A new study shows that Electronic Medical Records (EMRs) can have a significant positive impact on outcomes and cost in chronic disease.
The study is published in the on-line medical journal BMC Medical Informatics and Decision Making has demonstrated for the first time that electronic medical records improve patient care, lower mortality and reduce costs in chronic disease. The peer-reviewed article shows significant advantages achieved by using a properly organised electronic medical record. Mortality was reduced 40 percent and, as a further bonus, use of the EMR increased the efficiency of the staff, leading to the ability to deliver better care with 25 percent fewer staff needed. The retrospective analysis studied almost 4000 patient years of prospectively collected data on dialysis patients treated over a 9-year period at The Rogosin Institute, a non-profit treatment and research institute affiliated with New York-Presbyterian Hospital/Weill Cornell Medical College. US dialysis patient mortality has stayed at approximately 23 to 24 percent annually for many years. This compares quite unfavourably with most of the developed countries in the world. Using this EMR, mortality dropped by almost 40 percent (to 15 percent annually) and has remained low through today. Rogosin's results are now better than 99 percent of US dialysis units. George Rovegno, CEO of MIQS, notes: 'For some years we have all believed that computers can provide the information tool needed to improve the quality of care, reduce costs and avoid serious errors. At last, in this landmark study, is the proof of the hypothesis. Since 80 percent of our healthcare costs are incurred caring for patients with chronic diseases, these findings will have important implications for the cost, quality, and safety of American health care.' Data on the Rogosin patients was entered into and managed using an electronic Medical record developed by MIQS of Boulder, Colorado, USA, and designed for day-to-day patient care. The record stores and organizes the patient's information including diagnoses, procedures, symptoms, signs, medications, orders, test results, dialysis treatments and data on all conditions, whether or not directly related to kidney disease. The record stores the information from all venues of care provided by any healthcare provider. The information is layered into the system, which contains a query and decision support system and reminder tools that help medical personnel track data in real time. In a typical year over 25,000 discrete pieces of data were recorded for each patient. The system includes a large library of reports and tools that provide a mechanism to flag conditions, lab values or other unexpected health outcomes that may not normally be seen. 'We believe that having a system to collect, query and analyse extensive data - including information that is not directly related to the condition we are treating - greatly impacts the outcomes of patients. This is especially important for patients who have multiple systemic diseases that need ongoing evaluation and treatment by many health care providers over many years and at various sites,' said Jonathan Lorch, MD, of The Rogosin Institute and Weill Cornell Medical College. 'The improved mortality rates we saw in our patients who were tracked using MIQS are striking.' The MIQS electronic patient record was incorporated in three Rogosin Institute dialysis centres in 1998, 1999 and 2000. By December 31, 2006, the patients had been treated by maintenance haemodialysis for a total of 3924 treatment years. A retrospective analysis was made using query tools embedded in the software. The data was compared with patient information compiled from the US Renal Data System dialysis population. The 1790 patients had underlying primary diseases and multiple co-morbid conditions affecting many organ systems. Year by year mortality, hospital admissions and staffing were analysed. An analysis of data annually after the implementation of the electronic patient record system in the three centres showed a marked decrease in mortality, with rates of 37 percent, 37 percent and 35 percent less than that reported by the US Renal Data System. Clinical staffing was 25 percent lower per 100 patients than the national average, thereby lowering costs. 'Because dialysis is such a standardised treatment throughout the country, the difference we saw in outcomes in the Rogosin patients was very significant,' said Victor Pollak, MD of the University of Colorado and MIQS. 'This is clearly a case when patients' improved outcomes could be directly attributed to an electronic patient record.' The Rogosin Institute is a non-profit treatment and research institute affiliated with the New York-Presbyterian Hospital/Weill Cornell Medical College. The Institute provides treatment for kidney disease, including dialysis and transplantation, cardiovascular disease related to cholesterol and lipid problems, cancer, diabetes and hypertension. The Institute participates in research to improve the treatment and prevention of these conditions.
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