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Study: EMR ROI Stronger In Low-Income Setting

Posted on November 23, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Well,  here’s some information which caught my eye right away. According to a new study published recently in the Journal of the American Medical Informatics Association, EMRs can provide a good return on investment for hospitals located in low-income areas.

In the study, researchers studied the what happened when a tertiary hospital in Malawi implemented an enterprise- wide EMR system.  The felt it was important to evaluate an EMR implementation in a low-income area such as this, the authors noted, because such hospitals face obstacles unlike those in more prosperous areas, such as marked supply and staff shortages, which might change the effect of such a system.

To examine the impact of the EMR, researchers looked at three areas: length of stay at the facility, transcription times and lab use.  The hospital saved an estimated $284,395 per year in U.S. dollars. By the third year of operation, the EMR  started generating a positive ROI, and by five years, it provided net benefit of $613,681, according to FierceEMR.

This is an inspiring study for those who hope to see EMR success stories, as until recently, there’s been little if any information to suggest that EMRs can offer a substantial savings on operations, much less help to generate a profit.

This doesn’t necessarily mean that hospitals aren’t generating savings or even profits by implementing an EMR.  As we noted in a previous story, few hospitals are planning for and implementing EMR ROI measures early in the game, according to a recent study from Beacon Partners.

If hospitals don’t dig in and integrate EMR ROI measurements into their strategic planning, it’s not surprising that they aren’t getting the fullest picture of what their systems are delivering. Backward-looking measurements aren’t likely to do as much as measurements built on a hospital’ls entire vision for success. Let’s see what happens when hospitals focus on ROI as a top-of-mind item going forward.

Memphis HIE Lowers Readmissions, Study Says

Posted on May 31, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

HIEs may still be struggling commercially — to my knowledge nobody’s found a business model that works without big subsidies  — but data is coming in to suggest that they can have a major impact nonetheless. That seems to be the case  in Memphis, where a study concluded that the local HIE saved $2 million by significantly reducing readmissions.

The study, which appears in the Journal of the American Medical Informatics Association this month, looked at a 13-month stretch during which emergency physicians at 12 hospitals had access to patient information through an HIE.  The hospitals are all members of the the MidSouth eHealth Alliance, which runs the HIE.

To determine what effect the HIE was having, researchers examined every ED encounter that happened between July 2007 and September 2008 that involved the use of HIE data.  All told, the researchers ended up crunching numbers for 15,798 HIE-related encounters. They then paired that data with an equal number of non-HIE-using encounters to look for differences.

One of the most interesting datapoints to be found here was that reduced admission levels for the 12 hospitals accounted for 97.6 percent of the $2 million in savings.  That’s a remarkable number, though it does leave me wondering whether the patients did equally well on other outcomes measures.

Even more interesting was that these results come from a relatively small number of ED encounters. ED physicians weren’t required to use the HIE, only accessed it about 6.8 percent of the time. You’ve got to wonder what would happen if ED doctors used the HIE most of the time.

Having learned all of this, here’s hoping the researchers dig in to other measures of care quality. For example, do ED physicians make fewer mistakes when they use HIE data?  Do they order fewer tests, or perhaps more given that they know more about patient needs?

This is a promising study. Now let’s see someone compare the financial and technical models for HIEs and tell us which, if any, are proving themselves.

Using PHR To Correct Provider Drug Lists Can Improve Safety

Posted on May 21, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Especially in a rapid-fire hospital setting, providers don’t always find out whether the medication list they have on file is accurate, which can lead to mistakes or even patient harm.  But new research suggests that if patients get to review and update their medication list via PHR, the number of unexplained discrepancies between the list and the patient’s regimen falls substantially — and the risk of mistakes capable of causing serious harm falls as well.

The study, which was published in the Journal of the American Medical Informatics Association, was conducted largely by researchers from Brigham and Women’s Hospital. The team found research subjects within 11 primary care practices using the same set-up, a PHR tied to their EMR.

The main study group consisted of patients given special access to the linked PHR, specifically a medications module prompting patients to review med lists. When the patients found discrepancies in the list, they documented the problem using an “ejournal” format designed to make physician list updates easy.

To see what effect this would have, the researchers gathered data from 267 patients who used an “ejournal” to warn of med list discrepancies, and also from 274 patients who worked with a different PHR-related technology.

Researchers found that unexplained medication list discrepancies affected 42 percent of the study group, while the control group had 51 percent. More alarmingly, the number of unexplained discrepancies with potential for causing severe harm was 0.08 within the control group, but only 0.03 percent in the study group.

According to FierceEMR, which covered this story, other studies have shown that patients want access to information in their provider’s EMRs, and that such access improves the accuracy of EMR data.

This is all well and good. My question is, how did the researchers motivate patients to use the PHR?  While it may be that patients like fixing errors, if they’re not prone to PHRs they’ll never get around to fixing med lists or correcting errors in care documentation.

If patients were merely invited to participate and jumped at the chance, they were tech-friendly or at least open-minded, as people don’t generally salivate at the opportunity to plow through medical data.

I’d love to see a study that researched how to motivate patients to engage in this type of dialogue. If PHRs can really do such good, figuring out how to get them into wide use is critical, isn’t it?  And shouldn’t hospitals be using this type of approach, or at least testing it?

Beware: EMR Installs Could Slow ED Throughput

Posted on November 9, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

It’s hard to argue that in the wake of an EMR install, some processes are likely to slow down or even break. What makes the following study interesting is that it attempts to do something intriguing —  sorting out how EMRs  affect emergency department throughput they’re implemented.

A new study appearing in the Journal of the American Medical Informatics Association concludes that EMR installs have a distinct impact on ED processes, as well as patient length of stay.

Researchers with the Cincinnati Children’s Hospital Medical Center attempted to track the impact an EMR install had there by looking at how often non-acute patients got routed to alternate sites.  Specifically, they looked at how often potential victims of the H1N1 flu virus were routed to non-acute sites before and after the Center did its implementation.

The hospital phased its EMR rollout in over two years, setting the ED section of the rollout for November 2009, a date which overlapped with the peak of t he H1N1 outbreak in its region. During that period, the hospital set up an overflow clinic — staffed by non-ED providers — to deal with patients who had flu-like illnesses.

The overflow clinic began seeing 50 to 60 patients per day, 10 to 20 percent of the ED’s volume, within two weeks, but plunged to pre-surge levels by November 2009, researchers reported in JAMIA.  While 10 percent or more of patients were being diverted prior to the ED rollout, that total fell to 5 percent afterwards, the study concluded.

Another intriguing finding was that length of stay in the ED went up markedly during the implementation. LOS in the emergency department was 24 to 53 minutes for admissions, and 9 to 19 minutes for discharges prior to the EMR rollout; during EMR implementation, LOS for both groups was greater than the pre-overflow clinic block and the H1N1 overflow clinic block by 32 to 62 minutes for admits and 35 to 44 minutes for discharges.  If reproducible, those are some serious numbers.

Of course, there’s a long ton of confounding factors here, including but not limited to the fact that patient flow in the H1N1 outbreak may be significantly different in important ways than the standard patient population. For all I know, the H1N1 diversions were not too hard to identify, which could mean that the EMR would  have had a worse impact if the virus wasn’t raging.

That being said, the question it asks — what impact the EMR rollout has on the “front door to the  hospital” — is one that deserves more attention. Rest assured that if I get more data on this subject I’ll be reporting it here.