Running head: BENEFITS OF ELECTRONIC HEALTH RECORD ADOPTION 1

Benefits of Electronic Health Record Adoption: A Comprehensive Summary

Matthew R. DeVlieger

University of San Diego

13 March 2017
BENEFITS OF ELECTRONIC HEALTH RECORD ADOPTION 2

Abstract

This paper seeks to summarize the overwhelming evidence in favor of utilizing electronic health

records (EHRs) instead of the former paper-based method. Overall, patient care is improved with

these systems, as well as many additional benefits. Health care practitioners are more able to

accurately recommend treatment for patients. EHRs also assist in providing a continuance of care

across different organizations, since the medical information is electronic and easily accessible.

Medical errors are reduced from previous legibility issues as well as from dangerous drug

interactions. Further, health care organizations benefit financially from adopting EHRs. This

paper also documents efficiency increases in health care personnel’s workflow. Finally, security

of patient data is improved.

Keywords: electronic health records

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Introduction

The purpose of this paper will be to show the benefits of adopting electronic health

records (EHRs) into health care delivery systems. There has been some controversy on whether

or not EHRs should be implemented in health care, and this paper will seek to elucidate the

overwhelming evidence in favor of utilizing these systems. Using electronic health records will

overall improve patient care. Physicians using the EHR are more able to accurately recommend

treatment, order appropriate tests, as well as facilitate patient communication. These electronic

records also reduce medical errors by monitoring and preventing drug interactions, which can be

significant. This, in turn, can reduce the incidence of medical malpractice cases.

Also, literature shows that in the long run, adopting EHRs will be financially

advantageous for health care personnel. Sure, there is an up-front cost that may seem steep to

some practitioners, but research has shown that this cost can be turned to profit in three years.

Over a five year period of EHR use, many health care organizations can see a net benefit over

$85,000 (Wang et al., 2003). These savings are primarily from a reduction in drug expenditures,

improved utilization of radiology tests, better capture of the charges of services rendered, as well

as reduced billing errors. Coding efficiency is increased, and physician groups are better able to

increase their volume of reimbursements, thus increasing revenue for the practice. With the EHR

in place in an organization, there is less accidental duplication of services, such as multiple lab

tests. In addition, adoption of EHRs over paper based records increases efficiency, and in effect,

can lower the amount of time spent on documentation. Thus, it can speed up the process so
physicians can spend more time with the patient, if required. Another way that EHRs can be a

financial boon is that they eliminate the need for medical personnel to file and pull paper charts.

BENEFITS OF ELECTRONIC HEALTH RECORD ADOPTION 4

The finances saved on salaries paid to these personnel can be significant, especially in larger

organizations where many are employed.

Body

Electronic health records (EHRs) can be defined as a systemized collection of patient and

population electronically-stored health information in a digital format (Gunter & Terry, 2005).

These records can be shared across different health care organizations, known as interoperability,

which is very important to be able to provide the best care when multiple practitioners are

involved. EHRs may include patient demographics, medications, allergies, immunizations,

laboratory tests, radiology images, vital signs, age, weight, and billing information. Electronic

health record systems were created in order to store health information accurately and securely,

as well as to show the state of a patient across time periods. There is no longer a need to track

down a physical copy of a patient’s health record, which would be limiting when moving

locations or practitioners. When the record is electronic, the information can be accessible

around the world by anyone authorized to use it. Also, legibility will no longer be an issue as

with paper records, so medical errors will be reduced. Further, the EHR system has embedded in

its software error detection systems, such as monitoring drug interactions, that will further reduce

medical errors. There will be no risk of lost paperwork, and since there is only one EHR for each

patient, it is more likely that the record will be up to date. With the paper record, often there was

ambiguity on whether it was the most current information for the patient. Another benefit of the

implementation of EHRs is the possibility for research studies to be conducted with the
medical information. When paper based records were still in place, studies were much more

tedious to gather the medical data.

BENEFITS OF ELECTRONIC HEALTH RECORD ADOPTION 5

The federal government is giving large incentives for health care practitioners and

organizations to adopt electronic health records over the previous paper-based method. In their

view, there are many more benefits than negatives for the system. Congress has stated that they

will give incentives to organizations, including up to $44,000 per physician under Medicare, and

up to $65,000 over six years for Medicaid. They also will levy penalties for those organizations

who continue to only use the paper-based method, including reduced Medicare and Medicaid

reimbursements to doctors. These policies are due to the Health Information Technology for

Economic and Clinical Health Act (HITECH) enacted in 2009 (U.S. Health and Human Services,

2009).

There have been many studies that have shown that overall efficiency will be improved

with the adoption of EHRs. Research has shown that of those physicians using EHRs, 78% have

reported enhanced patient care (King, Patel, Jamoom, & Furukawa, 2014). Many of the medical

services patients require will be accessed/ interpreted through one computer interface, instead of

trying to track down multiple forms. Evans, Nicole, & Perlin (2006) have shown that the

implementation of the electronic health record system can improve overall efficiency by 6% per

year. Also, the EHR monthly cost will be offset by only a few unnecessary tests that would have

resulted with the paper system. Further, a study by Poissant, Pereira, Tamblyn, & Kawasumi

(2005) showed overall efficiency improvement by doctors and nurses. The use of bedside

terminals and central station desktops using the electronic health record system saved nurses

24.5% and 23.5%, respectively, of their overall time spent documenting during a shift. This is
quite significant, and can add up over time. One reason for this reduction in time is the fact that

nurses input standardized medical information into the computer, which can be accomplished

BENEFITS OF ELECTRONIC HEALTH RECORD ADOPTION 6

quite easily.

Another study by VanDenKerkhof, Goldstein, Lane, Rimmer, & Van Dijk (2003) showed

that physicians using an EHR on a PDA (personal digital assistant) while interviewing patients

about their symptoms take 22.2% less time than using the traditional paper-based format. This

study utilized over 90 patient encounters to interpret the results. This reduction in documentation

time can result in more time available to spend with the patient, which is a very important

outcome, which ultimately can improve health care delivery. Pizziferri et al. (2005) also showed

that the benefits of implementing the EHR can be achieved without sacrificing time spent with

the patient. They studied both pre and post implementation of an EHR and measured the overall

time per patient visit. There was no significant difference in the change of time spent interacting

with each patient, yet the overall time per clinic patient visit decreased by 0.5 minutes. This

shows that efficiency was gained. Also, a majority of the respondents believed EHR use resulted

in quality improvement. One major factor that results in less documentation time is the level of

training of the health care personnel. When a practitioner is well-versed on how to use the EHR

system, their patient documentation times significantly diminish. Therefore, it is highly

suggested that before a health care organization goes live with their electronic health record, they

should provide adequate hands-on training to the practitioners. This will help increase overall

efficiency dramatically.
 In addition, the implementation of the electronic health record has benefits for health care

organizations from a financial perspective. However, many organizations have not adopted

EHRs yet due to the estimated high cost of initialization. According to Wang et al. (2003), a

BENEFITS OF ELECTRONIC HEALTH RECORD ADOPTION 7

much higher percentage of foreign nations use an EHR system, since the initialization costs are

lower. There are two types of costs associated with EHR implementation: system costs and

induced costs. System costs are those from software and hardware, training, and ongoing

maintenance and support. Induced costs are those from the transition from paper to an electronic

system, such as temporary reduced provider productivity after implementation (Wang et al.,

2003). Taking these costs into the calculation, after five years with an EHR, the net cost-benefit

analysis shows an average of an $86,400 benefit per provider. Savings in drug expenditures

comprised the largest of this total (33%), followed by decreased radiology utilization (17%),

decreased billing errors (15%), and improvements in coding charge capture (15%) (Wang et al.,

2003).

One of the best studies that highlighted the increased coding efficiency of EHR

implementation was by Miller et al. (2005). They found that small practices with EHR systems

were able to increase coding for medical services for about 15 percent of visits. Assuming that

providers are seeing about 3,000 patients per year, and a bump in coding levels equates to an

extra $35 per visit, this equals an extra $15,750 each year. Over five years, that’s almost an

additional $80,000 per provider. Also, unintentional duplication of medical services will be

minimized with the EHR system, which will result in more revenue saved. Other financial

benefits of EHR adoption include not needing to have medical personnel pull paper charts any
longer. The salaries paid to these former workers, especially when totaled in a large health care

facility, can be significant.

Another benefit for the implementation of the electronic health system is increased levels

of security and confidentiality for patient information. With paper-based records, the security is

BENEFITS OF ELECTRONIC HEALTH RECORD ADOPTION 8

not ideal. There are no access barriers in place that would prevent people from seeing the

information. Also, privacy of patient medical information can become a problem when the paper

records are being transferred to another provider. If lost or misplaced during transit, the patient’s

medical history is open for any to see. With an EHR, on the other hand, there are security

protocols that prevent unauthorized access. The patient’s medical history is much more secure,

and ease of transference to another provider is seamless, due to its electronic format. In addition,

health care organizations now abide by the HIPAA laws, which further prevent misuse of

medical information. They have increased their security procedures, and will fine those who

commit a security infraction. Indeed, great care is given to protect the patient’s electronic health

record.

Conclusion

As seen, electronic health records clearly have the capability to revolutionize the health

care industry, and are drastically superior to paper-based records. There are many benefits to

utilizing EHRs, and one can easily realize their importance. Improving patient care is paramount,

and these systems have that capability. Studies have shown that patient care is enhanced in part

due to the ability of practitioners to more accurately recommend treatment and order appropriate

tests. A health care provider is able to see a patient’s entire medical history in an instant, which is

vital to be able to recommend any next steps. Also, medical errors are reduced from legibility
issues with the paper-based system. Paper consumption is decreased, and the security of patient

information is enhanced, especially when security protocols are in place. Unnecessary

duplication of tests will be minimized, because the provider is able to see the test history of the

BENEFITS OF ELECTRONIC HEALTH RECORD ADOPTION 9

patient through the computer system. Overall documentation time spent also decreases, which

allows more time to be spent with the patient. The EHRs also benefit the health care team by

increasing revenues from more accurate and complete billing for reimbursement, as well as less

cost on salaries for pulling physical paper charts.

Further studies should be conducted to see the average time it takes to train the health

care staff on utilizing the electronic health record system. These results would benefit

organizations when they are planning to transition to an EHR so they can determine how much

they should scale down operations during that period. It would be interesting to consider how

much the average monetary cost is for health care organizations during this period from a

reduction in overall output. Also, security issues with the EHR systems continue to resurface, so

studies should be conducted on how best to secure these networks on an ongoing basis. Since

technology continues to evolve, it is imperative that health care organizations adapt their

technology alongside it. Overall, adoption of the EHR system significantly benefits both the

patient and the practitioner, and introduction of new technology will continue to improve health

care delivery.
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References

Evans, D. C., Nichol, W. P., & Perlin, J. B. (2006). Effect of the implementation of an

enterprise-wide electronic health record on productivity in the Veterans Health

Administration. Health Economics, Policy and Law. 1(2), 163–169.

doi:10.1017/S1744133105001210

This article articulates the increase in productivity the Veterans Health

Administration has experienced due to adopting a national electronic health

record. This was accomplished in 1999, and since then the EHR has increased

productivity of the administration 6% per year, in addition to drastically

improving the quality of care delivered to patients.

Gunter, T. D., & Terry, N. P. (2005). The emergence of national electronic health record

architectures in the United States and Australia: Models, costs, and questions. Journal of

Medical Internet Research, 7(1), doi:10.2196/jmir.7.1.e3

This journal article seeks to elucidate the reasons why electronic health records

are being implemented. Two different national systems are contrasted between the

United States and Australia, and different approaches to providing patient

confidentiality and privacy are explored. Also, challenges faced to

implementation are explained. The article gives a coherent definition of an EHR

 and explains in detail how they are used in health care, with its many advantages

over paper-based records.

BENEFITS OF ELECTRONIC HEALTH RECORD ADOPTION 11

King, J., Patel, V., Jamoom, E.W., & Furukawa, M.F. (2014). Clinical benefits of electronic

health record use: National findings. Health Services Research, 49(1), 392--404.

doi:10.1111/1475-6773.12135

This journal article sought to exhibit whether the usage of electronic health

records affected patient care in a positive or negative way. Overall, the findings

were consistently reported as having more clinical benefits with more experience

using the EHR. This is likely due to the increased familiarity of the system and

reduced time spent using the system. Benefits included being able to access

patient’s charts remotely and being alerted for any potential input error.

Miller, R. H., West, C., Brown, T. M., Sim, I., & Ganchoff, C. (2005). The value of

electronic health records in solo or small group practices. Health Affairs, 24(5),

1127--1137. doi:10.1377/hlthaff.24.5.1127

The benefits and drawbacks of electronic health records in small group physician

practices are discussed in this article. From a financial standpoint, averages are

given about costs of related software for initialization and maintenance for the

practice. Initially, the financial toll is steep, but after a few years, many providers

recover the financial toll and earn a profit. Medical coding levels are increased
 overall, thus providing more revenue for the practice. However, some smaller

practices have more difficulties justifying the implementation.

Pizziferri, L., Kittler, A. F., Volk, L. A., Honour, M. M., Gupta, S., Wang, S., … Bates, D. W.

(2005). Primary care physician time utilization before and after implementation of an

BENEFITS OF ELECTRONIC HEALTH RECORD ADOPTION 12

electronic health record: A time-motion study. Journal of Biomedical Informatics, 38(3),

176–188. doi:10.1016/j.jbi.2004.11.009

These authors performed a time-motion study to determine if electronic health

records sped up or slowed down workflow in primary care organizations. Five

different clinics were tested, and efficiency data were collected. The authors were

determining if EHRs certainly were more efficient than the former paper-based

records in terms of time spent documenting medical information. They showed

that EHRs were indeed more efficient, and time spent with the patient is not

sacrificed.

Poissant, L., Pereira, J., Tamblyn, R., & Kawasumi, Y. (2005). The impact of electronic health

records on time efficiency of physicians and nurses: A systematic review. Journal of the

American Medical Informatics Association, 12(5), 505-516. doi:10.1197/jamia.M1700

Documentation time for physicians and nurses was studied using electronic health

records. This article explored how electronic systems changed the time that health

care personnel spent inputting data into the computer interface. This was a

systematic literature review of previous studies on time efficiency. Overall, nurses

 significantly reduced their time spent documenting during their shift on bedside

terminals and central workstations.

VanDenKerkhof, E., Goldstein, D., Lane, J., Rimmer, M., & Van Dijk, J. (2003). Using a

personal digital assistant enhances gathering of patient data on an acute pain

management service: A pilot study. Canadian Journal of Anaesthesia, 50(4),

368–375. doi:10.1007/BF03021034

BENEFITS OF ELECTRONIC HEALTH RECORD ADOPTION 13

This study was documenting physician’s time spent interviewing patients about

pain assessments using an electronic health record on a personal digital assistant

handheld device compared to the traditional paper-based method. The study

reported how long it took to become comfortable with the software on the PDA.

Overall, a significant reduction in time spent documenting was realized while

using an EHR.

U.S. Department of Health and Human Services. (2009). Centers for Medicare & Medicaid

Services 42 CFR Parts 412, 413, 422 et al. Medicare and Medicaid Programs, Electronic

Health Record Incentive Program. Final Rule

This law stipulated that if health care practitioners wanted to receive

reimbursement for services rendered under Medicaid and Medicare, they would

need to be implementing electronic health records for meaningful use

requirements. Also, they would receive financial compensation for incentive to

adopt these EHRs. The U.S. Congress would provide the amount of incentives.

Wang, S. J., Middleton, B., Prosser, L., Bardon, C. G., Spurr, C. D., Carchidi, P. J.,

… Bates, D. W. (2003). A cost-benefit analysis of electronic medical records in

 primary care. The American Journal of Medicine, 114(5), 397 – 403.

doi: http://dx.doi.org/10.1016/S0002-9343(03)00057-3

The purpose of the article was to study the net financial benefit or cost to health

care organizations from the implementation of electronic health records. The

study was comparing the EHR results against the former paper-based method, and

was looking at the results after a five-year period. Data was obtained from other

BENEFITS OF ELECTRONIC HEALTH RECORD ADOPTION 14

literature as well as from their own study. Overall, the financial net benefit to

primary care organizations over the five-year period is shown to be significant.