Aug
5
2014

A study published in the Aug. 1 edition of the Journal of the American Veterinary Medical Association (JAVMA) looked at a small sampling of veterinary hospitals' use of electronic veterinary medical record (EVMR) systems. Despite the small sample size, the researchers came away with some big ideas about how the veterinary profession can better use EVMRs to improve animal health care.

In the study, researchers surveyed 84 independent small animal veterinary practices in Massachusetts to learn about how these practices are using EVMRs, and discover perceived barriers to using EVMRs.

They found that of the 82 practices that reported the type of medical record system they use, 17.1 percent used EVMRs only, 19.5 percent used paper records only, and 63.4 percent used a combination of both systems. Of those, large and medium-sized practices were significantly more likely to use EVMRs combined with paper records than were small practices, researchers reported. But when it came to only using EVMRs, small practices were similarly likely to do that compared to medium and large practices.

Among the practices that only use paper records, researchers found many perceived barriers to adoption and use of electronic records. These included anticipated technological problems, reluctance to change, time constraints, and cost. 

EVMR users missing key opportunities to improve health care

According to the study, more than half of surveyed practices that used EVMRs only or in combination with paper records reported using them for business activities such as scheduling, automating client reminders, recording medical and surgical information, ensuring billing, automatic billing, providing cost estimates, reviewing veterinarian performance, and marketing. 

Fewer than half of respondents using combined systems or EVMRs only reported using EVMRs for care credit, identifying EIDs, insurance, and research purposes. Additional uses reported by these groups included:

  • Interfacing with laboratory test results and email systems
  • Tracking clinical inventory
  • Storing diagnostic (radiographic, ultrasonographic, and endoscopic) images and videos
  • Accommodating patient discharge comments and client instructions
  • Communicating with referring veterinarians

That a high percentage of respondents use their EVMRs for practice management purposes but less so for tracking and improving patient and population health "concerns us for several reasons," researchers wrote. 

They pointed out that in human medicine, electronic medical records (EMR) "improve medical care and patient safety beyond the capacity of paper medical records to do so by reducing the number of medical errors associated with illegible handwriting, incorrect prescribing practices, and inappropriate use of tests and procedures. They can also be used to contribute to the early identification of emerging health problems and adverse health events."

"These capabilities allow practitioners to tailor medical practice to the unique individuals or populations they serve by applying appropriate preventative medicine treatments and practices, identifying protocols effective for the reduction of adverse events and frequency and severity of disease, and practicing evidence-based medicine for the treatment of common diseases and conditions," researchers wrote.

Recommendations for enhanced adoption and use of EVMRs

Researchers said that in order to progress toward a better companion animal surveillance system for public health purposes, a growing goal within the animal health care world, there will need to be greater use of EVMRs. 

They acknowledged that achieving enhanced adoption and use of EVMRs is no small task, and that it will take efforts from individual veterinarians, state boards, professional organizations such as the AVMA and AAHA, and public health-oriented institutions such as the CDC.

As the usage of EVMRs evolves over time, researchers speculated that it could lead to linking between the systems of independent, stand-alone veterinary practices. The sharing of data from geographically disparate practices would enable monitoring and tracking patient health over large areas, leading to improved surveillance of diseases - particularly zoonotic diseases. 

"The use of EMRs holds great promise for monitoring and improving the health of individual human and animal patients as well as human and animal populations," researchers wrote. "Independent veterinary medical practices have the potential to contribute to the veterinary medical profession's understanding of the natural history of and risk factors for diseases in animals, the effectiveness of treatments and procedures, and the prevention of modifiable diseases among animals and humans."

Comments (5) -

Jim Johnson
Jim JohnsonUnited States
8/7/2014 4:01:24 PM #

This study overlooks an important factor: most EVMRs are not utilized to their fullest extent because they are, for a variety of reasons, pretty much unusable. My practice embraced "paperless" records 6 years ago, and not a day goes by that we don't wonder if we made the right decision. Electronic integration promises so much, yet buggy software, poorly implemented interfaces, and corporate greed all work together to limit the usefulness of these systems. "Tracking and improving patient health"? We can't even print or export complete records in a single pass. Our vendor now allows us to print all of a patient's lab results on a single graph - yippee! - but only if we purchase all of our lab equipment from them. The data is stored in the system, regardless of the vendor... but for some reason, they just won't integrate it unless we are using their equipment. Interfacing with email? The latest version of our software has it, but it is so badly designed and buggy that we have never made upgraded to that version. Etc. We are ready for next-gen software.. where is it?

Dennis Woodruff
Dennis WoodruffUnited States
8/8/2014 5:03:54 AM #

EVMR's have definite advantages over paper medical records.   However until better veterinary computer software is developed the use of EVMR's will be of limited value globally.  Veterinary software is cumbersome at best.  New software developed from the ground up would greatly increase the value of EVMR's and decrease the time it takes to input data.  Current software systems were developed as cash registers and then additional features were added.  This makes use of the software very labor intensive and it is difficult to extract good data from the system.  Currently there is no really good software system on the market.  My opinion!

Janice W Hayes BS,RVT
Janice W Hayes BS,RVTUnited States
8/9/2014 6:46:10 AM #

So this was a good article but take it a step further.  What software is available for veterinarians to begin using EMR?  Currently my doctor is having trouble keeping up with charts.  We would consider our practice paper lite. We have no file folders of patient medical records.  We try to input all information into the computer medical record and here is where the backlog begins.  Ideas for solutions would be current veterinary practice management systems upgraded to allow dictation into their software or an interface software that would allow dictation which would integrate with current veterinary practice management systems.

Sagi Solomon
Sagi SolomonUnited States
1/20/2015 10:29:50 PM #

In my opinion, one of the primary reasons clinics are not leveraging the data is because the data resides in a closed environment (that is, in the clinic itself).  In this context, the data has limited value.  However, as part of a larger pool of data, it becomes much more valuable.  In order to fully leverage the benefits of the data (one of those benefits being improving the surveillance system for public health purposes mentioned in the article), we must move toward a model where data is freely exchanged for the benefit of the patient, the clinic and the public.  Legacy server-based vendors and the systems they sell this exchange close to impossible.  Fortunately, cloud-based technologies are rapidly changing rapidly breaking down these traditional barriers and are enabling the exchange and analysis of mass amounts of data quickly and efficiently.  I expect that in the next few years big data will play a much more important role in veterinary healthcare.

M Carolyn Miller
M Carolyn MillerUnited States
1/22/2015 4:07:40 PM #

Good catch. My apologies for the unclear information. Students will start annually but won't return to Japan, logically, until they complete their education, which is in 2018. The post has been edited.

Thanks for reading, and keeping us on our toes.

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