Health Information Technology

Our EMR! Could This Be a Disaster? As the chief information officer (CIO) of Pacific NW, a large health system in the Pacific Northwest, you understand that Medicare has mandated that all practices pursuing Medicare compensation are required to use electronic medical records (EMR). Incentives have been set by Medicare for medical practices to place EMRs in their offices in order to provide financial rewards to those medical practices achieving specific outcomes. These EMR systems allow for communication between practitioners and other healthcare entities so that medical information may be quickly and efficiently transferred between those entities in order to provide more efficient care to patients. The EMR enables physicians to access records from other providers related to their own patients. Eventually, EMRs will be easily accessed so that any physician or hospital will be able to obtain complete medical information on a patient. All hospital-owned physician practices at Pacific NW have been mandated to use the United Medical Record System (UMRS). The UMRS was initially designed by a central committee. As part of the Medicare incentives program, Medicare will reimburse each practice when they meet specific goals. This constitutes meaningful use. Meaningful use is defined by the US Department of Health and Human Services as the implementation of EMR technology for: • improving quality, safety, efficiency and reducing health disparities • engaging patients and family • improving care coordination for population and public health • maintaining privacy and security of individual patient health information One of the hospitals in the Pacific NW system has several primary care and specialty practices. However, the UMRS system was designed primarily for primary care practices, not specialty services.

The committee that developed the system did not take into account what specialty services might utilize, which is significantly different than other delivery models like primary care practices. Several medical specialists have brought to your attention that the UMRS system is cumbersome and extremely difficult to use. The system does not give the specialists the information they need when taking care of their patients. In fact, it takes them approximately 10 to 15 minutes longer per patient visit to access the information. Since an average day for these specialists include seeing between 20 and 25 patients, the addition of 10 to 15 minutes per patient adds as much as 3 to 4 hours each day. In other words, this delay represents a 30% decrease in productivity, which results in the inability to meet Medicare-defined productivity measures. For more information visit,

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To summarize, the requirement to use the UMRS system has  affected the efficiency and productivity of the specialists and has decreased revenue at Pacific NW. All of the physicians in the primary care practices and specialty practices complain that the UMRS system does not talk to other EMR systems or even the hospital’s own patient information system. The UMRS system as a whole is not integrated with medical databases as initially planned because it was so tailored to meeting primary care practice outcomes. These issues and concerns have been reported to the central committee that developed the UMRS system in response to Medicare mandates and financial incentives. The central committee reported that it could not make the system friendlier to the primary care practices or specially services despite the fact that procedures performed by the specialty services accounted for substantial revenue for Pacific NW. Revenue is down and the morale of the specialists has declined so much that many are talking about leaving the system or retiring early. Regardless, the central committee has refused to address or fix any of the problems with the UMRS system. As the CIO for Pacific NW, you are tasked with finding a solution to the issues surrounding the UMRS. What are you going to do?




What are the three main issues presented in this scenario?

Who are the main players here?

What is the impact on these constituents as well as to Pacific NW?

What are the advantages and pitfalls for the implementation and utilization of an EMR?


Should all systems be required to utilize a unified EMR?

What role should physicians and other providers have in the development or selection of an EMR for their practice?

As the CIO for Pacific NW, how are you going to address the concerns of your provider staff? What recommendations will you make to address the issues brought forth by the specialty services? Explain your rationale.

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