Reaping the benefits of electronic medical record systems

Healthcare Financial Management, June, 1993 by Michael W. Davis

INFORMATION SYSTEMS

An electronic medical record system can provide benefits beyond the obvious functions of efficient and less labor-intensive scanning archiving, retrieving, and printing of patient care information. The less tangible benefit of providing record access to several users simultaneously is difficult to quantify, but can enhance operations and improve the quality of patient care throughout a healthcare facility.

Before beginning a discussion of electronic medical record systems, it is important to make the distinction between an electronic medical record system and a computerized medical record system.

An electronic medical record system provides the system architecture to maintain in a database the text and image files that represent the paper documentation in the medical record. The text file data are captured via an interface with existing hospital information systems or clinical information systems in either a cumulative format, or at patient discharge in final report form. Image file data are created by scanning paper documents in patient records and capturing information that would not otherwise be integrated into the computer system. This architecture produces the complete medical record in an electronic format that provides multiple access capability and an environment facilitating quick retrieval and access of record documents. In the future, the electronic medical record system also will accommodate voice and video data as part of the patient record.

A computerized medical record system, in contrast, receives clinical patient treatment information in an on-line real-time mode from computers and maintains a database which acts as a central access repository for graphical/trend analysis of a patient's clinical data. In order for the data to be received on-line and in real-time, all information must be collected in data-element form from existing clinical computer systems, or the computerized patient record system must provide the capability of on-line entry of patient treatment data. Most healthcare facilities have the majority of their financial processes automated, but automation in the clinical areas is only slowly becoming a reality, due in some degree to the capital expenditures required to implement a full compliment of clinical information systems (see Exhibit 1). According to one recent report, only 40% of hospitals will achieve the automation required for a computerized patient record system by 1995.(a) Exhibit 1: Projected percentage of hospitals with installed information systems

      (Total number of hospitals: 5,919)

                1990     1991   1992    1993    1994    1995
Financial       94.9%    95.2%  95.6%   95.9%   96.2%   96.4
Patient car     48.5     53.3   56.2    58.7    60.9    63.5
Laboratory      46.3     48.6   51.9    55.1    58.2    60.9
Pharmacy        51.3     55.7   60.2    67.6    74.1    80.0
Radiology       20.6     24.8   30.1    36.0    36.4    40.9
Source: R.L. Johnson & Associates/Modern Healthcare

The provider's needs

The demand for an electronic medical record system has existed for several years, and recent surveys have identified the growing importance of the electronic medical record system. One survey reported 70.1 percent of hospital executives felt an electronic medical record system would improve operations, and 50.4 percent said they would implement an electronic medical record system within three years.(b) In another survey, 77 percent of the respondents indicated that electronic medical record systems have more potential for improving hospital services than alternative automation projects.(c)

Electronic medical record system vendors have been struggling to try and keep the cost of delivering the technology within the pricing expectations of the market place. The system configurations necessary to accommodate the scanning operations for hospitals with minimal clinical information systems require larger optical archive storage devices and increased scanning workstations; this drives up the cost of an electronic medical record system. The increased use of clinical information systems, as well as the reduction of the cost of technology, eventually will bring electronic medical record system costs in line with the pricing expectations of the market. Until then, managers should pursue aggressive operating and capital leasing alternatives when considering acquisition of an electronic medical record system. Leasing alternatives afford protection for equipment obsolescence, and provide the opportunity to update equipment configurations, thereby assuring use of the most current technology with a minimum of expense.

External factors also are influencing the current market. Changes in the Health Care Financing Administration's capital pass-through policy for Medicare may not hinder some hospitals' pursuit of electronic medical record systems,

while other hospitals may be penalized for pursuing these systems if they currently have existing capital expenditures for new plants or plant expansions.(d) The Government Accounting Office (GAO) released a report which promotes and encourages the implementation of electronic medical record systems.(e) The GAO's recommendation is not entirely altruistic, in that this agency recognizes the advantages of accessing and analyzing medical record data in an electronic format. The GAO's recommendation also endorses the Uniform Clinical Data Set as a standard for electronic medical record systems. The Institute of Medicine (IOM) endorses the computerized patient record system, and is calling for use of such systems by all hospitals by 2001. The IOM endorsement is supported by the American Medical Association. With agencies such as these promoting the electronic medical record system and the computerized patient record system, market demand and awareness should increase rapidly.