HRS: EMRs may have slow roll-out, but immense benefits
Denver—EMRs are the wave of the future and despite slow roll-out times and new technology learning curves, these electronic solutions cut healthcare costs and boost patient care, said Elizabeth A. Ching, RN, from the Cleveland Clinic, during a presentation May 13 at the 31st Heart Rhythm Society (HRS) scientific sessions.
At the Cleveland Clinic, rolling out an EMR solution took time, but the push from policymakers and the Centers for Medicare & Medicaid Services (CMS) to focus on implementing better health IT solutions that optimize patient care encouraged the staff to consider enhancing its facility-wide technology to conform to meaningful use criteria.
“I am not a computer geek,” said Ching. “I am telling you that from the get go this has been a learning experience for me and most of my staff because literally turning on a computer used to be the extent of what we could do.”
To completely understand the “whole premise” of device therapy, follow-up and EMRs, you must understand Health Level 7 (HL7), which provides a framework for facilities for the exchange, integration and sharing of patient EHR information.
“There are some strategies with HL7 and these have to be coherent, extendable standards that permit structured healthcare information to be exchanged in computer applications,” said Ching. “In other words one computer has to be able to talk to the other to make sure that the patient’s record can flow throughout the enterprise.”
According to Ching, HL7 members want to make the aforementioned standards and framework world-wide and ensure that the standards “meet real-world requirements” for all types of practices and facilities.
In 2006, when the push for health IT standards arose, it was said that implementation of these solutions would “lead to more efficient, safer and a higher quality of care,” said Ching. “The thought is that all the data are controlled in one database then there would be a decrease in cost for medical services.”
Additionally, the goal to create a digital health record for every American is quickly approaching and will be mandated within the next five years.
“We have rising costs and inconsistent quality,” explained Ching. “You see it with patients coming into your practice that you shake your head at and ask, ‘How did this patient stay alive to get to see us?’”
She touched on how many limitations stem from paper records, which take up room and create problems and deficiencies within the organizational process. “There had to be a paradigm shift,” she said.
Particularly within the private practice sector, the switch to computerization and health IT must be justified and costs must be deeply considered in order to ensure that the benefits are worth the overhead cost.
Surprisingly, even with the push toward meaningful use and electronic patient documentation, only 15 percent of U.S. physicians are using a minimally functional or comprehensive EMR.
Hospital EMR usage ranges from 5 to 59 percent and the systems vary in functionality and characteristics implemented, from prescriptive and drug therapy, computerized ordering and more.
According to Ching, as an incentive to meet the looming deadlines for meaningful use, CMS has issued financial incentives ($18,000) for facilities that deploy EMRs before 2011.
However, if facilities do not deploy EMRs, these incentives will turn into 1 to 3 percent declines in reimbursements, said Ching.
To first implement health IT systems at the Cleveland Clinic, the facility entered into a pilot program with Google and Microsoft to evaluate the efficiencies of the Microsoft HealthVault system, which provides access to patient data.
The facility enrolled 250 patients—26 percent were diabetics, 6 percent were heart failure (HF) patients and 68 percent had hypertension.
Blood pressure pumps, cuffs and weight scales were administered to patients enrolled in the study and data were entered into the computer application by patients and transferred into HealthVault and into the EMR.
“This allows patient care across time zones,” said Ching. “Being a tertiary care center, we follow patients from all over the world and its very nice for them to know that their care is being driven by the same person regardless of where they are.”
Researchers found that days between appointments for both the diabetic and hypertension patients increased and the need for follow-up was delayed because patient data were constantly streaming into the hospital facility.
On the other hand, the time between visits for HF patients decreased. “This was felt to show a more timely intervention on an outpatient basis of those headed into heart failure,” said Ching. This therefore decreased hospitalization costs.
“It is not just care it is proactive care,” said Ching. “Healthcare should be delivered by developing innovative, cost-effective solutions that allow patients to prospectively manage their healthcare.”
Besides use of HealthVault and the EMR, the Cleveland Clinic uses Mychart, which gives all patients at each of their 17 health offices and six hospitals a unique patient identifier where patients can log into the application to manage appointments, prescriptions, medications, and lab results.
Ching said that EMRs help tremendously with device-based follow-up because data are fed directly into the EMR. “Closing the loop and letting the patient get involved with their follow-up electronically is important.”
More patient involvement with medical records has the potential to eliminate their calls to the facility, said Ching.
“All of these questions can be easily answered in a time that is convenient for you and the patient,” she concluded.
At the Cleveland Clinic, rolling out an EMR solution took time, but the push from policymakers and the Centers for Medicare & Medicaid Services (CMS) to focus on implementing better health IT solutions that optimize patient care encouraged the staff to consider enhancing its facility-wide technology to conform to meaningful use criteria.
“I am not a computer geek,” said Ching. “I am telling you that from the get go this has been a learning experience for me and most of my staff because literally turning on a computer used to be the extent of what we could do.”
To completely understand the “whole premise” of device therapy, follow-up and EMRs, you must understand Health Level 7 (HL7), which provides a framework for facilities for the exchange, integration and sharing of patient EHR information.
“There are some strategies with HL7 and these have to be coherent, extendable standards that permit structured healthcare information to be exchanged in computer applications,” said Ching. “In other words one computer has to be able to talk to the other to make sure that the patient’s record can flow throughout the enterprise.”
According to Ching, HL7 members want to make the aforementioned standards and framework world-wide and ensure that the standards “meet real-world requirements” for all types of practices and facilities.
In 2006, when the push for health IT standards arose, it was said that implementation of these solutions would “lead to more efficient, safer and a higher quality of care,” said Ching. “The thought is that all the data are controlled in one database then there would be a decrease in cost for medical services.”
Additionally, the goal to create a digital health record for every American is quickly approaching and will be mandated within the next five years.
“We have rising costs and inconsistent quality,” explained Ching. “You see it with patients coming into your practice that you shake your head at and ask, ‘How did this patient stay alive to get to see us?’”
She touched on how many limitations stem from paper records, which take up room and create problems and deficiencies within the organizational process. “There had to be a paradigm shift,” she said.
Particularly within the private practice sector, the switch to computerization and health IT must be justified and costs must be deeply considered in order to ensure that the benefits are worth the overhead cost.
Surprisingly, even with the push toward meaningful use and electronic patient documentation, only 15 percent of U.S. physicians are using a minimally functional or comprehensive EMR.
Hospital EMR usage ranges from 5 to 59 percent and the systems vary in functionality and characteristics implemented, from prescriptive and drug therapy, computerized ordering and more.
According to Ching, as an incentive to meet the looming deadlines for meaningful use, CMS has issued financial incentives ($18,000) for facilities that deploy EMRs before 2011.
However, if facilities do not deploy EMRs, these incentives will turn into 1 to 3 percent declines in reimbursements, said Ching.
To first implement health IT systems at the Cleveland Clinic, the facility entered into a pilot program with Google and Microsoft to evaluate the efficiencies of the Microsoft HealthVault system, which provides access to patient data.
The facility enrolled 250 patients—26 percent were diabetics, 6 percent were heart failure (HF) patients and 68 percent had hypertension.
Blood pressure pumps, cuffs and weight scales were administered to patients enrolled in the study and data were entered into the computer application by patients and transferred into HealthVault and into the EMR.
“This allows patient care across time zones,” said Ching. “Being a tertiary care center, we follow patients from all over the world and its very nice for them to know that their care is being driven by the same person regardless of where they are.”
Researchers found that days between appointments for both the diabetic and hypertension patients increased and the need for follow-up was delayed because patient data were constantly streaming into the hospital facility.
On the other hand, the time between visits for HF patients decreased. “This was felt to show a more timely intervention on an outpatient basis of those headed into heart failure,” said Ching. This therefore decreased hospitalization costs.
“It is not just care it is proactive care,” said Ching. “Healthcare should be delivered by developing innovative, cost-effective solutions that allow patients to prospectively manage their healthcare.”
Besides use of HealthVault and the EMR, the Cleveland Clinic uses Mychart, which gives all patients at each of their 17 health offices and six hospitals a unique patient identifier where patients can log into the application to manage appointments, prescriptions, medications, and lab results.
Ching said that EMRs help tremendously with device-based follow-up because data are fed directly into the EMR. “Closing the loop and letting the patient get involved with their follow-up electronically is important.”
More patient involvement with medical records has the potential to eliminate their calls to the facility, said Ching.
“All of these questions can be easily answered in a time that is convenient for you and the patient,” she concluded.