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The Tech Doctor: The EMR - Savior or Poseur?


New research is raising uncomfortable questions about the connection between EMRs and improved patient outcomes. Can information technology really make you a better physician?

If you’re an EMR skeptic, you’ll love this:

A new study, conducted by the Centers for Disease Control and recently published in the Archives of Internal Medicine, examined some 50,000 charts across 2,500 practices and found no statistical difference between EMR practices and non-EMR practices on 14 of 17 quality parameters (e.g., percentage of patients on statins, or whether patients are receiving smoking cessation counseling).

What gives?

A casual observer of the various government pronouncements regarding EMRs might conclude that there is a one-to-one correlation between implementing an EMR and improving quality of care.

But it’s not that simple.

The reason: At its core, an EMR is a record-keeping tool for electronically creating and storing patient information. As the referenced study suggests, just because records are stored electronically doesn’t mean that the fundamental processes that support patient care have changed.

This reminds me of the physicians in a primary-care practice with which I worked in Wisconsin who were shocked when they realized that two years after successfully implementing an EMR that their quality of care - as measured by parameters such as the ones cited above - had not budged from their pre-EMR levels.

So are the quality mavens wrong about what they claim EMRs can deliver?

No. They are in fact right.

Here’s why: While an EMR can simply be used to digitize existing paper methods, it also has the potential to accomplish tasks that are difficult, if not impossible, to do with paper charts. For example:

  • Point-of-care reminders: Your EMR can easily be configured to generate point-of-care reminders based your patients’ age, sex, or disease. This function can always remind you or your staff to do an overdue foot exam or to collect an HgA1c reading on your diabetic patients, even if they come in for a sore throat. It’s not easy to do that with paper charts when you are seeing 20 to 30 patients per day.

  • Staff initiatives: Let’s say you want to more fully engage your staff in proactively managing specific patient pools, such as those with diabetes, asthma, or heart disease, so you can ace your payers’ P4P incentives. With an EMR, one of your staffers can sit at a single terminal and electronically slice and dice your entire patient population, based on specific parameters, so you can easily organize and collect patient data.

  • Tracking data: Quality - at least for the government and payers - is all about data. EMRs give you the ability to not only aggregate your data so you can evaluate your own performance, but they can also determine whether your quality interventions are actually having any effect. While paper charts will never crash due to a software glitch, they’re lousy at producing and aggregating data.

As the CDC study found, having an EMR is no absolute guarantee that your quality of care will improve. But it’s also virtually impossible to meet the kind of quality objectives that third parties demand without one.

Ask The Tech Expert

QDoes it matter which EMR I get in terms of improving quality?
A Yes; not all EMRs are equal in this area. You’ll want to evaluate each potential system for preventive reminders or health maintenance features as well as reporting capabilities. Start with CCHIT-certified vendors.

QWhat’s the No. 1 piece of advice you would give to an EMR-based clinic that wants to improve its quality?

A Use the EMR to unleash the power of your staff. An EMR suddenly makes patient information universally available in your office, which makes it possible to design new processes that will positively affect your quality of care. Even the most EMR-astute physician cannot do it alone.

Do you have a question for our Tech Doc columnists? Send it to bgabriel@physicianspractice.com.

Bruce Kleaveland is president of Kleaveland Consulting, a management consulting firm focused on healthcare IT. Prior to forming Kleaveland Consulting, he was chief operating officer at a leading EMR company. He can be reached via bgabriel@physicianspractice.com.

This article originally appeared in the February 2008 issue of Physicians Practice.

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