Improving Hospital Efficiency Through Electronic Medical Records

Introduction: Healthcare Change and Hospital Challenges

Healthcare continues to undergo fundamental change. Legislation such as the Affordable Care Act has created a much higher percentage of insured citizens. Patent legislation is now allowing for much greater competition for popular drugs. Generic drugs in particular, which are cheaper for consumers and more profitable for producers, are eroding the market share of brand-name products. Even the adoption of cloud computing is changing the way care is administered within facilities.

Despite these innovations, healthcare facilities still struggle with bloated cost structures, inefficient workflows, and chronic staffing shortages. The university hospital examined in this paper is no different. It faces a large influx of patients alongside an inability to provide timely care. The following sections describe these issues in detail and identify practical, real-world solutions.

Current Process and Areas That Slow It Down

The current process is inadequate primarily due to staffing-related issues. Only 65% of patients are actually seen during their scheduled appointment time. Of those who are seen, many have waited nearly four hours simply to meet with a physician. This congestion is worsened by a lack of clear guidelines governing when an examination is even necessary.

A major source of delay is redundant information gathering. In many instances, patients must repeat the same process multiple times within a single visit. Paperwork and questionnaires are completed more than once, even though they ask identical questions. This duplication wastes both patient and staff time without adding clinical value.

The overall staff is also overloaded with patients. The hospital is world-renowned for its quality of care and medical expertise, and many patients are willing to travel long distances to access this high level of service. Unfortunately, staffing and the physical facility are not adequately keeping pace with the influx of patients. Currently, 34,000 surgeries are performed each year, yet the hospital has only 52 operating rooms. Coordination among all stakeholders is therefore very difficult, owing primarily to time constraints, inefficient systems, and a lack of available space. Incomplete or missing pre-operative work-ups frequently delay the start of surgery, which in turn forces other patients to wait. This bottleneck—compounded by the fact that all 52 rooms are in constant use—contributes to roughly 57,000 minutes of lost productivity per year.

The charge nurse role also slows the process. The charge nurse manually tracks patients and assigns them on a first-come, first-served basis. Because inputs are recorded manually rather than electronically, errors occur: the charge nurse may simply forget to assign a patient, causing two providers to work with the same individual and creating further inefficiencies. The system also relies heavily on providers notifying the nurse when they are available to see a patient. Without reliable communication, providers may move on to other tasks, deliberately delay notifying the charge nurse, or simply forget to do so.

Evaluating Proposed Solutions

Many of the proposed solutions are sound. In particular, the adoption of electronic medical records (EMR/EHR) would have the largest impact on revenue, customer service, and operational efficiency (Roukema et al., 2006). Although the initial start-up, training, and implementation costs are high, an electronic medical records system would eliminate many of the root causes of inefficiency within the facility. Electronic records and data transfers would allow patients to complete required paperwork at home before arriving. Registered nurses could then review this information prior to the patient's arrival. Currently, an RN spends 27 minutes reviewing past medical history and an additional 11 minutes conducting assessments and explaining procedures. The average patient spends nearly two hours in the facility. If an RN can review medical records in advance, approximately 25% of each patient's wait time could be eliminated.

The electronic system is the strongest solution because its benefits extend across the entire facility rather than addressing only one particular aspect of care. Other solutions—such as expanding the facility or extending operating hours—are viable but less impactful. With facility expansion, ongoing population growth and the approaching retirement of the baby-boom generation will demand continuous, incremental additions to capacity. Although expansion will at some point be warranted, it does not address the fundamental problem of inefficient activity. Of all the options evaluated, electronic medical records address the root of the problem with a straightforward and effective intervention.

Conclusion

The solutions presented above are primarily technology-driven. The hospital should leverage technology extensively to make its operations more efficient. As the case analysis demonstrates, simply expanding operations or hiring more personnel is not a sufficient answer. Instead, the facility must become smarter about how it uses its time and resources.

The elimination of the manual charge nurse assignment process, the establishment of clear guidelines for when a patient examination is required, the adoption of electronic health records, and the requirement that patients pre-complete necessary documents all work together to reduce operational waste. These changes will ultimately lower costs, improve customer service, and strengthen workforce morale—positioning the hospital to handle current patient volumes and future growth more effectively.

References

Roukema, J., Los, R. K., Bleeker, S. E., Van Ginneken, A. M., Van Der Lei, J., & Moll, H. A. (2006). Paper vs. computer: Feasibility of an electronic medical record in general pediatrics. Pediatrics, 117(1), 15–21.