EMRs and the Transformation to Patient-Centered Care

By Ralph Henderson, president, nurse and allied, AMN Healthcare

May 11, 2011 - Over the past few years, technology has changed healthcare delivery in ways that even healthcare leaders could not have envisioned. Just a decade ago, for instance, how many of us would have thought that mobile phones and other handheld devices would have so many clinical applications? Or that telemedicine would provide a viable solution to expanding access to care?

Now, as healthcare providers across the nation are finding their way through the complicated process of implementation and utilization of electronic medical records (EMRs), we can start to see the enormity of this step—for the present and future. Not only does EMR implementation have a profound impact on how clinicians perform their jobs in their own facility, it has implications far beyond their own walls. It is part of an overall transformation in how patients and providers interact and how healthcare will be delivered in the digital age.

EMRs, also referred to as electronic health records (EHRs), are more than just a government mandate or a tool to meet one facility’s efficiency goals—they are a key component in connecting hospitals, physician practices, pharmacies and government agencies with the patients who need their care. And they are a necessary step toward the ultimate goal of improving outcomes and helping patients manage their own health.

Worthwhile investments in the future

Thanks to the 2009 American Recovery and Reinvestment Act (ARRA) that allocated $19.2 billion toward health IT, achieving meaningful use of electronic health records is one of today’s top priorities for hospitals and healthcare systems. In the 2011 HIMSS Leadership Survey, half of the healthcare IT professionals surveyed named it their top IT priority for the next two years, and two-thirds reported that their organization is making additional investments to qualify for meaningful use incentives; more than 80 percent reported that they expected their organization to qualify either this year or next.

The health systems that reach these goals have a lot more to look forward to than just some federal funding, according to the organizations that have gone before them.

Out of the 56 hospitals that have achieved a “complete” EMR to date, as described by Stage 7 of the Healthcare Information and Management Systems Society (HIMSS) AnalyticsTMEMR Adoption Model, 10 case studies highlight a variety of clinical and operational benefits gained through the process. In virtually every case, the hospital leaders said improving patient care was—and still is—the driving force behind their efforts. And many of their results reflect that, with everything from significant reductions in medication errors to shorter patient admit times, shorter lengths of stay and fewer readmissions.
These case studies coincide with our own experiences, as well.

In the many EMR system conversion projects that AMN Healthcare has been a part of, one consistent expectation cited by our hospital clients is that implementing electronic records will help them provide the best patient care; thus they are willing to make the short- and long-term investments to get there. The current financial incentives may have shortened the timetable for hospitals, but today’s efforts will impact healthcare organizations and their patients well into the future.

Many understand that this is not an IT-driven program, but a patient-centered program. Clinicians and hospital leaders benefit from improved workflow, system usage and long-term patient outcomes and in most cases, a hospital’s own clinicians are involved upfront, meeting alongside the IT professionals. And they continue to be an integral part of any system changes or upgrades.

Recent trends

According to the HIMSS Analytics Database, 30 percent of U.S. hospitals are still relying on paper-based documentation, and have yet to achieve Stage 3 of the EMR Adoption Model (as of the end of the first quarter of 2011). Following that same trend up to Stage 6 (Physician Documentation), and the numbers needed to transition grow, as only 4.5 percent of hospitals have reached Stage 6 or 7, leaving more than 95 percent left to make that transition. Many more will need to perform system upgrades before they can qualify for meaningful use incentives.

But studies are already starting to show some of the patient and provider benefits for those who have made the conversion.

One of the latest was published in the April issue of Pediatrics. Researchers from Stanford University School of Medicine and Lucile Packard Children's Hospital in Palo Alto, Calif., found that pop-up reminders in the electronic medical records reduced unnecessary blood transfusions by 460 and saved $165,000 in just one year. The system used evidence-based studies to help Packard’s physicians make more informed decisions.

The study’s authors also saw potential applications in many other clinical areas. According to Packard’s Eloa Adams, M.D., "We're showing you can use electronic medical records as a tool to improve health-care delivery, not just as a way to store records," he said in the hospital’s press release. "You can take evidence-based medicine and bring it to the bedside in a decreased amount of time."

And increased efficiencies from EMR systems have been shown time and time again, from Modern Healthcare’s “Most Wired” hospitals list on down to those that have just implemented their first electronic charting system. The trick, as most hospital leaders that we’ve worked with will tell you, is to get through the conversion process and come out on the other side.

Learning from best practices of the early adopters of EMR, most hospitals have begun to bring on travel nurses, locums physicians and other per diem healthcare professionals to supplement their clinical teams during training and go live. These flexible professionals, such as provided by AMN, come with experience with various EMR technologies as well as the clinical skills to assist with patient care while core team members learn the systems and work through the change management process. After spending millions on software and system configuration, a small investment in staffing can make the implementation process go smoother, accelerate user adoption, improve patient experience during go live and accelerate the hospital’s return on investment.

So when it’s time to make the necessary investments into a new EMR system, hospital and IT executives will want to be sure that their nurses, physicians, pharmacists and allied health professionals are fully invested in the project; and that when the time comes to go live on the system that they are sufficiently staffed to help make the transition/implementation process a success. It’s an important step for any facility and its patients—and for healthcare as a whole.

You can contact Ralph Henderson directly atRalph.Henderson@amnhealthcare.com.