The point of this blog is: Purchasing and installing an EMR and hoping that you’ll realize a positive return-on-investment is not enough. You need to dedicate the time and resources to constantly iterate, refine and improve the utilization of that EMR over time, far beyond its installation and go-live. It’s a race without a finish line so you might as well train, budget and plan for that accordingly-- up front.
At Northwestern, we take great pride in being one of the first fully-institutionalized adopters of an EHR in healthcare. We’ve had an ambulatory EMR (Epic) for 12 years and an acute care EMR (Cerner) for 10. For the past 18-24 months, we’ve been studying not just the adoption of the EMR, but also studying the utilization of the EMR. Drawing upon an analogy to illustrate the point, if a carpenter buys a pneumatic nail gun, I call that “adoption” of a new tool. But if that carpenter is still using the nail gun to manually pound nails as if it were a hammer, has he achieved “utilization” of the tool? If you believe there is added value to an EMR over a paper chart—or even a word processor-- where does that added value reside and are we using it for those purposes? I’ve been slowly polling and collecting data in an attempt to understand EMR “utilization.” I doubt my data collection process would pass Gallup’s scrutiny, but I still believe that it paints an informative picture. Here’s what I have so far…
Qualitative Assessment of Epic EMR Utilization: “Do you personally use the Electronic Medical Record for the following purposes?”
- Remote, Internet-based access to the EMR for the benefit of physician convenience and faster patient treatment: 87%
- Data-driven reports and analytics which benefit patient care, such as disease management: 34%
- Data-driven clinical research: 73%
- Data-driven compliance, regulatory, or accreditation reporting: 19%
- Referral communications through a clinical In-Basket or automatic letter generation: 94%
If you are a physician or other clinician who uses an EMR and want to add your 2 cents, go ahead and fill out this survey: EMR Utilization.
Quantitative Assessment of Epic EMR Utilization
Based on data from the EMR itself, we run queries in an attempt to objectively measure how the EMR is being utilized in a few key areas of “added value” over a paper chart. To me, those key areas of added value of an EMR reside in the computable data that’s collected in medication orders and management; allergies management and awareness; problem list management and awareness; and family history of disease Below are the questions we asked in the queries of our data. The reporting period for the queries is December 2008 through April 23, 2009.