Running head: ELECTRONIC HEALTH RECORD: 98,000 REASONS

Electronic Health Record: 98,000 Reasons to Invest in Technology George P. Brown Southwest Medical Group

ELECTRONIC HEALTH RECORD: 98,000 REASONS

Table of Contents I. II. III. IV. V. VI. VII. Executive Summary ...............................................................................................................3 Introduction ............................................................................................................................4 Improving Quality of Care .....................................................................................................5 Creating Workflow Efficiencies ............................................................................................7 Reducing Costs and Increasing ROI ......................................................................................7 Conclusion .............................................................................................................................8 References ..............................................................................................................................9

ELECTRONIC HEALTH RECORD: 98,000 REASONS Executive Summary Electronic Health Records (EHRs) lead to standard of care improvements that save thousands of lives every year. The EHR provides a systematic way of storing and sharing data related to the healthcare of a major population. The data stored in electronic format consists of various kinds of medical records like personal information, lab reports, vital signs, medical history, medication and allergies, immunization status and billing information. This data is also useful for processing information such as billing and settlement claims. These systems are usually connected to a central database that stores personal information of a community population. As seen in the following chart, EHRs have been implemented in less than half of most physician specialties (Centers for Disease Control and Prevention, 2012). Figure 1. EHR Systems That Meet Federal Standards

EHRs undoubtedly have great value when properly executed. They create workflow efficiencies that save time, money, and ultimately lead to increased patient satisfaction. While upfront capital costs can be significant and organizational change challenging, investing in EHR technology will lead to significant increased quality and profitability at Southwest Medical Group in the coming years.

ELECTRONIC HEALTH RECORD: 98,000 REASONS Electronic Health Record: 98,000 Reasons to Invest in Technology Healthcare affects all of us in a very personal way. A 2001 report by the Institute of Medicine stated there are 98,000 preventable deaths due to medication errors annually (Halamka, 2006). EHRs contain a number of features that work together to at least minimize, but with the goal of eliminating harmful medication errors. President Bush said in his 2006 State of the Union address that the United States will make wider use of electronic records and other health information technology, to help control costs and reduce dangerous medical errors (Bush, 2006). Since then, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, and the healthcare industry has raced to implement an IT infrastructure to comply with the laws mandates. There are numerous, well documented examples, of the qualitative and quantitative benefits derived from implementing an EHR. Health organizations, both small and large, have realized quality improvements, maximized workflow best practices, and cost benefits. This paper will show that Southwest Medical Group should invest in an EHR system to ensure compliance with federal law, increase profits, and ensure better health engagements and outcomes for our patients. The Health Information and Management Systems Society (HIMSS) is a global nonprofit focused on optimizing healthcare through information technology. They have collected data from more than 500 health organizations that have implemented an EHR and summarized the information in a value matrix as shown in Figure 1 (HIMSS, 2013). In their studies, HIMSS (2013) showed approximately 85% of cases reporting improved safety, quality of care, or gained efficiencies and 65% reported positive ROI.

ELECTRONIC HEALTH RECORD: 98,000 REASONS Figure 2. Health IT Value Matrix

Improving Quality of Care Quality standards of care are the basis for a successful healthcare organization and optimizing patient encounters. Many people see numerous health care providers over the course of their lifetime, and a comprehensive EHR contains all-inclusive details of those encounters. These systems ensure that all diagnoses including reports, test results, medications, and allergies are available so the physician can make informed decisions regarding a patients current medical condition. Secondly, EHRs contain decision support capabilities that perform quality and safety checks to ensure the patient is getting the correct medication dose and prevent harmful drug to drug reaction by comparing the ingredients of all drugs patient is taking.

ELECTRONIC HEALTH RECORD: 98,000 REASONS

EHRs ensure coordination of care because all primary caregivers and specialists can view a common record of patients entire healthcare experience, including inpatient, outpatient, and emergency care. This ensures that all prescribing is done in the context of the entirety of care for a patient, and not in isolation by a particular specialist trying to solve a particular problem (Halamka, 2006).

The positive effects on quality improvement after EHR implementation are well documented as follows (Wise, 2013): Mount Sinai Medical Center (MSMC) and NorthShore University Health System reduced medical errors by 80% Childrens Hospital Chicago saw a 50% decrease in serious medical errors Jeremy L. Bradley Family Practice Clinic eliminated medical error by virtually 100%

Considering that approximately 100,000 people die annually from preventable medication errors, one can surmise from the studies cited above that the EHR saves thousands of lives every year. In the past year alone, Southwest Medical Group investigated 27 patient encounters involving medication errors. All but 6 were deemed preventable by the investigating authority. These costly mistakes reduce profits, and more importantly, damage the trust between our patients and their providers. A Computerized Physician Order Entry (CPOE) system is a key part of an EHR system that allows a health provider to enter treatment information electronically into a computer. For example, when a doctor prescribes a medication the CPOE checks the EHR patient history to ensure the medication will not be harmful to the patient, verifies dosing information, and rapidly sends the request to the pharmacy. This advanced technology will lead to increased patient satisfaction, improved safety, and mitigate litigation risk.

ELECTRONIC HEALTH RECORD: 98,000 REASONS Creating Workflow Efficiencies Workflow efficiencies such as elimination of chart search time, standardized order sets, and reduced variation in clinical practices are helping to boost morale of healthcare workers and increasing patient satisfaction. Many different business factors are influencing organizations to push their clinicians to see more patients. The increase in patient volume brings added difficulty of tracking and monitoring patient data. EHRs include the capability to give healthcare providers notifications, alerts, and reminders that enhance and focus patient care coordination. For example, abnormal test results can be immediately sent electronically to the primary caregiver, ensuring the patient receives prompt care for their condition. Another piece of the EHR is the ability for the patient to view some or all of their record, make appointments, and renew medication prescriptions. This added level of patient involvement has led to significant increases in patient satisfaction by improving patient/provider/staff communication. Reducing Costs and Increasing ROI Southwest Medical Groups competitors are experiencing financial improvements derived from deploying an EHR system, which is posturing them for strong future growth. MSMC saved $12.2M in medical record supplies and management, reduced transcription costs $5.6M, and increased average monthly collections by $27M from 2007-2011(Wise, 2013). Massachusetts is projecting an annual savings of $4.5 billion by setting up workflows in their state EHR that will eliminate redundant care (Halamka, 2006). Many organizations have set up standardized prescription formularies in their EHR and CPOE that have reduced bad patient outcomes, and ultimately lowered malpractice insurance premiums. Beth Israel Deaconess Medical center collaborated with Blue Cross/Blue Shield and realized a 10% drug reduction cost compared to the national average (Halamka, 2006). NorthShore University Health System saves

ELECTRONIC HEALTH RECORD: 98,000 REASONS $7 million annually from computer-based microbial monitoring, $40 million from automation of basic EMR functions, $1.5 million annually from documentation for IHI reporting of invasive line placements, and $1.8 million savings the first year due to backend speech recognition Efficiency Improvement (Wise, 2013). The Southwest Medical Group financial office has estimated a minimum increase of $1.2M in future free cash flows, even with the deployment of a basic EHR. Conclusion My research has shown there are many factors to be considered when implementing an EHR system. There are many challenges, but the opportunity potential outweighs the risk. EHRs reduce costs, enhance workflow, and improve quality of patient care. They also create an environment of partnership between healthcare entities that leads to shared knowledge and industry best practices. Regardless of the capital investment amount, there are many scalable EHR solutions to consider. I recommend the Executive Committee commission a committee to conduct a business case analysis on deploying an EHR at Southwest Medical Group.

ELECTRONIC HEALTH RECORD: 98,000 REASONS References BIDMC Stats and Facts. (2012). Retrieved January 21, 2014, from Beth Israel Deaconess Medical Center: http://www.bidmc.org/About-BIDMC/Stats-and-Facts.aspx Bush, G. W. (2006, February 1). State of the Union Address. Retrieved January 21, 2014, from PBS: http://www.pbs.org/newshour/bb/white_house/jan-june06/bush_01-31.html Centers for Disease Control and Prevention. (2012, September 7). Percentage of Physicians with Electronic Health Record (EHR) Systems That Meet Federal Standards. Retrieved January 20, 2014, from Centers for Disease Control and Prevention: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6135a4.htm Halamka, J. (2006). The Perfect Storm for Electronic Health Records. Journal of Healthcare Information Management, 25-27. plus.com/FileDownloads/HIMSS%20Interoperability%20Definition%20FINAL.pdf HIMSS. (2013, July 13). The HIMSS Health IT Value Suite. Retrieved January 22, 2014, from HIMSS: http://www.himss.org/files/HIMSS%20Health%20IT%20Value%20Suite%20Executive %20final.pdf Wise, P. (2013, February 2013). THE EHR: Providing Exceptional Value. Retrieved January 21, 2014, from HIMSS: http://www.himss.org/ResourceLibrary/ResourceDetail.aspx?ItemNumber=17246