EMR Sharing Health Information By: Gregory-Thomas C. Stanger BUS 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 care Objectives: 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 visits 3.Transcription codes 4.Observation guide 5.Case study report template

EMR System and Use Assessment Survey ★ ★ ★ ★ ★ ★ ★ ★ ★     

Themes in EMR CS Clinic culture and leadership Motivation EMR capabilities and use Technical issues Scanning Workflow and process change-organization impact Implementation strategy Patient safety Key success factors and lessons learned Facilitators of EMR adoption Quality of care Costs versus benefits Efficiency Lessons learned Future plans Benefits of EMR Barriers to EMR adoption

The benefits of EMR system functions from the interviews “Benefits of EMR”

Intrinsic: peace of mind, provisions of better care and patient satisfaction Practice: Reduced physician turnover, saved space, improved morale, practice audit, creation of data Financial: 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populate  Changes to office configuration  Lost productivity  Insufficient interoperability- “electronic island”  Outdated/restrictive legislation  Fee-for-service reimbursement model “Barriers to EMR Adoption” Addressing: attitude, misconceptions, lost productivity, lack of interoperability, outdated and restricted legislations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 #1Picture #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

Triggers toward EMR Economic strains Rising HC cost Increased HC demand Customers seek increase in quantity and efficiency Political strains Healthcare as a Right (American Recovery and Reinvestment Act of 2009) Presidential Initiatives for EMR implementation, 2014 Financial incentives, 2011 Financial penalties to HCP, 2014 Keep updated systems Legal Strains HIPAA rules Office of the National Coordinator for Health Information technology Health Information Standards Committee Privacy Laws Security Laws

IT Strategy via EMR Standards and Regulation Interoperability Support Existing technologies National Health Information Network Network and Integration (for alignment w/ 3 rd pt) Sharing information to other HCP, payers, and patients Emerging technology integrate emerging technologies adoption Review of emerging technologies Early adoption

Strategic Alignment IT linkage with Clinical Administration Streamlined Scheduling Integration of Billing National Health Information Network Share clinical data Avoid Duplications Trained in Technology IT linkage with Physicians DM, user, admin, purchaser Commitment to adoption/use Bear cost while insurance companies, patients, and government associations Physicians linkage to clinical administration Physician 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 satisfaction Quality care from database of health information and DSS->ADR->FDA->Drug safety monitoring Global health risk via demographic data Outcomes leading to competitive advantage Clinical computerized 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 collections Physician Efficiency 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 transparency Wealth of information Privacy-> inadequate quality of care Rising cost of EMR

Privacy Do 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

Privacy Reduction in medical identity theft Accomplished by: Issues with data security Issues with confidentiality

Privacy Reduction 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(NetworkNetBenefitsEMR ijt, StandAloneNetBenetfitsEMR it |Pri vacyLaw it ) 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.Political B.Economic C.Private D.Legal E.None of the above

MC In states _________ privacy protection laws, there was no measurable effect on network effect according to the case study. A.Without B.With C.With little D.None of the above

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