Acute Care EMR (Global)
Electronic medical record (EMR) software products used outside the US that provide core inpatient functionality, including a clinical data repository, order entry, results reporting, and/or clinician charting and documentation.
Subject Expert
Everton Santos
Research Director
Recent Insights
Improving Patient Care Often the Core Driver of EMR Implementations
Improved patient care is the main overarching clinical goal of an EMR implementation for most organizations. Almost all surveyed said they achieved this, at least in part. Care improvement is realized through a variety of avenues. Organizations most often cite consolidation of the medical record (which creates a smoother, more transparent patient journey) and reduced medication errors—e.g., through decision support and electronic medication administration tools. Other vehicles of care improvement include alerts and triggers for potential adverse events, the ability to do virtual visits, use of predictive models for patient care, and real-time data that gives clinicians a better view of the patient journey. 21%-40% of respondents feel the degree of care improvement has fallen below their expectations due to slower-than-expected enterprise adoption of the EMR.
Detailed insights
Improved patient care
Achieved to some degree by almost all respondents. Improvement driven by transparency in patient journey, tools for CDS and electronic medication administration that reduce errors, and alerts/triggers in the EMR. Slower adoption of the EMR can delay full realization of care improvements.
Consolidated medical record
Most organizations able to bring together patient records into single source of truth. Creates greater visibility into patient history/care journey and higher patient and clinician satisfaction. Degree of outcome depends on adoption across departments; enterprise buy-in yields best results.
Reduced medication errors
Includes both improved legibility for prescriptions and technological benefits. Order sets, alerts, CDS, and barcoded medication administration help catch issues of high doses, allergies, and other errors. May be difficult to measure due to lack of pre-implementation benchmarks at some organizations.
Use of clinical decision support (CDS)
Closely tied to reduced medication errors. Often set up later in EMR implementation journey. More digitally mature organizations often achieve this benefit, including a related drop in medication errors. About half of respondents have not achieved this as expected, citing the longer-than-expected process to develop databases and set up needed rules and triggers.
Reduced sepsis/other HAIs
Multiple organizations report ability to identify sepsis faster because of EMR alerts and triggers. Organizations also see improved visibility into and measurability of HAI rates, which can be difficult to compare to pre-implementation rates. Often varies by vendor depending on strength of sepsis tools.
Increased time with patients
Organizations have mixed opinions of EMR’s effect on patient/clinician care time. Improvement is greater when staff sees efficiency gains (see below for more on operational/financial benefits)—when users are up to speed with the EMR, templated documentation and faster access to records lead to improved clinician efficiency and, for some, more time with patients. Outcome is highly dependent on the individual organization, depending on how efficiency gains are used (i.e., more time with patients versus increasing patient load). For some, electronic charting takes similar time as paper charting, especially in early stages, leading to nonexistent or lower-than-expected gains in clinician time with patients.
Staff Efficiency and Other Operational Benefits Frequently Achieved, though More Often Fall Below Expectations
Healthcare organizations also expect significant financial and operational benefits from their EMR, and these are often the types of benefits tied to the business case for implementing an EMR. Increased staff efficiency is the biggest overarching operational outcome that interviewed organizations expect. 61%–80% achieved this outcome to some degree, particularly when staff members were up to speed with the EMR. These organizations describe templated clinician documentation, less duplicate documentation, faster intradepartmental communication about orders and results, and automated alerts and notices (which prevent clinicians from having to chase reports). However, just over 60% of surveyed organizations have not achieved the level of efficiency gains they expected. Some say gains were bigger for clinicians than IT personnel; naturally, implementing an EMR increased the IT load, specifically infrastructure management and IT support. Other organizations say EMR documentation still takes a good deal of time, and the number of clicks detracts from expected efficiency gains. Notably, most organizations can only estimate effect on efficiency, which is difficult to concretely measure.
Detailed insights
Increased staff efficiency
Benefit is enhanced by clinician documentation templates, less duplication, electronic communication tools, and alerts. Often the level of improvement falls below expectations; EMR documentation increases IT load, and it can take time for clinicians to get up to speed on EMR processes. Difficult to measure efficiency gains in a concrete way.
Reduced paper usage
Very often achieved by respondents, especially those live 5+ years. Most take a phased approach, beginning in specific sites and departments, with the end goal of going fully paperless. Time required to convert historical paper documents and specialized forms.
Improved billing operations
Top of mind especially in regions with private healthcare organizations (e.g., Australia and the Middle East). Supported by integration between clinical and financial systems and standardized documentation; results in more accurate charge capture at point of care and improved billing workflows. Implementing RCM software along with EMR (a major organizational lift) makes improved billing more likely, though many don’t and consequently feel this outcome falls below their expectations.
Reduced duplicate documentation
EMR enables information to be collected once and used multiple times, reducing need for duplication at multiple steps in the patient journey. Less measurable due to lack of pre-implementation baseline data. Highly dependent on how well EMR is adopted across the enterprise.
Fewer unnecessary orders
Benefit is driven by increased visibility into patient history and journey, along with tools like alerts, triggers, and CDS. Difficult to measure. Lagging adoption results in lower-than-expected degree of improvement for more than half of respondents. Also affected by lack of information exchange with outside organizations and clinician skepticism around alerts or alert fatigue.
Regulatory requirements met
Not usually a primary driver—the exception being where regulations mandate electronic record use. EMR as single source of truth supports improved reporting. Some mentioned the need to audit data for accuracy or work with their vendor to make the EMR fit their regulatory needs.
Fewer internal integrations and vendors/contracts
Achieved at least in part by all interviewed organizations. Many are able to reduce legacy systems (by up to 60%) and consolidate to fewer vendors and contracts (by up to 25%). Requires time and organizational buy-in to set up needed integrations and retire legacy systems.
Increased patient volume/throughput
Organizations split on whether EMR can increase patient volume. Use of virtual care is the most tangible benefit around patient volume (especially noticeable during the COVID-19 pandemic). Some feel the EMR helps organize patient flow. Expected increase in patient volume hindered in some cases by less-than-expected staff efficiency gains or by the decision to put efficiency gains toward more clinician/patient time or a more balanced clinician load.
What Can Organizations Do to Achieve More Benefits from an EMR Implementation?
Have a strong plan and vision in place before beginning the implementation
46% of interviewed organizations feel their success was driven mostly by their organization, and 43% say it was achieved in even partnership with their EMR vendor. Across both of these groups, organizations agree they needed to come to the table with a clear understanding of their own needs, unique workflows, and goals and objectives to guide the implementation. They likewise agree the level of benefits achieved is highly dependent on the organization’s change management and EMR adoption. Also, organizations recommend ensuring sufficient training is provided (including from the vendor) and that the EMR is personalized by end users to meet their needs.
Work closely with your vendor partner
Organizations that feel benefits were equally driven by the organization and the vendor were more likely to report clinical and financial/operational benefits, compared to those whose success was primarily organization-driven. One organization described the necessary partnership as one where the healthcare organization can bring ideas to the vendor, and the vendor provides guidance and suggestions on what to do and how to do it. It’s important to select a vendor partner who will work with the organization to understand their specific needs and workflows and implement the EMR accordingly. Some vendors can be more proactive about this type of partnership than others.
“Our EMR vendor is a really positive and proactive partner. They provide capabilities and technology, and then it is up to us to apply that technical solution to our organizational process, business processes, and the work that our staff needs to undertake. We need to own the problem in order to deliver the benefit. Not every organization is the same, although there are many similarities. . . . The problem has to be owned and driven by our needs and objectives.” —CIO
“For the first six months, the benefits were mostly driven by the organization. But our EMR vendor was supportive of the process. They were there for us and helped us understand how we could succeed. And then, over time, as we identified new benefits, we drove those benefits. Our EMR vendor provides recommendations, but we focus internally on our digital health plans and our metrics for success. . . . They are part of the conversation, but we are definitely driving the benefits.” —IT director
Learn More about IT Implementation Success
Additional best practices are detailed in KLAS’ recent white paper on how HIT vendors and customers can lay a foundation for success with their IT implementation. This study is part of KLAS’ new Landmark Insights initiative—aimed at helping health systems currently implementing an HIT solution determine whether their project is on track for success.
How Quickly Can Organizations Expect to See Outcomes?
Organizations live for 5+ years more often report benefits have been realized, though the time frame is frequently longer than expected. However, they ultimately realized most benefits to the degree they expected. Across the board, organizations expect different EMR benefits to come at different speeds. Some come immediately after implementation, but others require time for adoption to deepen, databases to grow and mature, and care processes to become more standardized. The organization’s preparation and change management efforts also impact the speed of benefits. Despite the inevitable time required for staff to learn the EMR, buy-in to the change before implementation can speed up adoption.
more benefits were reported by organizations live with their EMR for 5+ years versus those live for <5 years.
Realized almost immediately
- Improved legibility
- Improved chart management (and related time savings)
- Reduced medication errors (through barcode medication administration)
- Time savings for technicians no longer entering orders (with implementation of CPOE)
- Improved information transfer and visibility
Realized more gradually with adoption and EMR mastery
(most beginning within the first year)
- Reduced paper usage
- Standardization of documentation practices
- Improved insights into patient history/journey
- Increased clinician efficiency
- Reduced duplicate documentation
- Improved billing operations
Realized in the long term
- Use of clinical decision support
- Data-driven initiatives (health analytics)
“For some of our KPIs, like CPOE, we expected to realize benefits immediately. We had a strong plan that we were going to go all in, adopt the technology quickly, and do our best. We did our initial benefits-realization report at six months. That was our first formal report to review how we were tracking, and we continue to maintain and review those key operational metrics to this day. The metrics have augmented over time, and we have KPI dashboards so that we can look at those things. . . . That data gave us the ability to create work plans as we progressed so that we could get on track for meeting our targets.” —IT director, live 3–4 years
What Unexpected EMR Costs Should Organizations Prepare For?
of 28 responding organizations reported unexpected costs from implementing an EMR. These costs came in the following forms:
Resources:
A number of organizations needed to add IT staff, administrators, and consultants beyond their original plans. Some who expected to decrease administrative staff instead had to repurpose them to manage workflows and data quality. A few felt their vendor did not accurately estimate the staffing organizations would require for the revenue cycle side.
Infrastructure/hardware:
Some organizations had to upgrade existing infrastructure for additional storage, upgrade computers to support a web-based EMR, and purchase additional hardware to take advantage of EMR functionality.
Ongoing maintenance:
Some were surprised by costs related to keeping their EMR up to date through upgrades and adopting additional modules.
Integration:
Some organizations needed additional integration outside their initial scope, and some had to build workarounds to integrate their EMR with legacy systems.
Other costs:
Other costs mentioned include higher costs for the EMR vendor’s hosting services due to insufficient risk management, along with implicit costs like underdelivered vendor services and less time spent with patients after the EMR implementation.
About This Report
Data for this white paper was collected through interviews with leaders at 36 healthcare organizations outside the US. Respondents were asked to report the clinical and financial/operational benefits they expected from their EMR implementation, whether those benefits were realized as expected, how long benefits took to be realized, and any unexpected costs they encountered during their EMR implementation.
Respondents span world regions and EMR vendors and represent healthcare organizations at various points in their EMR journey—from newly implemented to live for 10+ years. Organizations in the US were excluded from this report. The tables below summarize respondent demographics.
A Note about Terminology
Though the nomenclature used to describe the core patient record used throughout a hospital varies from region to region or language to language (e.g., EHR, EPR, EMR, EPD, EPJ, DPI, KIS, HCE, PEP, etc.), the term that will be used in this research is EMR (electronic medical record).
The EMR is the core record used by hospitals for day-to-day clinical tasks, such as clinical noting and documentation, ordering, results reporting, and ePrescribing. Some systems in this research may not include all of these clinical functions, but they are all viewed by their users as their core patient record. Solutions used solely for document management or scanning are excluded from this research even though they are the primary clinical system in use at some hospitals.
Additionally, the term “vendor” is used throughout this report to refer to the company supplying the EMR technology. KLAS recognizes that different countries may have different terminology, including “supplier.”
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Performance Data
Overall Score by Product
Products Appearing in Decisions
Overall Score by Question Topic
Provider Facility Size by Product
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Reducing Filters
Unlike sizing filters, reducing filters DO NOT recalculate scores based on the evaluations that meet these requirements. They narrow the list of solutions to show the vendors and solutions that can meet a specific need.
This data is based on interviews with a sample of the firms' recent clients. As a result, it is not necessarily comprehensive of all work a firm may do in this segment.
We require a minimum of 2 confirmations of a service performed in the last 3 years for a solution to qualify.