By Matthew Kopetsky
In the 1-19-11 Time Magazine article, “Are Electronic Health Systems Cost Effective? Not So Much,” Alice Park provides a slew of reasons why not to jump on the Electronic Health Record (EHR) bandwagon. Park references 53 EHR reviews conducted by Dr. Aziz Sheikh at the University of Edinburgh which supposedly provide “little or weak evidence to support the massive investment that policy makers have made in electronic systems such as electronic health records” and rather supports home-grown health record technology.
Articles such as these can be scary news to healthcare consumers amid a federal stimulus package investing $19.2 billion in EHR implementation. I wonder sometimes, however, if hospitals and physicians hear enough of the right reasons to implement an expensive EHR system. While the long-term benefits of EHRs (continuity of care and universal web-based access to personal health records) may be years away, many short term benefits can be achieved by emphasizing the following.
- Ensure electronic documentation is an efficiency gain, not an excuse – Many schools today give Doctors and Nurses a head start in improved EHR use by exposing students to numerous systems throughout their education. These individuals, along with other experienced EHR users should be identified early in EHR implementations as project champions. While conducting time studies of Emergency Department Residents during my first healthcare process improvement internship, I observed that one Resident, who was very comfortable taking notes directly in the EHR system while interacting with patients, spent 60% more time interacting with patients than another resident who documented each patient encounter back at a desk. We then leveraged this Resident to provide training on how to more effectively use the EHR system.
- Utilize available reporting packages – One of my first employers utilized the ease of EHR reporting to track various metrics in an effort to quantify quality of care resulting from the EHR implementation. Some of these metrics included charge capture accuracy, provider compliance with patient care plans, medication administration errors, accuracy of patient weights and allergies in the system, pharmacist interventions and documentation time, and the cycle time of pharmacy/lab orders. These quality and improvement metrics were then celebrated by the organization and helped the staff to better understand the intended role that our newly formed Process Improvement office should have in their future improvement initiatives. This was also a great first step in moving towards data driven decision making and evidence based care.
- Notation quality above all else – Throughout the implementation phase, efficiency gains may not immediately be realized, but notation quality should be the expectation from the start. If you’ve ever tried deciphering a Doctor’s handwriting, you already realize the importance of poka-yoking orders via Computerized Physician Order Entry (CPOE). Standardization through documentation and work templates are also crucial during the initial instability of an EHR implementation. In addition to the above metrics, establishing quality related metrics to track the effectiveness of the change, such as reduction in the use of unapproved abbreviations, time spent transcribing physicians’ dictations/notes, or the need for clarification of orders, can further help the organization to rally around the change and support future process improvement initiatives.
Quantifying the exact ROI of an enormous EHR investment may be a monumental task but is it really as important as Park suggests? As one reader of the Time Magazine article commented, “I have never bothered to do a cost/benefit analysis on my computer vs a typewriter and paper, or wondered for even a split second whether my Internet connection was worth the $30 or so a month that I spend on it.”