michael m. awad, md, phd washington university in st. louis march 26, 2011

Electronic Medical Records: Efficiency

Michael M. Awad, MD, PhDWashington University in St. LouisMarch 26, 2011

No Disclosures

The ratio of the output to the input of any system

The extent to which time is well used for the intended task

Efficiency: Definitions

Task CompletionTime

During the 1990s, many industries invested heavily in IT:

telecommunications securities trading retail and general merchandising

Other Industries

IT resulted in advancements in:

Other Industries

Bar-coded retail checkouts ATM machines

Consumer reservation systemsOnline shopping and brokerages

IT thought to contribute to 6-8%

annual growth

Accessing Data◦ Reading history◦ Reviewing orders/medications◦ Examination of radiographs

Inputting Data◦ Admission orders◦ Inpatient orders◦ Discharge orders

What tasks are we referring to?

Can retrieve charts at any time Fewer lost charts Multiple individuals can refer to charts

simultaneously Remote chart access Most up-to-date data retrieval (labs,

pathology, radiology results) QA / Research

Accessing Data

Speeds input of multiple orders (order sets) Reduces clarification calls from Pharmacy Faster transmission of orders to point-of-

service (radiology, pharmacy, etc) Reduces time to sift through chart and

interpret handwritten notes Signing notes from afar

Inputting Data

Task CompletionTime Money=

Cost Efficiency

RAND Health Information Technology (HIT) Project 2003

Estimated potential savings and costs of widespread adoption of EMRs

RAND Analysis

increased exchange and flow of information

compliance with the regulations

ability to integrate graphic data such as electrocardiograms, alarms and warning systems, etc.

data quality data presentation data availability ease of production of data

reporting data handling access to reference

materials Legibility patient satisfaction productivity of the doctor reductions in incorrect

medication and data input errors

quality assurance training

RAND Analysis

Did not include savings for: Transcription Malpractice Research and public health savings

RAND Analysis

1.5%

4%

Sounds good,But…

Upfront Proper training required (Cedar Sinai, LA) May have initial loss of efficiency

(up to 15%-20% for 3 months) Implementation costs

Pitfalls

“Dumbing Down” Effect “EMR Plagiarism”

◦ Cut and paste for trainees◦ Lack of updates◦ Perpetuation of erroneous information

(In)attention to abnormal values Excessive notifications – quick dismissal Templatized notes

Pitfalls

Templatized Note

Other: Privacy

◦ Very easy to reproduce/transmit sensitive data◦ More pronounced with mobile devices

Research too easy to do◦ quick QA research quick conclusions

Hard to quantify:◦ reduction in medical errors◦ improvements in disease prevention and chronic

disease management

Pitfalls

Task Completion

Time

Quality

Pitfalls

Integration across disparate EMR systems Clinical-decision making tools Growth of mobile platforms

Future Directions

THANK YOU