Electronic medical records: A necessity, or costly nightmare? Providers weigh in

You don't have an electronic medical record (EMR) system implemented yet, and now there's talk of patients bringing you their personal electronic health records. Should you scramble to implement an EMR system, or continue to wait it out?

On the hospital side, larger facilities are more likely to have implemented EMRs than smaller ones. In one survey by the American Hospital Association, 23% of respondents with 500 beds or more had a fully implemented EMR; only 3% of hospitals with fewer than 50 beds had done so.1

According to a survey of ambulatory surgery centers completed last spring,2 most ambulatory surgery centers (ASCs) are opting to wait. The survey by Wolters Kluwer Health, Conshohocken, PA, showed that 82% of ASCs don't use an EMR. ProVation Medical, which is part of Wolters Kluwer Health, provides electronic provider documentation systems.

Melodee Moncrief, BSN, RN, CASC, administrator of Big Creek Surgery Center, in Middleburg Heights, OH, said, "We need to get ahead of that game and gain the advantage over our competition in the ASC. We really need to put the EMRs in." Moncrief spoke on this topic at this year's annual meeting of the ASC Association.

In referring to the Wolters Kluwer Health research, Kenny Bozorgi, MD, CASC, chief operating officer at Magna Health Systems in Chicago, said, "Interesting, in that study, the question was asked of leaders in surgery centers: 'What are your concerns?' About 49% said they were concerned about inefficiency and loss of revenue [during the EMR implementation process]," Bozorgi said. The ASC managers also were concerned about lack of assistance and trained personnel in implementing the EMR and the lack of interface with existing systems. They also were concerned about whether the EMRs are geared to the outpatient surgical setting. Those concerns are valid and point to reasons ASC managers should closely examine the switch to EMRs to determine if it is right for their ASC, said Bozorgi, who is a candidate for a master's degree in medical information from Northwestern University in Evanston, IL.

The issues that EMRs can address are efficiency and patient care, said Mary Griskewicz, MS, FHIMSS, senior director of ambulatory information systems, Healthcare Information and Management Systems Society (HIMSS). "The use of an EMR system can assist the center with several processes, improver workflow for scheduling, case documentation, [and] sharing of clinical information such as lab results," she said.

Need another reason? The federal government has called for health care facilities to have EMRs available by 2014. "I think the implication for surgery centers is similar to implications for other broad-scope health care changes," Bozorgi said. "ASCs will have to follow suit."

New federal legislation has been introduced that would require the government to create standards for an interoperative health information technology system. The Health-e Information Technology Act of 2008 (HR 6898) was introduced by Rep. Pete Stark. It would offer financial incentives through Medicare to providers that adopt and use electronic medical records systems that meet the standards.

However, not everyone is urging immediate adoption. Bozorgi said, "In the best of all possible worlds, EMRs would allow for safer, more effective, more efficient, more patient-centered care." However, the verdict still is out about whether EMRs help ASCs and other health care facilities achieve those goals, he maintains. "The final definitive studies of the benefits of EMRs are not conclusive yet," he said.

While providers still debate the need for EMRs, interest is growing, Moncrief said. One distinct advantage is reduction in paper costs, she said. Those costs include storage, copying, faxing, and lost or missing files, "That all creates staff time," Moncrief added.

From its opening day in 2006, Moncrief's center used an EMR manufactured by Amkai in Waterbury, CT (www.amkai.com).

"Our paper cost averages $3.66 per case, and that's including our support and hardware, annually, which is a great savings for us," she said.

At her center, 90% of cases (all except pain cases) are handled with an EMR. The only other piece of paper is the consent form. EMRs offer a competitive advantage in hiring, because staff from other facilities can become accustomed to being paperless and unwilling to go back, Moncrief explained. "Staff satisfaction creates retention," she said.

Moncrief pointed to surgery center staff who work PRN in other facilities that use paper documentation but return to centers that have EMRs. "They say, 'I don't want to even work there anymore. It's all paper. I'm not used to that. It takes too long to do the charting,'" she said.

Quality improvement is easier, she said. "Chart reviews and peer reviews are made very simple by having an EMR."

Also, EMRs can reduce liability because the system doesn't allow "pre-charting." Also, it provides an audit trail and can offer failsafes for medication administration, Moncrief said. "It works nice if you're giving them [ketorolac trometamol] and they're already on the aspirin," she said. "A big, blinking light comes up and says, 'no. no. no.'"

The future is changing, "and we need to keep our ASCs ahead of the game," Moncrief said. Take the time to research and implement an EMR, she advised. "Stay focused, and try to move ahead."


  1. American Hospital Association. Continued Progress: Hospital Use of Information Technology. Chicago: American Hospital Association; 2007. Accessed at www.aha.org/aha/content.
  2. Provation Medical Ambulatory Surgery Center Administrators — Report of Research Findings. Edwardsville, IL: Renaissance Research; 2008.