Electronic health record (EHR) systems continue to face physician resistance in some quarters, but the benefits of electronic health records -- namely, cost savings and improved care -- are becoming apparent.
In 2004, NorthShore University HealthSystem in Evanston, Ill., replaced paper records with an Epic Systems Corp. EHR system. NorthShore, which encompasses four hospitals and 2,000 affiliated physicians, and has some 75 office locations in the greater Chicago area, did it for "quality, safety and speed," CIO Tom Smith said -- and the health system is reaping many benefits.
Front and center is the computerized physician order entry (CPOE) module of the Epic system. Getting doctors to enter information into the system via drop-down menus and text boxes has yielded significant savings. One four-doctor office in the NorthShore system spent $4,800 a month to let doctors dictate their observations, then have their words transcribed. After a few weeks of entering information directly into the CPOE system, the office was spending only $400 per month on dictation, Smith said.
Eliminating handwritten prescriptions and using bar codes for medication delivery have increased accuracy dramatically. "Sixty percent of medication errors were due to handwriting issues. Those are gone now," Smith said. In addition, near misses -- instances where the wrong medication was almost given to a patient -- have dropped from almost 1,000 per year to virtually none.
It's critical that a patient's history and physical records be on hand for a pending surgery. However, it was once rare, and that led to delays and lost revenue because fewer surgeries were performed. "Now we hardly ever miss a case because history and physical is not ready," Smith said, adding, "The No. 1 benefit for the doctor is that he has all the information he needs in one spot. He has the chart [and] doesn't have to look for it."
Another of the benefits of electronic health records has been the increase in copayments collected. Before the system was deployed, the copay rate was 20%; six months later it was 50%; and it is now at 92%, Smith said. In addition, NorthShore's billable services were being denied initially by insurance companies at a rate of 23%. Thanks to more accurate coding and documentation, that rate now is down to 10%. "Sometimes the process would go on for six months, and the doctor would give up," he said.
Increasing productivity, eliminating bottlenecks
The benefits of electronic health records don't always come overnight. Thomas Ciccarelli, CIO of East Orange General Hospital in New Jersey, is implementing a GE Healthcare EHR system. He anticipates a period of reduced efficiency, but is looking forward to significant gains after that.
"Because of tie-in to different departments, there will be efficiencies. Those savings should pay for the systems two to three times [over]," Ciccarelli said. "Physician order entry can save a secretary two hours per day. Nurses can save an hour a day by improving the way they document. They can use the time to give better care."
Despite the unavoidable period of adapting to a different way of doing things, the elimination of paper can be liberating. "One thing I have come to appreciate is that the paper medical record is a very expensive system and very labor-intensive," wrote Dr. Peter Deane, principal and CIO partner of Allergy, Asthma, Immunology of Rochester [[http://www.aair.info/]] in New York, in an email exchange.
Deane's office staff has been using EHR applications from Sequel Systems Inc. for several years. Getting rid of paper has let the office reduce its clerical staff -- "through attrition, I am happy to say," he wrote. Although it's hard to document savings from the e-prescribing application, the primary savings is that nurses don't spend time on the telephone with pharmacies; that frees them for other duties, Deane said.
Squashing sepsis, cutting waste with EHR system
Methodist le Bonheur Healthcare, which comprises four adult hospitals and one children's hospital in Memphis, Tenn., has used automation to come up with a system that greatly reduces patient deaths from sepsis.
Thomas CiccarelliCIO, East Orange General Hospital
"Sepsis is a major killer in a clinical environment," noted Andrew Fowler, the hospital group's senior vice president of information systems. To treat sepsis, its symptoms have to be identified within six hours. But because its symptoms resemble those of other ailments, a correct diagnosis is not always possible in a timely manner. The problem, Fowler said, was exacerbated by the inherent delays of paper records.
The group's EHR system from Cerner Corp. thus has been customized with a warning sign that is triggered by certain clinical indicators and delivered to a patient's nurse so that intervention can begin. The result has been a 30% drop in mortality from sepsis, or potentially more than 100 lives saved each year.
Methodist Le Bonheur reports several other EHR benefits. For example, its CPOE system has forced doctors to enter their own information rather than assign that task to the unit secretary, whom emergency department head Dr. Marty Carr termed "a minimum-wage bottleneck." With doctors entering their own information, the unit secretary has been freed to take a more active role, tracking down nurses to administer medication or other proactive work, he said.
In addition, the efficiency of billing and the number of patients seen per shift have both increased. Pointing to a small stop sign that appears as an on-screen reminder to create a bill if that has not been done yet, Carr said, "Cerner tells you what level you should be charging for what you've done. … Overall, we're at least 10% more efficient and 10% more profitable."
Finally, the tighter record-keeping enabled by the EHR system has driven down the number of lawsuits filed against the hospital. "We've seen nuisance lawsuits go down. Frivolous lawsuits have disappeared," Carr said.
Finding future benefits of electronic health records
Methodist Le Bonheur's Fowler said he believes the health care system should be able to recoup federal funds through the Health Information Technology for Economic and Clinical Health Act, or HITECH Act, by achieving meaningful use of EHR.
"We're probably as well positioned as anyone in the country," Fowler said. With the CPOE system rollout in the final stages, he's looking forward to experimenting with smart devices that can take patient readings and enter information into the system automatically via a wireless network, he added.
For its part, NorthShore has introduced several initiatives to further reap the benefits of EHR. Its latest automation effort, for example, is a patient portal called NorthShoreConnect, which has proved extremely popular and has led to new possibilities for delivering patient care, CIO Smith said.
"A patient can sign on to the system and look at past X-ray films and other information," Smith said. So far, 100,000 patients have signed up for the portal, and 30% use it every month. There are 20,000 transactions per month on the portal, ranging from questions from patients and queries about bill payment and insurance, to diabetics entering information about their condition. Without automation, many of those transactions would take two to three phone calls each, Smith said.
In other work, NorthShore has started a personal health record system for members, and is experimenting with automated testing tools that patients can use at home to take readings and send the information to the hospital.
Finally, NorthShore is experimenting with using kiosks -- much like those used at airports -- for patient check-in. Also following the airlines' lead, NorthShore is looking into giving patients the ability to check into the hospital from home before they arrive, Smith said.
Stan Gibson is a contributing writer based in Boston. Let us know what you think about the story; email firstname.lastname@example.org.