Electronic Medical Record Software Trends Survey (EMR Survey)
SUMMARY OF OBSERVATIONS
Electronic Medical Records Institute’s
Ninth Annual
Survey of Electronic Medical Records
Trends and Usage
2007
Co-sponsored by Philips Speech Recognition Systems
ABOUT THE EMR SURVEY
MRI’s Survey of Electronic Medical Record Trends and Usage is an annual poll of IT usage among healthcare providers of various sizes and types. A total of 1011 individuals responded to the survey. To increase relevancy and diminish bias, responses from vendors and consultants are not included in the results, reducing the total database to 819.
The MRI Survey of EMR Trends and Usage includes 20 questions (some with multiple components) that reveal insights into:
* Priorities for strategic decisions in IT
* Factors driving adoption of EMRs
* Major barriers to implementing EMR systems
* Information capture methods being used or planned
* EMR applications and functions being used or planned
* Wireless technologies being used
* Perceived effect of EMRs on patient care, patient safety, efficiency of healthcare delivery
Summary of Observations
Of the 819 respondents:
* 63.6% are either final decision-makers or have strong influence in EMR decision-making.
* The percentage increases to 89.1% when those with some influence are added.
* Thus, only 10.9% have little or no influence in EMR decision-making.
Respondents to the survey are strongly US-based (91.9%)
Role categories most represented among respondents
* IT managers and professionals
* Physicians and nurses
WHY EMRs ARE BEING IMPLEMENTED
The following are most cited as priorities for strategic decisions in IT.
* The need to improve clinical processes or workflow efficiency.
* The need to improve quality of care.
The following are most cited as factors driving the need for EMR systems in the hospital segment.
* Patient safety considerations
* Efficiency and convenience
* Satisfaction of physicians and clinician employees
The following are most cited as factors driving the need for EMR systems in the medical practice segment.
* Improved patient documentation
* Efficiency and convenience to physicians through workflow benefits
* Remote access to patient information
The following are most cited as barriers to EMR implementation plans.
* Lack of adequate funding or resources
* Anticipated difficulties in changing to an EMR system
* Difficulty in creating a migration plan from paper to electronic documentation and recordkeeping
* Inability to find an EMR solution or components at an affordable cost
DOCUMENT IMAGING APPLICATIONS
Document imaging is most in use and most planned to
* Digitize paper documents received from third parties in order to integrate them and view them in EMR systems.
CLINICAL INFORMATION CAPTURE INTO THE EMR
The following are most cited as methods for entering clinical information into the EMR:
* Free text keyboard entry
* Structured data entry with pull-down menus
* Structured data entry with keyboard/mouse
The following are most cited as having more frequent use:
* Structured data entry with keyboard/mouse
* Structured data entry with pull down menus
* Free text keyboard entry
The methods most cited as not being used are
* Light pen
* Digital pen & paper
* Optical character recognition
Regarding current satisfactory use of information capture devices and methods:
* Use of dictation and transcription without speech recognition is most cited as satisfactory and most cited as unsatisfactory.
SPEECH RECOGNITION TECHNOLOGY ADOPTION
The following are most cited as very important factors driving installation of speech recognition (SR) technology.
* Improve productivity
* Reduce turnaround time
* Reduce transcription costs
* Facilitate real-time healthcare documentation
* Improve clinical workflow
The types of SR reported as most in use are
* Dictation system with SR that automatically uploads to EMR
* Direct dictation into EMR (seamless integration)
* Stand-alone SR (no integration with EMR)
The majority of those using speech recognition to generate reports report using only front-end SR with no medical editor or other person involved.
EMR EXPERIENCE
Almost a third report experience with a system that some partner/s employees refuse to use.
Fewer than one-fifth of respondents report past or current EMR deinstallation to replace with another.
Fewer than one-tenth report past or current EMR deinstallation to revert to paper records.
EMR INPATIENT/OUTPATIENT SUPPORT
EMR systems within most hospitals, IHDSO, managed care organization, or similar healthcare institutions are reported as supporting both inpatient and outpatient capabilities.
EMR ADMINISTRATIVE AND FINANCIAL APPLICATIONS
The following EMR administrative and financial applications are reported as most in use.
* Billing and accounts receivable
* Scheduling
* Claims processing
* Patient appointments
Reported as most planned are:
* Consents
* Release of information
* Advance directives management
EMR DATA CAPTURE, REVIEW, AND UPDATE CAPABILITIES APPLICATIONS
The following EMR data capture, review, and update applications are cited as most in use:
* Patient demographics
* Allergies and adverse reactions
* Laboratory results
Reported as least in use are:
* Problem knowledge couplers
* Pre-visit health screenings, evaluations, or assessment
* Post-visit patient education
Cited as most planned are
* Pre-visit health screenings, evaluations, or assessments
* Alerts, warnings, or reminders generated by decision support
* Problem knowledge couplers
* Post-visit patient education
ORDER ENTRY AND E-PRESCRIBING APPLICATIONS
The survey shows that, in hospital settings, nurse/staff order entry continues to exceed physician order entry and is increased over 2006.
The respondents indicate that, in hospital settings, the level of planned physician order entry with clinical decision support exceeds that planned for physician order entry without clinical decision support.
E-prescribing applications to commercial/retail pharmacies reported as most used are:
* Drug-drug interactions
* Access to drug reference information
* Drug allergy checking
E-prescribing applications to commercial/retail pharmacies reported as least used and most planned are
* Patient eligibility for specific drug within health plan formulary
* Patient eligibility verification
* Refill tracking
COMMUNICATION
Use of the Continuity of Care Record (CCR) has increased since 2006.
The most planned uses of the CCR are
* Personal health record
* Referrals
* Transfers
Regarding access to reference information, respondents indicate
* Drug reference information is most used.
* Most planned are
Access to notifications/reminders for disease management, preventive services, and wellness
Access to clinical guidelines/protocols.
Respondents indicate that email continues to be more used between practitioners than between patients and clinicians.
CLINICAL DATA REPOSITORIES
The following clinical data repositories are cited as most used.
* Storage of reimbursement codes
* Storage of EMR data and text
Least used is storage of voice or sound.
OTHER EMR APPLICATIONS
Among 3 additional EMR applications:
* Remote EMR access by physicians is reported as having the most current use.
* Use as data warehouse or secondary database is most planned.
* Use for clinical trials is least used and least planned.
STATUS AND TRENDS OF MOBILE /WIRELESS APPLICATIONS
Respondents indicate increased use of WiFi, WWAN (digital and analog), and WPAN wireless connectivity, with WiFi most used.
EMR EFFECT ON QUALITY OF PATIENT CARE
Almost two-thirds of those responding rate quality of care until now as improved by EMRs in their organization.
Over two-thirds of those responding rate quality of care until now as improved by EMRs in healthcare in general.
Over 90% anticipate that EMRs will have improved quality of care 10 years from now.
EMR EFFECT ON PATIENT SAFETY
Over half of those responding rate patient safety until now as improved by EMRs in their organization.
Over two-thirds of those responding rate patient safety until now as improved by EMRs in healthcare in general.
Over 90% anticipate that EMRs will have improved patient safety 10 years from now.
EMR EFFECT ON EFFICIENCY OF HEALTHCARE DELIVERY
More than half of those responding rate the efficiency of healthcare until now in their organization as improved by EMRs.
Almost two-thirds of those responding rate the efficiency of healthcare until now in healthcare in general as improved by EMR
Over 90% anticipate that EMRs will have improved efficiency in healthcare 10 years from now.