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Study Suggests Use of EHR System Slows the Rise of Healthcare Costs

Posted by Matthew Smith on Sep 11, 2013 12:36:00 PM

EHR, New Study, University of Michigan, ANN ARBOR—Use of electronic health records can reduce the costs of outpatient care by roughly 3%, compared to relying on traditional paper records.

That's according to a new study from the University of Michigan that examined more than four years of healthcare cost data in nine communities. The "outpatient care" category in the study included the costs of doctor's visits as well as services typically ordered during those visits in laboratory, pharmacy and radiology.

The study compares the healthcare costs of 179,000 patients in three Massachusetts communities that widely adopted electronic health records and six control communities that did not. The findings support the prevailing but sometimes criticized assumption that computerizing medical histories can lead to lower healthcare expenses.

"To me, this is good news," said Julia Adler-Milstein, an assistant professor in the U-M School of Information and School of Public Health who led the study. "We found 3 percent savings and while that might not sound huge, if it could be sustained or even increased, it would be a substantial amount.

"That said, when we talk about cost savings, it does not mean that the costs went down, but that the costs did not go up as quickly in the intervention communities. This suggests that adopting electronic records helped slow the rise in healthcare costs."

The communities that computerized their records – Brockton, Newburyport and North Adams – did so in approximately the middle of the study period of 2005-2009. All the communities, including the controls, had applied to be part of the Massachusetts eHealth Collaborative's pilot that gave funding and support for entire cities' worth of doctors' offices to convert their records. To maximize the benefit from computerized records, experts believe it's important that the shift occurs throughout entire communities, rather than piecemeal. This real-world experiment gave the researchers a chance to test that premise.

Adler-Milstein and her colleagues calculated healthcare costs per patient per month, which amounted to 4.8 million data points. They examined not only total cost, but broke the data down by hospital care and outpatient care. They further examined outpatient costs for prescriptions, laboratory and radiology.

They didn't find any savings when they looked at measures of total cost or inpatient cost. The savings showed up when they narrowed the scope to outpatient care.

"That makes sense because the people who adopted electronic records were the community physicians, not the hospitals," Adler-Milstein said. "It's reassuring that the electronic records were adopted on the ambulatory side and that's where we saw the savings."

On average, the researchers estimated $5.14 in savings per patient per month in the communities with electronic health records relative to those without the records. Most of the savings were in radiology, and Adler-Milstein says doctors may have ordered fewer imaging studies because they had better access to patients' medical histories.

Digitizing health records is expected to lead to higher-quality, lower-cost care as well as fewer medical errors. This motivated the passage of the 2009 Health Information Technology for Economic and Clinical Health Act, which created a $27-billion incentive program to encourage doctors and hospitals to adopt electronic records.

Critics of using taxpayer dollars to fund electronic health records argue that use of these systems could actually raise costs because they make it easier to order tests, and they could be used to justify higher reimbursement.

"I think our findings are significant because we provide evidence to support the use of taxpayer dollars to invest in electronic health records," Adler-Milstein said. "We really have not had compelling evidence that proved that they would save money. It was assumed, but there are a lot of skeptics. This study helps clarify whether there are cost savings and what the magnitude of those are in the near-term."

The study, "Effect of Electronic Health Records on Health Care Costs: Longitudinal Comparative Evidence from Community Practices," was published in the July 16 edition of Annals of Internal Medicine. The research was funded by the Massachusetts eHealth Collaborative.

EHR, Meaningful Use, Stage 2

Topics: EHR, EMR, Electronic Health Records, New Study, University of Michigan

Study Cites EHR Meaningful Use Challenges; Praises Adoption Progress

Posted by Matthew Smith on Jun 10, 2013 1:24:00 PM

EHR, EMR, Meaningful Use, Annals of Internal MedicineThe task of automating America's health care system via physicians' use of electronic health record (EHR) technology is progressing but far from finished. That's the conclusion offered by authors of a new study in the June 4 issue of Annals of Internal Medicine.

According to the article, "Meeting Meaningful Use Criteria and Managing Patient Populations: A National Survey of Practicing Physicians," U.S. physicians are embracing EHRs in increasingly high numbers, but as recently as 2012, few physicians could meet the objectives set forth in stage one of the federal government's EHR meaningful use (MU) program. 

In fact, of 1,820 primary care and subspecialty physicians in office-based practices who responded to the survey, 43.5 percent reported having a basic EHR, but only 9.8 percent said they had achieved MU. Fewer than half of the respondents said their EHR systems were capable of performing any of the patient population management tasks included in the survey. 

The results didn't surprise study co-author Michael Painter, M.D., J.D., a family physician and senior program officer at the Robert Wood Johnson Foundation, which partnered with the Commonwealth Fund to fund the independent assessment of the nation's progress in adopting EHR technology. "Transformation is incredibly hard, but our family docs -- and everybody else -- are doing a heroic job at adopting and then learning to use this new technology," said Painter. 

EHRs are a tool that can be used to automate America's health care system -- an absolutely necessary process, according to Painter. Pulling an EHR out of a box is just the first step, said Painter. The real magic is in learning to use EHRs to perform key tasks, such as managing patient populations and generating quality metrics. 

"Yes, we're having steady sustained increases in adoption, and that's exactly what we wanted to see," said Painter. "But what we really want is the transformation process."

Study Highlights

In addition to answering questions about national trends in EHR adoption and determining how many physicians were able to meet MU criteria, researchers also wanted to know which MU measures were most difficult for physicians to meet and whether physicians were able to use their EHRs to manage the health of their patient populations. 

According to survey results, physicians most commonly used their EHRs to

  • view lab results,
  • order prescriptions electronically,
  • view radiology and imaging results, and
  • record clinical notes.

On the other hand, physicians were least likely to use an EHR to

  • exchange patient clinical summaries and lab and diagnostic test results with clinicians outside the office,
  • generate quality metrics, and
  • provide patients with post-visit summaries and copies of their personal health information.

As for meeting MU criteria, 11.2 percent of primary care physicians had done so compared with just 7.6 percent of subspecialists. 

Among primary care physicians, 40.5 percent had between eight and 10 MU functions available via their EHRs compared with 36.5 percent of subspecialists. Nearly equal proportions of primary care physicians and subspecialists reported having no MU functions (14.6 percent and 12 percent, respectively). 

The authors noted that "computerized systems for patient panel management and quality reporting do not seem widespread, and, where they are implemented, physicians reported that they are not always easy to use." For example, fewer than half of physicians could generate lists of patients by diagnosis. Furthermore, only about one-third of physicians could

  • track referral completion,
  • generate reports on quality of care,
  • send patient reminders for preventive or follow-up care,
  • pull names of patients who missed appointments or were overdue for care,
  • create patient lists by lab results, and
  • provide patients with after-visit summaries.

Physician responses regarding ease of use of patient-management functions varied, but nearly half of physicians said they could not, or found it very or somewhat difficult to, perform many of the above functions.

Moving Forward

Researchers concluded that the study results held implications for federal policy, particularly in light of MU bonus payments doled out to more than 145,000 health care professionals and totaling more than $3.9 billion through September 2012. 

"The pace of adoption of basic EHRs seems to be increasing, and findings around availability and perceived ease of use of systems that can help to manage patient populations should be of concern to policymakers," said the authors. "Using EHRs as simple replacements for the paper record will not result in the gains in quality and efficiency or the reduction in cost that EHRs have the potential to achieve." 

However, Painter focused on the positive. He pointed out that although just 10 percent of physicians in the study had met MU criteria, "the number who are really close is really big -- almost 40 percent. It's 40 percent for primary care physicians and almost 40 percent of (sub)specialists, and that's a big deal."

In addition, Painter said he would expect that a good number of physicians would have "tipped over" into actually meeting the criteria if they were surveyed now. He predicted that when the already written and approved MU stage two rules take effect in mid-2014, physicians would "blow right past those because they're going to need -- and want -- to use those population tools and quality metric tools." 

Painter, who saw patients in private practice from 1995 to 2003, urged his family physician colleagues to beat back discouragement. "It's really hard to practice primary care right now. It's slow going, but we are making progress," he said. "The best developers are going to try to develop things that physicians just love to use, but we're not there yet. We can't go back, because we can't get to where we need to be with health transformation without automating all these information processes." 

However, physicians can help move things along by being very vocal with health information technology developers about what they need in EHR systems to get the greatest results possible, he added.

Electronic Health Records EHR Assessment

Topics: EHR, EMR, Electronic Health Record, EHR Adoption, Physicians, New Study

New Studies Explore How EHR Use Influences Physician Behavior

Posted by Matthew Smith on May 30, 2013 3:02:00 PM

NewStudyJPG resized 600Two separate studies published this week examined the effect of electronic health record systems use on physician behaviors.

EHR Alert Fatigue Study

Clinicians might ignore positive alerts from EHR systems because of a deluge of repetitive, inappropriate alerts, according to a case report published this week in PediatricsMedscape reports.

Researchers from Stanford University Department of Biomedical Informatics and Harvard Medical School examined the case of a two-year-old boy who died after clinical staff overrode EHR alerts about potential drug allergy cross-reactivity. Prior to inappropriately administering a diuretic to the patient, the clinical staff overrode more than 100 alerts over the course of one month.

"Excessive electronic alerts warning clinicians of potential but rare adverse drug cross-reactions result in increased patient safety risks by rendering these alerts meaningless," the authors wrote, adding, "The threat of missing a rare event must be balanced with the dangers of burdening clinicians with unnecessary and interruptive electronic alerts."

In an accompanying editorial, Stephen Lawless -- with the Nemours/Alfred I. duPont Hospital for Children -- wrote EHR alerts "should neither replace nor minimize accountability that occurs through daily physical examination and reassessments."

Lawless concluded, "If the reliance on alerts results in either the purposeful or fatigue-induced deterioration of clinical assessment and decision-making skills, then alternative messaging techniques should be sought and studied" (Brown, Medscape, 5/28).

Provider Reliance on EHRs Study

Physicians might rely less on EHRs because they accept medical uncertainty as part of their practice, according to a separate study published in the Journal of the American Medical Informatics AssociationInformationWeek reports.

Based on interviews and observations of 28 doctors at a Texas multispecialty group, researchers organized physicians into three categories:

  • Reductionists: Clinicians who believed that the more information they put into an EHR the less uncertainty felt by physicians and the better care outcomes are;
  • Absorbers: Clinicians who spent less time documenting information and more time talking to patients; and
  • Hybrids: Clinicians who had characteristics of both reductionists and absorbers.

Reductionists used EHR systems the most, while absorbers used EHRs the least, the study found.

Those seeking to reduce uncertainty believed documentation through the EHR could help other providers who might care for the same patient.

In comparison, absorbers believed their conversations with patients were the most important tool for diagnosis and treatment.

Whether a physician was tech savvy did not necessarily predict his or her use of EHRs, study authors noted.

Lead author Holly Lanham--assistant professor of medicine at the University of Texas Health Science Center at San Antonio--said, "Uncertainty reduction is helpful, and IT is already designed to help us with that. What I'm hoping is that the finding of this paper will encourage EHR developers and policy makers to recognize that uncertainty is inevitable and figure out how to help doctors and nurses cope with that uncertainty" (Terry, InformationWeek, 5/28).

Topics: EHR, EMR, Electronic Health Record, EHR Adoption, Physicians, New Study

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