Electronic Health Records

Transcription

1 Electronic Health Records Costs and benefits Ulf E. W. Sigurdsen, MD, PhD Hans Nielsen Hauge, MD Regional Health Authority SE Norway

2 - What are the main gains of implementing EHR?

3 EHR = Media that facilitate transportability of pertinent information concerning patient's illness across varied providers and geographic locations. Some versions include direct linkages to online consumer health information that is relevant to the health conditions and treatments related to a specific patient. Year introduced: 2010 (MESH/PUBMED)

4 ? EPJ / EHR / PRISM / CPOE / PQRI?

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6 The American Recovery and Reinvestment Act of 2009 Somebody will say there are gains $ 27 billion in incentives to encourage physicians and hospitals to adopt and use EHR because: EHR will lead to higher-quality, lower-cost care by avoiding inefficiencies, inappriopriate care, and medical errors* *Blumenthal D, Glaser JP. Information technology comes to medicine. N Engl J Med. 2007;356: [PMID: ] Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med. 2009;360: [PMID: ] Hillestad R, Bigelow J, Bower A, Girosi F, Meili R, Scoville R, et al. Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Aff (Millwood). 2005;24: [PMID: ] Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The value of health care information exchange and interoperability. Health Aff (Millwood). 2005;Suppl Web Exclusives:W5-10-W5-18. [PMID: ]

7 Research results are modest

8 Clinical trial shows reductions in radiology and laboratory use when past test results are electronically available (Tierney et al 1987) EHR adoption in 2 Kaiser Permanente regions led to reductions in radiology and clinical laboratory services with a 14% decrease in the use of radiology services in 1 region (Garrido et al 2005) A national cross-sectional study showed that electronic availability of test results was associated with an increased likelihood of ordering diagnostic tests among physicians (McCormick 2012) EHRs in community practices seems to modestly slow ambulatory cost growth (Adler-Milstein et al 2013) Health information exchange use is associated with 64% lower odds of repeated diagnostic imaging in the emergency evaluation of back pain. Health information exchange effect on estimated costs was negligible. (Bailey et al 2013) Cost savings from HIT will be realized largely by eliminating duplicate tests and avoiding medical errors; this requires comprehensive records for each patient, not just clinician or organization-level EHRs such as those implemented within large hospitals (Yasnoff et al, 2013)

9 Why small gains?»broader changes in the organization and payment of care may prompt clinicians to use EHRs in ways that result in more substantial savings» (Adler-Milstein 2013)

10 The main gains are dependant on Access to clinical information across the continuum of care to support provider decision making Real-time clinical decision-support prompts and allerts to physicians, which directly lead to better patient care and a reduction in medical errors Increased medication and surgical safety and fewer adverse drug events Standardization of care to improve patient outcomes, notably through the use of standard order sets, based on evidence-based medisince, for major medical conditions Better preventive care through improved communications between physician and patient as well as proactive patient reminders (Bell, Thornton, 2012)

11 Implementation of EHR as a part of PRISM and the main gains 60% decrease of near-miss medication events 20% increase in daily fall assessment 25% drop in number of patient charts needing to be pulled for signing orders Relative to the size of the health system: $ million over 5-year period following EHR implementation (Bell, Thornton, 2012)

12 Global Trigger Tool Norway patient records 16% experienced adverse event 37 % infection - Report from the Norwegian national medical record review using Global Trigger Tool in Norwegian Knowledge Centre for the Health Services (Kunnskapssenteret)

13 37 %

14 Sweden 35,1 % infection Almost identical to Norway

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16 From the Swedish works, main gains could be: Estimated: Total cost of complications = SEK 11 billions Avoidable cost = SEK billions Corresponds to 500,000 inpatient days

17 The main gains of EHR come from improvement of clinical work processes and clinical outcome with a cut in adverse events and costly complications assume modern EHR capable of measuring clinical outcome, quality, adverse events and efficiency

18 When gains are measured remember effect of other efficiency and quality trends within health service organisation (e.g. increased day surgery) health personnel responsibilites (shift in who-does-what) available medication and surgical procedures (e.g. biological immunoregulants) personell mix (e.g. increased use of non-medical personnel) health care financing (e.g. altered incentives)

19 Thank you!