Langlade Memorial Hospital

 

 

 

Electronic Health Record, the Next Step in Patient Safety and Convenience

 

 

Presented by Jennifer Miller and Pat Tincher

 

December 10, 2004


Executive Summary

 

The business of health care is constantly changing, with information technology being a significant factor in this change.  We are now at a point where continuous cost management, patient safety, and consumer driven health care are paramount to our success.  While we are able to provide quality patient care and excellent outcomes, we need to take the next step.  This involves a significant financial and human resource investment, involving our patient care staff, physicians and significant IT resources.  This next step is the electronic health record(EHR). 

 

As described in the following pages, the EHR will allow us to electronically document all activity regarding a patient’s visit, as well as having physicians provide orders electronically.  Depending on security levels, this information can be shared with providers across the country.  It will also allow us to provide our patients with an electronic health record that contains all of the relevant information regarding their treatment.

 

This relatively new technology will also provide us the ability to evaluate trends and activities on a real-time basis and provide information that currently takes significant review to obtain.  While it may appear that we have a choice in this technology today, the Federal Government and the JCAHO have set goals for universal implementation of the electronic health record.

 

This technology will also aid in reducing medical costs, as physicians who treat our patient after they visit us will be able to review the electronic records and possibly reduce the amount of testing that they would normally do, thus saving the patient money and providing more timely, accurate medical advice.  While there will be cost savings to implementing this technology, these savings will be primarily realized by the patient and the insurance company, as there should be less diagnostic testing performed and improved treatments.

 

Besides the electronic health record and the data repository that will be necessary, we will also need to consider additional technologies to include computerized physician order entry and digital imaging(PACS) for radiology exams.  These technologies will provide us with state-of-the-art information technology that will support us and our patients for the foreseeable future.

 

These technologies will not come without significant costs, both financially and in personnel, but they are necessary to provide our patients with the utmost in safety, convenience and cost effective care.  Due to this, we will also want to make sure that we have the appropriate individuals, including physicians, clinicians and IT staff involved in the evaluation, decision making and implementation of this technology.

 

 

 

 

 

Health Care Industry

 

The health care industry includes several different disciplines, with hospitals, physicians, nursing homes and home care services being some of the primary providers.  In total, there are approximately 5,000 hospitals, 690,000 physicians, 6,000 nursing homes, and 7,500 home health care providers.  In addition, there are a wide variety of other providers, including outpatient surgery and imaging centers, durable medical equipment providers, and pharmacies.  In the industry, there is a significant deviance in the size of organizations, with large systems that may have upwards of 100 hospitals, 1,000 physicians, and other health care services being the extremely large providers.  At the same time, there are providers who operate a single company, whether it be a hospital, nursing home, or a physician office.  The information systems utilized in these organizations are as diverse as the size of the organizations, with some organizations being essentially paperless, while some organizations provide only manual billing and outsourcing the majority of their backoffice functions.

 

Industry Opportunity

 

With this wide diversity, there are significant issues in the communication of medical information, its accuracy and the overall safety of the patient. The communication issue includes:

 

1.                              Timeliness

2.                              Completeness

3.                              Portability

 

With our current paper-based medical record system, each provider has only their portion of the medical record for the services that they provide for the patient.  These records are unavailable to other providers, unless the patient requests that the records be released to that specific provider.  These requests take time and, if several providers are involved, requests need to be made to each provider.

 

The concerns with accuracy relate to the manualness of the paper record.  Whether it is a note provided by a physician or a nurse, or a prescription being ordered for a patient, handwritten notes have significant error possibilities.  This can impact the patient in a negative way, as evidenced by the Institute of Medicine research that indicates that 7,400 Americans died from medication errors in 1993(Jonietz, Erika). 

 

The Answer

 

An emerging information technology that may address these issues is the electronic medical record.  While it was developed in the late 1970’s(Advisory Board, 1999), it has been implemented in a relatively small number of organizations.  Concerns with cost, physician acceptance and the lack of a universal language delayed widespread implementation of electronic medical record systems.

 

The need for improved accuracy, patient safety, convenience and a national focus on health care information have been the primary reasons for the increase in popularity of these systems.

 

 

 

The Technology

 

The technological requirements include hardware, software, a well organized infrastructure, top-rate security features and proper training to use the new technology. 

 

The hardware would include all computer and workstation equipment and servers.  These computers will include wireless technology options, to include PDA’s, laptops, and Tablet PC’s. 

 

There are many different software options being developed by different vendors.  Some programs offer single resources for specific departments such as billing or scheduling.  Other programs include all departments to create an integrated system.  Other value adding programs allow for more functionality to a currently running system, such as a program that condenses a patient’s record and creates a master page. 

 

The infrastructure is one of the most important components to the technological side of EHR’s, since that creates the ability to communicate across departments and from different locations in the U.S.  Some may choose to create a fully integrated system within their facility.  Others may choose to outsource the infrastructure requirements.  One option is to choose an internet-based service.   The patient’s information is saved on the contractor’s server and is accessed via the internet.  This option helps to eliminate set-up and maintenance expenses, as well as the significant upfront hardware costs.

 

Security features are essential to a successful EHR system.  Complying with HIPAA requires extensive security measures to protect patient’s rights.  Tools often used to increase security are encryption, authentication and Extensible Markup Language (XML).  XML is a useful way to create the health record, because it is an open format that doesn’t tie the information to a proprietary system.  This will make it easier for the data to be easily transferred to other systems with accuracy.    The U.S. Department of Health and Human Services(HHS) is working with HIPAA to create specific guidelines for EHR systems.  This will make it easier for system designers to ensure that all federal regulations are being followed. 

 

Once the system is chosen and implemented, extensive training needs to take place to ensure that all users understand how the system works.  With the EHR system being such a huge investment, proper training is critical to increasing ROI.   Planning and training are key components of a successful installation and long-term viability of the system.

 

 

Strengths and Limitations to Technology

 

The HHS goal is an EHR system being implemented across the country with in the next 10 years.  They have worked with the College of American Pathologists in Northfield IL to create a medical terminology database, which includes uniform terminology and 340,000 medical concepts. (Brewin, 2003)  The plan is to provide this database at no charge.  They have also asked the National Academy of Sciences in Washington to design a model patient record, which they will also offer at no charge.  They are current converting all the database files into an electronic meta-thesaurus to distribute to system developers.  Rep. Patrick Kennedy (D-R.I) introduced a bill that would provide $5 billion to fund health care IT from 2005 to 2008.  Half of that amount would be allocated to development of information exchanges. ( Brewin, 2004)  All of these efforts are aimed towards the government’s goal of making a common health information infrastructure for a nationwide network.  The database and model health record will be the basis for successful implementation of an individual EHR system. 

 

Another major strength of the EHR system is that electronic records are actually more secure than paper records, since there is an audit trail left behind to track all that view a patient’s record.  Paper records can be more easily lost, can have missing information that needs to be researched on other documents and can be illegible.  An EHR system would solve those problems and also would allow reminders to automatically pop up to ensure proper follow up care.  It also allows for more quality control efforts, since all data is in one place.  Metrics can be established to ensure that procedures are being followed across departments or at different facilities.  While electronic records may be more secure than paper records, any of these systems will also be exposed, especially those utilizing the internet, to attacks and unauthorized access.  Vigilance and common sense, with regards to security will be the core safeguards for making the internet safe for health data (Goedert, 2004).  The Health Insurance Portability and Accountability Act provide the standards for health organizations to utilize in protecting the privacy, security and integrity of health information.  These standards will need to be understood and implemented as part of the implementation of the HER.

 

There are many limitations to the technology that revolves around the EHR system.  Currently only 5% of U.S. hospitals have fully integrated EHR systems. (Abrahamsen, 2003)  One major problem hospitals are having is not being able to integrate various applications, because they are not compatible.  As a result, records are kept in electronic and paper form, which is not saving time or money.  Fragmented data entry also leads to higher errors. 

 

Another limitation is the huge price tag attached to implementing these systems.  Mike Kappel, senior vice president of strategic planning at McKesson Corp (a pharmaceutical distributor and health care IT provider), predicts the cost of developing a national EHR system could cost up to $10 billion. The federal government has only budgeted $50 million this fiscal year and $100 million next year for health care IT. (Berwin, 2004)  This means most of the cost will fall on doctors and hospitals.

 

The commitment to change over from paper to electronic records requires time.  In small clinic settings, doctors may not be able to give the proper amount of time with out sacrificing patient care.   The high costs may be seen as more useful to invest in other technologies, because they will see a faster rate of return. 

 

Additional limitations are the buy-in of all necessary partners.  This is especially true of physicians, who may see the EHR as a time wasting task and will need to be part of the process on the front-end, so they will be able to understand the purpose behind the EHR and will be able to be part of the selection process and actively promote it.  An excellent example of this is a the Marshfield Clinic, where a small number of participants evaluated Tablet PC’s to be utilized for point-of-care computing in October, 2002.  Within a year, formal testing began, and in July, 2004, the process of distributing the PC’s began, with 50 clinicians receiving their PC’s.  The Clinic is distributing 30 Tablet PC’s per week through 2006, until roughly 2,000 physicians, physician assistants, nurses, and other are equipped.  While not all physicians are necessarily ecstatic about the change, they are now able to wirelessly connect to the EHR, find historical data, update a patient’s chart, write electronic prescriptions, and even show a patient and parents an X-ray.(Goedert, 2004).

 

To deal with these limitations, a clearly thought out plan needs to be established.  This plan needs to include the following points; how to decide what system will best fit current and future needs, who to involve in the process, how will the installation take place, and how training will take place.  Some recommendations include installing a system in increments to ensure that each piece of the puzzle is fully integrated and everyone is fully trained.  This breaks the big project into more manageable pieces.  Since EHR’s require large hardware, software and training investments it is critical that the plan includes clear management of the process, to ensure that there is the possibility of ROI. 

 

Other things to take into consideration when choosing an EHR system include how the product is licensed.  Licensing is usually offered through unlimited usage per facility at one price or a specific charge per user.  It is also important to look at the technical support the vendor can provide.  Questions to ask are what kind of technical support is available, when is it available and who will be providing it.  Sometimes the technical support is included in the usage fees, but more extensive support is usually offered at an extra cost. 

 

Industry Impacts

 

The biggest impact will be the cost savings across the board.  Health and Human Services secretary Tommy Thompson predicts that a nationwide EHR system could lower the country’s annual health care bill of $1.7 trillion dollars by 10%(Brewin, 2004).  The use of electronic health records in the U.S. health care industry will allow care-givers from multiple locations to view the same exact data.  This will improve patient care through more uniform diagnoses.  It will also speed up the health care process, since a doctor does not have to wait for a fax or mailing of a patient’s records from another doctor.  There will also be cost savings with the reduction of repeat tests and procedures due to lack of full patient information.  This will also cut costs of copying, faxing and storage of medical records.   There will be increased efficiency in creating, reading and accessing patient’s records.  The integration with departments from billing to scheduling will reduce labor hours needed and increase revenues.  Many insurance companies are willing to give 5 to 10% discounts to EHR system users. 

 

A second impact is the ability to utilize patient information in researching how to improve the health care that is being provided.  Medical records can be identified via I.D. numbers, and eliminating any personal information.  This will allow researchers to track patients with certain ailments across a period of time at different locations with in the U.S.  Doctors can utilize this system to learn how doctors across the country are dealing with certain ailments, to provide better health care advice for their own patients. 

 

Recommendations

 

While there may be some rationale to delaying implementation of the EHR system, in the interest of patient safety, clinical efficiency and improvements in quality of care, we recommend that Langlade Memorial Hospital move forward with the evaluation of an electronic health record, and the related technologies of computerized physician order entry, digital imaging and a data repository.  These technologies are vital to our long-term goals and will provide for improved patient care and satisfaction.

 

Additionally, the EHR system has the potential to create major costs savings across the health industry.  Our early entry into this system will give us the time and experience to fully utilize this system when the nationwide system is in place.  Early entry will also allow us to take adequate time to plan and implement this system.  Our ability to see a return on investment will increase if we have a clear plan for management of the process.  Our patients will see the results of this investment of money, time and effort.

 

A team approach is necessary in implementing this, to include the clinicians, physicians, IT staff and others who may be impacted by this technology.  It may also be wise to include our partners, including physicians and area hospitals, to determine if there are opportunities to implement a single solution that will work for all.

 

The team designated to head up this challenge needs to closely follow the HHS recommendations.  Their database of terminology and model patient record will help to ensure that our system’s infrastructure is fully compatible to nationwide system.  Following their recommendations will also open the door to financial help from the limited government grants.  Outsourcing our infrastructure is the optimal choice for us, since we can eliminate the set-up and maintenance costs.  Our criteria should include the expectation that this service provider follows HHS and HIPAA recommendations and guidelines.  They need to provide extensive training and technical support.  The extra costs will increase our ability to fully integrate and utilize the EHR system. 

 

While we are not prepared to provide an estimate of the financial ramifications of this proposal, we expect that the total cost will be at least $2 million for a facility our size.


Bibliography

 

 

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