The State of the EMR: Gaining Traction, Showing Results

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Healthcare facilities and physician practices large and small are investing in electronic medical records to improve patient safety and quality of care while cutting cost and putting behind them the inefficiencies of paper records. A variety of facilities tell how they've taken the plunge - and offer advice for those ready to make the jump.

The concept of an electronic medical record (EMR) has existed for more than 20 years. Yet U.S. healthcare providers have been slow to embrace the idea. Economics is a major barrier, says Peter Waegemann, CEO of Medical Records Institute (Boston). "While we need the EMR for a variety of reasons - patient safety, costs, quality of care - individual physicians, clinics and hospital don't realize an immediate return on investment (ROI) with an EMR," explains Waegemann.

Economics extends beyond the micro level; British and Australian governments have invested $12 billion in EMR projects. The U.S government commitment of $100 million over a decade seems paltry in comparison. The big picture in the U.S. shows that only 9 to 12 percent of U.S. providers have invested in an EMR, says Waegemann. Other estimates go as high as 15 to 20 percent infiltration in physician offices and 20 to 25 percent for hospitals. But things are looking up as a recent study in Health Affairs shows that one-third of small practices have an EMR in the plans over the next two years.

Deane Morrison, CIO of Capital Region Healthcare and Concord Hospital in Concord, N.H., agrees that nearly no one has a complete EMR portfolio. But most U.S. healthcare providers have deployed components of the EMR, says Morrison. "In the acute care/hospital setting, the EMR consists of a collection of applications that work in concert to bring all of the pieces of the paper medical record into what appears to be a single system." The applications include nursing assessment and medication administration, transcription, radiology images and reports, historical documents and physiological monitoring and may include decision support and computerized physician order entry. On the other hand, the electronic health record (EHR) - a term often, but wrongly, used interchangeably with EMR - consists of many EMRs across different hospitals, clinics, pharmacies and health insurance companies, explains Waegemann.

This month, Health Imaging & IT visits with a handful of providers that have embarked on the EMR process to learn more about the hows and whys of the EMR. We're also taking a look at some of the challenges - and finding there is plenty of good news.


  • Healthcare facilities earn an ROI as medical records staff and transcription costs are cut.
  • Patient safety is greatly enhanced via the elimination of the stereotypical chicken scratch notes and medication orders.
  • Information is available in real-time and in multiple locations, allowing physicians to maximize their time while providing better patient care.
  • The EMR is a richer, more complete picture of the patient. It can be mined to alert patients, such as following the Vioxx incident.
  • Electronic records can advance care as on-call clinicians have a better knowledge of the patient's condition. For example, if a cardiac patient is admitted to the hospital on Friday night, an EMR-equipped cardiologist may release him sooner than a conventional provider as he has a more complete understanding of the patient's condition.

While the benefits are real and fairly consistent, the EMR selection and deployment processes are not standard. "There is not one straight avenue to success. Every experience is different," cautions Waegemann.

The rationale

Although the federal government is touting EMRs and could create incentives or disincentives to spur on adoption, there are a variety of other reasons for implementing an EMR.

Take for example Associated Cardiology Consultants, a six-site cardiology practice in New Jersey. The practice grew out of a 1994 merger of three practices, each with its distinct charting processes; some placed x-rays and labs in the front of paper charts. Others put them in back. "It was confusing," recalls Executive Director John Morris. Hence the first EMR goal: a standard chart. The practice also aimed to provide access to patient charts across its offices, decrease transcription costs and search the medical record for research purposes. Improved billing and collections also was key. "Doctors tend to undercode. An EMR provides clear documentation of the patient visit, so