Electronic Medical Records

Vital Information Source or Obsolete Documentation?

Living in the information age provides us with incredible opportunities and expectations. Communication, accurate information and timely delivery are important in every industry, but perhaps no more so than in healthcare. The massive amounts of information about our individual health - from test results to prescription allergies to simple medical records - has caused an explosion of computerized documentation that may or may not translate to quality care. Continuing to provide state-of-the-art care in today's changing environment will require a complete process change-one that will create a straightforward, user-friendly way for healthcare providers to exchange critical patient information.

Healthcare advocates talk of reform, quality, and patient safety. These are all commendable ideas, but none alone can solve the healthcare problems we face today. The focus must be placed on information and how it enters the healthcare equation-how it is used, processed, managed and archived. The outcome of the patient encounter is most important and to get the proper outcome, meaningful information must be available to the healthcare provider at the right place and at the right time.

Hospitals, individual physicians, private laboratories, specialized clinics, insurance and pharmaceutical companies all produce a massive amount of healthcare information. Their unique data types, formats, computer applications, operating systems and transfer formats make it very difficult to share data, causing an overload of mismatched information that is spiraling out of control. Today in the United States, there are:

240 million people with health insurance;
500,000 office-based physicians;
7,600 hospitals;
820,000 physicians and surgeons, 77,000 occupational therapists, 182,000 physical therapists, and 94,000 respiratory therapists within those hospitals; and
16,000 certified nursing facilities

It is estimated that there are over 785 million healthcare tests conducted each year just in the United States. The lack of interoperable systems to effectively communicate the results among the various providers who need to review them is consuming one billion hours of administrative processing time just to get the data in the right place, according to one estimate.

These numbers do not take into account the hundreds of major and minor healthcare insurance entities that must also interact with the providers. In addition, most healthcare institutions have several separate and disparate operational databases that are not integrated and may be incapable of communicating from one source to another. These competing systems are found in every major department of the healthcare system including radiology, lab, outpatient surgery, patient accounting, and clinical engineering, to name a few. Each generates information that is fragmented and seldom integrated into a common patient record system.

A key concern expressed by physicians is the lack of consistent data when presented with a new patient, leaving no proven way to assess the patient's actual health history. In order to "fill in the gaps," the physician relies on recollections from the patient who is asked to update paper or semi-digital health records which may or may not be complete. Because the collection and exchange of healthcare information is so complex and time-consuming when duplicated, vital information for appropriate patient care can be missing, overlooked or lost. This is no way to manage patient care in our age of information. It is no surprise that the healthcare industry is looking to technology to provide the global answer to its information needs.

Unfortunately, there may not be a global answer. The kinds of information that are part of any healthcare information management system must first be supported by all of the stakeholders in the healthcare community including physicians, hospitals, and insurance companies as well as technology providers. Some see the Electronic Medical Record (EMR) as the answer. Clearly, the EMR offers a common denominator in the management of patient records and patient care. However, the unanswerable question is that even if the medical community has access to the EMR, will it be used for more intelligent clinical decision making? In a recent study where EMR is available, it was found that only 25% of physicians used the EMR for clinical decision making some of the time and only 6% used it on a regular basis.

What's it worth?
Making it easier to communicate between systems should make a substantial difference in the efficiency of operations and accuracy of data transfer/sharing across systems. Perhaps better use and sharing of information can guide decisions as to the use of specific treatments, eliminating unnecessary or even duplicate medical tests and allocation of resources. The January 2005 issue of Health Affairs states:

By improving interoperability between both freestanding and hospital-based outpatient clinicians in their use of external labs, there could be between $8 billion and $32 billion in annual savings related to the elimination of redundant tests, plus a reduction of delays and costs associated with paper-based ordering and reporting of results.
By improving interoperability between pharmacies and outpatient providers, there could be a savings of as much as $2.7 billion per year just in medication related phone calls.
Transactions between healthcare providers and insurance companies could create savings of over $20 billion a year.
Improved interoperability will allow the payers to see paybacks from improved efficiency of their transactions, estimated to be about $10 billion a year.
The elimination of unnecessary lab and radiology tests would save almost $12 billion a year.

These numbers are staggering and suggest that individual facilities could save millions annually. When the highest interoperability standards are in place in an individual medium-sized hospital, the annual costs to maintain such a system would be approximately $250,000 per year, while the gained efficiency savings would be approximately $1.3 million. These are absolute dollar savings; the intangible savings to the patients would be immeasurable.

So the big question is not should we manage medical records electronically; but how do we? We will also need to consider what standards are put in place to get a common ground for communicating information. To make this a reality in the healthcare industry, a multi-step process that includes external and internal healthcare information integration tools is needed.

Before an organization can share its electronic information in an efficient manner externally, it must take an enterprise approach to managing the information internally. This internal integration begins by creating an inventory of information gathering processes, applications, languages, and storage places. Information "owners" identify where information can be shared and where it can't. This prevents duplicate storage of information which can lead to inconsistencies and the inability of one system to communicate with another - even within the same organization. To get to the point of true information convergence, one where information is processed and shared consistently and efficiently, an enterprise approach to the management of these information "silos" is required. In today's compliance-driven world, where data must be reliable and accurate, this enterprise approach is especially critical. In order for information to be shared with external users, organizations must first be able to manage all of their information across the enterprise.

EMR is a valuable tool for managing patient medical records, but it provides only a piece of the solution. Healthcare data comes from a myriad of sources that includes but is not limited to the information found within the EMR. By relying solely on the EMR to manage healthcare records, it squanders its potential value as a tool to transform healthcare delivery. The EMR becomes just one more document that offers short term gains at the risk of missing real long-term reforms. Standing alone, the EMR is not the answer the healthcare community is seeking, nor the "magic pill" that the industry would like it to be.

Quality patient care and healthcare reform will be realized when organizations and the industry as a whole look at the bigger picture and what is required to manage the entirety of the information. The approach should be carefully constructed and skillfully executed through Enterprise Content Management (ECM) technologies that are used in conjunction with EMR and other line of business applications. This will enable the industry to actualize a true electronic health record and will be a huge step towards improved and more efficient quality patient care.

Third Wave IT
Management and technology consultant, Bearing Point, recently identified a new vision in healthcare management. Using a strategic relationship with Google to build adapters for commercial applications, Bearing Point's approach allows for information from disparate sources to be searched and retrieved. Their adaptors provide privacy, security and levels of authorization as well as conform to HIPAA requirements.

Bearing Point suggests that we are in the third wave of computing. The first wave began with the use of large mainframe computers; the second wave started in the 1980's when personal computers with graphical user interfaces (GUI) applications became the workplace standard. This second wave was designed for independent work and allowed for limited interaction among computers. According to Bearing Point, we are currently in the third wave which came into its own in the early 1990's with the World Wide Web and is network based. In the third wave, the connection among users is more important than programs.

In today's market, we are all connected. Information is readily available and can be shared in ways not possible only a few short years ago. Current technology allows for a "new approach to healthcare management, replacing the primacy of the application with the primacy of the network." The EMR solution is limiting and perhaps already outdated because it relies on an initial EMR programming package that was designed without full networking capabilities or the technology of the third wave of digital information in which the network becomes the computer.

Regardless of the approach taken, whether it be the EMR or the network third wave, healthcare service providers must start managing all of their information at the enterprise level. Failure to do so perpetuates an outdated system that cries out for immediate reform and demands the best electronic solution available for sharing healthcare information.

About IMR
IMR is a leading provider of ECM and document management solutions to healthcare organizations, governmental entities and commercial enterprises. IMR has been providing information management solutions since 1981.

About the Author
Scott McCabe is the Chief Operating Officer at IMR with extensive experience in healthcare, technology, and education; he can be reached at smccabe@imrdigital.com.