State of the EMR

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State of the EMRWhen can three minutes add up to $13.5 million? When an EMR is teamed with PACS at the University of Texas M.D. Anderson Cancer Center. It’s no riddle. An internal study by the University of Texas M.D. Anderson Cancer Center found that by integrating a picture archiving and communications system into an electronic medical record (EMR), the Houston institution saved $13.5 million per year simply by eliminating the three minutes on average it took clinicians to visit the radiology department to access images.

For the variety of institutions contemplating a move to electronic records and imaging, the value could be even greater, mostly because the cost of making the switch has come down so drastically in recent years.

The M.D. Anderson study noted that the components of a typical radiologist’s electronic workstation dropped from a list price of $160,000 in 1998 to a very affordable $20,000 seven years later.

Over the same time period, the setup evolved from four analog monitors to three flat-panel displays, reflecting a vast improvement in PACS interpretation software, according to Kevin McEnery, MD, associate division head for informatics in the Division of Diagnostic Imaging. Essentially, the workstation evolved from a big-ticket capital investment to a commodity purchase in just seven years.

Today, digital imaging is making a difference at virtually every major teaching hospital in America to some degree, and it is starting to make its way into the community hospital — but putting in technology is never a simple process.

Cedars-Sinai Medical Center in Los Angeles went live with PACS in radiology in April 2001, but it took five more years for the hospital to automate the rest of its imaging. (It’s still not 100 percent digital, as scoliosis studies and some mammography remain on film.)

Cedars may not have saved much money making the conversion, as IT professionals making top dollar replaced legions of low-paid film handlers, but digital imaging has grown in popularity as medical technology has advanced.

“Traditional surgeries are demanding more imaging,” Franklin Moser, MD, the hospital’s director of clinical and interventional neuroradiology, said at an international conference this year. At the same time, Cedars has converted traditional operating rooms into “interventional suites” for high-tech, minimally invasive procedures like virtual colonoscopies, and such techniques rely heavily on advanced imaging.

In September, just a year after watching the surrounding community get all but washed away by Hurricane Katrina, Memorial Hospital in Gulfport, Miss., started a nine-month migration to a filmless and digital imaging system in cardiology. The hospital already had been fully filmless in radiology and, thanks to an EMR, essentially paperless as well.

The automation helped Memorial survive the killer storm without losing so much as one patient chart. Ask other Gulf Coast healthcare providers if they can make that claim.

It also made sure that physicians scattered by the hurricane could access records from anywhere, via a secure internet connection. More importantly, complete medical records were available for the untold tens of thousands of patients who fled coastal Mississippi.

“What we learned from Katrina was the value of the digital record,” says Gary G. Marchand, president and CEO of Memorial Hospital.

It didn’t take a hurricane to create massive fragmentation of patient information at the George Washington University School of Medicine and Health Sciences in Washington, D.C., just 41 different specialties and subspecialities, each with its own paper charts.

That changed when George Washington University Medical Faculty Associates went to an EMR, pulling scattered snippets of information into a single, complete record of each patient’s encounters with the entire 280-physician faculty practice. “We’ve got all of the data instead of some of the data,” says CEO Stephen L. Badger.

And since the Department of Medicine became paperless in July 2005, the practice has saved more than $1 million in staffing costs and freed up 5,100 square feet of space for its nuclear cardiovascular, cardiac treadmill and nursing triage programs. All that square footage previously was reserved for chart files.

“This has been a home run for us,” Badger reports.

The automation includes an internet portal for patients to communicate with their physicians, view test results, request prescription refills and set appointments. Except in the event