The Cost Benefits of Electronic Medical Records in Primary Care

One of the fundamental trends globally is the implementation of information technology which aims at transforming the quality of goods and services across all realms, from manufacturing to healthcare. eHealth, which Reis et al. (2017) espouse as a critical transformation in the healthcare sector presents a number of benefits with regards to patient health information (PHI). Three major uses of these technologies are collecting, processing, and storage of patient’s medical information for use by healthcareproviders to make profound decisions. According to Gao, Li, and Luo (2015), consistent and effective patient care requires computerization of patients’ data for better communication and informed decision making. Critical also in providing effective care is semantic interoperability, which is imperative in consistently maintaining information. The implementation of information technology in the healthcare sector not only provides efficient services, but is also relevant in justifying technology investments. Nevo, Nevo, and Pinsonneault (2016) argue that information technology benefits are reflected across the financial, cultural, ethical, and social aspects. In the United States, the adoption of health information technology (IT) is supported and accelerated by incentive programs that offer financial incentives to healthcare providers and medical facilities that demonstrate the use and effectiveness of certified health IT as specified under the Centers for Medicare and Medicaid Services. Among the healthcareIT approaches is Electronic Medical Records (EMR), which is described as the storage of patient information such as histories, medications, and test results electronically. As espoused by Reis et al. (2017), this approach replaces the paper model and is related to efficiency in healthcare services. 

Based on the importance of IT on health, this literature review examines the cost benefits of EMR in the sector. The literature analysis includes among other aspects, the definition of EMR, sources of healthcare costs, the merits and downsides of the IT initiative, application in the healthcare, and its cost benefits. The cost benefits of EMR are reflected in the improvement of patient quality outcome and safety, reduction of health careerrors, and promoting efficiency based on costs, utilization, timeliness, and health caretime burden. 

Defining EMR

Electronic Medical Records (EMR) is described as an information technology approach where patients’ information such as the historyof their present illness, demographics, past results of their health diagnosis, and treatment approaches are stored electronically. According to Jones, Rudin, Perry, and Shekelle (2014), EMR was introduced as a replacement to the paper model which was characterized by inefficiencies, errors, and patient care delays. In addition, EMR allows healthcare providers to not only read and analyze patient’s health information, but also transfer the data to another medical facility, department, or among health professionals. According to Gao et al. (2015), the use of EMR begins when the healthcare provider use voice readers and scanners to enter or transfer the patient’s health history, access previous records, and evaluate the treatment approaches into the professional’s EMR interface. EMR, in this regard, refers to the sum of this information for every patient. Through a portal interface that is intuitive, the patient also has the ability to access some of his or her EMR such as the healthcaretest results and treatment approaches. This is in accordance with the Health Insurance Portability and Accountability Act (HIPAA) where the patient has a right to access his or her EMR upon requesting (White, Dudley-Brown, & Terhaar, 2016). 

A critical aspect about EMR is that the health careprovider has the opportunity to access the patient’s information for ease in decision making while the patient access to the healthcare information allows for collaborative care between the two stakeholders to achieve better outcomes. Consistent with Jones et al.’s  (2014) assertions regarding EMR enhancing the qualityof care, it is apparent that the patient portal side presents an opportunity for their active involvement in their own health through the ability to access the care plans, the schedulefor appointments and make various requests such as refilling the prescriptions. Moreover, the EMR portal forboth the medical provider and the patient’sinterfaces allow for communication and interaction between the two stakeholders through secured messages. According to Gao et al. (2015), this enhances the patient’s awareness regarding their health and getting involved in the implementation of the management plan. EMR, in this case, advocate and fosters patient-centeredcare where the needs and preferences of the individual are integrated intothe care.           

Sources of Healthcare Costs

Healthcare costs can be described fromthe patient, organizational, and the country’s perspectives. While patient’s costs are the resources incurred by an individual to enhance their health and manage conditions, organizational costs are those required to conduct health operations. For a country, healthcare costs are resources set aside by the state to facilitate the health sector. According to Grosse, Nelson, Nyarko, Richardson, and Raskob (2016), an example of country healthcare costs is managing chronic illnesses such as the 7-10 billion USD spent in addressing venous thromboembolism (VTE). In the patient context, healthcare costs can be described further based on hospitalization duration, medical errors, and poor quality of service delivery. Alva, Gray, Mihaylova, Leal, and Holman (2015) argue that poor healthcare management approaches, especially in chronic illnesses such as diabetes, have a significant relationship with high healthcare costs incurred by the patient, medical facility, and the country. Considering the medication errors aspect, healthcare costs are reflected in the management of adverse effects associated with the discrepancies (Daniel & Makary, 2016; Heneghan et al., 2017). Essential to note is that addressing these costs requires effective approaches among them the implementation of information technology initiatives to promote efficiency in service delivery.  

Cost Benefits of EMR in Primary Care

EMR upsides are numerous which are based on the enhancement of quality care, reduction of errors, and mitigating avoidable care costs. On the other hand, it is important to mention the main downside of EMR which revolves around the cost issue. In a cost-benefitanalysis (CBA) conducted by Choi, Lee, and Rhee (2013), EMR challenges and downsides were centered on the medical facility incurring other costs that were not present in the paper model. The quantitative study revealed that although the adoption of EMR in primary care is critical in enhancingthe quality of services offered by the organization, it is imperative for the medical facility to consider the costs incurred in implementing the initiative. Agarwal and Kochhar (2017), in a systematic review regarding the effectiveness of EMR and Electronic Health Records (EHR) in the healthcare, noted that although doctors and other healthcare professionals implement these initiatives with an aim to promote the nature of care, there are also critical costs incurred such as setting up the infrastructure which is a major downside for adopting the IT initiatives. To affirm these assertions, Hess et al. (2016) conducted a retrospective database analysis to examine the treatment patterns using chemotherapy and patient outcomes diagnosed with gastric cancer and noted that while EMR is effective in storing patients’ information for ease of use in decision making, the costs incurred in using the initiative are based on high finances incurred in setting up the infrastructure. Based on these analyses, it is evident that the main downside of EMR is based on the cost challenge in implementing the initiative in the healthcare sector despite the numerous merits associated with the approach, which include effectiveness in delivering care and access to patient information by both the medical practitioner and the patient for collaborative care and profound decision making. 

The benefits of using EMR outweigh the costs/downsides considering the cost-related issues of healthcare errors and poor decision making. In a literature critical review by Heart et al. (2016), which purposed to evaluate the value threats and challenges of EMR, PHR, and HER, it was discovered that among the cost benefits of these approaches is enhancing the quality of care and reducing the hospitalization duration. EMR, according to Heart et al. (2016), is an internal organizational system which is used by both the healthcare provider and patient. Based on this literature analysis, it is apparent that both the medical practitioners and patients have access to the EMR data which aids in collaborative care. In addition, it is through the integration and combination of various patient’s data such as lifestyle, behavioral, and demographicswith the health information that patient-centeredcare is provided. Inzucchi et al. (2015) define patient-centered care as delivering healthcare management approaches in consideration of the individual’s needs and preferences. This aids in quality outcome and promotion of patient awareness regarding their conditions and effectiveness in care. EMR, in this regard, allowsphysicians to make quality decisions regarding the patient’s health using data in the IT initiative. 

As outlined by Jones et al. (2014), EMR contains various patient’s information such as history in their health conditions, diagnosis results, and management approaches which allowfor making of criticaldecisions regarding the individual’s condition. In addition, advanced EMR hasthe ability to analyze the diagnosis and test results and offer suggestions to the physician on possible diagnosis and possible differentials. The cost benefit in this regard is that the qualityoutcome of the patient reduces other challenges such as time spent at the medical facility which saves on the cost. Schnaus, Michalik, and Skarda (2017,) in a natural change study, confirmed the cost-benefitof EMR with regards to reducing hospitalization duration. These authors discovered that over the last two decades, patient-centered care has evolved with the integration of advanced information technology initiatives such as EMR that allow for making efficient and safer decisions regarding the patient. On the other hand, Schnaus et al. (2017) study raised a major question regarding the importance of preselected orders in care. In this question, efficiency in thedecision-makingprocess as informed by EMR is argued against. 

The relationship between quality of care and cost reduction in using EMR transcends efficient decision making to include the aspect of error reduction in delivering care. A systematic review by Reis et al. (2017) discovered that EMR improvesclinical practice and offers a wide range of benefits such as promoting the efficiency of nursing staff efficiency. However, in all the six systematic reviews from the 288 papers used in the evaluation, the cost-effectiveness of using EMR was not clearly identified based on the inconclusive and mixed results obtained from the quantitative studies. Smith et al. (2016) in a counter argument note that the use of EMR and other IT initiatives including primary care physician (PCP) enhances communication among various stakeholders in the healthcare sector and also contains patient safety approaches such as computerized discharge which reduces medical errors and promotes quality patient outcome. The pre-post-experimental research design among patients with at least two comorbidities and at least 5 terminal medications discovered that medication errors which are the leading causes of increased health carecosts for both the medical facilities and the patient arereduced profoundly through the use of information technology approaches. 

Yazar, Gooden, Mackey, and Hewitt (2014) confirm the importance of technological approaches in reducing healthcare errors and notes that automation in healthcare systems contain both interaction and safety tools which promote the patient welfare, especially among those with medically complex conditions. The reduction of health errors relates to cost benefits in two main ways, which include the patient’s incurred incur in treating other conditions that may present with these errors and the funds spent by the healthcare organization in addressing the error-related challenges. In a medical discrepancies study conducted by Bishop, Cohen, Billings, and Thomas (2015), it was concluded that approximately 2 out of 5 patients have medication errors which increase their financial burden. To avert this challenge, healthcare information technology initiatives such as the use of EMR by both pharmacists and physicians aids in the identification of these discrepancies and their correction. This reduces the adverse drug events which offer a benefit for both the patient and the medical facility. Essentially, the medication error aspect presents other challenges such as legal suits against the organization which has a financial implication for the facility and health careproviders (Chukmaitov, Harless, Bazzoli, Carretta, & Siangphoe, 2015; Saposnik, Redelmeier, Ruff, & Tobler, 2016). The importance of EMR in averting these implications is the ability ofall health careproviders from physicians to pharmacists to access the patient’s health information which aids in profound decision making and evaluation and correction of discrepancies. 

Thebenefitof EMR is centered on providing comprehensive patient care including tracking the patient data in the history of care, establishing those patients that require follow-up and ongoing care, maintaining baseline on monitoring the individual’s condition, establishing how the benchmarks are met, and overall improvement of care. According to Nevo et al. (2016), the use of EMR solutions by hospitals not only allowsfor effective patient care management through their data, but also saves costs which outweighs the financial implication related with the technology installation. Bates, Saria, Ohno-Machado, Shah, and Escobar (2014) argue that the use of big data in patient medical records will increase the effectiveness of managing clinical information dramatically. Both in the present and future, this will allow for detailed patient analysis and therefore gaining new insights from the evaluation. While basing their analysis and literature evaluation in the US, Bates et al. (2014) discovered that employing big data will profoundly reduce healthcare costs. To achieve this, some of the opportunities that present with the use of big data include reducing readmissions, triage, high-cost individuals, decompensation, especially when the condition of the patient worsened, and optimization of treatment especially in conditions that affect multiple organs. 

The upsurge in EMR adoption in hospitals offersa wide range of cost-related benefits that are associated with using computerized systems to make effectivepatientdiagnosis and reduce healthcare errors which are costly to the patient and the medical facility. Scott, Pillans, Barras, and Morris (2018) through a narrative review evaluated EMR potential and noted that the IT initiative is critical in averting the challenges associated with prescription of potentially inappropriate medications (PIMs) that have more risks than benefits. In comprehensive patient care and in particular, geriatric patients, Scott et al. (2018) noted that some of the challenges associated with multiple interventions including educational campaigns, geriatric assessments, feedback and audits, and restrictions in the formularyare mitigated with the use of EMR. The benefitsof EMR at the point of care is centered on the uptake and integration of various approaches in delivering quality care. These include the residential aged care facilities (RACFs), eHealth, and computerized physician order entry (CPOE). A critical element to note is that in the US, there has been an increase in expenditure related to healthcare which places a significant weight on the state’s economy. Hu et al. (2015) in this regard note that it is imperative to predict the future healthcare utilization to not only comprehend the deliveries in the health carebut also effectively management of the clinical resource allocation. While examining the effectiveness of EMR inpatientresource utilization, Hu et al. (2015) through a retrospective cohort-based study discovered that the use of EMR has a cost benefitwith regards to enabling more profound care management and resource utilization which enhances patient outcomes. 

The benefits of EMR can also be explained throughhealth screening. In baby-boom generation screening, Al-hihi, Shankweiler, Stricklen, Gibson, and Dunn (2017) note that the Centers for Disease Control and Prevention (CDC) has in the recent past increased the risk-based screening to incorporate a one-timebirth cohort (1945-1965). With regards to the eradicationof the hepatitis C virus (HCV), these authors noted that the treatment and referral rate isa limiting factor which can be averted by the use of EMR. This is based on the identification of the screening needs for a given condition such as HCV and establishing an EMR visual reminder for facilitating awareness and enhancing the screening rates. In the primary care setting, Al-hihi et al. (2017) discovered that the use of EMR allowed for closing the care gaps which promotes the quality of patient outcome. Marshall et al. (2016) confirm the importance of EMR in obtaining patient data during screens and management of chronic illnesses and note that individuals receive therapies that match their profiles thus promoting their outcome. With an increase in patient screens to enhance the government and medical facility collaboration in managing the conditions and enhancing the overall population health, EMR has a cost benefitin relation to maintaining patients’ records and informing the management strategies that match the individual’s condition. Regardless of the demographics, EMR presents an opportunity for the healthcare sector to develop effective management plans based on data stored and extracted in the IT initiatives such as EMR. Consistent with Hu et al. (2015), this allows for saving the huge financial burden placed on the healthcare sector in managing various conditions and in particular the chronic illnesses. 

One of the main financial implications of increased length of stay at the hospital and in the intensive care unit are the costs incurred by the patient in treating the individual. Bowton et al. (2014) espouse that the use of IT initiatives is directly related to institutions and healthcare professionals making profound decisions that are related to the data stored in the technological initiatives. Thompson, O’horo, Pickering, and Herasevich (2015) offers a contrary opinion based on a 45-studies systematic review that sufficed the selection criteria and notesthat electronically basedinterventions do not have a significant effect on length of stay, cost, or mortality rate in a primarycare setting. Sriram et al. (2017) through a quality improvement program (QIP) noted that the use of EMR has a notable relationship with length of stay (LOS) at the hospital and readmissions. Through a pre-post design on the nutrition-focused QIP, these authors established that 30-day length of stay and readmissions were significantly reduced among malnourished individuals through the use of EMR among other approaches such as sustainable nutrition support and education of both the caregiver and the patient and effective provision of the oral nutritional supplements (ONS) in the malnutrition risk context. The benefitaspect in this regard isbased on a reductionin the possibilityof the patient to be readmitted. 

Quality deterioration in the patient’s health in the ICU is based on a number of aspects including poor attendance by the healthcare provider and presentation of other conditions such as hospital-acquiredinfections including those on the surgical wound and mechanical ventilation pneumonia. According to Burwell (2015), although the introduction of the Affordable Care Act (ACA) in the US is credited for reducing the overall cost incurred by the patient and enhancing the quality of care, the goal cannot be achieved without harnessing the strength of information which is significantly related to enhanced quality of patient care. This further introduces the importance of IT approaches in achieving the objectives of ACA. Among these initiatives include EMR and her, which are essential in the collection, processing, and storage of patient health information from their demographics to health conditions and management plans. The use of IT in delivering quality healthcarein the medicalparadigm is related to the safety and ethics ofusing the drugs. Tassinari and di Sarsina (2014), in this regard, note that the effectiveness of these drugs to enhance the patient’s care cannot be achieved without consideration of the individual’s data. Cost-effectivenessof using EMR is related to that of using the person-centeredcare model where not only is the patient’s condition established through the details provided in the IT approach but also allowing for employing effective patient’s intervention.

Another cause of hospitalization and readmission is deficiencyin patient involvement in implementing the management plan. This is related to their limited acknowledgmentand awareness onthe implementation of holistic care that incorporates both the pharmacological and non-pharmacological approaches in line with their needs and requirements. The benefits of this aspect are two-fold including enhancing the qualityof the patient and reducing the costs associated with advanced management (Inzucchi et al., 2015). Andrews et al. (2017), in a study to evaluate the hospitalization risk among psychotic disorder patients using information from EMRs, discovered that the use of this technologyinitiative is feasible in the identification of future hospitalization possibilities and identifying patients that may require intensive management interventions. One of the risks that may result in hospitalization is medication non-adherence. Benerjee et al. (2016) confirm the importance of using EMR in identifying patients at risk of hospitalization and adds that it is possible to reduce the rate of readmission for patients with heart failure through the use of EMR based reports. More merits regarding the use of the EMR-basedtool in the quick and accurate identification of heart failure patients entail establishing the discharge risk factors. In these two studies, they reflect on the merits of using EMR in identifying individuals at risk of terminal conditions which has a cost implication in developing effective treatment (Heart et al., 2017; Smith et al., 2016; Saposnik et al., 2016). Patients with chronic conditions are severely affected by emergency situations which may result in more health conditions and in worst situations, death. The increase in the number and adversity of the individual conditions is associated with an escalate in the patient’s medical costs and poor quality of health which can be mitigated using EMRs. 

Besides the high cost of implementing the EMR infrastructure, a key downside associated with the approach is the financial requirement in training the health careproviders onthe use of information technological initiatives. Vuk et al. (2015) are of the opinion that the effective use of electronic medical records among physicians and nurses in the outpatient setting is related to their self-efficacy. However, a major cost implication is that the training programs require numerous resources for facilitation including developing the simulations and providing incentives to the participating medical providers. The equilibrium in the training programs is centered on the numerous resources required to support the programs versus the merits of the approaches such as improving the preparedness and self-confidence among the healthcare providers in using the EMRs (Lopez, Omizo, & Whealin, 2018; Gottlieb, Tirozzi, Manchanda, Burns, & Sandel, 2015). Across all healthcare providers including physicians and nurses, the use of EMRs is a critical factor in promoting the quality of care on service delivery. As suggested by Lopez et al. (2018), it is, therefore, the role of the professional to enhance their technical competence in using these IT initiatives. At the same time, it is the function of the medical organization to implement both the on-job training approaches as well as regular education approaches among the staff to enhance their competence in using initiatives such as EMRs. Although such approaches are associated with financial implications to both the healthcare providers and the hospital in promoting the professionals’ competence, the upsides of considering these approaches are reflected in enhanced patient care throughquality service delivery. 

EMR use in diverse healthcare setting remains among the promising technologies in both the current and future practice. However, the adoption of the technologyinitiative is dependent on a number of elements including healthcare providers support for change, implementation of IT support systems, and more innovation on the technology to enhance its application in the primary care setting. In a study by Cellucci, Cellucci, Stanton, Kerrigan, and Madrake (2015) on the current and future statuses on EMR use in clinics, among the discoveries were that EMR diffusion in training clinics reflects on rapid growth and that IT support and costs are among the fundamental concerns by the non-adopters to these technologies. According to the findings by these authors, adopters ofthese technology approaches portrayed little concerns on the IT support, costs, implementation, and interaction with the patients. These aspects further introduce a cost benefitsfoundation of the technology. 

While the adoption of the systems is associated with numerous benefits including the enhancedinteraction between the medical providers and the patients, some of the costs associated with the implementation of the approach include the timerequired for the adoption and possible resistance to change by the workers who can be identified as non-adopters. Stubbs, Uzuner, Kotfila, Goldstein, and Szolovits (2015) further counterthe merits of using EMRs in the primary care settings and introduces the challenge of protecting PHI. Essentially, the online access of patient information presents a major risk with regards to cyberthreat in the healthcare setting. In a state-of-the-artreview by Jawhari, Ludwick, Keenan, Zakus, and Hayward (2016), both the opportunities and challenges of using EMR are provided in resource-constrainedcontexts and settings, particularlyin Sub-Saharan Africa. According to these authors, it is imperative to consider knowledge gaps in the implementation of EHRs which is a critical element in demonstrating the cost-benefits of the approach. While it is important to examine the complexities of the approach and social considerations which contribute to the high financial costs coupled with the training requirements, the summative guidelines andtoolkits are critical in assisting the EMR implementers. 

Conclusion

The above discussion reflects on one of the profound technological initiatives, Electronic Medical Records (EMR), which has both merits and the downsides. The evaluation specifically focuses on the benefits of the initiative which can be described based on a number of aspects including reduction of medical errors, enhancing the qualityof patient outcome, reducing readmissions and hospitalization duration, fostering patient-centeredcare, and promoting quality decision making. On the other hand, it is essential to acknowledge the challenges and downsides of EMR which may hinder realization of its effectiveness. Some of these setbacks include the huge costs required to implement the infrastructure in the hospital setting and the resources required in training healthcare professionals on the use of the technology. According to the literature analysis above, EMR presentsa promising technological initiative in both the current and future practice in line with the information technology initiative. The balance between the merits and demerits of EMR is centered on improved quality of service delivery, application of patient-centeredcare, and collaborative care between the healthcare provider and the patient. In this regard, while the implementation and adoption of EMR requiretechnical competence and resources, its benefits are acknowledged in the patient, hospital, and the state’s health sector contexts based on reducing the huge financial burden. 

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