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Executive Summary
Electronic Medical Records (EMR) is a digital version of the paper based medical records of an
individual. It allows hospitals to keep millions of patient records within its system and transfer it
between departments. Recent legislation by the US government has incentivized EMR utilization
by instituting financial punishments and rewards. Despite potential challenges with
implementation, this critical software will improve efficiency, strengthen connections between
physicians and patients, and reduce preventable deaths.
Critics of EMR present concerns with implementation and security. The concern vary between
spending a considerable amount of time learning about the software instead of medicating the
patients. Also, the privacy issue where patients shared electronic record is viewed as a threat
since staff members are able to view patient medical information. However, eventual cost
decreases associated with training and the development of more secure software mitigates these
concerns.
In addition, the overwhelming benefits of EMR is results in better continuity of care through
sharing the records between hospitals that share the system. Also, the training that the healthcare
providers get allows them to learn the system and derive lower costs in future. EMR highlights,
the potential collaboration between medical professionals throughout the departments and
focuses on reducing preventable deaths. Therefore, the associated benefits outweigh the costs for
these reasons and hospitals should implement EMR service.

Takieddine, Bahaeddine

The Need for Electronic Medical Records adoption in Hospitals

The fact that paying more will get you better quality is an oxymoron, especially the quality of
care in the hospitals. In the USA where the bill stands at 18% of GDP and costs have risen three
times faster than economic growth over the past 20 years [1], the patients are hospitalized more
frequently for chronic illness than people in many other developed countries. Also, the United
States still ranks low internationally on scores of patient safety, care coordination and patient
centeredness [2] Additionally, U.S. News states that medical errors are the 3rd leading cause of
death in the US, which amounts to 250,000 annual deaths. These preventable deaths represent
10% of the total deaths per year. The government addressed this issue in 2009, where the federal
government started offering incentives to physicians adopting electronic health records.
Physicians who did not meet the standards by 2015 faced reduction in their Medicare
reimbursements unless they were able to prove significant hardships. [3] In addition, the
transformation to value-based healthcare care where Medicare would reimburse hospitals based
on their performance increased the pressure on hospitals to be more efficient in driving costs
down. [4] In the light of that, hospitals are trying to install Electronic Medical Records in their
system to improve patient safety and have financial benefits. However, many believe EMR has
potential disadvantages such as changes in workflow, and temporary loss of productivity
associated with EHR adoption. Yet, the investment in this technology is a long-term investment
and measuring the outcomes can be valid after least 5 years of implementation. Despite potential
challenges with implementation, this critical software will improve efficiency, strengthen
connections between physicians and patients, and reduce preventable deaths.
The transition to paperless medical records has a number of benefits, such as the ability to
locate the record online which takes seconds instead of going over the paper file of each patient.
EMR systems enable the transfer of information inside and outside of the hospital. The provider
that is assigned to the patient has the right to access the patients information by accessing the
username and password. This greatly decreases the ambiguity of patient information in the case
of transferring hospitals, where new doctors must be able to understand information about
patients drug usage and medical background.[5] However, many hospitals are still facing the
challenge of investing in EHR systems which cost between $15,000 and $70,000 per doctor to
Takieddine, Bahaeddine

purchase. Nevertheless, the future cost of installation, maintenance, and training on this software
is creating concerns for the physicians who might want to adopt it. On the other hand, many
reputable hospitals like Cleveland Clinic invested about $1 billion in information technology and
$400 million in the EMR system alone. President Tobey Cosgrove mentioned in the Cleveland
Clinic Way that digital resources eliminated accidental deaths from drug interactions, overdoses,
or lost records. For example, in case of emergency the EMR gives the provider an instant
comprehensive picture of the patient to make a prompt medical decision rather than reviewing
the paper charts to treat the patient. Therefore, the government is pushing the use of EMR by
paying $3 billion to 2000 hospitals and more than 41,000 private doctors who meet the
standards. [6]. This trend of advancing the hospital system to become comprehensive (Electronic
Clinical Information, Computerized Provider entry, Results management and decision support) is
increasing significantly.

This highlights the fact that hospitals are abiding by the incentive program and are aiming to
share and exchange information through this common software. A case study done by Geisinger
Health System regarding optimization of their EMR in HeartBypass surgery showed promising
results of a 45% decrease (6.9% to 3.8%) in readmission within 30 days and a decrease in
Takieddine, Bahaeddine

average length of stay (from 6.3 days to 5.3 days) [7]. This reveals the need to discharge patients
with confidence that they will not be quickly readmitted and incur additional healthcare costs.
Despite the movement for EMR implementation, researchers estimate that EHR end-users spent
134.2 hours on implementation activities associated with buying and learning a new system [8].
These hours spent on nonclinical responsibilities had an estimated cost of $10,325 per physician.
Regardless, this training is a crucial step in implementing EMR within the hospital as it also
encourages innovative health providers to optimize tools and motivate other providers to do the
same. However, EHRs are said to be a risk for patient privacy due to the rise in the amount of
health information exchanged electronically. To counteract this concern, hospitals are creating
new rules to protect patients information by creating specific login pages to their web and
making it harder for staff members to view patient profiles and medical history. In my experience
at University Medical Center - Rizk Hospital in Lebanon, I was able to witness the power of
PACS (Picture Archiving and Communicating System) in facilitating coordination between
physicians and doctors to allow sharing of CT scan images in matter of seconds. It also allowed
an efficient scheduling process for patients. However, the problem facing EMR is its lack of
alignment with the Billing & Admission department since the Radiology Information System
was an independent platform. This kind of platform within a hospital where an employee has to
go over three accounts and passwords generates frustration and anxiety. That is why hospitals
should concentrate on eliminating delay through collaboration between each department.
I designed a system dynamics model (Casual Loop) utilizing Vensim to emphasize the
relationship between different factors in a healthcare environment. This highlights the fact that
service costs and patient satisfaction are inversely related, and highly trained staff eventually
lower costs. This diagram provides the bigger picture on what a hospital can focus on in deriving
objectives like improving patient satisfaction and training the employees.

Takieddine, Bahaeddine

The adoption of EMR systems and valid comparative performance reporting would enable the
development of value-based competition and quality improvement to drive transformation.[9]
The need for the government and insurance companies to emphasize the learning process of
organization in adapting to this technology is crucial. The system must be beneficial to the
clinician that will be entering the data and using the results for patient care decisions. Thus, data
receipt and entry should not be excessively time consuming. [10] Moreover, many other
healthcare improvements in operations like six sigma and the lean techniques can create an
operational efficiency with the help of IT to develop the best patient care. In reference to Built to
Last, the myth of successful companies focusing primarily on beating competition applies to
hospitals as well. Instead, visionary hospitals such as Cleveland Clinic, Mayo Clinic, Virginia
Mason Hospital, and Theda Care Health System focus on beating themselves by asking how do
we improve ourselves to do better tomorrow than we did today is what makes them a better
patient-centered facility.
This report has a limitation in going over other countries application of EMR and the benefits
and consequences it holds within each. It lacks financial information on how to measure costs
associated with investing in EMR. It would require further study and analysis on the HITECH
Takieddine, Bahaeddine

Act aim which tends to create a strategic plan for implementing a nationwide interoperable
health information system in case patients move between countries with differing systems,
cultures, and languages. A final area of potential development is the collaboration between
international doctors to make improvements in medical treatments.

Takieddine, Bahaeddine

References:
1- Larson,S, Peter Lawyer & Silverstein. M From Concept to Reality Boston Consulting
Group 2010.
2- OPTUM Can value based reimbursement transform healthcare White Paper 2013.
3- Adopting Electronic Medical Records: What Do the New Federal Incentives Mean to
Your Individual Physician Medical Practice Management July/August 2009.
4- Michael Porter, Thomas Lee The Strategy that Will Fix Healthcare Harvard Business
Review October 2013)
5- Okpala. Peter The electronic medical record (EMR) Journal of Applied Medical
Sciences vol.2.mo 2,2013 79-85 ISSN: 2241-2328 (print version), 2241-2336 (online)
Scienpress Ltd, 2013
6- Emily P.Walker Adoption Way up in Hospitals, February 2012.
7- McCarthy. D, Mueller. K, Wren. J Geisinger Health System Case Study Organized
Health Care Delivery System June 2009
8- Fleming NS, Culler SD, McCorkle R, et al. The financial and nonfinancial costs of
implementing electronic health records in primary care practices. Health Aff
(Millwood) 2011;30(3):481489
9- Hilestad. R, et. Al Can Electronic Medical System Transform Healthcare HEALTH
AFFAIR S - Volume 24. Number 5
10- Hersh,W The Electronic Medical Record Biomedical Information Communication
Center, Oregon Health Sciences University, BICC, 3 18 1 S.
11- ONC Data Brief No. 23 | Adoption of Electronic Health Record Systems among U.S.
Non-Federal Acute Care Hospitals: 2008-2014

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Appendix

Takieddine, Bahaeddine