EMR and EHR System Implementation Best Practices - Part 4 - Literature Review

This is the fourth article in a series dedicated to				ultimate goals of implementing an EMR system.
uncovering the best practices for an EMR				This complex interaction of both human and
implementation. The information presented has				functional provider systems leads to the case for
been developed by the author as part of a				an EMR system. Ewing suggests that the complex
research project.				interactions of a patient with the medical delivery
Literature Review - Introduction				system expose the patient to significant risk of
Opinions vary on widely on the benefits of EMR				adverse treatment. Risks identified include delivery
technology and whether providers should				of incorrect medication, prescription interactions
implement them. Christman suggests that the				and lack of medical history in emergency
security issues alone is reason enough to seriously				situations. EMR systems are designed to help
assess whether an EMR is right for a particular				improve patient medical care and the provider's
practice (Christman, 2006). However, government				ability to deliver accurate medical information
entities at both the state and federal level				(Kizer, 2007).
(Edwards, Lovelock, & Rose, 2006) along				EMR systems may ultimately feed other systems
with third party payer groups (Wojcik, 2006) and				such as an aggregation point for a PHR that a
corporate entities (Bit by bit, 2006) are driving				patient can access and carry with them from
health care providers ultimately to electronically				appointment to appointment (Shetty, 2007).
accessible medical records.				Reversing the scenario, an EMR system can
Currently, about 25 percent of U.S physicians are				collect and aggregate information from other
using systems that facilitate electronic health				sources such as laboratory, x-ray and
records (Murdock, 2007). As EMR systems gain				unstructured data like faxes or handwritten notes
momentum due to private and public pressures,				(Wojcik, 2006). Reduction of the storage
the number of implementations will continue to				necessary to keep paper charts is also a noted
rise and subsequently lead to the rise in failures				as a reason to leverage and EMR freeing up of
(The Standish Group, 1995). It is the purpose of				space better used for revenue generation. Paper
this study to help reduce failures by providing a				charts have their own risks associated with them
framework in which effective best practice within				in terms of getting lost, productivity impacts to
the field.				maintain and retrieve paper records and the
Many factors may influence the successful				resulting negative patient care. (Carpenter, 2002).
implementation of EMR systems. An				Effective access to medical records has become
understanding of an EMR system's purpose,				is another purpose of an EMR system. The ability
function and intended benefits help determine in				to access a record from remote locations is
part what influences the success or failure of an				important to ensure continuity of care (Research
EMR project along with awareness of mistakes in				notes, 2006).
the past while leveraging integration best practices				The intended effect of EMR systems on the
that may be unique to EMR implementations.				healthcare landscape is wide-ranged depending on
Electronic Medical Record Systems				the type of system and the environment in which
The collection of personal health data is described				it is being implemented. A group practice
to have many formats when speaking of				implemented an EMR system to improve the
systems that manage it. An Electronic Medical				accuracy of their claims and improve efficiency
Record is the collection of data that is central to				and information flow (Sonnenberg,
the patient (Rishel, Handler, & Edwards,				2007). Government entities such as the
2005). An EMR system exists to facilitate the				Department of Veteran Affairs and the
storage, retrieval and continuity of the record				Department of Defense have larger goals of
itself (Gans, Kralewski, Hammons, & Dowd,				integration and delivery of a common medical
2005). EMR systems vary in functionality.				record and full digitization of clinical data that can
According to Gans et al., EMR systems typically				be shared with branches of the military (Melvin,
have the following functions listed from most				2007).
common to least common:				The near term presents providers with realizing
- Patient Demographics				the digitization of the boxes of paper that is
- Visit/encounter notes				generated by patient encounters. These paper
- Patient medications/prescriptions				databases represent the clinical data that is
- Presenting complaint				ultimately needed to take EMR systems to the
- Physical exam/review of symptoms				next level. Clinical data is the baseline in which all
- Past medical history				healthcare processes subscribe including decision
- Problem lists				support, health outcome analysis, billing and claims
- Procedure/operative notes				processing and health maintenance.
- Laboratory results				Correlation and access to this data is what EMR
- Drug interaction warnings				systems seek to facilitate (Handler & Hieb,
- Radiology/imaging results				2007). With Clinical data as a basis, further
- Consult/reports from specialists				utilization of EMR systems can occur. EMR
- Referrals to specialists				systems, once materially implemented across the
- Drug reference information				healthcare spectrum, will itself become the
- Immunization tracking				framework in which more overarching goals can
- Drug formularies				be accomplished, such as the centralization of a
- Clinical guidelines and protocols				person's health history.
- Integration with practice billing system				Gartner (Handler & Hieb, 2007) break down
Other functions may include a claims processing				EMR system into generational phases of maturity
component that allows the coding and transmitting				(summarized):
of clinical data to insurance companies to improve				Phase 1 systems are designed to collect
the time and cost involved in dealing with				encounter based information such as prevalent in
insurance carriers (Research Notes, 2006).				a physician provider environment.
There are other names for EMR systems such as				Phase 2 systems are designed to allow the
the Electronic Health Record (EHR), Personal				updating and entry of information at the point of
Health Record (PHR), Electronic Patient Record				care. For example, a physician is making rounds at
(EPR) and Computerized Patient Record (CPR).				a hospital and can update his EMR records
Confusion around the many terms as well as				remotely rather than just access it.
what is represented by them impacts a provider's				Phase 3 systems are designed to support clinical
ability to strategically assess which system is best				episodes where there are one or more
for them (Rishel et al., 2005). Still, there are some				encounters that provide complete information on
subtle differences between each of the terms. An				a patient with system recommended treatment
EMR is typically generated by a physician's				options provided by decisions support systems.
practice. An EPR or EHR is typically generated				Phase 3 attempts to provide basic level evidence
using multiple sources such as those shared				based medicine implementation.
between a physician and a hospital. Finally, a PHR				Phase 4 systems are designed to further enhance
is a collection of patient information that the				the integration of systems to provide all
patient themselves hold and share with providers				stakeholders (physicians, nurses, pharmacists, etc.)
(Barlow, 2007).				access to patient data and to help facilitate the
EMR systems can be a complex set of connected				care process rather than just document it.
systems with significant data collection points or it				Phase 5 are complex, fully integrated systems
can be a simple system that collects basic data				that provide solutions across the full spectrum of
needed to record and associate health information				care. These systems provide both visual and data
with a specific patient (Rishel, 2007). An EMR				driven insight and suggested courses of action
system is a collection of information technology				where appropriate. Knowledge management is
that perform the functions noted above by				fully integrated into phase 5 systems to facilitate
leveraging databases for repositories of data or				a more partner based approach to care.
aggregation points for summary data from other				The iterative nature of EMR system provides a
systems (Rishel et al., 2005).				baseline in which each generation can grow.
The result of multi-faceted interaction of patient				However, very few EMR implementations
and the health care system is a distributed health				reviewed have been shown to reach much past
record that resides in as many locations as the				the first generation. Even those that are utilizing a
patient has seen physicians (Ewing, 2007). No one				Phase 1 EMR system are about one in four
provider has a consistent and full picture of the				(Murdock, 2007). As adoption continues to grow,
patient history or treatment. One of the primary				so will opportunities to further integrate with
benefits of the EMR system is to help eliminate				disparate systems and the development of
the disconnect and attempt to aggregate patient				standards for access to EMR data in a format
data as well as make it easier to share the data				that can be shared with both the consumer of
with other participating providers.				services and the providers of care.
The patient's complex interaction with the				The next article(s) will delve into additional
healthcare system (Ewing, 2007) further reveals a				reference material and case studies related to
problematic approach to the purpose and the				EMR Implementations.

Integrail

EMR and EHR System Implementation Best Practices - Part 4 - Literature Review