January 4, 2009
The National Center for Health Statistics (NCHS) conducted a mail survey of office-based physicians to obtain a preliminary estimate of EMR use. This estimate will supplement information from the 2008 National Ambulatory Medical Care Survey (NAMCS), an annual survey of patient visits to office-based physicians. In this mail survey, 38.4% of physicians reported using full or partial EMRs in their office-based practices. About 20.4% reported using a system described as “minimally functional,” including: orders for prescriptions, orders for tests, viewing laboratory or imaging results, and clinical notes. Comparable figures for the 2006 NAMCS were 29.2% and 12.4%, respectively. According to NCHS, EMRs conforming to certain interoperability standards are defined as electronic health records, either “basic” or “fully functional”. In the 2008 mail survey, 17.0% of physicians reported having “basic” systems, and 4.0% “fully functional” systems. Comparable figures in the 2006 NAMCS were 11.2% and 3.1%, respectively. These data will be important in debates over the need for incentives to accelerate EMR/EHR adoption.
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February 3, 2008
by Meredith B. Rosenthal and R. Adams Dudley. In: Journal of the American Medical Association 2007 February 21;297(7):740-4.
The authors review five key design elements of pay-for-performance programs that are important determinants of their influence:
- deciding on an individual vs. group focus for payment;
- paying the right amount;
- selecting high-impact performance measures;
- having payments reward all high-quality care; and
- making quality improvement for underserved populations a priority.
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February 3, 2008
On January 17, the Certification Commission for Health Information Technology published the first draft of its EMR test scripts for the 2008 certification year and the second draft of its certification criteria. In order to continue to refine and improve the proposed criteria, the Certification Commission has opened a 30-day public comment period, closing February 16, 2008. Get it here
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February 3, 2008
An electronic medical records (EMR) is a patient’s health record in digital format and the technology related to their use. EMR systems are believed to increase physician efficiency and reduce costs, as well as promote standardization of care. Even though EMR systems with computerized provider order entry (CPOE) have existed for more than 30 years, less than 10 percent of hospitals as of 2006 have a fully integrated system.
An electronic medical record might include:
- Patient demographics.
- Medical history, examination and progress reports of health and illnesses.
- Medicine and allergy lists, and immunization status.
- Laboratory test results.
- Radiology images (X-rays, CTs, MRIs, etc.)
- Photographs, from endoscopy or laparoscopy or clinical photographs.
- Medication information, including side-effects and interactions.
- Evidence-based recommendations for specific medical conditions
- A record of appointments and other reminders.
- Billing records.
- Advanced directives, living wills, and health powers of attorney
Advantages of electronic medical records over paper records
A medical record includes any of an individual’s health documents of the types listed above. Medical records may be on “physical” media such as film (x-rays), paper (notes), or photographs, often of different sizes and shapes. Physical storage of documents is problematic, as not all document types fit in the same size folders or storage spaces.
Physical records usually require significant amounts of space to store them. When physical records are no longer maintained, the large amounts of storage space are no longer required. Paper, film, and other expensive physical media usage (and therefore cost) is also reduced with electronic record storage.
When paper records are stored in different locations, furthermore, collecting and transporting them to a single location for review by a healthcare provider is time-consuming. When paper (or other types of) records are required in multiple locations, copying, faxing, and transporting costs are significant.
In 2004, an estimate was made that 1 in 7 hospitalizations occurred when medical records were not available. Additionally, 1 in 5 lab tests were repeated because results were not available at the point of care. Electronic medical records are estimated to improve efficiency by 6% per year, and the monthly cost of an EMR is offset by the cost of only a few unnecessary tests or admissions.
Handwritten paper medical records can be associated with poor legibility, which can contribute to medical errors.. Pre-printed forms, the standardization of abbreviations, and standards for penmanship were encouraged to improve reliability of paper medical records. Electronic records help with the standardization of forms, terminology and abbreviations, and data input.
Electronic records keeping and order entry were found to reduce errors associated with handwritten documents and were recommended for widespread adoption.
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