Michael M. Awad, MD, PhD Washington University in St. Louis March 26, 2011

 The ratio of the output to the input of any system  The extent to which time is well used for the intended task Task Completion Time

During the 1990s, many industries invested heavily in IT:  telecommunications  securities trading  retail and general merchandising

 IT resulted in advancements in: Bar-coded retail checkouts ATM machines Consumer reservation systems Online shopping and brokerages IT thought to contribute to 6-8% annual growth

 Accessing Data ◦ Reading history ◦ Reviewing orders/medications ◦ Examination of radiographs  Inputting Data ◦ Admission orders ◦ Inpatient orders ◦ Discharge orders

 Can retrieve charts at any time  Fewer lost charts  Multiple individuals can refer to charts simultaneously  Remote chart access  Most up-to-date data retrieval (labs, pathology, radiology results)  QA / Research

 Speeds input of multiple orders (order sets)  Reduces clarification calls from Pharmacy  Faster transmission of orders to point-of- service (radiology, pharmacy, etc)  Reduces time to sift through chart and interpret handwritten notes  Signing notes from afar

Task Completion Time Money=

 RAND Health Information Technology (HIT) Project 2003  Estimated potential savings and costs of widespread adoption of EMRs

 increased exchange and flow of information  compliance with the regulations  ability to integrate graphic data such as electrocardiograms, alarms and warning systems, etc.  data quality  data presentation  data availability  ease of production of data  reporting  data handling  access to reference materials  Legibility  patient satisfaction  productivity of the doctor  reductions in incorrect medication and data input errors  quality assurance  training

Did not include savings for:  Transcription  Malpractice  Research and public health savings

1.5% 4%

But…

Upfront  Proper training required (Cedar Sinai, LA)  May have initial loss of efficiency (up to 15%-20% for 3 months)  Implementation costs

“Dumbing Down” Effect  “EMR Plagiarism” ◦ Cut and paste for trainees ◦ Lack of updates ◦ Perpetuation of erroneous information  (In)attention to abnormal values  Excessive notifications – quick dismissal  Templatized notes

Templatized Note

Other:  Privacy ◦ Very easy to reproduce/transmit sensitive data ◦ More pronounced with mobile devices  Research too easy to do ◦ quick QA research  quick conclusions  Hard to quantify: ◦ reduction in medical errors ◦ improvements in disease prevention and chronic disease management

Task Completion Time Quality

 Integration across disparate EMR systems  Clinical-decision making tools  Growth of mobile platforms THANK YOU