Taking your practice electronic has a host of proven clinical and organizational advantages –  the impacts can be felt across practices’ diverse functions from

•  supporting patient engagement and retention,
• to preventing medical and billing errors,
• to improving practitioner workflow,
• to reducing administrative and operational costs.

While much of the research is with academic medical centers and physicians, the benefits highlighted below are applicable to the integrative practice (whether naturopathic, acupuncture, TCM, chiropractic, or other) as well. [1]

 

An EHR Supports Patient Health and Happiness

One of the major benefits of EHR/EMR adoption is that they support the (integrative) practice by improving patient quality of care – simply defined as “doing the right thing at the right time in the right way to the right person and having the best possible results”¹ – and overall satisfaction.² The use of EHRs reduces error rates, costly, redundant testing, and is associated with better patient treatment and results.

1. Improve patient outcomes and make care more effective

A number of studies have demonstrated that computerized physician reminders, launched through an EHR, increase the use of prophylactic care. The use of EHRs boosts vaccination rates, adherence of medication regimens, and other preventive behaviors, sometimes by as much as 11-22 percentage points.

• The Evidence: One study found computerized reminders increased treatment adherence by 11.3% for hypertension in primary care.³ Another study demonstrated significant increases in vaccination rates (from 47% to 65% of patients for influenza, from 19% to 41% for pneumococcal vaccinations) among rheumatology outpatients taking immunosuppressant medications.⁴

2. Avoid the waste of supplies, equipment, energy and other resources

EHRs reduce redundant and costly testing – which, by the way, can also lead to false positives and additional unnecessary tests and costs! They enable better sharing of patient test results across different practices and practitioners and build in reminders of previous testing.²

• The Evidence: In a nationally representative profile of physician use, 30% of physicians mentioned they had ordered fewer tests as a result of lab results’ availability through the use of an EHR in the past month.⁵ In an outpatient setting, researchers observed a 14.3% decline in diagnostic tests ordered per visit, and a 12.9% reduction in diagnostic test costs per visit, when using an EHR.⁶

3. Avoiding patient injuries from care

Many EHRs have clinical decision support (CDS – assists provider in making patient care decisions) and computerized physician order entry systems errors (CPOE – allow providers to enter order electronically). These reduce the likelihood of significant medical or medication errors, sometimes by as much as 83%. This reduction of errors is attributed to i) CPOEs’ elimination of reliance on penmanship of providers and thus more efficient processes as staff and pharmacies do not need to solicit additional information, and ii) CDS’ provision of additional information regarding drugs, interactions of medications, and other patient issues.^2,7

• The Evidence: Bates et al. demonstrated that the use of a CPOE system can reduce serious medication errors by as much as 55% (and by 83% when coupled with a CDS). ^8,9 A similar, more recent study in the outpatient setting found that computerization resulted in an error rate reduction from 18.2% to 8.2%.¹⁰
• In full transparency, while the vast majority of studies found significant improvements in patient safety through the use of electronic software, a few studies found additional medical errors caused by poorly designed CPOE interfaces (e.g., dense pull-down menus, and text entry fields), lack of training, or systems that weren’t properly integrated.²

4. Benefit patient satisfaction from care

Pinpointing the precise impacts of electronic application implementation on ‘patient satisfaction’ is complex. The impact of EHR (not to mention practice management) implementation can have a range of impacts on patients – from those mentioned above to ramifications for physician-patient interactions to the ease of scheduling appointments and the accessibility of their health data. Initial EHR patient satisfaction research has shown a largely positive (or neutral) impact of EHR use on patient satisfaction. ^7,11,12

• The Evidence: EHRs with electronic prescribing (e-prescribing) provide patients with improved access to prescriptions. They reduce the likelihood paper prescriptions are lost or misread (resulting in medication checks), while lowering costs for doctors and pharmacies. 92% of patients were happy their doctor used e-prescribing, while a full three-quarters (76%) reported it made obtaining medications easier.^13,14

 

An EHR Benefits Practitioner Workloads

Three-quarters of physicians are using EHRs to remotely access their patient charts – the prevalent use of EHRs in practices has been associated with more flexible and generally reduced workloads (particularly on time spent on and looking for documentation). Overall, it is correlated with greater practitioner practice and career satisfaction.

5. Simplify Your (Practitioner) Workflow

EHRs can save practitioners time and energy – they facilitate charting, record-keeping and access, and allow practitioners to communicate directly with their patients.

• The Evidence: EHRs allow for more complete, accurate, reliable and comprehensive data collection than paper-based systems,  and less provider time is spent on documentation and  on tasks like searching records when EHRs are used.¹⁵  Practitioners particularly like being able to immediately access records when on a call.[2]  In a nationally representative study, 74% of physicians used EHRs to access patient charts remotely, and 52% reported having been alerted to critical lab value values through their EHR.¹⁶ 
• EHRs further reduce practitioner workloads by facilitating communication with patients – 25% of physicians use their EHR to facilitate communication directly with their patients.¹⁶

6. Improve Your Work (and Life) Satisfaction

EHR research shows adoption of an electronic solution can benefit providers’ work satisfaction.

• The Evidence: In preliminary studies, EHR implementation was associated with improved provider satisfaction.^13,14 In a study of fourteen solo or small group practices implementing EHRs, Miller et al. found that quality of life improved for some practitioners over the implementation period. Three practices saw the same number of patients in less time and took the gain as more personal time (rather than seeing more patients). Providers in most practices particularly liked accessing records from home, which enabled some of them to go home earlier, spend time with family, and then work later in the evening.¹⁷

 

An EHR Will Save You Money

A range of studies have demonstrated that the use of EHRs can have financial benefits for practices by improving patient visits and attendance, reducing operational costs, enhancing revenue capture and tracking, and mitigating billing errors. In addition, a sampling of studies have other less tangible non-pecuniary benefits of EHR use, such as improved legal and regulatory compliancy and reduced malpractice claims.

• 79% of providers report that their practice functions more efficiently with an EHR.¹⁸ 
• In solo and group practices, EHRs recouped financial benefits averaged $33,000 per FTE provider per year.
• Efficiency-related savings and revenue gains combined accounted for 48.3 percent of financial benefits, or $15,808 per FTE provider per year, most of which consisted of a decrease in personnel costs.[3] ^19,20

7. Increase Your Patient Visits (from reminders and reduced no-shows)

Using an EHR can help practitioners see more patients – and thereby increase revenues. By sending automated reminders to patients, practitioners can increase the number of patients who come in for preventive or routine health visits and reduce the number of appointment no-shows.²⁰

• The Evidence: In a blinded control group assessment of nonattendance rates at an employee health outpatient clinic, Lim and Varkey found that the mean nonattendance rate for patients who started to receive e-mail reminders significantly decreased by 35% (from 9.7% to 6.3%). Almost 200 of 5,407 appointments showed up just as a result of the email reminder, resulting in tens of thousands in additional revenues.²⁰
• On a reduced scale, the impact is just as significant for smaller practices. Research amongst solo and small group practices found 1 percent more patient visits from reminders – for practices who chose to see more patients, the gains ranged from $6,600 to $22,500 (median – $8,200). As mentioned above, some practitioners decide to take more personal time, instead of using it to see more patients. ¹⁷

8. Reduce Your Cost to Operate

Most of the EHR pecuniary savings result from automating time-consuming, paper-driven tasks.²² Benefits include increased utilization of tests, reduced staff resources devoted to patient management, reduced supply costs to maintain paper files, decreased transcription costs, and lower costs relating to chart pulling, storage and refiling.²²

• The Evidence: In Miller et al.’s study the time required for most administrative tasks decreased within six months of EMR implementation, unlocking the majority of observed cost savings.¹⁷
• The use of EHRs can reduce the redundant use of tests and the time associated with ordering and reviewing them, as well as the costs of mailing hard copies of test results to different providers. By making patient information more readily available, they reduce costs related to chart pulls and the supplies (cabinets, space, etc.) needed to maintain paper charts. Through point-of-care documentation and other structures, they can also reduce transcription costs.²
• At a large, academic, outpatient primary care setting, EHR implementation was associated with a significant reduction in after-hours calls through the implementation of electronic prescribing.^13,14 
• Finally, EHR use is associated with a reduction in staff time spent on calendar management and scheduling as they allow practitioners to post their calendar online and/or facilitate calendar tracking and appointment scheduling. Managing practice space and rooms associated with procedures may also be simplified from the EHR deployment.

9. Capture ALL Patient Charges/Reduce Outstanding AR days/ Reduced Billing Errors

EHRs’ more accurate reimbursement coding allows for the reduction of billing errors and improves the capture of patient charges. Superbill actions and on-the-spot billing allow for improved tracking of (and hence easier reduction of!) outstanding account receivable days. The result is substantial cost recovery.^2,13

• The Evidence: In a family practice implementing an EHR and practice management system, ~50% of visits were found to be under-coded based on the level of medical decision-making involved. In another example, EHR documentation templates in a multi-specialty clinic led to increased use of ICD code 99214 by 11%, with average billable gains of $26/patient and increased revenue over more than $100,000 during the study period.^14,19 In Miller et al’s study, higher coding levels accounted for more than half of financial benefits, or $16,929 per FTE provider per study.¹⁷

10. Improve Your Legal and Regulatory Compliance (aka Lower Your Risk of A Lawsuit)

Amongst the less tangible benefits of EHRs, research identifies that they can facilitate legal and regulatory compliance by improving data security and patient confidentiality through more controlled and auditable provider access.

• The Evidence: Researchers in Massachusetts have found that physicians using an EHR had fewer paid malpractice claims.^5,6 Approximately 6% of physicians with an EHR had paid malpractice claims compared with 10.8% of physicians without EHRs. This potentially results (no causal claims can be made!) from strengthened caregiver communication, better record keeping, and improved adherence to clinical guidelines. In a national survey, 70% of doctors mentioned EHRs enhance data confidentiality.¹⁸

Overall, EHRs may improve risk management by:

• Providing clinical alerts and reminders;
• Improving aggregation, analysis, and communication of patient information;
• Making it easier to consider all aspects of a patient’s condition;
• Supporting diagnostic and therapeutic decision making;
• Gathering all relevant information (lab results, etc.) in one place;
• Support for therapeutic decisions;
• Enabling evidence-based decisions at point of care;
• Preventing adverse events;
• Providing built-in safeguards against prescribing treatments that would result in adverse events;
• Enhancing research and monitoring for improvements in clinical quality

EHRs may support providers by preventing liability actions by:

• Demonstrating adherence to the best evidence-based practices;
• Producing complete, legible records readily available for the defense (reconstructing what actually happened during the point of care);
• Disclosing evidence that suggests informed consent.^14,22

 

 

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[1] Chaudhry et al. notes that a large share of EHR studies were conducted in a select few academic medical centers raising the question about whether or not many of the benefits identified can be generalized to other settings. Very little existing research focuses on EHR benefits enjoyed by integrative practitioners. More research on the types and extent of benefits associated with EHRs implementation and use is necessary, especially in smaller practices and nonacademic settings.^6,18  Wherever research is available for smaller practices, we have done our best to profile it.

[2] Interviewees reported that providers worked longer hours for an average of four months (ranging from one to twelve months), mostly because of the need to enter clinical data during the patient’s initial visit after implementation and to become familiar with using the software.¹⁹

[3] In the study, all practices reported some savings (ranging from $1,000 to $42,500 per FTE provider per year). Efficiency-related revenue gains from increased visits accounted for 8.1 percent of financial benefits, but only three practices reported gains. Some practioners chose to see the same number of patients and take the time savings as personal time instead.¹⁹

References and Additional Resources

1. National Healthcare Quality Report. AHRQ Publication No. 05-0013ed. Rockville, MD: Agency for Healthcare Research and Quality; 2004.
2. Menachemi N, Collum TH. Benefits and drawbacks of electronic health record systems.Risk Management and Healthcare Policy 2011; 4: 47.
3. Rossi RA, Every NR. A computerized intervention to decrease the use of calcium channel blockers in hypertension. Journal of General Internal Medicine. 1997; 12(11):672–678.
4. Ledwich LJ, Harrington TM, Ayoub WT, et al. Improved influenza and pneumococcal vaccination in rheumatology patients taking immunosuppressants using an electronic health record best practice alert. Arthritis & Rheumatology Journal. 2009; 61(11):1505–1510.
5. Jamoom E, Beatty P, Bercovitz A, et al. (2012) Physician adoption of electronic health record systems: United States, 2011. NCHS data brief, no 98. Hyattsville, MD: National Center for Health Statistics.
6. Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. New England Journal of Medicine. 1990;322(21):1499–1504.
7. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: Institute of Medicine; 2001.
8. Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998; 280(15):1311–1316.
9. Bates DW, Teich JM, Lee J, et al. The impact of computerized physician order entry on medication error prevention. Journal of American Medical Informatics Association.1999; 6(4):313–321.
10. Devine EB, Hansen RN, Wilson-Norton JL, et al. The impact of computerized provider order entry on medication errors in a multispecialty group practice. Journal of American Medical Information Association. 2010; 17(1):78–84.
11. Irani JS, Middleton JL, Marfatia R, Omana ET, D’Amico F. The use of electronic health records in the exam room and patient satisfaction: a systematic review. The Journal of the American Board of Family Medicine. 2009; 22(5): 553-562.
12. Liu J, Luo L, Zhang R, Huang T. Patient satisfaction with electronic medical/health record: a systematic review.Scandinavian Journal of Caring Sciences. 2013; 27(4): 785-791.
13. Duffy L, et. al.Effects of electronic prescribing on the clinical practice of a family medicine residency, Family Medicine. 2010; 42(5):358-63
14. Improved Diagnostics & Patient Outcomes. Health IT website.  https://www.healthit.gov/providers-professionals/improved-diagnostics-patient-outcomes. Published March 19, 2014. Accessed November 11, 2015.
15. Häyrinen K, Saranto K, Nykänen P. Definition, structure, content, use and impacts of electronic health records: a review of the research literature. International Journal of Medical Informatics. 2008; 77(5): 291-304.
16. Jamoom E, Beatty P, Bercovitz A, et al. (2012) Physician adoption of electronic health record systems: United States, 2011. NCHS data brief, no 98. Hyattsville, MD: National Center for Health Statistics.
17. Miller RH, West C, Brown TM,  Sim I, Ganchoff C. Economics Of Health Information Technology: The Value Of Electronic Health Records In Solo Or Small Group Practices. Health Affairs. 2005; 24:51127-1137; doi:10.1377/hlthaff.24.5.1127
18. Jamoom E, Patel V, King J, Furukawa M. (2012, August).National perceptions of ehr adoption: Barriers, impacts, and federal policies. National conference on health statistics.
19. Holt J, Warsy A, Wright P.Medical decision making: guide to improved CPT coding, Southern Medical Journal. 103(4):316-22, 2010 Apr. AHRQ Publication No: 09-0095 dated September 2009.
20. Lim L, Varkey P.E-mail Reminders: A Novel Method to Reduce Outpatient Clinic Nonattendance. The Internet Journal of Healthcare Administration. 2004; 3(1).
21. Kumar S, Bauer K. The business case for implementing electronic health records in primary care settings in the United States.Journal of Revenue and Pricing Management. 2011; 10(2), 119-131.
22. Couch J. CCHIT certified electronic health records may reduce malpractice risk, Physician Insurer.