Mona Osman MD, MPH, MBA

Mona Osman MD, MPH, MBA

Objectives To define an Electronic Medical Record (EMR) To demonstrate the benefits of EMR To introduce the Lebanese Society of Family Medicine- EMR

Reality Check The healthcare system is fragmented: care is delivered by a variety of independent physicians, hospitals & other providers. Physicians often take care of patients without knowing previous treatments and by whom, which can lead to treatments that are redundant, ineffective or dangerous. Vital data available in paper medical records are not easily accessed or combined into an integrated form to present a clear and complete picture of the patient s care.

Facts & Figures Physicians spend an estimated 20-30% of their time searching for and organizing information. Physicians spend up to 38% of their time writing up patient charts. Nurses spend up to 50% of their time writing up charts. Medical records are misplaced or missing in 30% of patient visits. The average office spends $10 per visit to track and file paper records The average patient record weighs 0.68 Kg. Source: Committee on Improving the Patient Record, Institute of Medicine

Facts & Figures Between 44,000 and 98,000 Americans die in hospitals each year as a result of medical errors the cost is approximately $37.6 billion annually. Estimated 770,000 people are injured each year due to adverse drug events and up to 70% may be avoidable. Inadequate availability of patient information is directly associated with 18%. Adverse drug events occur in 5% to 18% of ambulatory patients.

Paper Medical Record Readable Writing Availability Tracking Getting Data in the record in a timely manner Moves with patient Putting the right Diagnosis Code Doing a Chart Review is a Nightmare!

Weaknesses of Paper Medical Record Lack of Standardization in Content Lack of standardization in Format Incompleteness Inaccuracies A patient s age is not included in the medical record 10% of the time. A diagnosis is not recorded in the patient s record 40% of the time. Physicians, while taking a medical history, fail to note the chief complaint in the patient s record 27% of the time. Committee on Improving the Patient Record, Institute of Medicine.

Definition of an Electronic Medical Record It is a software that allows the primary care physician to create, store, organize and retrieve the record of the patient on a computer. It is an electronic representation of the medical information of an individual. Is it simply a replacement of the paper medical record? The computerized version of this record?

Characteristics of an EMR Local and Remote Information Authorized User Access Confidentiality, Privacy and Audit Trails Links with Other Patient Records (longitudinal view of the patient) Problem Lists, Procedure Notes, and Progress Notes Order entry & Results Use Standard Vocabulary Electronic Prescriptions Drug Reference Billing and Coding Alerts and Decision Support Patient education and tracking Integration and Interfacing Tools for selective retrieval and formatting of patient information (graphs etc).

Benefits of EMR Operational Benefits Clinical Benefits Financial Benefits Additional Benefits

Operational Benefits EMR allows physician to access multiple records at the touch of a button. Simultaneous Access by multiple users at the same time. The workflow is enhanced as less efforts are required to retrieve information: 100% availability of the medical records (no missing or misplaced records). Legible, accurate and non-redundant data. Integrated data. Hence less patient waiting time. It protects patient data by preventing unauthorized individuals from accessing the clinical record: secure long in access is a must.

Operational Benefits EMR improves interdisciplinary collaboration and efficient communication among different health care providers taking care of the patient. EMR can facilitate the efficient creation and transmission of reports that relate to health care operations. EMR is time saving for physicians and staff by reducing time needed for documentation in the chart: Availability of templates Search tools (disease coding)

Operational Benefits Eliminates lost orders and ambiguities caused by illegible handwriting, generating related orders automatically, monitoring for duplicate orders and reducing time to fill orders: Reducing Redundancy. It allows tracking and understanding of medication delivery processes which can pinpoint opportunities for improvement in safety and efficiency. Can allow better appreciation of clinician performance, which can be used for employees bonuses.

Clinical Benefits More time allocated for the patient: Decrease the amount of time the health care providers spend on documentation. The alerts and Reminder programs in EMR will increase the physician attentiveness to certain areas such as preventive medicine, drug level monitoring. Information on patient allergies and other medications, in combination with the alerts and reminders can decrease the number of medications related adverse events. Help making medical history more efficient and accurate by providing templates.

Clinical Benefits Provide an integrated view of patients to physicians so that they can spend less time for getting patients' history, laboratory etc. Physicians make the diagnosis more accurately and faster. Preventing patients from undergoing redundant unnecessary tests. By integrating guidelines and clinical information tools, EMR improves the quality of patient care. Better Management of Chronic Diseases. Patient Education and involvement in care: more patient satisfaction.

Financial Benefits Lower Paper Charts and Storage Costs. Labor savings and efficiencies Fewer chart pulls and less filing Improved internal office communication Reduced overtime More time for value-added services Reduction in phone communication

Financial Benefits EMR leads to revenue enhancement through reminders of overdue health maintenance procedures. Can improve billing by allowing improved medical staff documentation and lack of lost or misplaced charts. EMR can prevent unnecessary duplication of diagnostic tests that might occur when a patient sees multiple healthcare providers (benefit to patients & managed care). Electronic "triggers" can be implemented to generate notifications to physicians and pharmacists when less costly but equally efficacious drugs can be substituted for the prescribed medication.

Additional Benefits Instrumental in connection to national disease registries allowing practices to compare their performance with that of others, which in turn might improve quality of care and facilitate research. Better Understanding of the community such as regarding epidemiology of the diseases. Can provide important information for health policy planning and developing future strategies.

Challenges Technology Failure/ Electricity Failure Training of users Patient-Physician Communication during consultation. Periodic Back up of the data is a must.

Facts & Figures $44 billion in savings per year could be realized from adoption of EMR in the ambulatory care environment. Primary care providers could realize savings of $86,000 over five years. Benefits include reduced drug spending, reductions in radiology, and decreased billing errors. When physicians used a computerized system, the average time spent in the unit dropped by 4.9 days to 2.7, slashing costs by 25% One hospital s use of a community-based clinical data sharing network resulted in reduction in emergency room charges of $26 per encounter

Facts & Figures Prevention of more than 2 million adverse drug events and 190,000 hospitalizations per year by adoption of EMR in the ambulatory care environment. EMR has been shown to reduced error rates by 55%-- from 10.7 to 4.9 per 1,000 patient days and reduced serious medication errors by 88%. Incidents of allergic drug reactions and excessive drug dosages have been shown to drop by 75%.

Take Home Message Electronic Medical Record is a tool for better care