Computerized patient records benefit physician offices

Healthcare Financial Management, Sept, 1997 by Alan Bingham

The use of computerized patient record systems in ambulatory settings is still a relatively new concept; however, such systems offer a variety of benefits to physician practices. Computerized patient record systems can help improve the quality of care provided, for example, by providing real-time patient status reports, test results as soon as they are available, and graphs and flowsheets of test trends. They can help reduce costs by eliminating many manual functions and the supply and staff expenses associated with these functions. Finally, they can provide practices the data necessary to attract and negotiate favorable managed care contracts.

Because computerized patient record technology is still new, substantive empirical evidence upon which to base payback calculations is scarce. Time and motion studies were conducted at a model five-physician, primary care clinic to determine where efficiencies and cost savings could be realized through the use of a computerized patient record system. In addition, actual and anecdotal information from several clinics of comparable size that have such systems was used to reach some preliminary conclusions. Findings suggest that computerized patient record systems may return productivity gains and help physicians attain their patient care and financial goals.

A computerized patient record system provides a true systems approach to providing care. It drives and directs patient care activities in part by building upon basic functions of an electronic medical record, such as documentation of medical encounters, prescription writing, generation of consultation letters and materials for patient education, and other care-related activities. Acceptance of computerized patient record systems in ambulatory care settings, however, has been low, with industry estimates of only 5 to 7 percent market penetration.(a) Concerns regarding financial payback may be one factor responsible for this low figure.

What Physicians Want from Computer Systems

Physicians see computer systems as a means to improve quality of care, increase cost efficiency, and attract and negotiate favorable managed care contracts.(b)

Quality of care. Physicians want to improve both the quality of the care they deliver and patients' satisfaction with that care. A computerized patient record system increases physicians' ability to research and validate quality improvements and customer satisfaction.

Cost efficiency. Physicians view computers as tools to help reduce costs and increase monetary returns and, therefore, expect a quantifiable financial payback on any incremental technology they implement.

Managed care contracts. Physicians need to optimize the value and comparative costs of the services they deliver to compete effectively for managed care contracts and negotiate the best terms for their practices. A computerized patient record system can determine how many different procedures are handled by a practice and the relative values for those procedures. The system also can help quantify the time and resources consumed by activities, such as seeing patients, managing care at other locations, and resolving a medical complaint.

Requirements of an Effective System

To be effective, a computerized patient record system should perform a sufficient number of essential patient management tasks so that the need for supplementary systems is minimized. Such tasks include the following:

* Making medical records readily available at all times and from all designated locations;

* Providing accurate, up-to-date patient status and care management information;

* Creating automatic, up-to-date graphs and flowsheets that show test-result trends;

* Providing immediate notification of test results and status changes;

* Performing insurance verifications/preauthorizations;

* Facilitating timely and reliable health maintenance screening, planning, and scheduling; and

* Flagging allergies and possible drug interactions automatically.

In addition to clinical functions, the computerized patient record system should manage patient-related administrative tasks, such as registration and scheduling.

To maximize productivity payback of the system, most, if not all, transactions should be captured during the patient encounter. Activities that should be recorded in the computerized patient record include patient history, physical exam information, and progress notes. Other transactions, such as ordering prescriptions, procedures, and diagnostic tests, should automatically trigger issuance of reports, referral letters, and other types of communications. A computerized patient record system also should offer real-time processing of information, which can eliminate double and triple handling of patient forms, repetitive dictation, and manual note-taking and reduce the trail of activities that usually follows a patient visit.

An effective computerized patient record system should allow practice personnel on-line access to hospital information and other systems at other facilities to retrieve billing and accounting information and laboratory results and to order tests and schedule procedures. A computerized patient record system also can connect to diagnostic monitoring instruments of home care patients. All these applications can save time, money, and effort and reduce errors of commission and omission.