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The future of EMRs according to Intermountain

Installing a fairly sophisticated, commercially available electronic medical-record system will enable a hospital to significantly improve patient care, but fully implementing a best-of-breed EMR will provide “significant additional benefits,” including both cost reductions and improvements in patient safety and quality of care, according to a recently published study by a trio of healthcare informatics researchers and consultants.

The report, EMRs in the Fourth Stage: The Future of Electronic Medical Records Based on the Experience at Intermountain Health Care, combines a literature search of studies on “third stage” systems available now from commercial vendors and an analysis of what the authors classify as a prototype of “fourth stage” IT systems, the home-grown Health Evolution through Logical Processing, or HELP, and HELP 2 systems that have developed over more than the past two decades at Intermountain Healthcare, an 18-hospital integrated delivery system based in Salt Lake City. The 12-page report appears in the current issue of the Journal of Healthcare Information Management published by the Chicago-based Healthcare Information and Management Systems Society.

Two of the researchers are Intermountain veterans, physicians David Classen and Peter Haug. Classen is a vice president and heads the clinical quality consulting practice at the IT consultancy, First Consulting Group, Long Beach, Calif. Classen served as chairman of the healthcare clinical quality committee for drug use and evaluation at Intermountain and is an associate professor of medicine at the University of Utah and a consultant in infectious diseases at the University of Utah School of Medicine in Salt Lake City. Haug is a senior informaticist at Intermountain and a professor in the department of biomedical Informatics at the Utah medical school as well as a consultant in infectious diseases there. They were joined in the research effort by Douglas Thompson, director of the health delivery practice at First Consulting Group.

The main focus of the report is on the newer, more advanced stages of systems and compares side-by-side the performance boost provided by adopting a stage-three system and by upgrading to stage four.

According to the report, stage four of EMR development is or will be characterized by systems: that have a broad adoption of commercial EMR systems; that have “greatly increased knowledge about how to use these (systems) more effectively and efficiently”; and that introduce the advent of greater sophistication in the systems, particularly in the area of decision support.

Among the benefits at stage three, for a hypothetical 300-bed hospital, the systems should enable medication-safety improvements of the magnitude of 138 fewer transcription-related adverse drug events and between 206 and 343 prescribing-related adverse drug events with a net financial benefit of between $182,000 and $1.9 million depending on payer mix. Time savings for nurses should generate $11,000 to $33,000 in potential financial savings. Better drug utilization could yield another $437,000 to $1.17 million in net financial benefit even after adjusting for the loss of charge-based revenues. Lengths of stay should drop by 5% to 10% for many hospitals, with a net benefit to the hospital ranging between of $1.3 million and $6.8 million depending on payer mix, the researchers said.

Many of the above improvements would be enhanced by a shift to stage-four systems, and other areas of improvement would be added, including, for example, in sophisticated disease management. For instance, an advanced diabetes-management system if deployed in a seven-physician clinic would provide a “net social benefit” of $200,000 per year in increased physician productivity, reduced costs from diabetes-related depression, and reduced hospitalizations and thus, “net financial benefit to the provider may be negative.”

While the researchers said the system at Intermountain is unique, “There are some exemplar organizations that have done this well,” Classen said in a telephone interview. Many have achieved these improvements by either developing in-house decision-support supplements to their commercial systems or purchasing decision-support tools from niche vendors.

“I expect we’ll have 20 of these (niche) companies in the next couple of years because they can bring this stuff to market much sooner than the larger vendors,” Classen said. These decision-support niche products will come prepackaged with interfaces to the larger enterprise systems. For hospitals, “I think that will be quicker than waiting for the (enterprise) vendors to develop this technology,” he said.

Currently, GE Healthcare is involved in a multiyear partnership effort with Intermountain to come up with a commercial product that replicates the workflow and decision-support advances that Intermountain has developed.

“If you looked at those applications at Intermountain, you wouldn’t find them in any of the commercial applications,” Classen said. “It really is different. The key is the Intermountain stuff is really, really customized around workflow and a process of care, not just a task. They looked at the entire process, not just ordering a medication. That’s why GE partnered with them. They really wanted to leapfrog to the fourth stage.”

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