EMRSharing Health Information

By: Gregory-Thomas C. StangerBUS 550 The Contemporary Firm

Spring 2013, Dr. Minder Chen

Intro• EMR: 1970s• Allow for electronic exchange of patient histories with

other HP• Reduce medical errors• Bring better consistent care• 2005: only 41% US hospitals• Rising Trend in “health consumerism”• $34b in America’s Annual healthcare higher efficiency and

safety• Network effect: Hospitals->Hospitals, HCP->HCP

Case Study

Canadian Medical Assessment (CMA)20 Cases in primary careObjectives: ID & capture best practices in EMR

Paterson, Grace I. et. Al. Cross-Canada EMR Case Studies: Analysis of Physicians’ Perspectives on Benefits and Barriers (2011). Electronic Journal of Health Informatics. Vol 6(4):e34.

1. How are EMRs implemented?2. How are EMRs used in clinical practice?3. How can EMR adoption be increased and sustained?

Three primary research questions

Tools Used

1. EMR System and Use Assessment Survey

2. Interview guide for site visits3. Transcription codes4. Observation guide5. Case study report template

EMR System and Use Assessment Survey

★★★★

★★

★

★

★

http://www.cma.ca/EMRCaseStudies.

Themes in EMR CSClinic culture and leadership

MotivationEMR capabilities and use

Technical issuesScanning

Workflow and process change-organization impactImplementation strategy

Patient safetyKey success factors and lessons learned

Facilitators of EMR adoptionQuality of care

Costs versus benefitsEfficiency

Lessons learnedFuture plans

Benefits of EMRBarriers to EMR adoption

The benefits of EMR system functions from the interviews

“Benefits of EMR”

“Benefits of EMR”

Intrinsic: peace of mind, provisions of better care and patient satisfactionPractice: Reduced physician turnover, saved space, improved morale, practice audit, creation of dataFinancial: As a whole, generally reduce cost

Fear of change/mistakes Need to scan documents and possibility of introducing errors

from this and/or data entry Lack of speed and reliability Need for expert IT support Start up delays due to need to populate Changes to office configuration Lost productivity Insufficient interoperability- “electronic island” Outdated/restrictive legislation Fee-for-service reimbursement model

“Barriers to EMR Adoption”Addressing: attitude, misconceptions, lost productivity, lack of interoperability, outdated and restricted legislations

Discussion

Picture #1 Picture #2

Conclusion of findings

• Social Benefits>Barriers• EMR in medical schools• Reengineer practice and master EMR use

Conceptual Model toward a Competitive Advantage

Richards, Rhonda J., Prybutol, Victor R., and Ryan, Sherry D. Electronic Medical Records: Tools for Competitive Advantage (2012). International Journal of Quality and Service Sciences. Vol 4 No. 2, pp. 120-136.

Triggers toward EMREconomic strains

Rising HC costIncreased HC demand

Customers seek increase in quantity and efficiencyPolitical strains

Healthcare as a Right(American Recovery and Reinvestment Act of 2009)

Presidential Initiatives for EMR implementation, 2014Financial incentives, 2011

Financial penalties to HCP, 2014Keep updated systems

Legal StrainsHIPAA rules

Office of the National Coordinator for Health Information technology

Health Information Standards CommitteePrivacy LawsSecurity Laws

IT Strategy via EMR Standards and Regulation

InteroperabilitySupport Existing technologies

National Health Information Network

Network and Integration(for alignment w/ 3rd pt)

Sharing information to other HCP, payers, and patients

Emerging technologyintegrate emerging technologies adoption

Review of emerging technologiesEarly adoption

Strategic AlignmentIT linkage with Clinical Administration

Streamlined SchedulingIntegration of Billing

National Health Information NetworkShare clinical dataAvoid Duplications

Trained in Technology

IT linkage with PhysiciansDM, user, admin, purchaser

Commitment to adoption/useBear cost while insurance companies, patients,

and government associations Physicians linkage to clinical administrationPhysician play role in scheduling, doc, bill,

referral, Rx services, storage and data mining for competitive use of information

Implementation vs. need financial benefit

Patient IS interface with users; web apps: apt., registration, Rx

services and surveys.Decreased ADR, Antibiotics, hospital stay, and cost

Enhanced satisfactionQuality care from database of health information and

DSS->ADR->FDA->Drug safety monitoringGlobal health risk via demographic data

Outcomes leading to competitive advantage

Clinicalcomputerized patient records, document management systems, data warehouses, distribution networks, and

telematics. Allow for speed, reduced errors, and cost savings.

Integration of Dx, treatment codes->faster collectionsPhysicianEfficiency

Access to data, automated Rx, more support

Competitive Advantage

• Firms compete on the basis of unique resources

• High Quality Care• Satisfaction• Outcome Measurement and

Monitoring (MU)• Affordable Healthcare

PACIS NEXTGEN REGION V North- User Group Meeting

• Contract Modules• Integrated PIR• Patient Portal• Clinical Viewer• Patient Keeper• PACIS.com

Risks and Disadvantages of EMR integration

Information transparencyWealth of informationPrivacy-> inadequate quality of careRising cost of EMR

PrivacyDo privacy protection laws inhibit

technology diffusion of EMR?

Ex: RFID privacy bill in 2004 in Utah House of Representatives, designed to prevent matching RFID data with consumer’s personal information

Miller, Amalia R. And Tucker, Catherine. Privacy Protection and Technology Diffusion: The Case of Electronic Medical Records (February 2009). NET Institute Working Paper No. 07-16.

PrivacyReduction in medical identity theft

Accomplished by:Issues with data securityIssues with confidentiality

PrivacyReduction in medical identity theft

Privacy laws can increase network costs or network benefits from EMR adoption.They can improve patient compliance:

“69% of survey respondents state that they are very concerned or somewhat concerned that an EMR system could lead to ‘more sharing of your medical information without your knowledge’”

They can also impose addition network costs:

“It is more expensive to design a system that has the additional flexibility to limit the flow of information by the type of detail in a patient medical record and by the type of external destination, irrespective of how many patients refuse to have their records shared.”

adopt*ijt =f(NetworkNetBenefitsEMRijt, StandAloneNetBenetfitsEMRit|PrivacyLawit)

Conceptual Model of Hospital EMR Adoption

Conceptual Model of Hospital EMR Adoption

ICU:Information they collect is only used at the time and not useful when it is transferred

Network effect

Contingent on:(1)Willingness of patient to provide health

information and have information transferred electronically across HCP

(2)Other HCP can exchange health information

Tables/Data in Study of Privacy Laws on EMR adoption

Privacy and EMR Adoption/ Network Effects

“In states without hospital privacy legislation, EMR adoption by one hospital increases the probability of a neighboring hospital adoption by 7% overall using cross-sectional data and by 2% every there years using panel data”

Network effect:No measureable network effect in states with privacy protection legislation.

EMR adoption:“… state privacy protection of hospital medical information is inhibiting EMR adoption by around 11% per three-year period, or 24% overall in states with such laws.”

T/F

From the Case Study, in states with privacy protection laws the EMR

adoption rate is negative?

MC

Which of the answers below is NOT a trigger from the conceptual model of

implementing EMR?

A.PoliticalB.EconomicC.PrivateD.LegalE.None of the above

MC

In states _________ privacy protection laws, there was no measurable effect on

network effect according to the case study.

A.WithoutB.With C.With littleD.None of the above

THANK YOU!!!