Are Electronic Medical Records a Cure for Health Care?

CASE STUDY #1
During a tyical tri to the doctor! you"ll often see shel#es full of folders and aers
de#oted to the storage of $edical records% E#ery ti$e you #isit! your records are
created or $odi&ed! and often dulicate coies are generated throughout the
course of a #isit to the doctor or a hosital% The $a'ority of $edical records are
currently aer()ased! $a*ing these records #ery di+cult to access and share% ,t
has )een said that the U%S% health care industry is the -orld"s $ost ine+cient
infor$ation enterrise% ,ne+ciencies in $edical record *eeing are one reason -hy
health care costs in the United States are the highest in the -orld% ,n ./1.! health
care costs reached 0.%1 trillion! reresenting 11 ercent of the U%S% gross do$estic
roduct 23D45% 6eft unchec*ed! )y ./78! health care costs -ill rise to .9 ercent of
3D4 and consu$e aro:i$ately ;/ ercent of total federal sending% Since
ad$inistrati#e costs and $edical record*eeing account for nearly 17 ercent of
U%S health care sending! i$ro#ing $edical record *eeing syste$s has )een
targeted as a $a'or ath to cost sa#ings and e#en higher <uality health care% Enter
electronic $edical record 2EMR5 syste$s%
An electronic $edical record syste$ contains all of a erson"s #ital $edical data!
including ersonal infor$ation! a full $edical history! test results! diagnoses!
treat$ents! rescrition $edications! and the e=ect of those treat$ents% A
hysician -ould )e a)le to i$$ediately and directly access needed infor$ation
fro$ the EMR -ithout ha#ing to ore through aer &les% ,f the record holder -ent
to the hosital! the records and results of any tests erfor$ed at that oint -ould
)e i$$ediately a#aila)le online% Ha#ing a co$lete set of atient infor$ation at
their &nger(tis -ould hel hysicians re#ent rescrition drug interactions and
a#oid redundant tests% >y analy?ing data e:tracted fro$ electronic atient records!
Southeast Te:as Medical Associates in >eau$ont! Te:as! i$ro#ed atient care!
reduced co$lications! and slashed its hosital read$ission rate )y .. ercent in
./1/%
Many e:erts )elie#e that electronic records -ill reduce $edical errors and i$ro#e
care! create less aer-or*! and ro#ide <uic*er ser#ice! all of -hich -ill lead to
dra$atic sa#ings in the future! as $uch as 01/ )illion er year% The U%S%
go#ern$ent"s short(ter$ goal is for all health care ro#iders in the United States to
ha#e EMR syste$s in lace that $eet a set of )asic functional criteria )y the year
./19% ,ts long(ter$ goal is to ha#e a fully functional nation-ide electronic $edical
record*eeing net-or*% The consulting &r$ Accenture esti$ated that aro:i$ately
9/ ercent of U%S% hositals are at ris* of incurring enalties )y ./19 for failing to
$eet federal re<uire$ents%
E#idence of EMR syste$s in use today suggests that these )ene&ts are legiti$ate%
>ut the challenges of setting u indi#idual syste$s! let alone a nation(-ide syste$!
are daunting% Many s$aller $edical ractices are &nding it di+cult to a=ord the
costs and ti$e co$$it$ent to ugrading their record(*eeing syste$s% ,n ./11! 81
ercent of hysicians and @/ ercent of hositals in the United States -ere still
using aer $edical records% 6ess than . ercent of U%S% hositals had electronic
$edical record syste$s that -ere fully functional% ,t"s also unli*ely that the $any
di=erent tyes of EMR syste$s )eing de#eloed and i$le$ented right no- -ill )e
co$ati)le -ith one another in ./19 and )eyond! 'eoardi?ing the goal of a national
syste$ -here all health care ro#iders can share infor$ation% Ao nation-ide
soft-are standards for organi?ing and e:changing $edical infor$ation ha#e )een
ut in lace% And there are $any other s$aller o)stacles that health ro#iders!
health ,T de#eloers! and insurance co$anies -ill need to o#erco$e for electronic
health records to catch on nationally! including atients" ri#acy concerns! data
<uality issues! and resistance fro$ health care -or*ers% Econo$ic sti$ulus $oney
ro#ided )y the A$erican Reco#ery and Rein#est$ent Act -as a#ail(a)le to health
care ro#iders in t-o -ays% Birst! 0. )illion -as ro#ided u front to hositals and
hysicians to hel set u electronic records% Another 018 )illion -as a#aila)le to
re-ard ro#iders that successfully i$le$ent electronic records )y ./19% To <ualify
for these re-ards! ro#iders $ust de$onstrate C$eaningful useD of electronic
health record syste$s% The )ill de&nes this as the successful i$le$entation of
certi&ed e(record roducts! the a)ility to -rite at least ;/ ercent of all rescritions
electronically! and the a)ility to e:change and reort data to go#ern$ent health
agencies% >ut in addition to sti$ulus ay$ents! the federal go#ern$ent lans to
assess enalties on ractices that fail to co$ly -ith the ne- electronic record(
*eeing standards% 4ro#iders that cannot $eet the standards )y ./19 -ill ha#e
their Medicare and Medicaid rei$)urse$ents slo-ly reduced )y 1 ercent year until
./11! -ith further! $ore stringent enalties co$ing )eyond that ti$e if a
su+ciently lo- nu$)er of ro#iders are using electronic health records% Electronic
$edical record*eeing syste$s tyically cost around 07/!/// to 09/!/// er
doctor% Although sti$ulus $oney should e#entually )e enough to co#er that cost!
only a s$all a$ount of it is a#aila)le u front% This -ould )urden $any ro#iders!
esecially $edical ractices -ith fe-er than four doctors and hositals -ith fe-er
than 9/ )eds% The e:enditure of o#erhauling record*eeing syste$s reresents a
signi&cant increase in the short(ter$ )udgets and -or*loads of health care
ro#idersEas $uch as 1/ ercent! according to Accenture% S$aller ro#iders are
also less li*ely to ha#e done any rearatory -or* digiti?ing their records co$ared
to their larger counterarts% ,$le$enting an EMR syste$ also re<uires hysicians
and other health care -or*ers to change the -ay they -or*% Ans-ering atient
hone calls! e:a$ining atients! and -riting rescritions -ill need to incororate
rocedures for accessing and udating electronic $edical recordsF aer()ased
records -ill ha#e to )e con#erted into electronic for$! $ost li*ely -ith codes
assigned for #arious treat$ent otions and data structured to &t the record"s
for$at% Training can ta*e u to ./ hours of a doctor"s ti$e! and doctors are
e:tre$ely ti$e(ressed% ,n order to get the syste$ u and running! hysicians
the$sel#es $ay ha#e to enter so$e of the data! ta*ing a-ay ti$e they could )e
sending -ith their atients% A .//@ Aational Research Council study found that
EMR syste$s -ere often oorly designed% Bor e:a$le! in one of these syste$s! it
too* eight $ouse clic*s on a digital record to locate atient infor$ation that &t
easily on a single sheet of aer% Health care rofessionals -ill resist these syste$s
if they add stes to their -or* Go- and co$ound the frustration of erfor$ing
re<uired tas*s% The H)a$a ad$inistration has -or*ed on standards to i$ro#e EMR
usa)ility% Many s$aller ractices and hositals ha#e )al*ed at the transition to EMR
syste$s for these reasons! )ut the e#idence of syste$s in action suggests that the
$o#e $ay )e -ell -orth the e=ort if the syste$s are -ell designed% The $ost
ro$inent e:a$le of electronic $edical records in use today is the U%S% Ieterans
A=airs 2IA5 syste$ of doctors and hositals% The IA syste$ s-itched to digital
records years ago! and far e:ceeds the ri#ate sector and Medicare in <uality of
re#enti#e ser#ices and chronic care% The 1!;// IA facilities use IistA! record(
sharing soft-are de#eloed )y the go#ern$ent that allo-s doctors and nurses to
share atient history% A tyical IistA record lists all of the atient"s health ro)le$sF
their -eight and )lood ressure since )eginning treat$ent -ithin the IA syste$F
i$ages of the atient"s :(rays! la) results! and other test resultsF lists of
$edicationsF and re$inders a)out uco$ing aoint$ents% >ut IistA is $ore than a
data)aseF it also has $any features that i$ro#e <uality of care% Bor e:a$le!
nurses scan tags for atients and $edications to ensure that the correct dosages of
$edicines are going to the correct atients% This feature reduces $edication errors!
-hich is one of the $ost co$$on and costly tyes of $edical errors! and seeds u
treat$ent as -ell% The syste$ also generates auto$atic -arnings )ased on
seci&ed criteria% ,t can notify ro#iders if a atient"s )lood ressure goes o#er a
certain le#el or if a atient is o#erdue for a regularly scheduled rocedure li*e a Gu
shot or a cancer screening% De#ices that $easure atients" #ital signs can
auto$atically trans$it their results to the IistA syste$! -hich auto$atically
udates doctors at the &rst sign of trou)le% The results suggest that electronic
records o=er signi&cant ad#antages to hositals and atients ali*e% The ;/!///
atients in the IA"s in(ho$e $onitoring rogra$ reduced their hosital ad$issions
)y .9 ercent and the length of their hosital stays )y ./ ercent% ,n addition! $ore
atients recei#e necessary eriodic treat$ents under IistA 2fro$ .8 ercent to 17
ercent for Gu #accines and fro$ 7; ercent to 1; ercent for colon cancer
screenings5% 4atients also reort that the rocess of )eing treated at the IA is
e=ortless co$ared to aer()ased ro#iders% That"s )ecause instant rocessing of
clai$s and ay$ents are a$ong the )ene&ts of EMR syste$s% ,nsurance co$anies
traditionally ay clai$s around t-o -ee*s after recei#ing the$! desite <uic*ly
rocessing the$ soon after they are recei#edF go#ern$ental regulations only
re<uire insurers to ay clai$s -ithin 19 days of their receit% Additionally! today"s
aer()ased health care ro#iders $ust assign the aroriate diagnostic codes
and rocedure codes to clai$s% >ecause there are thousands of these codes! the
rocess is e#en slo-er! and $ost ro#iders e$loy so$eone solely to erfor$ this
tas*% Electronic syste$s hold the ro$ise of i$$ediate rocessing! or real(ti$e
clai$s ad'udication 'ust li*e -hen you ay using a credit card! )ecause clai$ data
-ould )e sent i$$ediately and diagnostic and rocedure code infor$ation are
auto$atically entered% IistA is far fro$ the only otion for doctors and hositals
starting the rocess of udating their records% Many health technology co$anies
are eagerly a-aiting the co$ing si*e in de$and for their EMR roducts and ha#e
de#eloed a #ariety of di=erent health record structures% Hu$ana! Aetna! and other
health insurance co$anies are heling to defray the cost of setting u EMR
syste$s for so$e doctors and hositals% Hu$ana has tea$ed u -ith health ,T
Co$any Athena health to su)sidi?e EMR syste$s for aro:i$ately 1// ri$ary
care ractices -ithin Hu$ana"s net-or*% Hu$ana ays $ost of the )ill and o=ers
further re-ards for ractices $eeting go#ern$ental erfor$ance standards% Aetna
and ,>M! on the other hand! ha#e launched a cloud()ased syste$ that -ill ool
atient records and can )e licensed to doctors )oth inside and outside of Aetna%
There are t-o ro)le$s -ith the lethora of otions a#aila)le to health care
ro#iders% Birst! there are li*ely to )e $any issues -ith the sharing of $edical data
)et-een di=erent syste$s% Jhile the $a'ority of EMR syste$s are li*ely to satisfy
the seci&ed criteria of reorting data electronically to go#ern$ental agencies! they
$ay not )e a)le to reort the sa$e data to one another! a *ey re<uire$ent for a
nation-ide syste$% Many Gedgling syste$s are designed using IistA as a guide! )ut
$any are not% E#en if $edical data are easily shared! itKs another ro)le$
altogether for doctors to actually locate the infor$ation they need <uic*ly and
easily% Many EMR syste$s ha#e no caacity to drill do-n for $ore seci&c data!
forcing doctors to -ade through large reositories of infor$ation they donKt need to
&nd the one iece of data that they do need%
EMR #endors are de#eloing search engine technology intended for use in $edical
records% Hnly after
EMR syste$s )eco$e $ore -idesread -ill the e:tent of the ro)le$s -ith data
sharing and accessi)ility )eco$e clearer% The second ro)le$ is that there is a
otential conGict of interest for the insurance co$anies in#ol#ed in the creation of
health record syste$s% ,nsurers are often accused of see*ing -ays to a#oid or delay
aying health care clai$s% Jhile $ost insurers are ada$ant that only doctors and
atients -ill )e a)le to access data in these syste$s! $any rosecti#e atients are
s*etical% A May ./1. sur#ey conducted )y Harris ,nteracti#e found that only .L
ercent of U%S% adults -anted their $edical records con#erted fro$ aer to
electric% Most of those sur#eyed -orried a)out the security of electronic records! the
otential for $isuse of ersonal infor$ation! and the ina)ility of hysicians to
access atient records during a o-er or co$uter outage% Jorries a)out ri#acy
and security could a=ect the success of EMR syste$s and <uality of care ro#ided%
Hne in eight A$ericans ha#e s*ied doctor #isits or regular tests! as*ed a doctor to
change a test result! or aid ri#ately for a test! $oti#ated $ostly )y ri#acy
concerns% A oorly designed EMR net-or* -ould a$lify these concerns% Binally!
e#idence is $ounting that electronic health records $ay )e contri)uting to rising
Medicare costs )y $a*ing it easier for hositals and hysicians to )ill for ser#ices
that -ere not actually ro#ided% So$e electronic health record rogra$s allo-
doctors to auto$atically cut and aste the sa$e e:a$ination &ndings for $ultile
atients or )ill for rocedures that ne#er too* lace% More controls and federal
o#ersight are re<uired to $a*e electronic $edical record syste$s roduce the
results that -ere originally intended%
SourcesM Aicole 6e-is! CHealthcare Cost Cutting Hinges on ,T!D ,nfor$ation Jee*!
August 1/! ./1.F Reed A)elson! Nulie Cres-ell! and 3ri+n N% 4al$er! CMedicare >ills
Rise as Records Turn Electronic!O The Ae- Yor* Ti$es! Sete$)er .1! ./1.F Aeil
Iersel! CConsu$ers Still Jary of Electronic Health Records!D ,nfor$ation Jee*!
August @! ./1.F Pen Terry! CDocs May H#eresti$ate EHR Caa)ilities!D ,nfor$ation
Jee* Health Care! August ./1.F Ste#e 6ohr! CSeeing 4ro$ise and 4eril in Digital
Records!D The Ae- Yor* Ti$es! Nuly 18! ./11F Russ >ritt! CDigital Health 4ush Joos
Tech Bir$s! 4ains Doctors! Mar*etJatch! Nune .! ./11F Marianne Pol)asu* Mc3ee!
C>etter Clinical Analytics Means >etter Clinical Care!D ,nfor$ation Jee*! May .1!
./11F Eric Engle$an! CMore 4hysicians Adoting Electronic Health Records! U%S%
Reorts!D >loo$)erg Ae-s! Aril .L! ./11F Ne= 3old$an! C,$le$enting Electronic
Health RecordsM Si: >est 4ractices!D C,H ,nsight! March 8! ./11F Ro)in 6loyd!
CElectronic Health Records Bace Hu$an Hurdles More than Technological Hnes!D
Scienti&c A$erican! Aril 1L! ./11F Patherine 3a$$on! CConnecting Electronic
Medical Records!D Technology Re#ie-! August @! ./1/F Tony Bisher and Noyce
Montanari! CThe Current State of Data in Health Care!D
,nfor$ationManage$ent%co$! Nune 19! ./1/F and Naco) 3oldstein! CCan Technology
Cure Health Care?D! The Jall Street Nournal! Aril 17! ./1/%
CASE STUDY QUEST,HAS
1% ,dentify and descri)e the ro)le$ in this case%
.% Jhat $anage$ent! organi?ation! and technology factors are resonsi)le for the
di+culties in )uilding electronic $edical record syste$s? E:lain your ans-er%
7% Jhat is the )usiness! olitical! and social i$act of not digiti?ing $edical records
2for indi#idual hysicians! hositals! insurers! atients! and the U%S% go#ern$ent5?
;% Jhat are the )usiness and social )ene&ts of digiti?ing $edical record*eeing?
9% Are electronic $edical record syste$s a good solution to the ro)le$ of rising
health care costs in the United States? E:lain your ans-er%