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Rssdi role of Electronic Medical Record in Diabetes Care 27.10.12


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Talk given at RSSDI 2012 held at Chennai.

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Rssdi role of Electronic Medical Record in Diabetes Care 27.10.12

  1. 1. Role of Electronic Medical Records & Computer Gadgets in Diabetes Dr. Santosh Malpani MD
  2. 2. Changing Medical Records…..
  3. 3. Changing Medical Records…..The only thing which is permanent in this world is CHANGE.And the exception is MEDICAL RECORDs !
  4. 4. Strengths of Paper Record• Paper records are familiar to users who consequently do not need to acquire new skills or behaviors to use them.• Paper records are portable and can be carried to the point of care.• Once in hand, paper records do not experience downtime as computer systems do.• Paper records allow flexibility in recording data and are able to record "soft" (i.e., subjective) data easily.• No new technology to be learnt for keeping data on papers.
  5. 5. Weakness of Paper Record• Find the record: Lost, being used elsewhere• Find data within the record: Poorly organized, missing, fragmented• Read data: Language and Legibility• Research: Difficult to search across patients• Passive: No decision support
  6. 6. MCI Recommendations• Keep Records for of 3 years from the date of commencement of the treatment• If demanded issue in 72 hrs• Maintain a Register of Medical Certificates giving full details of certificates issued.• Efforts shall be made to computerize medical records for quick retrieval. MCI-Professional Conduct, Etiquette and Ethics Regulations, 2002
  7. 7. ADA recommendationsIX. STRATEGIES FOR IMPROVING DIABETES CAREChanges that have been shown to increase quality of diabetes care include1. Basing care on evidence based guidelines2. Implementing electronic health record tools ADA- Standards of Medical Care in Diabetes 2012
  8. 8. • Physiology is the logic of life‟• Pathology is „the logic of disease‟• Health informatics is „the logic of healthcare‟ – Electronic Medical Records are not WORD files stored with patients identity.
  9. 9. Definition of EHR– It is a longitudinal collection of electronic health information for and about persons– With Immediate electronic access to person and population level information by authorized users;– With provision of knowledge and decision-support systems that enhances the quality, safety, and efficiency of patient care and– Provides Support for efficient processes for health care delivery.”Institute of Medicine 2003 Patient Safety Report
  10. 10. Advantages of EMR in Diabetes Storage Space• Diabetes being a chronic disease, patients visits OPDs, does the reports, gets admitted more times as compared to any other diseases.• Each activity creates one record leading to a great quantum records.EMR requires virtually negligible space.• EMR allows for a complete set of backup records at little or no cost reducing the number of lost records
  11. 11. Back up of records
  12. 12. Advantages of EMR Quality Assurance• With EMR we an assure quality of medical care to the patients as it can be “measured” via analysis of records.• Practitioners using EMR are giving better quality of medical care as compared to practitioners using paper record provided they use it in “meaningful” way.
  13. 13. Author/ Title Sample/ Method Outcomejournal/ yrRandal et al EHR and 2007 to 2009 EHR sites were associatedNEJM/2011 Quality of 27,207 records in with significantly higher Diabetes 47 practices achievement of quality care Care and outcome standardsDAVIS BU- Benefits of Computer model Use of EHR improved theDiabetes IT- Enabled creation to health of patients withCare 2007 DM Mgt project IT impact diabetes and reduced on health health care expenditures. expendituresVICTOR M. The Impact 16 primary care Planned care was associatedMONTORI of Planned sites, 200 pt from with improvements inDiabetes Care and a each, measurement of HbA1c, HDLCare 2002 DEMR on comparison of cholesterol and Community baseline and microalbuminuria as well as DM Care after the provision of tobacco advice implementation data
  14. 14. Author/ Title Sample/ Method Outcomejournal/ yrDAVID IT Systems to 109 articles, Use of EMR improved GuidelineDORR et Promote 112 system adherence, visit frequency,al Improved Care description, documentation, treatmentJ Am Med for Chronic DM (42.9%)of adherence, referral rate, appropriate screening/testing,Inform Illness: A reviewed articles), and cost. Most Studies reportedAssoc. Literature heart disease and positive and few studies2007 Review mental illness . reported neutral results.Jesse C. EMR and DM Cross sectional Diabetes care quality in allCrosson Quality of Care: analysis of practices showed room forAnnals Of Results From a baseline data from improvement however, afterFamily Sample of 50 practice sites adjustment, patient care in theMedicine Family 37 practices not using an EMR2007 Medicine was more likely to meet Practices guidelines for process. Meaningful use of EMR recommended.
  15. 15. Inference• These studies indicate that “meaningful” use of EMR can be beneficial in improving Quality of care in Diabetes management.
  16. 16. What informationDo you want mymaster ?
  17. 17. Analysis of Practice Patterns and Research Activities• Demographic studies, prevalence studies can be done.• For clinical research specific sub-set of patients who can meet the qualifying criterion for a proposed trial can be easily extracted.• EMR output can be integrated in research software.
  18. 18. Use of a Large Diabetes EMR System in India: Clinical and Research Applications V.Mohan Journal of Diabetes Science and Technology May 2011 Prevalence ratesParameter T1 DM T2 DMNeuropathy 13.0 % 33.1 %Microalbuminuria 20 % 25 %CAD 9.2 % 17.5 %PVD 2.8 % 3.9 %Retinopathy 35.7 % 37.9 %Prevalence of microvascular and macrovascularcomplications of diabetes increased with increasing glycatedhemoglobin levels (p for trend < .001) and increasing diabetesduration (p for trend < .001)The DEMR helps track diabetes care and is a valuable tool forresearch.
  19. 19. Speed the Retrieval of Data
  20. 20. Advantages of EMR• Expedite the transfer of data between facilities, regardless of geographic separation• Opinion from a colleague, discussion of the case possible.• Are a proven long-term cost reducer, practice enhancers and a public relations tool.
  21. 21. Legible Record
  22. 22. Problems of wrong medication, wrong dose, wrong directions
  23. 23. Drugs from same group
  24. 24. Same drug again
  25. 25. Special Precautions for drug
  26. 26. Allergy Alert
  27. 27. Patient Education Material
  28. 28. Multilingual Facility
  29. 29. Multilingual Facility
  30. 30. Decision Support ModelJoAnn M. Sperl-Hillen - Diabetes Spectrum Volume 23, Number 3, 2010
  31. 31. Advantages of EMR• In professional liability suits against health care providers the medical record is “The witness that never dies.” A well documented, complete, and unambiguous medical record means a case that is infinitely easier to defend.
  32. 32. Finance
  33. 33. Improvement in Practice Pattern
  34. 34. Problems associated with EMR• High initial cost, Large training investment• Hardware crashes and breakdowns, power failures, software glitches, viruses, Trojan horses• Loss of eye contact with patient, Physicians don‟t feel free as with paper prescriptions.• Reluctance of physicians to use the tightly controlled format for notes.
  35. 35. Problems associated with EMR• Coding language is not fixed. Variable at each place.• Don‟t accept „loose terms‟ as program is „structured‟.• Delay between investment & benefit.
  36. 36. Using EMR is like riding a horse. New rider is afraid, Learner falls many times,Experienced enjoys the ride and remains ahead in the race ! Thank you !
  37. 37. Thank You !“Experience is a hard teacher because she gives the test first, the lessons afterwards.” -Vernon Law
  38. 38. •Presentation ends here. All other slides after this are not included.
  39. 39. Perceived barriers and related possible interventionsFinance• Provide documentation on return on investment.• Show profitable examples from other EMR implementations.• Provide financial compensation.• Government/ Association incentives.
  40. 40. Paper Record Versus EMR• Physicians spend up to 38% of their time writing up patient charts.• Nurses spend up to 50% of their time writing up charts.• Medical records are misplaced or missing in 30% of patient visits.• The average patient visit generates 13 pieces of paper.• The average office spends $10 per visit to track and file paper records• The average patient record weighs 1.5 lbs.Source: Committee on Improving the Patient Record, Institute of Medicine
  41. 41. Perceived barriers and related possible interventionsTechnical• Educate physicians and support ongoing training.• Adapt the system to existing practices.• Implement EMR on a module-by-module basis.• Link EMR with existing systems.• Promote and communicate reliability and availability of the system.• Acquire third party for support during implementation.
  42. 42. Perceived barriers and related possible interventionsTime• Provide support during implementation phase to convert records and assist.• Provide training sessions to familiarize users.• Implement a user friendly help function and help desk.• Redesign workflow to achieve a time gain
  43. 43. Perceived barriers and related possible interventionsPsychological• Discuss usefulness of the EMR• Include trial period.• Demonstrate ease of use.• Start with voluntary use.• Let fellow physicians demonstrate the system.• Adapt system to current medical practice.
  44. 44. Perceived barriers and related possible interventionsSocial• Discuss advantages and disadvantages for doctors and patients.• Information and support from physicians who are already users.• Ensure support, leadership, and communication from management.
  45. 45. Perceived barriers and related possible interventionsLegal• Develop requirements on safety and security in cooperation with physicians and patients.• Ensure EMR system meets these requirements before implementation.• Communicate on safety and security of issues.
  46. 46. Perceived barriers and related possible interventionsOrganization• Redesign workflow to realize a better organizational fit.• Adapt EMR to organization type.• Adapt EMR to type of medical practice
  47. 47. Perceived barriers and related possible interventionsChange process• Select a project champion, preferably an experienced physician.• Let physicians (or representatives) participate during the implementation process.• Communicate the advantages for physicians. Use incentives.• Ensure support, leadership, and communication from management.
  48. 48. Methods and Dimensions of EHR Data QualityAssessment: Enabling Reuse for Clinical Research Weiskopf NG, Weng C. J Am Med Inform Assoc (2012). doi:10.1136/amiajnl-2011-000681• There is currently little consistency or potential generalizability in the methods used to assess EHR data quality. If the reuse of EHR data for clinical research is to become accepted, researchers should adopt validated, systematic methods of EHR data quality.
  49. 49. EMR in Diabetes Management• Diabetes mellitus is a chronic illness that requires continuing medical care and ongoing patient self- management education and support to prevent acute complications and to reduce the risk of long-term complications.• Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed.• A large body of evidence exists that supports a range of interventions to improve diabetes outcomes.• To achieve this keeping health record which can be easily assessed, read and interpreted is required.
  50. 50. EMR in Diagnosing Diabetes• Current criteria can be incorporated and changed as per recommendations• Protocols of tests can be incorporated in EMR for specific population e.g. Symptomatic patient protocol, Asymptomatic patient protocol, Pregnancy with diabetes protocol.• This improves the “value” and meaningfulness” of test.
  51. 51. EMR in Glucose Monitoring• Data of SMBG, CGMS, Lab Reports can be incorporated in EMR.• Visualizing these reports graphs, bar diagrams on time line improves assessment of variability in glucose value.• This helps in monitoring diabetes, detecting both hypo and hyperglycemia in a better way.
  52. 52. EMR in Goals
  53. 53. Can Electronic Clinical Documentation Help Prevent Diagnostic Errors ? Gordon D. NEJM March 25, 2010• Providing access to information• Recording and sharing assessments• Maintaining dynamic patient history• Maintaining problem lists• Tracking medications Record• Tracking tests• Ensuring coordination and continuity• Enabling follow-up• Providing feedback• Providing placeholder for resumption of work• Providing access to information sources• Offering second opinion or consultation• Increasing efficiency
  54. 54. Evidence for handheld electronic medical records in improving care: a systematic review Robert C Wu- BMC Medical Informatics and Decision Making 2006• Handheld electronic medical records may improve documentation, but as yet, the number of studies is small and the data is restricted to one group of patients and a small group of practitioners. Further study is required to determine the benefits with handheld electronic medical records especially in assessing clinical outcomes.
  55. 55. Impact of electronic medical record on physician practice in office settings: a systematic review• We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction.• Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect.• Forty-eight distinct factors were identified that influenced EMR success. Several lessons learned were repeated across studies (a) having robust EMR features that support clinical use; (b) redesigning EMR-supported work practices for optimal fit; (c) demonstrating value for money; (d) having realistic expectations on implementation; and (e) engaging patients in the process.• Conclusions: Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review..
  56. 56. The Use of EMRs: Communication Patterns in Outpatient Encounters GREGORY MAKOULJ Am Med Inform Assoc. 2001;8:610–615.• Compared with the control physicians, EMR physicians adopted a more active role in clarifying information, encouraging questions, and ensuring completeness at the end of a visit.• A trend suggested that EMR physicians might be less active than control physicians in three somewhat more patient-centered areas (outlining the patient‟s agenda, exploring psychosocial/• emotional issues, discussing how health problems affect a patient‟s life).• The relatively fixed position of the computer limited the extent to which EMR physicians could physically orient themselves toward the patient.• Initial visits with EMR physicians took an average of 37.5 percent longer than those with control physicians.• An EMR system may enhance the ability of physicians to complete information intensive tasks but can make it more difficult to focus attention on other aspects of patient communication. Further study involving a controlled, pre-/post-intervention design is justified.
  57. 57. Electronic Discovery and EMRs: Does the Threat of Litigation affect Firm Decisions to Adopt Technology? Amalia R. Miller- April 27, 2009- Economics Department, University of Virginia, Charlottesville, VA• We ask how the threat of litigation affects decisions to adopt technologies that leave more of an electronic trail, like EMR .• On the one hand, firms may embrace a technology that allows them to easily document that their actions were appropriate if they have to defend them in court.• On the other hand, firms may fear that the ease of „electronic discovery‟ may increase their exposure to potentially costly litigation.• EMRs allow hospitals to document electronically both patient symptoms and the health providers‟ reactions to those symptoms.• We find evidence that hospitals are 33 percent less likely to adopt electronic medical records if there are state laws that facilitate the use of electronic records in court.
  58. 58. Primary care physicians‟ experiences with electronic medical records Dave Ludwick Can Fam Physician 2010;56:40-7• In order to understand how remuneration and care setting affected evaluation, selection, implementation, and adoption of EMRs, family physicians who practiced in urban, hospital, and academic settings and who were paid through alternatives to fee-for-service payment models were interviewed.• Findings were compared with the finding of previous interviews with community based family physicians.• This study suggests that stronger physician professional networks, more complete training, and in-house technical support might be more influential than remuneration approach in facilitating the adoption EMRs.
  59. 59. Web-Based Collaborative Care for T2DM JAMES D. RALSTON- Diabetes Care 32:234–239, 2009• Trial of 83 adults with type 2 diabetes randomized to receive usual care plus Web-based care management or usual care alone• Intervention patients received 12 months of Web-based care management. The Web-based program included patient access to electronic medical records, secure e-mail with providers, feedback on blood glucose readings, an educational Web site, and an interactive online diary for entering information about exercise, diet, and medication.• GHb levels declined by 0.7% (95% CI 0.21.3) on average among intervention patients compared with usual-care patients. Systolic blood pressure, diastolic blood pressure, total cholesterol levels, and use of in-person health care services did not differ between the two groups
  60. 60. Improving Outcomes for High-Risk Diabetics Using Information Systems A. John Orzano (J Am Board Fam Med 2007;20:245–251.)• Use of relatively simple systems to identify and track patient information can improve diabetic care outcomes. Practices making investments in an EHR must recognize that this technology alone is not sufficient for achieving desirable clinical outcomes. Researchers must explore the interrelationships of organizational factors necessary for successful information use.
  61. 61. How to Promote Meaningful Use of EMR• EMR Training Academy• Incentives• Web Based EMR• Fixing the Fields and terminologies• Coding parameters• Promote Evidence-based Practice• Workshops on EMR
  62. 62. • 1.3 Maintenance of medical records:• 1.3.1 Every physician shall maintain the medical records pertaining to his / her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India and attached as Appendix 3.
  63. 63. MCI-Professional Conduct, Etiquette and Ethics Regulations, 2002• 1.3.2. If any request is made for medical records either by the patients / authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours
  64. 64. MCI-Professional Conduct, Etiquette and Ethics Regulations, 2002• 1.3.3 A Registered medical practitioner shall maintain a Register of Medical Certificates giving full details of certificates issued. When issuing a medical certificate he / she shall always enter the identification marks of the patient and keep a copy of the certificate. He / She shall not omit to record the signature and/or thumb mark, address and at least one identification mark of the patient on the medical certificates or report. The medical certificate shall be prepared as in Appendix 2.
  65. 65. MCI-Professional Conduct, Etiquette and Ethics Regulations, 2002• 1.3.4 Efforts shall be made to computerize medical records for quick retrieval.
  66. 66. Changing Medical Records….. ?
  67. 67. DefinitionThe Institute of Medicine 2003 Patient Safety Reportdescribes an EMR as encompassing: – “a longitudinal collection of electronic health information for and about persons – Immediate electronic access to person- and population-level information by authorized users; – Provision of knowledge and decision-support systems that enhance the quality, safety, and efficiency of patient care and – Support for efficient processes for health care delivery.”
  68. 68. EMR Usage at Present…..• The total penetration of IT in the Indian healthcare industry is still very low as compared to other industries like financial institutions.• Majority of the physicians (75.8%) are familiar with EMR function and benefits and only 24.2 % said that they are unfamiliar with EMR function and benefits.• Gender, age, years of experience and qualification has no association with familiarity of doctors with EMR function and benefits. To Analyze The Scope And Acceptance Of Electronic Medical Records Among Doctors In India A Project Of Summer Training Fozia Afreen Institute Of Management Studies LAL QUAN, GHAZIABAD Batch: 2009-11
  69. 69. EMR Usage at Present…..• Area of practice has a moderately good association with familiarity of doctors with EMR.• Majority of physician (95.7%) agree with the statement that EMR will increase practice productivity, but on the other hand the majority (55.3%) disagree with the statement that EMR usage should be mandated.• Clinical functions of EMR diagnosis ,medication, clinical notes and reports were given higher rating. To Analyze The Scope And Acceptance Of Electronic Medical Records Among Doctors In India A Project Of Summer Training Fozia Afreen Institute Of Management Studies LAL QUAN, GHAZIABAD Batch: 2009-11
  70. 70. Why we are not changing?Barriers of EMR Adoption• Physicians resistance, Too much change involved• Lack of funding, No reasonable return on investment• Difficulty in evaluating EMRs• Lack of staff support, Lack of trained staff• Concern about amount of self-training needed• Data/chart conversion• EMRs do not meet needs• Lack of IT people to develop EMR• Security – System break downs, failures
  71. 71. EMR Usage at Present…..• Still very low as compared to other industries like financial institutions• Majority of the physicians (75.8%) are familiar with EMR function and benefits• Area of practice has a moderately good association• Majority (95.7%) agree that EMR will increase practice productivity• Majority (55.3%) disagree with the statement that EMR usage should be mandated. To Analyze The Scope And Acceptance Of Electronic Medical Records Among Doctors In India A Project Of Summer Training Fozia Afreen Institute Of Management Studies LAL QUAN, GHAZIABAD Batch: 2009-11
  72. 72. Doctors„ Use of EMR Systems in Hospitals: Cross Sectional Survey Hallvard Lærum-BMJ 2001;323:1344–8• Conclusions : Doctors used electronic medical records systems for far fewer tasks than the systems supported.
  73. 73. EHR and Quality of Diabetes Care Randall D. et all-NEJM 2011• From July 2009 through June 2010, data were reported for 27,207 adults with diabetes seen at 46 practices• After adjustment for covariates, achievement of composite standards for diabetes care was 35.1 percentage and composite standards for outcomes was 15.2 percentage points higher. EHR sites were associated with higher achievement on eight of nine component standards.• Across all insurance types, EHR sites were associated with significantly higher achievement of care and outcome standards and greater improvement in diabetes care.
  74. 74. Benefits of IT- Enabled Diabetes Mgt. DAVIS BU-Diabetes Care 30:1137–1142, 2007• All forms of IT-enabled disease management improved the health of patients with diabetes and reduced health care expenditures.• Over 10 years, diabetes registries saved $14.5 billion, computerized decision support saved $10.7 billion, payer- centered technologies saved $7.10 billion, remote monitoring saved $326 million, self-management saved $285 million and integrated provider-patient systems saved $16.9 billion.• IT-enabled diabetes management has the potential to improve care processes, delay diabetes complications, and save health care dollars.• These benefits must be weighed against the implementation costs.
  75. 75. The Impact of Planned Care and a Diabetes Electronic Management System on Community-Based Diabetes CareThe Mayo Health System Diabetes Translation Project• Planned care was associated with improvements in measurement of HbA1c, HDL cholesterol and microalbuminuria as well as the provision of tobacco advice• DEMS use was associated with improvements in all indicators, including microalbuminuria, retinal examination, foot examinations, and self-management support• Although planned care was associated with improvements in metabolic control, we observed no additional metabolic benefit when providers used DEMSVICTOR M. MONTORIDiabetes Care 25:1952–1957, 2002
  76. 76. Informatics Systems to Promote ImprovedCare for Chronic Illness: A Literature Review DAVID DORR-J Am Med Inform Assoc. 2007;14:156 –163• 109 articles were reviewed involving 112 information system descriptions. Chronic diseases targeted included diabetes (42.9% of reviewed articles), heart disease (36.6%), and mental illness (23.2%).• Studies assessed impact of informatics systems on process of care variables including guideline adherence, visit frequency, documentation, treatment adherence, referral rate, appropriate screening/testing, and cost; studies reported mostly positive and some neutral results.• The majority of published studies revealed a positive impact of specific health information technology components on chronic illness care. Implications for future research and system designs are discussed.
  77. 77. EMR and Diabetes Quality of Care: Results From a Sample of Family Medicine Practices Jesse C. Crosson Annals Of Family Medicine May/June 2007• Diabetes care quality in all practices showed room for improvement however, after adjustment, patient care in the 37 practices not using an EMR was more likely to meet guidelines for process (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.42-3.57) treatment (OR, 1.67; 95% CI, 1.07- 2.60), and intermediate outcomes (OR, 2.68; 95% CI, 1.49- 4.82) than in the 13 practices using an EMR• The use of an EMR in primary care practices is insufficient for insuring high-quality diabetes care.• Efforts to expand EMR use should focus not only on improving technology but also on developing methods for implementing and integrating this technology into practice reality.
  78. 78. Typical EHR Use in Primary Care Practices and the Quality of Diabetes Care Jesse C. Crosson Ann Fam Med 2012;10:221-227. doi:10.1370/afm.1370.• EHR use was not associated with better adherence to care guidelines or a more rapid improvement in adherence. In fact, patients in practices that did not use an EHR were more likely than those in practices that used an EHR to meet all of 3 intermediate outcomes targets for hemoglobin A1c, low density lipoprotein cholesterol, and blood pressure at the 2-year follow-up (odds ratio = 1.67; 95% CI, 1.12-2.51). Although the quality of care improved across all practices, rates of improvement did not differ between the 2 groups.• Consistent use of an EHR over 3 years does not ensure successful use for improving the quality of diabetes care. Ongoing efforts to encourage adoption and meaningful use of EHRs in primary care should focus on ensuring that use succeeds in improving care. These efforts will need to include provision of assistance to longer-term EHR users. NOT INCLUDED IN CHART
  79. 79. OPD- EHR-Based Diabetes CDS That Works: Lessons Learned From Implementing Diabetes Wizard JoAnn M. Sperl-Hillen - Diabetes Spectrum Volume 23, Number 3, 2010• EHR-based diabetes CDS can lead to measurable improvement in intermediate outcomes of diabetes care, with high PCP satisfaction and use beyond an initial period in which incentives were provided.• Carefully planned steps are required to maximize use of EHR- based CDS systems, including communication and collaboration with leadership and providers, tracking of utilization rates, and providing feedback and possibly financial compensation or other incentives for use.• Significant programming time is required to integrate CDS into existing EHR systems. Resources are also required for clinical experts to monitor and update clinical content and for programmers to implement updates when needed.
  80. 80. Impact of EHR Clinical Decision Support on Diabetes Care: A Randomized Trial Patrick J. O‟Connor ANNALS OF FAMILY MEDICINE JANUARY/FEBRUARY 2011• The intervention group diabetes patients had significantly better hemoglobin A1c (intervention effect –0.26%; 95% confidence interval, –0.06% to –0.47%; P = .01), and better maintenance of systolic blood pressure control (80.2% vs 75.1%, P = .03) and borderline better maintenance of diastolic blood pressure control (85.6% vs 81.7%, P = .07), but not improved LDL levels (P = .62) than patients of physicians randomized to the control arm of the study.• Among intervention group physicians, 94% were satisfied or very satisfied with the intervention• EHR-based diabetes clinical decision support significantly improved glucose control and some aspects of blood pressure control in adults with type 2 diabetes.
  81. 81. Advantages of EMR• EMR will not permit prescriptions or orders for drugs for which the patient has a known allergy.• The system will alert both provider and pharmacist of potentially harmful drug– drug interactions or incompatibilities with the patient‟s physical or laboratory findings.
  82. 82. Advantages of EMR• EMR systems automatically generate patient educational materials tailored to the patient‟s diagnosis and treatment.• In professional liability suits against health care providers the medical record is “The witness that never dies.” A well documented, complete, and unambiguous medical record means a case that is infinitely easier to defend.
  83. 83. Advantages of EMR• From a legal standpoint, an electronic record system will produce a legible record.• The problems of wrong medication, wrong dose, wrong directions, and wrong procedure caused by illegible and misinterpreted records will be eliminated.• EMRs can be used as a tool for Medical Education.
  84. 84. Advantages of EMRSource: Partners Health Care experience based on 2500 patients and providers. “Cost andBenefit Analysis for electronic medical records in primary care.” The American Journal ofMedicine 2003;114:397-403
  85. 85. Advantages of EMR• Properly planned medical record system can incorporate practice guidelines that are automatically triggered by a diagnosis or symptom syndrome.• Adherence to practice guidelines has been an effective defense in many malpractice actions.• Guidelines have also been championed as the most effective method of eliminating unnecessary and costly defensive medicine practices.
  86. 86. Hurdles in changing • Lack of user training. • Poor initial design of software • Systems difficult to use or complex • Dependence on one individual „champion‟. • Lack of involvement of local staff in design and testing. • Lack of perceived benefit. • Lack of back-up systems in the event of computer loss. • Poor system security leading to viruses and spyware. • Unstable power supplies and lack of battery back-up. • Lack of regular technical supportElectronic Medical Records: A Review Comparing the Challenges in Developed and Developing CountriesSanjay P. Sood- Proceedings of the 41st Hawaii International Conference on System Sciences - 2008
  87. 87. Who is entering data?
  88. 88. Advantages of EMR• EMR system can track ordered laboratory, diagnostic, or imaging tests, alert the provider of abnormal tests, and even notify the patient needed• EMR automatically confirm the date and times of all entries and keep a dated and timed log of all individuals who have accessed the record providing protection against fraud and abuse.
  89. 89. Use of a Large Diabetes EMR System in India: Clinical and Research Applications V.Mohan Journal of Diabetes Science and Technology May 2011• Patients with T2DM had higher prevalence rates of neuropathy (33.1% vs 13.0%), microalbuminuria (25.5% vs 20.0%,),coronary artery disease (17.5% vs 9.2%,) and peripheral vascular disease (3.9% vs 2.8%) compared with T1DM patients, while prevalence of diabetic retinopathy was similar (37.9% vs 35.7%).• .• The DEMR helps track diabetes care and is a valuable tool for research.