How Can Hospitals Make the Most of Their EMRs?

Laurie Saloman
APRIL 19, 2018

A decade ago, a visit to an emergency department looked very different than it does today. A patient complaining of a migraine would have been triaged by a nurse who jotted notes by hand. The records would have been physically passed from nurse to doctor or faxed from one department to another. The patient might have been automatically sent for a CT scan, as staffers would not know that one had been performed elsewhere a few weeks earlier. Even if the patient said as much, the hospital staff could not have accessed the results. The doctor also might have discharged the patient with a prescription—without knowing what other medications the patient might be taking and whether there was a risk of drug interactions.

Thanks to the near-universal adoption of electronic medical records (EMRs), the landscape has changed dramatically in the past 10 years. According to the Office of the National Coordinator for Health Information Technology, before 2009, most doctors’ offices, hospitals, and other healthcare organizations used paper-based data entry systems and relied on fax machines to transmit information. At least 87% of physicians’ offices now use EMRs compared with just 42% in 2008, and more than 95% of hospitals eligible for Medicare and Medicaid’s Electronic Health Records Incentive Programs, which were created to encourage the adoption and use of EMR technology, rely on the technology.

Today, upon arrival, a patient’s data enter the hospital’s files electronically. In theory, notes from previous medical visits appear, along with tests, existing medical conditions, and prescribed drugs. Information can be shared instantly among clinicians.

Stumbling Blocks

Love them or hate them, many healthcare facilities and physicians’ offices could be doing a better job of using EMR systems to their full potential. There’s no doubt that certain barriers and obstacles must be addressed by vendors and users to make the experience a much smoother, more productive one.

“There is absolutely a lot of frustration with EMRs,” Peter Winkelstein, MD, MS, MBA, FAAP, chief medical informatics officer for UBMD and Kaleida Health, both Buffalo, New York-based healthcare providers, told Healthcare Analytics News™. “There is a perception among physicians that EMRs have reduced the efficiency of healthcare delivery.” Although that might not be true for all healthcare professionals, if enough people on the front lines of medicine perceive EMRs as a barrier to quality care rather than an enabler of it, that indicates a persistent problem.

One thing that can make an EMR cumbersome is that it involves a lot of clicks. “Physicians like to count clicks,” said Winkelstein, highlighting the fact that time-pressed doctors and nurses are likely to find onerous any system that involves dealing with multiple steps. Another stumbling block is an EMR’s lack of interoperability, according to Levin. “The ability to share information between, and across, EMR systems remains a huge problem and one of the biggest barriers to success and innovation,” he said. “For example, many people are surprised to learn that moving data between 2 instances of the same brand of EMR is difficult.” A hospital that uses multiple EMR brands can find the ability to share information severely compromised.

With all of this potential sharing of information at the click of a mouse, what about patient privacy? The Department of Health & Human Services’ Office for Civil Rights suggests that hospitals and doctors’ offices use passwords and PINs to ensure that only authorized employees have access to the system and recommends that stored data be encrypted and accessible only with an electronic key. EMR systems also should feature the ability to track who accesses medical records, when the records are accessed, and what changes, if any, are made.

Cost Concerns

Investing in EMR technology means shelling out big bucks. If staff aren’t adept at leveraging all of an EMR’s features, or using the system at all, it can feel like an expensive waste. But some healthcare providers recognize that time saved is money in the bank. 

When Utah-based Intermountain Healthcare recently purchased an EMR system, the cost was on the decision-makers’ minds, said Stanley M. Huff, MD, clinical professor of biomedical informatics at the University of Utah and chief medical informatics officer at Intermountain. Similar to the actions of hospital executives, Intermountain accepted reimbursements available through the government’s Medicare and Medicaid Electronic Health Records Incentive Programs, totaling about $28 million in a year.

However, Huff said that the restraints of that incentive payment, such as the requirement that physicians personally interact with the EMR system instead of outsourcing the job to other clinicians or support staff, have proven onerous and time-consuming. If Intermountain could go back in time, Huff said, the company likely would not have accepted the government payments.

By analyzing the time saved on numerous tasks, Charlotte, North Carolina-based Atrium Health has been able to put a number on the value of its EMR system. Last year, it reported that nurses reduced the time it takes them to assess and document patients by 20%, or 35,000 working hours. The company also has seen its on-time medication administration rise by 14%. And by implementing a variety of new screening tools in the EMR, the quality of patient assessments has improved enough that Atrium is saving $60,000 a year in third-party costs.

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