Fit for Purpose - Developing Enterprise-wide Electronic Medical Records

A solution tailored specifically to each healthcare facility offers a wealth of benefits including improved outcomes, improved service and fewer errors.

Healthcare providers are under increasing pressure to ensure that critical information is available in the right place, at the right time for delivering a continuum of care to patients.While traditional hospital information systems worked well when patients’ needs could be met within a single facility, that technology is evolving to connect the growing network of facilities and caregivers that are engaged in serving a multitude of interconnected patient needs, according to a new study by Booz & Company.


The Forces of Change

“A major change affecting the healthcare industry is the transformation of its delivery model in the past decade,” explained Ramez Shehadi, a partner at Booz & Company. Care outcomes are important indicators of quality, as opposed to volume of patients, length of stay or occupancy rates. More co-morbidities and a higher prevalence of chronic diseases mean patients need to be treated more often by different specialists, over longer periods of time. Standalone facilities, with their increasing complexity and additional time required for reporting are also struggling to comply with new regulatory demands.

Prompted by these pressures, providers now use an integrated approach to care, delivering it from the cradle to the grave. “This new delivery model replaces single providers with multiple facility systems operating in integrated healthcare networks (IHNs)—collections of various types of healthcare delivery facilities that include primary, secondary, and tertiary care,” explained Walid Tohme, a principal at Booz & Company. These networks help facilities achieve economies of scale by pooling their respective resources and strengths.

This delivery model transformation to integrated healthcare networks demands technology solutions that link caregivers across an IHN, and outside of it. This gives caregivers access to patient data, allowing them to collaborate and make the right decisions about a patient’s care. “With centralised access to patient data, caregivers can monitor and treat patients consistently, and better leverage evidence-based medicine to increase the chances of successful treatments,” stated Jad Bitar, a senior associate at Booz & Company. Such technology is also making it easier for community physicians to interact with hospitals, especially as they look to physicians to refer patients.


Evolving to an Enterprise View

This growing constellation of facilities and providers is supported by a large set of healthcare technology systems that rely on an EMR—a single record that provides a patient’s information across facilities, and encounters. An EMR can capture all of a patient’s data and becomes the sole source of information for a patient which can be accessed by physicians, nurses, referring doctors, and other authorized users. It is the centerpiece and the unifying factor within an IHN’s clinical applications portfolio.

The emergence of IHNs in healthcare delivery is changing the EMR landscape, as hospitals interact with other facilities and outside partners. “The standalone EMR needs to be replaced with solutions that can support a provider’s different network facilities by linking modules to their EMRs for additional functionality,” commented Shehadi. EMR solutions allow hospitals to better manage their patients and their facilities through one system, improving patient care and increasing productivity and patient satisfaction. To gain efficiencies throughout the hospital, basic EMR solutions interface with other clinical and administrative systems such as radiology information systems, pharmacy information systems or lab information systems.

An enterprise EMR goes a step beyond the basic EMR solution by comprising a set of clinical functions and workflows that are fully integrated to provide patient information throughout the continuum of care. It typically integrates the core functionality of a stand-alone EMR with various additional modules, including:

  • Embedded Master Person Index (EMPI): This module ensures that the patient database is normalized by eliminating duplicate records and by preventing users from creating them inadvertently. This module will cross and match data elements from patient demographics, registration data, and encounter data from all clinical and administrative systems.

  • Clinical Physician Order Entry (CPOE): The CPOE enables caregivers to order laboratory and radiology tests, evaluate order status, and document the actions taken.

  • Clinical Decision Support System (CDSS): The CDSS helps caregivers make more informed decisions based on all possible information through a rules-based engine, such as incompatibilities between prescribed drugs, and a patient’s allergy profile and dosage errors.

The clinical and administrative benefits of an enterprise EMR are widely recognized within the healthcare community:

  • Improved outcomes, because caregivers have access to a patient’s full medical history.

  • Improved service: Some tasks are automated allowing caregivers to focus more on patient care.

  • Fewer errors thanks to standardization across departments, analytics, and smart systems.

  • Reduced overall costs mainly due to decreased duplication, the elimination of the need for manual entry, and a reduction in multiple requests for similar diagnostics.

  • Increased patient satisfaction from improved service delivery and increased caregiver focus on patients.

“To achieve these benefits, an enterprise EMR must be able to fully integrate with existing clinical and administrative systems within the IHN and be capable of exchanging critical decision support data, by proper integration,” Tohme said.


One Size Does Not Fit All

Different types of healthcare facilities have different needs; making the ability to customize their enterprise EMR solutions essential. Vendors today can deliver solutions that are more powerful and more responsive to healthcare providers’ needs.

“The key is to understand each provider’s needs. During Booz & Company’s recent development and implementation of an IHN IT strategy, we analyzed the enterprise EMR requirements of nine facilities within the IHN. We found that basic EMR was not sufficient for some facilities and a full enterprise EMR was excessive for others,” explained Bitar. To help providers select an appropriate EMR solution, we have categorized them into three groups:


Basic EMR

The basic EMR solution is offered to small physician offices (approximately 10 doctors) that need a quick, affordable solution including basic EMR functionality. “We found that basic enterprise EMR vendors combined elements of the common hospital database, with tailor-made functionality that met the physicians’ specific demands,” Shehadi explained. Typical modules include an EMR system with minimal functionality, registration and scheduling, limited prescription order entry, and laboratory and radiology results.


Partial Enterprise EMR

This version is often used by specialty center facilities that require more functionality than a small clinical office but have fewer and more specialized needs than a large general multi-facility hospital. Modules include all those in the basic EMR category, in addition to clinical decision support, electronic image viewing, and the ability to order laboratory and radiology tests. Such a solution requires significant effort to develop custom functionalities as bolt-ons to out-of-the box modules.


Full Enterprise EMR

The full enterprise EMR is aimed at large, multi-specialty hospitals, tailored to the facility’s needs. This version comprises the full suite of modules and functionalities available. Additional modules that would be integrated include extended clinical documentation, PIS, nurse triage, patient billing, CPOE/order entry, medical administration record, CDSS, and EMPI.


Conclusion

By creating a holistic view of patient related information, EMRs promise a number of benefits for healthcare organizations. A tailored approach that matches each healthcare organization’s needs with the necessary EMR capabilities is essential. Without this, organizations may end up with a redundant EMR solution and the quality, cost, and performance promise that EMRs bring will be wasted.