Electronic medical records remain an enigma. In a June poll conducted by Harris Interactive/HealthDay found that less than one in 10 American adults use EMRs, and nearly half didn't even know if their physicians had them. Despite this, 78 percent of the adults surveyed said they "strongly" or "somewhat" agree that physicians should be able to access their records electronically. To help understand how EMRs have affected renal care now and where they may go into the future, RBT asked the following experts three questions to get their take on EMRs.
- Bruce Thompson, founder and President of Gaia Healthcare Systems
- George Rovegno, President and chief executive officer of MIQS
- Ulrich Simonsmeier, chief executive officer of Cybernius Medical
- Beth Evans, chief executive officer of Health Informatics International
- John Sargent, President of Quantitative Medical Systems
How have EMRs and other computer-based applications helped improved renal care?
Thompson: Fully integrated EMR systems improve renal quality outcomes through data integrity and data synchronization while providing financial benefits. In order to help with patient outcomes, online real-time reporting systems track treatment care activities for immediate reporting back to caregivers. By having all treatment activity history and trending analysis available at chairside, caregivers can adjust daily treatment prescriptions using standing orders/protocols to better meet individual patient treatment goals and plans of care.
Data synchronization is where a single data point is only entered one time into the EMR and therefore only recorded once in the database. Programming shortcuts will create duplicate data in multiple tables opening the door to data recording/reporting errors. Entering a value only once and having it carry over to multiple sections within the EMR ensures that patient data is reported consistently across the care continuum. This allows caregivers to spend less time charting which allows for more one-on-one direct patient care.
By documenting all treatment activities in a single EMR database, facilities will see revenue increase by capturing 100 percent of billable patient charges through the treatment charting process. Facilities will also benefit from increased revenue due to averted costs, such as printing, as a result of decreased utilization. Facilities also can reduce costs associated with paper charting over time and increase productivity by improving workflow.
Rovegno: Annual U.S. gross HD mortality still exceeds 21.5 percent (USRDS). Computer and EMR use has expanded dramatically—now used in more than 90 percent of U.S. patients, but the impact on quality seems negligible. Perhaps, this is because computer use in dialysis has been driven by billing and compliance, not by serious commitment to improving quality of life and survival for ESRD patients; i.e., the focus is on correct payment claim generation rather than on facilitating high quality care delivery by nephrologists and clinical care staff.
To effectively care for ESRD patients, we believe complete, accurate clinical data must be accessible at the point of care. If we do this correctly we will see improved care. To test this belief, we studied 3 dialysis units deploying and effectively implementing the MIQS EMR. Annual HD mortality decreased by 1.4 percent per year, until, after 9 years, it was 35 percent to 40 percent lower than USRDS. Today it stands at 13.1 percent. Yet, compared to USRDS averages, they now employ 25 percent fewer clinical staff. This unique, comprehensive, patient-centered, coded, analyzable, EMR has improved renal care by enabling individualized, meaningful, actionable access to all relevant clinical information; allowing CQI for individual patients and groups; reducing nurse paper work by 70 percent; timely meeting all billing, administrative, and external reporting functions with fewer billing staff. Our EMR demonstrated improved care and reduced costs.
Simonsmeier: EMRs do of course have a varied offering the functions and features, resulting in resulting in a disparate set of benefits, depending on the system chosen. Basic benefits have been mainly in three areas: increased/ubiquitous chart access, increased chart legibility; reduced administrative effort, automated data gathering, compilation and reporting; and standardization, enforcement of clinical policies in the treating areas. Such benefits can typically be classified into the categories of improved safety or improved efficiency.
Evans: Renal patient care involves massive volumes of data to properly manage. It requires different care protocols based on a large number of co-morbidities, different parameters of wellness, and unique treatment options such as dialysis. Fortunately, renal-specific EMRs exist to coordinate and improve renal care. We believe HII’s renal-specific TIMETM System has demonstrably improved renal care in many ways.
For example, entering and reviewing patient clinical data at the point of care more than saves time. It increases accuracy because the clinician enters medical documentation as part of the process of care. Our clients believe their EMR reduces the number of medical errors and helps educate patients to understand the cause and effect of the care they receive and what they do. Patient education can be an implicit benefit of an EMR.
Additionally, ubiquitous access to a single, comprehensive patient record expedites clinical co-operation, avoids duplication of data and effort, and ensures a patient’s data is available to any authorized member of staff whenever they need it. It also gives clinicians confidence that clinical data is tracked properly, that it is accurate, consistent, current and that any review of historical data has appropriate clinical context for improved clinical decision-making. Further, it routinely includes interfaces to automatically capture lab data, machine data, ADT data, and other relevant clinical data stored on other systems.
One other significant benefit of an EMR is that it can inform a clinician’s thinking with the right data and protocols of care at the point of decision such that patient management, compliance with administrative policies, and ongoing quality improvement are easier to achieve and in less time.
Sargent: Dialysis treatment is unique in that results and outcomes are by and large the result of the treatment, and orders are intended to move outcomes toward a specific clinical goal. To effectively address this issue, electronic medical records (EMRs) integrate different data sources to produce supporting analyses and facilitate effective dialysis therapy.
Staff efficiency is improved and clinician time saved by providing rounding information customized to the particular individual’s concern and specialty thus helping assure the complete delivery of ordered treatment items, medications, or other procedures.
Properly designed EMRs offer efficient data collection, using electronic inputs--e.g. from dialysis machine and lab analyses--and eliminating double entry. In addition to offering easy access to data at all user locations, data integration in the system offers capabilities not previously available when information resided in different parts of a paper chart. For example, the management of anemia can now be supported by a comprehensive understanding and analysis of IV iron use, blood iron values, blood loss, hemoglobins, and amount and frequency of ESA administration. Further, long-term longitudinal data from diverse sources provides analyses of trends to guide clinical responses and facilitate CQI programs.
An additional benefit comes from having all treatment information in electronic form – clinical staff spend less time ensuring that differing payer reimbursement requirements are met, freeing them to focus on patient care.
