EMR
RECENT NEWS AND SURVEYS
Survey
of EMR
The 2008 Survey of EMR Trends and Usage includes
40 questions that reveal insights into: |
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- Priorities for strategic decisions in IT
- Factors driving adoption of EMRs
- Major barriers to implementing EMR systems
- Satisfaction with EMRs re training, functionalities,
ROI, etc.
- Information capture methods being used
or planned
- Adoption, satisfaction with, and impact
of speech recognition
- EMR applications and functions being used
or planned
- Wireless technologies being used
- Perceived effect of EMRs on patient care,
patient safety, efficiency and cost of healthcare
delivery, and malpractice risk
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SUMMARY
OF OBSERVATIONS
Survey
of Electronic Medical Records
Trends and Usage
2007 |
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ABOUT
THE SURVEY
Survey of Electronic Medical Record Trends and
Usage is an annual poll of IT usage among healthcare
providers of various sizes and types. A total
of 1011 individuals responded to the survey. To
increase relevancy and diminish bias, responses
from vendors and consultants are not included
in the results, reducing the total database to
819. |
| |
| The
Survey of EMR Trends and Usage includes 20 questions
(some with multiple components) that reveal insights
into: |
- Priorities for strategic decisions in IT
- Factors driving adoption of EMRs
- Major barriers to implementing EMR systems
- Information capture methods being used or
planned
- EMR applications and functions being used
or planned
- Wireless technologies being used
- Perceived effect of EMRs on patient care,
patient safety, efficiency of healthcare delivery
|
Summary
of Observations
Of
the 819 respondents: |
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- 63.6% are either final decision-makers
or have strong influence in EMR decision-making.
- The percentage increases to 89.1% when those
with some influence are added.
- Thus, only 10.9% have little or no influence
in EMR decision-making. Respondents to the
survey are strongly US- based (91.9%)
|
 |
| Role
categories most represented among respondents
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- IT managers and professionals
- Physicians and nurses
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| WHY
EMRs ARE BEING IMPLEMENTED |
| The
following are most cited as priorities for strategic
decisions in IT. |
- The need to improve clinical processes or
workflow efficiency.
- The need to improve quality of care.
|
| The
following are most cited as factors driving the
need for EMR systems in the hospital segment.
|
- Patient safety considerations
- Efficiency and convenience
- Satisfaction of physicians and clinician
employees
|
| The
following are most cited as factors driving the
need for EMR systems in the medical practice segment. |
- Improved patient documentation
- Efficiency and convenience to physicians
through workflow benefits
- Remote access to patient information
|
| The
following are most cited as barriers to EMR implementation
plans. |
- Lack of adequate funding or resources
- Anticipated difficulties in changing to
an EMR system
- Difficulty in creating a migration plan
from paper to electronic documentation and
record keeping
- Inability to find an EMR solution or components
at an affordable cost
|
DOCUMENT
IMAGING APPLICATIONS
Document imaging is most in use and most planned
to |
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- Digitize paper documents received from third
parties in order to integrate them and view
them in EMR systems.
|
| CLINICAL
INFORMATION CAPTURE INTO THE EMR |
| The
following are most cited as methods for entering
clinical information into the EMR: |
- Free text keyboard entry
- Structured data entry with pull-down menus
- Structured data entry with keyboard/mouse
|
|
| The
following are most cited as having more frequent
use: |
- Structured data entry with keyboard/mouse
- Structured data entry with pull down menus
- Free text keyboard entry
|
| The
methods most cited as not being used are |
- Light pen
- Digital pen & paper
- Optical character recognition
|
| Regarding
current satisfactory use of information capture
devices and methods: |
- Use of dictation and transcription without
speech recognition is most cited as satisfactory
and most cited as
|
| SPEECH
RECOGNITION TECHNOLOGY ADOPTION |
| The
following are most cited as very important factors
driving installation of speech recognition (SR)
technology. |
- Improve productivity
- Reduce turnaround time
- Reduce transcription costs
- Facilitate real-time healthcare documentation
- Improve clinical workflow
|
| The
types of SR reported as most in use are |
- Dictation system with SR that automatically
uploads to EMR
- Direct dictation into EMR (seamless integration)
- Stand-alone SR (no integration with EMR)
|
The
majority of those using speech recognition to
generate reports report using only front-end SR
with no medical editor or other person involved.
EMR EXPERIENCE
Almost a third report experience with a system
that some partner/s employees refuse to use.
Less than one-fifth of respondents report past
or current EMR deinstallation to replace with
another.
Fewer than one-tenth report past or current EMR
deinstallation to revert to paper records.
EMR INPATIENT/OUTPATIENT
SUPPORT
EMR systems within most hospitals, IHDSO, managed
care organization, or similar healthcare institutions
are reported as supporting both inpatient and
outpatient capabilities. |
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| EMR
ADMINISTRATIVE AND FINANCIAL APPLICATIONS |
| The
following EMR administrative and financial applications
are reported as most in use. |
- Billing and accounts receivable
- Scheduling
- Claims processing
- Patient appointments
|
| Reported
as most planned are |
- Consents
- Release of information
- Advance directives management
|
| EMR
DATA CAPTURE, REVIEW, AND UPDATE CAPABILITIES
APPLICATIONS |
|
| The
following EMR data capture, review, and update
applications are cited as most in use: |
- Patient demographics
- Allergies and adverse reactions
- Laboratory results
|
| Reported
as least in use are: |
- Problem knowledge couplers
- Pre-visit health screenings, evaluations,
or assessment
- Post-visit patient education
|
| Cited
as most planned are |
- Pre-visit health screenings, evaluations,
or assessments
- Alerts, warnings, or reminders generated
by decision support
- Problem knowledge couplers
- Post-visit patient education
|
ORDER
ENTRY AND E-PRESCRIBING APPLICATIONS
The survey shows that, in hospital settings, nurse/staff
order entry continues to exceed physician order
entry and is increased over 2006.
The respondents indicate that, in hospital settings,
the level of planned physician order entry with
clinical decision support exceeds that planned
for physician order entry without clinical decision
support. |
| |
| E-prescribing
applications to commercial/retail pharmacies reported
as most used are: |
- Drug-drug interactions
- Access to drug reference information
- Drug allergy checking
|
| |
| E-prescribing
applications to commercial/retail pharmacies reported
as least used and most planned are |
- Patient eligibility for specific drug within
health plan formulary
- Patient eligibility verification
- Refill tracking
|
COMMUNICATION
Use of the Continuity of Care Record (CCR) has
increased since 2006. |
| |
| The
most planned uses of the CCR are |
- Personal health record
- Referrals
- Transfers
|
| Regarding
access to reference information, respondents indicate
|
- Drug reference information is most used.
- Most planned are
|
Access
to notifications/reminders for disease management,
preventive services, and wellness.
Access to clinical guidelines/protocols.
Respondents indicate that email continues to be
more used between practitioners than between patients
and clinicians. |
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| CLINICAL
DATA REPOSITORIES |
|
| The
following clinical data repositories are cited
as most used. |
- Storage of reimbursement codes
- Storage of EMR data and text
|
| Least
used is storage of voice or sound. |
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| OTHER
EMR APPLICATIONS |
| Among
3 additional EMR applications: |
- Remote EMR access by physicians is reported
as having the most current use.
- Use as data warehouse or secondary database
is most planned.
- Use for clinical trials is least used and
least planned.
|
STATUS
AND TRENDS OF MOBILE /WIRELESS APPLICATIONS
Respondents indicate increased use of WiFi, WWAN
(digital and analog), and WPAN wireless connectivity,
with WiFi most used.
EMR
EFFECT ON QUALITY OF PATIENT CARE
Almost two-thirds of those responding rate quality
of care until now as improved by EMRs in their
organization.
Over two-thirds of those responding rate quality
of care until now as improved by EMRs in healthcare
in general.
Over 90% anticipate that EMRs will have improved
quality of care 10 years from now.
EMR EFFECT ON PATIENT SAFETY
Over half of those responding rate patient safety
until now as improved by EMRs in their organization.
Over two-thirds of those responding rate patient
safety until now as improved by EMRs in healthcare
in general.
Over 90% anticipate that EMRs will have improved
patient safety 10 years from now.
EMR EFFECT ON EFFICIENCY OF
HEALTHCARE DELIVERY
More than half of those responding rate the efficiency
of healthcare until now in their organization
as improved by EMRs.
Almost two-thirds of those responding rate the
efficiency of healthcare until now in healthcare
in general as improved by EMR
Almost two-thirds of those responding rate the
efficiency of healthcare until now in healthcare
in general as improved by EMR
A) Experts in this industry
advocate the benefits of this technology, but
according to the survey, what has the survey
found to be the biggest driving factors for
EMR system adoption?
We ask that question of those who are in hospital
settings as well as those in medical practice
in order to look at the driving factors, depending
upon whether you’re talking about a hospital
or a provider institution versus a physician’s
practice. In the hospital environment, out of
the top five factors driving the adoption of
EMRs, there are two factors that were not even
offered or considered in 2006. This is a good
example of how the survey does indeed morph.
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B)
It sounds like there are some really good driving
factors that are furthering the adoption of EMRs,
but are there any current barriers to adoption?
Lack of adequate resources or funding continues
to be the primary barrier to adoption, although
the percentage of those identifying this as a
problem has dropped by 15 percentage points from
last year. This makes me wonder if there has been
a change in the marketplace where solutions are
now available for less than $1,000 per physician.
The range of solution prices now is really dramatic.
And I think the fact that there are increasing
numbers of options where physician practices can
get into the EMR world without a massive investment
is reflected in the decreasing number of people
dealing with lack of adequate sources, resources
or funding.
C)
According to the survey, can you identify the
biggest challenges that end-users are currently
dealing with when using EMR technology today?
How can they be addressed and overcome?
Today, I believe end-users are provided with more
valuable upfront information, which allows them
to better identify a system that matches their
needs. Users can make more confident decisions
and ensure they have a match between what was
promoted as the features; functionality and benefits
of a particular system and having it actually
meet those expectations.
D)
How can vendors use the information from the survey
to improve their products?
I think the survey provides a wealth of information
for vendors. I believe it’s imperative for marketing
and sales departments, as well as research and
development, to review the survey results and
really use them as a focus of discussion for the
development, refinement or adaptation of what
they’re doing.
E)
Does the survey identify users’ demands from this
technology?
The survey asks a series of questions on functionalities
– such as applications and functions, review and
update capabilities, order entry, e-prescribing
applications, continuity of care records, access
to reference information, and clinical data repositories,
as well as a few others. We ask respondents if
they are using these applications today. And if
not in use today, we ask when they plan on using
it, if at all. We do this to determine the wealth
and range of functions that are currently being
adopted, where the planned adoption is, and I
think equally important, what they’re not interested
in adopting. |
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F)
It’s obvious that this technology has become fairly
widespread in the healthcare arena as we realize
the need for EMR systems, but is there another
step that must be taken to fully realize all the
benefits of this technology? How can we encourage
further robust adoption?
After making a purchase decision and investing
in any system, it is crucial to gain training,
which should take place immediately before implementation,
because if there’s a gap between training and
implementation, the potential benefits are going
to be lost as well as throwing away some money.
It’s really an ongoing process. Adoption, in terms
of implementation, is never completely finished.
As I mentioned earlier, there’s a constant desire
to do more, to see more benefits, to utilize the
system, to upgrade the system and to change the
system in order to gain more benefits.
G) What do you see on
the horizon for EMRs?
I believe we are much further along now than we
were even five years ago. I think we’re finally
at a point where we’ve gained sufficient momentum,
and I think we’re going to continue to see stronger
adoption and higher enthusiasm for adoption –
not adopting because everybody’s doing it, but
because it’s actually needed. This is partly due
to the fact that we’re dealing with generations
now that grew up with electronics. Some of the
barriers we’ve been dealing with for the last
10 or 20 years are really going by the wayside.
Today’s physicians and healthcare professionals
have a high expectation of using electronics,
much like information technology is used in every
other aspect of life. |