Electronic Health Records' Benefits for Addiction Treatment
Connors, William R., Addiction Professional
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 cosdy 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 shutde 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.
EHRs also mitigate die risk of required or essential data being missing or buried within progress notes. EHRs require clinicians to collect important data elements prior to closing a document. This automated function allows for increased charting supervision without further human intervention, ensuring data will be complete and available when needed. The data can be used in standardized instruments to provide measurable outcomes. Even if they have some initial grumbling, clinicians ultimately will view the EHR as a tool for their services, rather than as an obstacle.
One of the most valuable tools delivered to inpatient addiction treatment providers via an EHR is computerized physician order entry (CPOE) and medication administration record (MAR). The Institute of Medicine publications To Err Is Human, Crossing the Quality Chasm and Improving the Quality of Health Care for Mental and Substance Use Conditions all include extensive findings that use of technology for medication management practices such as CPOE and MAR will drastically reduce medication errors and subsequent fatalities. Through an EHR, physicians are proactively offered immediate access to patient medication profiles, allergies, and adverse drug reactions prior to creating an order. The order is then immediately available in the patient's chart to be noted by the appropriate person-no routing of paper or delay. Nursing staff receive verified orders via the MAR without shuffling through paper records.
In addition, automation of these facets of addiction treatment eliminates transcription-orders go directly in their exact format to the appropriate persons. Shift changes no longer mandate review of all medications for transcription errors, and other onetime checks are mitigated or eliminated with electronic quality alerts and data validations.
Substance abuse organizations are well on their way to understanding the necessity of EHRs. However, necessity does not always bring adoption. It is in the realization that EHRs will offer a qualitative improvement to the delivery of care that endusers will open themselves to change. Change related to cost and outside pressures is not new to our industries; therefore, we need to address this change from a quality improvement or performance improvement paradigm. While EHRs continue to be discussed and defined, remember their simple yet profound impact on patient care-after all, that is what they should be about.
1. Cushman FR, Detmer DE. Information policy for die U.S. health sector: Engineering, political economy, and ediics. Report for the Milbank Memorial Fund. May 1997. www.med.harvard.edu/publications/Milbank/art/.
by William R. Connors, MSW
William R. Connors, MSW, is President/CEO of Sequest Technologies, Inc. He has extensive experience in operations and clinical services, as well as informational technology experience in several industries, including behavioral health services. His e-mail address is email@example.com.…
Questia, a part of Gale, Cengage Learning. www.questia.com
Publication information: Article title: Electronic Health Records' Benefits for Addiction Treatment. Contributors: Connors, William R. - Author. Magazine title: Addiction Professional. Volume: 6. Issue: 1 Publication date: January/February 2008. Page number: 42+. © 2008 Vendome Group LLC. Provided by ProQuest LLC. All Rights Reserved.
This material is protected by copyright and, with the exception of fair use, may not be further copied, distributed or transmitted in any form or by any means.