Guest editorial: Electronic medical records can transform healthcare

This article first appeared in the July 2012 edition of Pulse+IT Magazine.
There is a growing international consensus that electronic medical records (EMRs) are essential to transform healthcare. The benchmarking of progress around the world in adopting EMRs suggests that Australia is dragging its heels. At the recent HIMSS Australia Forum 2012, international eHealth leaders showcased the evidence for the EMR.

The theme of the HIMSS Australia Forum 2012 was that healthcare delivery can be transformed through information technology, business intelligence, eHealth and the electronic medical record (EMR). More than 100 executive leaders from the health industry attended the conference in Sydney on May 10 and 11, with delegates from the Asia Pacific, North America and Europe exchanging their ideas and experiences on how to innovate and to build ICT integrated healthcare with EMRs and other eHealth systems for intelligent hospitals of the future.

Information technology is not an end in itself. An intelligent hospital must in the future deliver a personal, customised service to its patients, and provide the highest quality care both in the hospital and at home. To support accurate diagnosis and treatment, an electronic medical record (EMR) is essential, according to Dr Byung-Chul Chang, professor of surgery at Severance Hospital in South Korea. Dr Chang identified an urgent need to reduce adverse medication events and errors in hospitals.

In a transformational journey towards being an intelligent hospital, Severance Hospital looks towards a global future where every patient is connected to their mobile personal device, whether smartphone, tablet, ultrabook, or whatever device that future technology may bring, Dr Chang said.

In such a future Severance Hospital has a startling vision to achieve zero medical errors and adverse events. The transformation to quality care depends upon the correct identification of the right patient at the right place; the prescribed medication for the right patient in the right doses; a timely consultation with the right clinician; and patient care with smart monitoring and surveillance.

In Singapore hospitals, a major success has been the implementation of electronic medication management. Robotised pharmacy departments dispense drugs in sealed bar-coded packs with unit doses, which are delivered to each patient, according to Dr Chong Yoke Sin, chief executive of integrated health information systems with the Singapore Ministry of Health.

Singapore’s electronic medication management aims for the ‘Five Rights’– the right drug with the right doses, via the right route at the right time, to the right patient. Some $5-6 million has been expended for each hospital on the closed loop medication management (CLMM) system. It has been calculated that by delivers a return on the investment to a hospital in just one year.

Much of the conference revolved around the HIMSS electronic medical record adoption model (EMRAM), which describes eight stages of EMR maturity, from the base of zero to its peak at Stage 7. Measurement by a healthcare service of its progress in implementing an EMR against EMRAM provides a catalyst, a benchmark and common language for transforming healthcare through information technology.

In Singapore, the closed loop medication management system has contributed to the country being ranked very highly against the EMRAM model; at 4.89, it is very close to Stage 5, and aspires to advance to Stages 6 and 7. At EMRAM Stage 7 there is true sharing of patient data, which improves process performance, quality of care, and patient safety.

Data mining is envisaged to be used in Stage 7 to analyse care data to improve performance, and advance clinical decision support protocols. And beyond the scope of the EMRAM model, Singapore has a 10-year master plan to integrate all its healthcare services, and better enable the translation of biomedical research advances into healthcare delivery.

By implementing the EMRAM model, Klaus Boehncke of PricewaterhouseCoopers identified in brief summary four main types of benefits arising from EMRAM’s eight stages:

  • Stages 0 – 2: Increased efficiency and better productivity from information sharing and reduced transactional costs
  • Stages 3 – 4: Improved error detection resulting from electronic orders and results, and clinical documentation
  • Stages 5 – 6: Better prevention, care planning and treatment eg improved error prevention through closed loop medication management
  • Stages 7: Prediction, where health information is aggregated and analysed, for continuous and integrated care delivery improvement.

Michelle Glenn, a senior director of HIMSS Analytics in the US, spoke of the EMRAM model in both acute and primary care, and how it is closely linked to the US government’s Meaningful Use eHealth program. Ms Glenn explained how the introduction of the program, under the HITECH Act, was aimed at driving both greater cost efficiency and quality of care.

Through the adoption of EMRs, and more than $US3 billion paid out so far to complying healthcare providers, the Meaningful Use program is beginning to change US healthcare, she said. The more than $US23 billion on offer has seen an increased rate of adoption of EMRs in recent years arising. There is also associated evidence that hospitals with EMRs for clinical support have lower costs, increase their rate of return on investment, and improve their patient outcomes.

NSW Health EMR leads Australia – or does it?

In recent years NSW has extended its EMR implementation across the state. In his presentation to the conference, Mike Rillstone, chief executive of HealthShare NSW, said he saw EMRAM as a framework for explaining the NSW eHealth strategy.

In NSW, the first phases of EMR and medical imaging investments have created the most mature clinical systems footprint in Australia, covering 60 per cent of hospitals and 80 per cent of beds. Although NSW Health leads the country with its statewide EMR implementation, Australia as a whole lags behind other OECD countries in adopting eHealth technology.

Despite its EMR rollout, NSW itself in aggregate ranks very low at only 1.49 on the EMRAM model, and as a minimum must make electronic medication management a priority if it is to emulate progress such as in Singapore. Mr Rillstone said healthcare leaders are in the main still ‘transactional’, working within the organisational culture as it exists.

For Australia to make faster progress up the EMRAM ladder, they must become transformational leaders, or in the words of Stephen Covey, author of The Seven Habits of Highly Successful People, ‘…to transform people and organisations in a literal sense – to change them in mind and heart’.

Andrew Howard, head of Australia’s PCEHR project, explained the ambitious initiative, which is a cornerstone of the federal government’s eHealth strategy. Although the PCEHR launched on July 1, significant challenges to its adoption remain and a slow take-up over the next few years is envisaged.

The PCEHR is another technology tool for enabling change in healthcare delivery, but transformation depends upon how clinicians use it. At the same time as facing the PCEHR challenge, individual health services in Australia must accelerate the upgrading of their EMRs, or in some cases implement a new EMR system, to advance their eHealth capability as measured by the EMRAM model.

In those countries where the EMRAM model has been used to rank and benchmark progress against its eight stages, the US has a score of 3.21, while Singapore leads with a score of 4.89. In comparison, NSW in aggregate is assessed at only 1.49, and languishes at the bottom of the table behind such countries as Canada on 1.88 and Germany on 1.62. In making assessments against the EMRAM model, there is clearly a degree of subjectivity and judgement involved, particularly to arrive at an aggregated score for a whole state or country.

A number of individual health services and hospitals, especially in Australia’s capital cities, would score above the level of 1.49. However, it has to be recognised that key requirements in the middle stages of the EMRAM model are clinical documentation and medication management, which are not widespread in Australian hospitals. The result is that in benchmarking against EMRAM, Australia is well short of world’s best practice.

Significant investment and strategic commitment at the highest level will be needed to lift Australia’s score up into EMRAM stages 3 and 4. Investment in the PCEHR is just one component in Australia’s development of eHealth, and it risks becoming a distraction from all healthcare providers’ core challenge.

Desirable as it may be, the PCEHR is no silver bullet, for it depends upon EMRs for its information. It can be argued that what is needed by all health services is an increased allocation of funds from within their existing budgets to an EMR and eHealth if they are to climb faster up the EMRAM ladder.

At the conclusion of the conference, Steven Yeo, vice president of HIMSS Asia and Middle East, said the EMRAM model is increasingly being seen worldwide as an excellent tool to identify best practices and opportunities for improving clinical, financial and operational outcomes.”

“It helps us explain our message to governments, managements and consumers, that EMRs and eHealth can facilitate the transformation of healthcare’s delivery and quality to every patient – anywhere and anytime,” he said. “The increased adoption of ICT and EMRs drives better health outcomes.”

Author Details

Bryn Evans
Director, JEMS Consulting
This email address is being protected from spambots. You need JavaScript enabled to view it.

Bryn Evans has many years’ experience as a chief executive of a clinical software supplier, and chief information officer in public hospitals. He is also an author, and writes extensively across a range of categories and genres, notably in the areas of sport, travel, history, information technology and eHealth.

Posted in Australian eHealth

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