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Volume 56, Number 3
May/June 2011

  • INTERVIEW
    Interview with Patrick A. Charmel, FACHE, President and Chief Executive Officer of Griffin Hospital
    Stephen J. O'Connor
  • TRENDS
    What Every CEO Should Know About Medicare's Recovery Audit Contractor Program
    Alan J. Goldberg and Linda M. Young
  • REFORM
    Three "Brutal Facts" That Provide Strategic Direction for Healthcare Delivery Systems: Preparing for the End of the Healthcare Bubble
    Nathan S. Kaufman
  • ARTICLES
    Exploring the Business Case for Ambulatory Electronic Health Record System Adoption
    Paula H. Song, Ann Scheck McAlearney, Julie Robbins, and Jeffrey S. McCullough
    Physician and Practice Characteristics Associated with Longitudinal Increases in Electronic Health Records Adoption
    Nir Menachemi, Thomas L. Powers, and Robert G. Brooks
    Developing a Transfer Center in a Tertiary Cancer Center: Streamlining Access and Communication to Accommodate Increasing Demand for Service
    Frank Tortorella, Michael S. Ewer, Pamela B. Douglas-Ntagha, Ronald Walters, and Wenonah B. Ecung

Executive Summary
Exploring the Business Case for Ambulatory Electronic Health Record System Adoption, Paula H. Song, Ann Scheck McAlearney, Julie Robbins, and Jeffrey S. McCullough

Widespread implementation and use of electronic health record (EHR) systems has been recognized by healthcare leaders as a cornerstone strategy for systematically reducing medical errors and improving clinical quality. However, EHR adoption requires a significant capital investment for healthcare providers, and cost is often cited as a barrier. Despite the capital requirements, a true business case for EHR system adoption and implementation has not been made. This is of concern, as the lack of a business case can influence decision making about EHR investments. The purpose of this study was to examine the role of business case analysis in healthcare organizations' decisions to invest in ambulatory EHR systems, and to identify what factors organizations considered when justifying an ambulatory EHR. Using a qualitative case study approach, we explored how five organizations that are considered to have best practices in ambulatory EHR system implementation had evaluated the business case for EHR adoption. We found that although the rigor of formal business case analysis was highly variable, informants across these organizations consistently reported perceiving that a positive business case for EHR system adoption existed, especially when they considered both financial and non-financial benefits. While many consider EHR system adoption inevitable in healthcare, this viewpoint should not deter managers from conducting a business case analysis. Results of such an analysis can inform healthcare organizations' understanding about resource allocation needs, help clarify expectations about financial and clinical performance metrics to be monitored through EHR systems, and form the basis for ongoing organizational support to ensure successful system implementation.            

Executive Summary
Physician and Practice Characteristics Associated with Longitudinal Increases in Electronic Health Records Adoption, Nir Menachemi, Thomas L. Powers, and Robert G. Brooks

This article identifies practice- and physician-related characteristics associated with the increased use of EHRs by physicians in outpatient practices. Two Florida surveys conducted in 2005 and 2008 on physician use of EHRs were examined to determine the practice and physician characteristics associated with increased EHR use over time. Based on multivariate analysis, several variables were found to influence increased EHR adoption. Practice variables included participation in a single-specialty practice and percentage of Medicare patients in the practice, but not percentage of Medicaid patients in the practice. Physician characteristics included younger physician age, but not specialty nor years practicing in the community. Factors associated with EHR adoption at any given point in time did not necessarily predict longitudinal increases in EHR adoption. These results are important for physicians to consider in their potential adoption of EHRs and should also be considered by policymakers interested in promoting increased use of EHRs by physicians.

Executive Summary
Developing a Transfer Center in a Tertiary Cancer Center: Streamlining Access and Communication to Accommodate Increasing Demand for Service, Frank Tortorella, Michael S. Ewer, Pamela B. Douglas-Ntagha, Ronald Walters, and Wenonah B. Ecung

Hospital-to-hospital transfers in a tertiary cancer center present an unusual set of problems involving a diverse group of acutely ill patients with highly specialized needs. The level and urgency of care required and the costs of providing optimal management often are exceedingly high. We present the administrative issues involved during a major revamping and streamlining of the Transfer Center at The University of Texas MD Anderson Cancer Center. The impetus for change included overuse of the emergency facility as a triage center for transferred patients, lack of adequate preadmission medical and financial screening of patients in anticipation of a transfer, a suboptimal level of physician-to-physician handoff communication, and insufficient protocols for prioritizing potential admissions and thus optimizing the institution's limited resources. During implementation of these revised policies, additional concerns were identified, including reluctance to modify established protocols and an inability to ensure the arrival of non-emergent transfer patients at our institution during daytime hours. Prioritizing admissions based on the degree of urgency and available resources required ongoing flexibility in accepting new concepts and ideas. The success of the project is documented in this report, as are suggestions for how other centers that experience similar challenging reorganizations can apply the lessons learned from our endeavors.