Need for Improved Efficiency and Productivity
The goal is to have patient information available to anyone who needs it, when they need it and where they need it. With an EHR, lab results can be retrieved much more rapidly, thus saving time and money. It should be pointed out however, that reducing duplicated tests benefits the payers and patients and not clinicians so there is a misalignment of incentives. Moreover, an early study using computerized order entry showed that simply displaying past results reduced duplication and the cost of testing by only 13%. If lab or x-ray results are frequently missing, the implication is that they need to be repeated which adds to this country’s staggering healthcare bill. The same could be said for duplicate prescriptions. It is estimated that 31% of the United States $2.3 trillion dollar healthcare bill is for administration.EHRs are more efficient because they reduce redundant paperwork and have the capability of interfacing with a billing program that submits claims electronically. Consider what it takes to simply get the results of a lab test back to a patient using the old system. This might involve a front office clerk, a nurse and a physician. The end result is frequently placing the patient on hold or playing telephone tag. With an EHR, lab results can be forwarded via secure messaging or available for viewing via a portal. Electronic health records can help with productivity if templates are used judiciously. As noted, they allow for point and click histories and physical exams that in some cases may save time. Embedded clinical decision support is one of the newest features of a comprehensive EHR. Clinical practice guidelines, linked educational content and patient handouts can be part of the EHR. This may permit finding the answer to a medical question while the patient is still in the exam room. Several EHR companies also offer a centralized area for all physician approvals and signatures of lab work, prescriptions, etc. This should improve work flow by avoiding the need to pull multiple charts or enter multiple EHR modules.
Quality of Care and Patient Safety
As previously suggested, Electronic Health Records improve patient safety through many mechanisms:
(1) Improved legibility of clinical notes.
(2) Improved access anytime and anywhere
(3) Reduced duplication
(4) Reminders that tests or preventive services are overdue
(5) Clinical decision support that reminds clinicians about patient allergies, correct dosage of drugs, etc.
(6) Electronic problem summary lists provide diagnoses, allergies and surgeries at a glance.
The ability to receive information and respond to it quickly is vital. Based on internal data Kaiser Permanente determined that the drug Vioxx had an increased risk of cardiovascular events before that information was published based on its own internal data.Similarly, within 90 minutes of learning of the withdrawal of Vioxx from the market, the Cleveland Clinic queried its EHR to see which patients were on the drug. Within seven hours they deactivated prescriptions and notified clinicians via e-mail.
Quality reports are far easier to generate with an EHR compared to a paper chart that requires a chart review. Quality reports can also be generated from a data warehouse or health information organization that receives data from an EHR and other sources.Quality reports are the backbone for healthcare reform which are discussed further in another chapter.