Electronic Health Record

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Electronic Health Record

• What is in it for you?

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For 8 minutes the computer and I were both
functional today Randy Glasbergen
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Worried?

• Dr. Sattenspiel
• "If we go to a system like this and begin to
  implement it, we may not be drowning in paper
  every day, but if we cant get enough work
  doneif we cant see enough patients in a
  reasonable amount of time to be able to generate
  the revenues that will support our officethen
  that could be a disaster."

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Central Concerns

• More effort same output
• Interferes with patient time
• Reduces quality of care

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Other Concerns

• Pay for performance
• Anti-trust legal barriers
• Privacy and security obligations
• Liability exposure
• Lack of interoperability

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Other Concerns

• Pay for performance
• Anti-trust legal barriers
• Privacy and security obligations
• Liability exposure
• Lack of interoperability

Lets focus on central problems that physicians
express
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Worried about Effort

• What if we have to maintain both paper and
  computer records?

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We back up our data on sticky notes because they
do not crash Randy Glasbergen
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Worried about Effort

• Will it let me do what I am doing?
• Do I have to spend more time at it?
• I am not a typist
• Will I have to redo
• Is it fast?

Time saved because records are available on
demand or remotely
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Worried about Effort

• Will it let me do what I am doing?
• Do I have to spend more time at it?
• I am not a typist
• Will I have to redo
• Is it fast?

How much more time will it take?
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More Hype than Reality

• 1994 Twice as long
• 2001 5 more time
• 2006 No difference

Time Motion Studies of House Staff Physician
Offices
Bates DW, Boyle DL, Teich JM. Impact of
computerized physician order entry on physician
time. Proc Annu Symp Comput Appl Med Care.
1994996. Shu K, Boyle D, Spurr C, Horsky J,
Heiman H, O'Connor P, Lepore J, Bates DW.
Comparison of time spent writing orders on paper
with computerized physician order entry.
Medinfo. 200110(Pt 2)1207-11. Lo H, Newmark LP,
Yoon C, Volk LA, Carlson V, Kittler A, Lippincott
M, Wang T, Bates DW. The electronic health
record in specialty care A Time motion study.
AMIA Annu Symp Proc. 2006 Nov 112006(CD)1014.
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The Entire Industry is Changing

• The 2005 CMS / Mathematica Hospital survey
• 83 used electronic lab results
• 59 used electronic clinical notes
• 50 had electronic images and lab orders
• 24 used electronic reminders
• 21 used e-prescribing

What about CPOE?
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Use of Computerized Physician Order Entry in
Hospitals
Goal
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Use of Computerized Physician Order Entry in
Hospitals
In some areas,80 of Urban Hospitals Use CPOE
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Satisfaction with Order Entry
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Impact on Quality

• Much more complex than first imagined

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Long Term Impact Expected

• Reduced medication errors
• Reduced adverse sentinel events
• Reduced liability better reliance on guidelines
• Reduced waste and duplicate testing

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Reduced Duplicate Test

• There is delay in information flow from hospital
  to general practice
• Remote access could reduce the delay

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Less Medication Errors

• Improves fidelity of exchanges among physicians,
  pharmacists and nurses

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Quality Less Errors

• Improves fidelity of exchanges among physicians,
  pharmacists and nurses

5 months after CPOE
Before CPOE
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Less Medication Errors

• Improves fidelity of exchanges among physicians,
  pharmacists and nurses

5 months after CPOE
Allergy Warning System
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Less Medication Errors

• Improves fidelity of exchanges among physicians,
  pharmacists and nurses

Allergy Warning System
Drug-Drug Interaction System
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Less Medication Errors
Just storing and retrieving data is not much of a
benefit. To get more out of your investment, you
need to analyze and use the stored data.

• Improves fidelity of exchanges among physicians,
  pharmacists and nurses

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Less Medication Errors

• Improves fidelity of exchanges among physicians,
  pharmacists and nurses

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Less Medication Errors

• Improves fidelity of exchanges among physicians,
  pharmacists and nurses

Why should errors go down?
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Before EHR
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(No Transcript)
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EHR streamlines the process reduces sources of
error
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After EHR
Simple and straight forward
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Timetable at a Community Hospital
How fast will all of this happen?
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Timetable at a Community Hospital
Process improvement takes a lot longer
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What next?

• You get what you put in
• The sooner the better
• Success is more likely if you are involved
• Quality of systems
• Components included
• Configuration decisions

This is a quality improvement project and not an
IT project
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What do you want it to be?

• The Likely Impact Depends on the Details