In this day of managing our lives on smart phones, tablets and online cloud storage, the idea of electronic health records (EHRs) just makes sense.
The government has been nudging physicians and medical facilities to get on board with the HITECH (Health Information Technology for Economic and Clinical Health) Act of 2009, which calls for full scale use of EHRs by the end of this year. By providing financial incentives via its meaningful use program through 2014, doctors could make money (of course countered by what they spent on the software) by implementing EHR systems. Starting this year, physicians treating Medicare patients will actually be financially penalized if they do not integrate with an EHR system.
How then do electronic medical records affect patients? For the most part, it’s positive.
Influencing the cost and utilization of care
While the cost charged to patients for care probably won’t go down as a direct result of electronic medical records, patients may pay less because they’re undergoing fewer tests. If lab and diagnostic radiology results are available through a shared system, providers will be able to find the results they need without ordering duplicate exams. That’s also more convenient for patients, who don’t need to take time for additional testing or added exposure to radiation or needle sticks.
Patients may feel the pinch with duplicate exams if they are using multiple care providers who aren’t part of the same physician network, since it’s harder to coordinate care without shared records. While this was standard operating procedure in the past, it’s less so now. Patients in today’s world want a seamless healthcare experience.
Increasing patient safety and quality of care
The goal of healthcare systems is to increase patient safety and quality of care. Electronic medical records can help accomplish this goal in a number of ways.
Decreasing Error: Illegible writing is a major cause of medical errors. Typed documentation that comes with EMR implementation means that others reading the records can quickly and easily understand the patient’s status and current treatment.
Automating Reminders: EHR systems have built-in reminders to inform physicians if they haven’t reviewed lab or pathology reports, or if a patient has not shown up for a follow-up visit. This allows for increased administrative efficiency and a decreased chance that health findings will be delayed due to a lack of patient follow-up. Patients fail to show up for appointments 5-50% of the time, according to a New York Times article, due to a wide variety of factors.
Double Checking Dosage: When medications are prescribed, the EHR software checks on behalf of the physician for potentially harmful drug interactions and confirms that the dosage prescribed is in range.
Decision Support: A feature of electronic health records, decision support guides doctors through a number of processes for certain medical conditions to ensure they're considering all treatment options available. These might include clinical guidelines, reference information related to the patient's condition, or any number of other factors.
Patient Accessibility: By signing up for a patient portal account, patients can personally access their medical records and results more quickly, giving them the opportunity to potentially catch an issue that might otherwise have fallen through the cracks. For example, if a pathology report suggests further follow-up due to an incidental finding, the patient can take action and ask the doctor about it, even if the doctor hasn’t brought it up to the patient.
Electronic Prescriptions: E-prescribing is not only convenient for patients (the filled prescription is waiting when you arrive), but since it’s typed, there’s less chance for medical error. In fact, a study published in the Journal of General Internal Medicine found that by e-prescribing medications in community-based practices, error rates decreased sevenfold over paper prescriptions. Using e-prescriptions can also decrease fraudulent use of paper prescription pads.
The downside to EHRs
On the doctors’ side, not everyone is happy about the use of EHR systems. First, they aren’t cheap. According to a 2013 Medical Economics survey, 77% of the largest practices said they spent upwards of $200,000 on their software systems. These offices said that electronic records haven’t made their practices more efficient, but rather, the expense of acquiring, implementing and maintaining the system, plus training staff, has increased the provider burden. In addition, doctors are lowering their personal efficiency as they take extra time to input patient information into the online record, instead of their former method of jotting down notes on a paper chart.
Similarly, some doctors in the Medical Economics survey didn’t feel that patient care and physician/hospital coordination had seen the higher quality results they expected by this point. As with any major system change, this shift in business model is a work-in-progress that requires ongoing investment and assessment to yield long term return for everyone. It will be interesting to watch the EHR space - and the players in it (GE recently announced at HiMSS that they will no longer be pursuing the business) as they continue to grow and evolve with time. Undeniably, EHRs are an inevitable staple in the future of health; it’s really just a matter of building the foundation (which is where we come in) to make massive cost saving and increased efficiency possible.
The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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