Never mind that adoption of interoperable electronic medical record (EMR) systems across the United States could potentially deliver annual health-care savings of more than $81 billion, according to a 2005 edition of Health Affairs, a health-policy journal. The impact on patient safety and quality of care can deliver significant benefits right now if physicians and provider organizations implement well designed EMR systems.
No doubt, the challenges to adoption are significant -- it takes initial investment in hardware and software, provider downtime and continuing maintenance. Yet urgency grows daily to improve patient safety and ensure quality of care.
Health-care providers are only seven years away from President Bush's mandated deadline for having EMRs in place nationally. According to a 2005 Centers for Disease Control and Prevention national survey, only 31 percent of hospital emergency departments and 29 percent of outpatient departments were using EMRs. The same survey found only 17 percent of doctors using EMRs in their offices. Given the costs associated with EMR purchase and implementation, many hospitals and physicians across Texas are proceeding cautiously to ensure clinical systems are introduced effectively. Subsequently we are not seeing adoption move as rapidly as desired in Texas.
The 2006 Texas Health Information Technology Advisory Committee report reviewed successful health IT projects from across the nation, and concluded that one of the most promising projects is medication reconciliation through electronic medication history retrieval.
The medication reconciliation process requires providers to create a complete list of medications a patient was taking prior to admission to a hospital or medical practice. The health provider must also compare the new medications against those on the list.
Medication reconciliation, mandated for 2006 by the Joint Commission on Accreditation of Healthcare Organizations, addresses three areas of concern: An estimated 770,000 patients are injured or die each year in hospitals from adverse drug effects (ADEs); more than half of all hospital medication errors occur at transitions of care, such as outpatient to inpatient; and ADEs may cost as much as $5.6 million per hospital per year, depending on hospital size.
Looking to Indiana
Under the leadership of the Regenstrief Institute at the Indiana University School of Medicine, Indiana hospitals have made great strides in successful electronic medication reconciliation at the point of care. In the emergency room alone, hospitals realized a 60 percent to 70 percent successful retrieval (hit rate) per patient. When other data sources were added to hospital and clinic medication history, the hit rate increased significantly, according to Dr. Shaun Grannis, research scientist at the institute. Additionally RxHub and SureScripts provided sizable portions of medication history from pharmacy and drug-benefit repositories.
The Indiana medication reconciliation process holds great promise for Texas, if provider organizations and physicians gain ground in implementing internal EMRs. This will certainly be true when EMR systems include electronic access to medication histories within hospitals and other health-care organizations. According to Michael Sanborn, corporate director of pharmacy for the Baylor Health Care System, providers and patients can realize immediate benefits by accessing national retail pharmacy and drug-benefit databases. This gives admitting physicians and nurses valuable information on medications the patient is taking. Frequently this information has given disease management data that would have gone unnoticed in the patient's routine history, physical and patient interview process.
Using EMRs to collect and manage quality improvement data will enhance patient safety and quality of care. But to increase adoption and effective utilization of EMRs, Texas health-care providers must investigate successful nationwide implementation and learn lessons both from successes and failures.
Efficient health IT utilization can save lives -- and costly health-care resources -- and transform Texas' health-care delivery system by improving the patient safety, quality of care and health of the population.
Susan G. McBride, Ph.D., RN, is senior vice president of the Dallas-Fort Worth Hospital Council and president of the Dallas-Fort Worth Hospital Council Foundation.