ROI of EMRsBy Wylie Wong | Posted 2009-01-23 Print
Hospitals and medical clinics invest in technology to improve patient safety, save money, boost efficiency and position themselves for the future.
ROI of EMRs
The Beth Israel Deaconess Medical Center in Boston custom-built its online medical record application in 1985. It then developed a Web version in 2002 to give its hospital physicians the flexibility to use any computing device—including a notebook computer or a smartphone—to check their schedules, messages and patient data.
“Everything we do is browser-based and operating system neutral,” says Dr. John Halamka, the medical center’s CIO. “Doctors are mobile, and it’s key that they can use client devices while they’re on the road, at home or at the hospital.”
More recently, Beth Israel invested $8 million to build a hosting facility that will allow its 300 affiliated private practices to use EMRs as hosted applications. The hospital is subsidizing 85 percent of the costs, so the hospital and its affiliated doctors can coordinate care and improve patient care and safety, Halamka says.
Beth Israel’s pay-for-performance contracts with its health insurers require the hospital and clinicians to act as an integrated community and to report performance as a group. Moving everyone to a homogenous EMR allows the hospital to do that. “With an electronic health record, the primary care physician can send it to the next provider, so care is coordinated,” Halamka says. “It’s about providing quality health care, reducing redundant testing and making sure all doctors know what medicines a patient is taking.”
To build the hosting facility, Halamka standardized on eClinicalWorks’ medical software running on Hewlett-Packard servers connected to an EMC storage area network (SAN) that holds up to 11.1 terabytes (TB) of storage. To better utilize servers, the IT staff is using VMware software to virtualize servers. Each doctor’s office will be given its own virtual server to house and access its EMRs.
The Beth Israel IT staff is implementing the EMR system at eight practices per month and should finish the project by 2010. Each private practice will pay $6,000 for software and $9,000 for hardware. Without the subsidy, each practice would have had to spend between $40,000 and $60,000, and most would not have been able to afford it, Halamka says.
The Fallon Clinic also invested heavily in technology: It spent $24 million over three years to migrate its clinics to the new EMRs. Prior to the upgrade, the clinic stored most of its patient data in electronic format, but it still used paper charts when the staff saw patients. When the clinic began implementing the new EMR software from Epic Systems in 2005, staffers scanned in the remaining paper documents and then rolled out the technology in phases.
Initially, the IT staff implemented the basic functions, allowing doctors to access patient test results and clinical notes in read-only format. Then they rolled out e-prescriptions. Next, IT installed desktop computers and monitors in each exam room, allowing physicians to show patients their test results. After that, IT implemented all the EMR features, where everything is done on the computers. “We separated each phase by six to eight months to allow the physicians to become proficient and comfortable with their skills,” Garber says.
The Fallon Clinic’s data center has 40 servers on a Citrix farm that supports 1,550 Epic software users. A SAN stores 15TB of clinical data, X-rays and other images. The servers are mirrored, so if one goes down, it fails over to another server.
The EMR technology helps the clinic save money in two ways: First, the electronic workflow is more efficient, so the clinic no longer pays its staffers to process paper. Second, it has saved millions of dollars by using speech- recognition software to replace outside transcription services. Doctors use Nuance Communication’s Dragon Medical Software to dictate to their computers, and the software translates it into text. By eliminating transcription costs and paper shuffling, Garber estimates that the system will pay for itself in five to six years. Beth Israel, which uses Nuance’s eScription software, has saved $5 million in transcription costs since 2002.
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