Improved Diagnostics & Patient Outcomes

How? EHRs don't just contain or transmit information; they "compute" it. That means that EHRs manipulate the information in ways that make a difference for patients. For example:

• A qualified EHR not only keeps a record of a patient's medications or allergies, it also automatically checks for problems whenever a new medication is prescribed and alerts the clinician to potential conflicts.
• Information gathered by a primary care provider and recorded in an EHR tells a clinician in the emergency department about a patient's life-threatening allergy, and emergency staff can adjust care appropriately, even if the patient is unconscious.
• EHRs can expose potential safety problems when they occur, helping providers avoid more serious consequences for patients and leading to better patient outcomes.
• EHRs can help providers quickly and systematically identify and correct operational problems. In a paper-based setting, identifying such problems is much more difficult, and correcting them can take years.

EHRs May Improve Risk Management By:

• Providing clinical alerts and reminders
• Improving aggregation, analysis, and communication of patient information
• Making it easier to consider all aspects of a patient’s condition
• Supporting diagnostic and therapeutic decision making
• Gathering all relevant information (lab results, etc.) in one place
• Support for therapeutic decisions
• Enabling evidence-based decisions at point of care
• Preventing adverse events
• Providing built-in safeguards against prescribing treatments that would result in adverse events
• Enhancing research and monitoring for improvements in clinical quality

Certified EHRs May Help Providers Prevent Liability Actions By:

• Demonstrating adherence to the best evidence-based practices
• Producing complete, legible records readily available for the defense (reconstructing what actually happened during the point of care)
• Disclosing evidence that suggest informed consent

EHRs can improve public health outcomes

EHRs can also have beneficial effects on the health of groups of patients.

Providers who have electronic health information about the entire population of patients they serve can look more meaningfully at the needs of patients who:

• Suffer from a specific condition
• Are eligible for specific preventive measures
• Are currently taking specific medications

This EHR function helps providers identify and work with patients to manage specific risk factors or combinations of risk factors to improve patient outcomes.

For example, providers might wish to identify:

• How many patients with hypertension have their blood pressure under control
• How many patients with diabetes have their blood sugar measurements in the target range and have had appropriate screening tests

This EHR function also can detect patterns of potentially related adverse events and enable at-risk patients to be notified quickly.

Studies Show: Better Patient Outcomes With EHRs

Using EHR Prompts & Reminders to Improve Quality of Patient Care 3

High Patient Satisfaction

• 92% were happy their doctor used e-prescribing.
• 90% reported rarely or only occasionally going to the pharmacy and having prescription not ready.
• 76% reported it made obtaining medications easier.
• 63% reported fewer medication errors.

High Provider Satisfaction

• Reduced overall rate of after-hours clinic calls.

Using EHRs to Improve Quality of Care 4

Improved Quality of Care Screenings

• Breast Cancer
• Diabetes
• Chlamydia
• Colorectal Cancer

Increase in Services

• Blood pressure control for patients with hypertension
• Breast cancer screenings
• Recording of body mass index and blood testing for patients with diabetes

Using EHR Decision Support to Improve Asthma Care and Compliance 5

The Study

• Cluster randomization of clinics
• Intervention: Clinical decision support (CDSClinical decision support) embedded in EHR

Outcomes

• 6% greater use of controller medications (preventive or maintenance medications to help prevent asthma symptoms from occurring)
• 3% greater use of spirometry (a common office test used to diagnose asthma and other conditions that affect breathing)
• 14% greater use of asthma care plan
• Spirometry improved by 6% in suburban practices

EHRs Transforming the Clinical Process 6

A community hospital in Vermont recently implemented and EHR and reported:

• 60% decrease in near-miss medication events
• 20% increase in completion of daily fall assessment helping to avoid prolonged hospital stays
• 25% drop in the number of patient charts needing to be pulled for signing orders and dictated reports

Using EHRs to Improve Documentation and Coding 7

• Based on level of medical decision-making, ~50% of visits under-coded
• Rural family practice implementing EHR + Practice Management (EPM) system
• Increased case mix (type or mix of patients treated by a hospital or unit) by 10% over 2 years from 1.34 to 1.47
• EHR documentation templates in multi-specialty clinic
• Increased use of ICD code 99214 by 11%
• Average billable gain of $26/patient
• Increased revenue by >100K during the study period

1. Jamoom, E., Patel, V., King, J., & Furukawa, M. (2012, August). National perceptions of ehr adoption: Barriers, impacts, and federal policies. National conference on health statistics.
2. BCouch, James B. "CCHIT certified electronic health records may reduce malpractice risk," Physician Insurer. 2008.
3. Duffy L, et. al. "Effects of electronic prescribing on the clinical practice of a family medicine residency, Fam Med. 2010;42(5):358-63
4. Lisa Kern et al., "Electronic Health Records and Ambulatory Quality of Care," Journal of General Internal Medicine, Oct. 3, 2012
5. Bell LM, Grundmeier R, Localio R, Zorc J, et al. Electronic health record-based decision support to improve asthma care: a cluster-randomized trial. Pediatrics. 125(4):e770-7, 2010 Apr.
6. Bell, B, Thornton, K. (2011). From promise to reality achieving the value of an EHR. Healthcare Financial Management, 65(2), 51-56.
7. Holt J, Warsy A, Wright P. "Medical decision making: guide to improved CPT coding", Southern Medical Journal. 103(4):316-22, 2010 Apr. AHRQ Publication No: 09-0095 dated September 2009.