of GDP: 17.9%:Ranked 1st in the world (source)
As you can see, the U.S. continues to be far and away the world’s greatest healthcare spender. What does it have to show for this? A healthcare system that consistently ranks among the worst for developed countries. So no, money does not inevitably lead to better care. A systematic distribution of money, along with effective strategies to utilize it is necessary for optimal results. But the primary issues is first finding the funding for such a system to exist. Luckily, EHRs can help. HealthIT.gov states that based on the size and scope of implementation, financial benefits for large hospitals can range from $37M to $59M over a five-year period. Though these results fluctuate, in the current financial situations many hospitals are in, that amount of money can go a long way.
In the past, one of the primary motives against adopting EHRs was the high cost of implementation. Today, that rationale has considerably subsided thanks to improvements in the convenience and affordability of EHRs. The most notable of which was the Health Information Technology for Economic and Clinical Health (HITECH) Act in the United States, which was enacted under the American Recovery and Reinvestment Act of 2009. The HITECH Act became the nations first significant commitment towards the endorsement of electronic health records by offering financial incentives to healthcare professionals and hospitals that adopt the use of EHRs. The development of innovative companies continues to enhance the simplicity of EHR integration by offering a more seamless and affordable option. Practice Fusion, for example, now offers entirely free EHR software that takes a mere 5 minutes to install – making it the fastest growing and best ranked EHR available.
Despite the required initial investment, a correctly utilized EHR system will save money in the long run while also using the money that is being spent in a more efficient manner – which leads me to the next phase.
Increased efficiency and accessibility are two of the more directly applicable benefits of electronic health records. Traditionally, gaining access to a patients health records has been a tedious and time-consuming task. A hard copy of the report would need to go through a number of people and processes in order for it to get from the storage of one office to the office or institution in need. Not only does this waste valuable time, it also increases the likelihood of human error.
These risks are eliminated with EHRs. No longer is there a need for filing, paperwork or physical transportation – the data is remotely available at all times. As a result, hospitals are able to allocate time, space, and funding much more adequately due to massive reductions in physical storage and labor necessities. The accessibility difference between traditional health records and Electronic Health Records is almost incomparable. Physicians can now securely access a patient’s file in a matter of seconds.
With EHRs, the files themselves are also much more organized and regulated than the traditional alternative. A typical patient visits a number of different doctors for a variety of reasons. Each occasion leads to new information that needed to be added or updated in that patients file. Doctors often need to communicate with one another in regards to a patient’s health history in order to properly update a health record. With such little free time, getting in contact with another doctor to discuss a patient has never been the quickest or smoothest process. The complications of having so many separate individuals adding to a patient’s health record tends to lead to further confusion. It is a very unsystematic approach that leads to costly mistakes far too often. EHRs, on the other hand, significantly improve the coordination and organization of a patient’s health record. As HealthIT.gov puts it, “EHR systems can decrease the fragmentation of care by improving care coordination. EHRs have the potential to integrate and organize patient health information and facilitate its instant distribution among all authorized providers involved in a patient’s care. For example, EHR alerts can be used to notify providers when a patient has been in the hospital, allowing them to proactively follow up with the patient.”
EHRs also present far fewer communication barriers with both patients and other healthcare professionals. Most EHR systems boast a two-way communication tool for doctors and patients that acts as an integrated EHR text messaging system. Several EHRs are also expanding their spectrum through apps and tablets that give patients access to their own medical records – something doctors urge patients to take advantage of. A recent Accenture survey shows that 82% of U.S. doctors want patients to actively participate in their own healthcare by updating their electronic health records. A patient who is aware of their health history makes it that much easier for them to communicate with their doctor.
The efficiency EHRs provide also generates more time that doctors can spend working directly with patients. According to Soliant Health, the average doctor spends 8 hours a week on paperwork. This means that 336,336,000 hours per year are spent on administration rather than patient care in the U.S. alone. With EHRs however, nurses are able to spend 15-25% more time monitoring patients. EHR systems maximize the amount of time that can be spent with patients by minimizing the time needed to complete paperwork. Efficiency and accessibility are two fundamental elements in an industry like healthcare where errors can be fatal.
There are certain professions where wrong decisions do not lead to severe consequences – healthcare is not one of them. Doctors do not always have the luxury of fixing their mistakes or righting their wrongs. A slight misinterpretation or miscalculation can be deadly. The decisions made on a daily basis are often the difference between life and death. Doctors depend on the information in a patient’s health record to be able to fully recognize and address all aspects of the situation. Needless to say, it is crucial for the information at hand to be entirely accurate in order for the correct decision to be made.
Medical errors are the third-leading cause of death in the America, trailing only heart disease and cancer. A 2013 Journal of Patient Safety study claimed there are up to 400,000 preventable deaths in America each year due to medical errors. That’s more than the amount of deaths due to car accidents, AIDS, Alzheimer’s, and Diabetes combined. In the Journal of Patient Safety study, author John T. James ends his report with this powerful conclusion:
“It does not matter whether the deaths of 100,000, 200,000, or 400,000 Americans each year are associated with PAEs (preventable adverse events) in hospitals. Any of the estimates demands assertive action on the part of providers, legislators, and people who will one day become patients. Yet, the action and progress on patient safety is frustratingly slow; however, one must hope that the present, evidence-based estimate of 400,000+ deaths per year will foster an outcry for overdue changes and increased vigilance in medical care to address the problem of harm to patients who come to a hospital seeking only to be healed.”
EHRs have proven to be one of those assertive actions that James solicits. According to the Soliant article listed above, hospitals using EHR systems have a 3-4% lower mortality rate than those that don’t. From a broad perspective this may not seem like much, but this shows that thousands of lives can be saved each year in the U.S. alone simply by implementing EHRs in all hospitals.
The ability for EHRs to lead to more accurate decisions is a result of the efficiency and accessibility advantages mentioned earlier. A successful operation relies on a precise diagnosis, which depends on an accurate health record. Most EHRs also feature additional built-in functionalities designed to reduce unintentional mistakes and raise red flags when something seems incorrect. For instance, several include electronic prescribing (e-prescribing) capabilities, which allow doctors to electronically send prescriptions to patients quickly and accurately.
Electronic health records are not the quintessential solution to reducing medical errors. However, they are certainly a step in the right direction. EHRs provide more organized, secure, and precise information to help doctors make better data-driven decisions about a patient’s health. This increased accuracy is a major component of the underlying goal James covets in his conclusion – which also happens to be the fourth and final level of the overall benefits of Electronic Health Records.
The fourth phase of the funnel is not as much of a step in the process as it is the ultimate goal of each previous level. This isn’t about saving time or money; it’s about providing patients with better care. Yes, you should turn to EHRs because they can save you money. Yes, you should turn to EHRs because they are more efficient and accessible. Yes, you should turn to EHRs because they result in more accurate decisions. But most importantly, you should turn to EHRs because they make healthcare better.
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