Executive Checklist: Four ways to leverage EMR to improve patient outcomes, increase satisfaction and control costs.

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1 White Paper Executive Checklist: Four ways to leverage EMR to improve patient outcomes, increase satisfaction and control costs. Brendon Buckley Healthcare Enterprise Solutions Manager Lorrie LiBrizzi Director, Marketing and Strategy, Systems Richard W. Smith Director, Healthcare Johnson Controls, Inc.

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3 Introduction Electronic medical records (EMR) technology is widely accepted as an advance over the old paper file system. By having access to complete, accurate, real-time data at the point of care, healthcare professionals can provide safer, more effective and less expensive care. However in many organizations, the promise of EMR is not fully realized. A recent study of more than 300 hospitals in California found that EMR did not necessarily lower costs and improve clinician productivity. 1 In a separate study of more than 600 nurses, nearly half of the respondents stated that EMR has either a negative or no effect on the quality of patient care. 2 The American Recovery and Reinvestment Act of 2009 (ARRA) set aside nearly $40 billion to help implement electronic health systems nationwide, offering significant incentives for hospitals and other health care providers to implement EMR - and demonstrate its meaningful use by To receive incentives, hospitals across the country may have begun the installation phase before taking into consideration how EMR can fully leverage building, business and clinical systems. When deployed in a vacuum, an EMR software package alone may not deliver against expectations of improved patient outcomes and increased productivity. As a result, EMR demonstrates meaningful use, but not necessarily beneficial use to clinicians, administrators and most importantly, patients. Beneficial use is achieved when EMR is recognized as more than a software implementation. It is central to the way care is provided and as such, it must be coupled with careful consideration and optimization of a hospital s network, workflow, point-of-care devices and other business and building systems. Meaningful use is just the beginning. By taking a holistic approach, healthcare leaders can, in fact, leverage EMR to achieve their goals of improved patient outcomes, increased satisfaction and controlled costs. By taking a holistic approach, healthcare leaders can, in fact, leverage EMR to achieve their goals of improved patient outcomes, increased satisfaction and controlled costs. Leverage EMR to improve patient outcomes EMR applications are designed to deliver data at all points of care, for all health care professionals, at all times. By having access to a patient s complete medical record on demand, caregivers can be confident they are making decisions based on the patient s one truth. With it, efficiency improves and errors can be minimized. A study by the Agency for Healthcare Research and Quality concluded that the use of computerized physician order entry (CPOE) systems, a component of EMR, could prevent up to 57 percent of medication prescribing errors. The study, which was done by researchers from the American Academy of Family Physicians, examined medication-error reports from two previous studies. Researchers found 194 medication errors, of which 70 percent were prescribing errors. Of those, 59 percent reached patients, but none resulted in death or permanent harm to those patients. 3 While the use of electronic medical records can help hospitals reduce avoidable medical errors, best-in-class implementations demand even more from EMR. The data stored in electronic medical records should be leveraged by other systems to further improve patient outcomes. 1

4 mu Opportunity #1: Unlock the value of EMR by integrating it with other clinical, business and building systems to improve patient outcomes proactively. Margaret, a new patient, is classified as a fall risk which is noted in her electronic medical record. When sensors in her bed detect a sudden shift or loss in weight, Real Time Location Services (RTLS) checks to see if a clinician is in her room. If not, the nurse call system - which is tied to the EMR - notes the risk and sends an alarm. Margaret s nurse, who is 50 feet down the hallway, receives the alert on her handheld device. She responds immediately, finds Margaret attempting to stand and safely repositions the patient in bed. This scenario demonstrates how EMR data can be leveraged by other technologies to provide value. When integrated with nurse call, RTLS, robust wireless capabilities and mobile devices, critical electronic medical records data is delivered when and where it is needed. Further integration with infotainment and building automation sensors can also trigger audio and video alerts, as well as adjustments to the room s lighting to assist disoriented patients. These capabilities would help clinicians proactively protect patients and improve patient outcomes. Leverage EMR to increase staff satisfaction EMR will transform the way physicians, nurses, pharmacists and technicians do their jobs. EMR will transform the way physicians, nurses, pharmacists and technicians do their jobs. The challenge for hospital executives is to ensure staff embraces the change. What makes them willing? The promise that EMR gives clinicians more time for what they re passionate about; taking care of patients. A 2008 study conducted by The Permanente Journal showed that medical-surgical nurses spent less than one-fifth of all nursing practice time on activities defined as patient care activities. 4 The majority of time was spent on documentation, coordination of care with other clinicians and medication administration. Imagine how those percentages might shift - and, as a result, how clinician satisfaction might increase - when EMR is used to streamline activities and automate administrative tasks. Nurse Jeannine is about to enter a patient s room, handheld device in hand. As she walks through the doorway, critical information about the patient is automatically displayed on the device screen. He s allergic to latex gloves, at risk of falling and poses a threat to security - information she needs to minimize risk and increase productivity as she s providing care. During the visit, she uses the device s barcode scanner to scan the patient s bracelet and confirm his identity before dispensing medication. She records his vitals, indicates that the patient has been turned and notes his disposition - all with her handheld device which uploads the data to his record in real time. As she concludes the visit and leaves the room, the device display shows the name and room number of the next patient on Jeannine s roster. In scenarios such as this, what makes EMR so valuable for clinicians is not that the patient information is stored electronically. The value comes in the nurse s ability to access, monitor and update EMR data relevantly. mu Opportunity #2: Empower clinicians to fully utilize EMR data by making it available to them wherever they are, at the right level of detail, at the right time, using the right device. Today s point-of-care devices are powerful tools that can enable hospital staff to be more productive than ever before if they are appropriately matched with the needs of the user. Too often, hardware is selected as part of an EMR implementation without adequate consideration of existing workflow and processes. As a result, the device doesn t always support the needs of its user, leading to uncertainty, distrust and frustration. 2

5 While hospitals may not be able to accommodate every staff preference, the most successful EMR deployments ask end users for input. What type of hardware works best for each situation? How can workflow and processes be improved to take full advantage of EMR? When clinicians and other users are invited to participate in the process they are more likely to embrace the change and become ambassadors for the transformation. Leverage EMR to increase patient satisfaction Today s healthcare consumers demand more than quality care. A 2010 study by CareChex, a division of The Delta Group specializing in rating the quality of hospital and physician care, found that hospitals can no longer assume patients are satisfied with their medical care simply because a hospital meets a particular standard of clinical quality. 5 Customer-oriented care and service excellence also play a vital role in determining value. mu Opportunity #3: Make it a patient experience to remember. EMR data can be used to inform and empower patients, deploy resources appropriately and track assets accurately, all of which leads to increased response times and patient satisfaction. Electronic medical records can be used to enhance a patient experience in ways unimaginable just a decade ago. John is scheduled for surgery. Prior to his visit, he goes online to complete a patient profile. On the day of his surgery, he arrives at the hospital where an administrator greets him by name. While checking in, a nurse gives John a hospital bracelet containing a RTLS device that is linked to his personal profile and preferences. Upon arriving in his room, the room lighting and music immediately adjust to his preferences. At his bedside, a monitor displays patient and clinician information including allergy warnings, primary physician, medications due, labs results and patient reminders. John uses the touch screen monitor to increase the temperature, dim the lights in his room, and request a second blanket. A few minutes later, Dr. Wilson enters the room, and the monitor automatically displays his presence. Dr. Wilson gives John an updated diagnosis. While at John s bedside, Dr. Wilson updates John s medical records using a mobile device. Electronic medical records can be used to enhance a patient experience in ways unimaginable just a decade ago. By integrating EMR with other systems such as Real Time Location Services, ADT, security, lighting, video, and HR systems, hospitals can provide a positive, safe, memorable experience for patients. Leveraging EMR to reduce costs Hospital executives are, by now, well aware of the ARRA incentives and penalties established for the adoption and use of certified EMR systems. Millions in Medicare reimbursements are at stake. The pressure is on to deploy EMR and demonstrate its meaningful use. But beyond federal incentives, an EMR implementation can be leveraged to further control costs. 3

6 mu Opportunity #4: When evaluating the ROI on an electronic medical records investment, consider the value of increased efficiency and reduced risk. EMR data, particularly when integrated with other clinical, business and building systems, can be used to provide safer, more effective and less expensive care by: Increasing the accuracy of procedure tracking, resulting in timely reimbursement Assigning resources appropriately, allowing nurses to spend more time on patient-care activities Alerting clinicians of potentially critical situations, allowing them to proactively reduce risk Reducing transcription services Managing asset inventory accurately, reducing the need purchase excess quantities (In one example, a hospital administrator received a request for 100 additional pumps. An investigation into the Real Time Location Services metrics showed that this purchase was unnecessary, saving the facility roughly $300,000.) EMR data, particularly when integrated with other clinical, business and building systems, can be used to provide safer, more effective and less expensive care Critical success factors and next steps Regardless of where you are in the EMR process, it s not too late to leverage EMR to attain positive, measurable results while empowering clinicians and patients. The following critical success factors should be addressed: Take a holistic assessment of the patient care model and recognize that EMR is more than a software implementation. Patient and staff satisfaction, along with operational efficiencies and workflows, can be maximized when EMR is integrated with other clinical, business and building systems. Secure input from clinical staff, hospital administrators and other key stakeholders throughout the planning, design and management process. These individuals will champion EMR-related outcomes. Work with a building systems integrator who has knowledge and experience with a variety of building systems (i.e. security, IT, point-of-care end devices) to properly help assess efficiency needs, and develop recommendations and a vendor neutral design that leverages EMR throughout the clinical environment and patient care experience. Ensure that the network infrastructure (wired and wireless) is robust, secure and scalable. Gone are the days of simple voice, video and data convergence. Today s hospital networks must also be able to support the communication and integration of critical security, clinical, building and business systems. EMR installations, even those already deployed, can meet the ARRA standard for meaningful use. However with proper integration design considerations in mind, EMR can be further maximized to achieve beneficial use, illustrated through patient satisfaction research, clinician recruitment and retention, cost reductions, as well as government incentives. 4

7 Resources 1 EMR Adoption Increases Hospital Costs. InformationWeek. Retrieved from showarticle.jhtml?articleid= on Nurses Express Mixed Opinions on Computerized Records. Retrieved from on Study: CPOE can cut prescribing errors 57 percent - FierceHealthIT. Retrieved from #ixzz14ccUYQZ6 on Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time? Retrieved from on Is there a correlation between a state s quality of care and patient satisfaction? Retrieved from on Unlock the value of EMR Hospitals can provide safer, more effective and less expensive care by integrating electronic medical records with other clinical, business and building systems such as: - Nurse Call - Real Time Location Services - Security (Access Control) - Building Automation Systems - Point of Care Devices (Clinician Hand Held Devices) - ERP 5

8 Printed on recycled paper Johnson Controls, Inc. P. O. Box 423, Milwaukee, WI Printed in USA MISC-710 (1/11)

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