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Michael M. Awad, MD, PhD Washington University in St. Louis March 26, 2011.
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Transcript of Michael M. Awad, MD, PhD Washington University in St. Louis March 26, 2011.
Electronic Medical Records: Efficiency
Michael M. Awad, MD, PhDWashington University in St. LouisMarch 26, 2011
No Disclosures
The ratio of the output to the input of any system
The extent to which time is well used for the intended task
Efficiency: Definitions
Task CompletionTime
During the 1990s, many industries invested heavily in IT:
telecommunications securities trading retail and general merchandising
Other Industries
IT resulted in advancements in:
Other Industries
Bar-coded retail checkouts ATM machines
Consumer reservation systemsOnline shopping and brokerages
IT thought to contribute to 6-8%
annual growth
Accessing Data◦ Reading history◦ Reviewing orders/medications◦ Examination of radiographs
Inputting Data◦ Admission orders◦ Inpatient orders◦ Discharge orders
What tasks are we referring to?
Can retrieve charts at any time Fewer lost charts Multiple individuals can refer to charts
simultaneously Remote chart access Most up-to-date data retrieval (labs,
pathology, radiology results) QA / Research
Accessing Data
Speeds input of multiple orders (order sets) Reduces clarification calls from Pharmacy Faster transmission of orders to point-of-
service (radiology, pharmacy, etc) Reduces time to sift through chart and
interpret handwritten notes Signing notes from afar
Inputting Data
Task CompletionTime Money=
Cost Efficiency
RAND Health Information Technology (HIT) Project 2003
Estimated potential savings and costs of widespread adoption of EMRs
RAND Analysis
increased exchange and flow of information
compliance with the regulations
ability to integrate graphic data such as electrocardiograms, alarms and warning systems, etc.
data quality data presentation data availability ease of production of data
reporting data handling access to reference
materials Legibility patient satisfaction productivity of the doctor reductions in incorrect
medication and data input errors
quality assurance training
RAND Analysis
Did not include savings for: Transcription Malpractice Research and public health savings
RAND Analysis
1.5%
4%
Sounds good,But…
Upfront Proper training required (Cedar Sinai, LA) May have initial loss of efficiency
(up to 15%-20% for 3 months) Implementation costs
Pitfalls
“Dumbing Down” Effect “EMR Plagiarism”
◦ Cut and paste for trainees◦ Lack of updates◦ Perpetuation of erroneous information
(In)attention to abnormal values Excessive notifications – quick dismissal Templatized notes
Pitfalls
Templatized Note
Other: Privacy
◦ Very easy to reproduce/transmit sensitive data◦ More pronounced with mobile devices
Research too easy to do◦ quick QA research quick conclusions
Hard to quantify:◦ reduction in medical errors◦ improvements in disease prevention and chronic
disease management
Pitfalls
Task Completion
Time
Quality
Pitfalls
Integration across disparate EMR systems Clinical-decision making tools Growth of mobile platforms
Future Directions
THANK YOU