The popularity of electronic health records (EHRs) has reached a pinnacle. EHRs are a topic of national debate, presidential candidates’ platforms, and editorials in major newspapers. Trade show agendas, once dedicated solely to clinical, advocacy, and leadership topics, are seeking to educate addiction treatment providers on the need for, and challenges and benefits of, the EHR. Yet the topic of technology to many in the helping professions is daunting enough without the added complexity of many of the latest topics, such as regional health information organizations (RHIOs), interoperability, and national data standards. Many addiction treatment providers are seriously wondering what the simple rewards for this major capital purchase are.
The successful implementation of an EHR allows a provider to operate on a new plateau. New-found efficiency includes reduction of documentation time, immediate access to patient data, improved cash flow, streamlined clinical work flow, increased reimbursement, and detailed real-time aggregate reporting. Inpatient facilities experience automated medication ordering and administration that drastically improve safety processes. Believe it or not, despite all the techno-garble, EHRs truly enhance quality of care and ultimately reduce the cost of care delivery. Let's review some basic returns of a move from paper to electronic.
A Harvard Medical publication stated, “Such a structure [paper] is inherently costly to administer—the share of US expenditures devoted to administration is variously estimated at one-fourth to one-fifth of the health dollar.”1 Paper charts complicate data collection and require standard data to be collected at each point of the client's service. The preadmission and intake processes often have to be repeated, meaning clients are asked time-consuming questions again and again; this leads to client frustration.
Yet an EHR allows organizations to collect data only once. The impact of this on a once paper-based system is profound. A well-designed, EHR-based clinical work flow moves a patient through the preadmission, intake, treatment, and discharge processes without requiring data entry to be repeated. A major service of addiction treatment providers is group therapy. EHRs allow entry of group notes in a process that populates all group attendee notes with required documentation. Clinicians no longer are forced to hunt for all attendee charts or to open each chart to make the note.
Not only do EHRs allow data to be collected only once, the data are available everywhere. With paper records, the client's ID and name have to be entered on each form, a tedious task eliminated by EHRs, which can place such information wherever and whenever desired. When this simple yet often overlooked benefit is applied to the area of medication, all clinicians are immediately made aware that a patient medication has been received/not received. The availability of data has a major impact on staff communication, but it is when that data is critical that we experience the true impact of immediate availability.
Another basic benefit of EHRs is related to the storage and maintenance of charts. A client record is the only source of a patient's data an organization has to use as a tool in service delivery, yet in paper-based systems often the chart is not available when needed. In organizations with multiple sites, using paper-based charts as a real-time reference often is difficult or impossible. Staff members have to shuttle paper charts between buildings in an attempt to follow the point of service, but they often are far behind, meaning charts are not available to clinicians. Having only limited access to key data increases the risk of error and exposes organizations to potential privacy/security breaches.
Maintaining paper-based records is a drain on productivity and a financial drain. Paper records are estimated to cost approximately $8 annually per record to maintain. Storage areas need to be maintained according to state, federal, and accreditation requirements. Storage policies typically require tracking, audit trails, and supervision, all of which are costly to organizations, add further human intervention, and increase expenditures in most instances. In comparison, electronically storing data is extremely cheap and compact. For example, a single computer CD can store in the region of 600 MB, equivalent to some 100,000 pages of text or about 200 large textbooks that would need more than 64 feet of shelf space.
HIPAA compliance requires organizations to adhere to not only technical security policies, but also administrative policies difficult to abide by with paper charts. An EHR is easily copied and stored off-site with minimal inconvenience to the organization; this allows for effective and sound disaster recovery policies mandated by HIPAA. No disaster recovery plan can retrieve destroyed paper records: The record itself likely is the only copy that exists, as duplication of paper records is extremely costly and counterproductive to a streamlined work flow (i.e., as streamlined as a paper-based system can be).
Aside from the revolutionary way EHRs can change administrative practices, an automated chart offers a better quality tool for professional documentation. Once patient data are entered in an EHR, the documentation is available to all clinicians connected to the central database, while a paper chart is viewable by only one staff member at a time. An EHR eliminates the possibilities of losing the chart, missing data, and illegible entries. The data screens are structured templates that provide legible, easily attainable, and directed data.