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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.
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