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HCIMS: Balm or Bomb for What Ails the US Health Care System?

Written By: Jane Affleck
Published On: February 6 2009



Upon his inauguration, President Obama reiterated his campaign pledge that improving the US health care system is among the top issues to be addressed during his first term in office (and beyond). In response, many people are expressing support, as well as some degree of skepticism. At the forefront of Obama’s promise is that technology will play a key role in bringing about improvement: he initially vowed that $10 billion per year over the next five years would be invested toward creating electronic health records (EHRs) for every US citizen.

The majority of voices have seemed to be strongly in favor of spending whatever it takes to update health records, citing cost-savings, better delivery of health care (resulting in improved health and more saved lives), and job creation as some of the major benefits of making the transition from old handwritten records to standardized electronic records.

There does, however, seem to be some grumbling about the projected cost of and difficulty involved in creating electronic records. Several deterrents have been noted, including an ongoing shortage of sufficiently skilled IT professionals available to help with nation-wide implementation; privacy issues, such as identity theft; and, the fact that few hospitals and doctors have already started using “computerized record-keeping systems” (presumably suggesting that not only implementation, but also user training will need to be addressed for any benefits to be realized).



The US spends upwards of 16 percent of its gross domestic product (GDP), or an average of $6,280 per person (figures from 2004) on health care per year. It seems hard to believe that implementing a system that includes EMRs and other health care IT applications could prove to be more expensive in the long run.

More recently, however, as the Democrats announced their economic stimulus package, the amount to be devoted to computerizing health records was set at $20 billion (this figure, it’s implied, is now the total to be invested over the five-year period). Health IT professionals quoted in the same source say that the “total cost to build an electronic medical records system could be between $75 billion and $150 billion.”

But even the majority of these curmudgeonly naysayers will admit that some form of change to the health care system is needed, and that no matter the cost, well-chosen EHR applications will go a long way to improving patient health and boosting efficiency (thereby reducing costs).

To reinforce the benefits of EMRs and other components of health care information management systems (HCIMSs)—as well as perhaps sway any (ma-)lingering curmudgeons—here’s a break-down of a number of key functionalities EMR systems offer, as well as the proven benefits.

Functionality 1:

  • Automates search functionality, by patient name, date of birth, social security number, or other patient data


Benefit:

  • Speeds up access to patient records, reducing administrative burden and allowing faster location of files, more efficient appointment-making, etc. (an employee can waste up to 31 minutes searching for and filing paper files every day—more than 129 hours per year—or 16 workdays!)


Functionality 2:

  • Allows patient demographic and other data to be shared amongst various clinics and physicians (those who are authorized to view data)


Benefit:

  • Streamlines registration and other administrative tasks (once patient data has been entered at one clinic, time isn’t wasted filling out another form or providing info to a new health care provider, as that provider can access the info in the electronic record; but per security restrictions, data cannot be changed except by authorized users)


Functionality 3:

  • Enables longitudinal record of patient history at all health facilities, with ability to track immunizations, prescriptions, and diagnoses


Benefit:

  • Provides health care provider with clearer, more holistic picture of patient’s health and how treatment is progressing (or if another treatment ought to be employed); whether patient’s prescription drugs are compatible; and how one health condition and treatment may affect another



  • Additionally, makes it easier to determine when a patient is overdue for a treatment or procedure, such as an immunization or a pap test


Functionality 4:

  • Features “progress notes,” with automatic updates from other sections of the patient record


Benefit:

  • Allows physicians to better plan patient care/treatments, and to more easily and accurately document patient progress



  • Also expedites completion of charts and files, for increased efficiency and accuracy


Functionality 5:

  • Security features, such as the requirement for physician signature or authorized user password, with last access to data time stamped with the user’s ID


Benefit:

  • Ensures that patient privacy is protected, as each record is confidential and accessible only to those authorized to view it (unlike paper files, which can be accessed by any passerby—whether medical staff or random stranger—if file cabinets are left unattended)


Functionality 6:

  • Restricts views of patient records according to the specialty/subspecialty of the doctor/nurse, or other criteria… (such as “need-to-know” basis); restricted access is in accordance with the US Health Insurance Portability and Accountability Act (HIPAA) and other standards, with role-based user IDs and other functionality


Benefit:

  • Further assures patient confidentiality (and, if a new specialist needs access, she or he can be added to the list of authorized users; likewise, a doctor can be removed for whatever reason)


Functionality 7:

  • Patient “problem list” functionality allows listing and tracking of patient health problems (e.g. allergies, chronic conditions)


Benefit:

  • Allows health care providers to create and maintain a clear and easily identifiable list of conditions, reducing the risk that a health condition will be missed amid copious and possibly illegible hand-written notes


Functionality 8:

  • Automates a variety of functions throughout patient file (automatic updates after patient encounters, and linking problems to test results, etc.)


Benefits:

  • Helps ensure consistency of data within a patient file and across health care facilities


Functionality 9:

  • Offers problem-solving tools for physicians, including knowledge bases, administrative databases, online literature, analytical tools, e-mail alerts, reminders, etc.


Benefit:

  • Allows doctors to access the most recent medical research about diseases and conditions, helping them to make decisions about patient care and helping ensure the most current treatments and preventative care are offered


Functionality 10:

  • Includes standardized measures of health status (average health statistics/status for demographics, as well as averages for various health conditions)


Benefits:

  • Helps monitor patient progress, and allows health care provider to make a fairer assessment of patient’s  condition (i.e. how a diabetic patient is doing relative to average or expected for someone of his age, taking into consideration other health or demographic factors)


Functionality 11:

  • Provides functions for automatic generation of patient letters, service reminders, physician-to-physician communications, etc.


Benefits:

  • Helps ensure patients get follow-up or referral appointments in a reasonable period of time following initial consultation, as automated communication reduces burden on doctors and administrators


Functionality 12:

  • Provides patients with online access to perform such actions as request appointments, access advice, get prescription refills, learn about lab results, etc.


Benefit:

  • Allows patients to be more involved in managing their own health, as well as in their treatments and preventative therapies—helping improve long-term prognosis especially for those with chronic illnesses


Functionality 13:

  • Allows data synchronization between devices, or from remote to central system


Benefit:

  • Helps ensure accuracy and timeliness of patient information


And, never mind the added benefit that “it is estimated that a stimulus investment of $10 billion in health information technology for one year would create as many as 212,000 jobs, over half of which would be in small businesses and high-paying, high-tech industries.” True, the investment may not end up being $10 billion; but even creation of half that many jobs is nothing to sneeze at. Finally, you should know that that an EHR application is only one component of an entire suite of a health care information management system (HCIMS).

Other health care software systems include








Each of them can play a crucial role in streamlining and improving the value of patient care throughout all health care facilities. But as with any other software application, the benefits can’t be fully realized unless a proven selection methodology, including definition of requirements, is followed.

Find out about TEC’s software selection methodology and Evaluation Centers.



And, tell us what you think: will electronic health records be the shot in the arm that the US health care system needs?
 
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