Justifying the expense of health information technology undergoes unparalleled scrutiny. Competing priorities for expenses must be balanced by revenue, all within the confines of the "service" industry. Whether for profit or non-profit, healthcare is ultimately a business.

Technology in healthcare is not always viewed as a tool to increase efficiencies, unlike other industries where technology is pivotal to competitive advantage. The absence of even simple, day-to-day technology in the healthcare environment - the dead battery in the physician's pager or the inconvenience of only one functioning elevator - and, suddenly, technology finds it relevance! Technology enables workflow efficiencies: "Implementing an EMR is a strategic undertaking - not simply an operational endeavour. In addition to understanding this distinction, they must embrace the vision and be proactive in advancing it at all levels of the organization" (2006 HIMSS Davies recipient, Cardiology of Tulsa, www.himss.org/ASP/
davies_organizational.asp ).

UHN's MOE/MAR implementation was leveraged by embracing it as the "right thing to do" rather than just jockeying for a competitive advantage in the marketplace. Even with the obvious overall benefit, however, UHN was scrupulous with its business decision:

Before the project received the green light, however, there was considerable debate among members of the executive team. The point of contention: Was the MOE/MAR project truly the best use of time and money in comparison to other much-needed and much-requested initiatives? Other initiatives that were considered included clinical documentation, clinical decision support alerting for lab and diagnostic orders and incident reporting electronic system changes.

Ultimately, it was decided that attempting to manage multiple patient safety projects would be too much of a drain on financial and people resources. As well, implementing multiple initiatives simultaneously would likely be too much change for the organization to handle. Based on the expected relative impact on patient safety, compared with these other initiatives, the choice was made to support MOE/MAR. (Excerpt from "Executive Perspective: The Business Case for Patient Safety," by Anderson et al., at p. 20 in this issue of Healthcare Quarterly.)

UHN's business decision can be supported by organizations recognized for their excellence in implementation and use of electronic health record systems, such as those receiving the HIMSS Nicholas E. Davies Award of Excellence. Two past Davies award recipients cite a number of patient safety improvements in several areas in addition to improving prescription practices:

Maimonides Medical Center (Davies 2002, www.himss.org/content/files/
davies_2002_maimonides.pdf ), a 705-bed hospital, saw problem medication orders drop by 58% and medication discrepancies by 55% in 2001 after its EMR-EHR implementation. That same year, the decision support feature identified 164,250 alerts, resulting in 82,125 prescription changes. The provider's EMR-EHR addressed "high alert medications," confusing look-alike and sound-alike drug names, as well as patients with similar names that could potentially cause the pharmacy confusion.

On-line medication charting saw errors in transcription drop to zero for departments in which EMR-EHRs were in full use at Ohio State University Health System (Davies 2001, www.himss.org/content/files/
davies_2001_osuhs.pdf ). In areas where the EMR-EHR had not been implemented, transcription errors ran as high as 26% in its system. Other healthcare providers also saw transcription errors drop to zero.

Although healthcare is ultimately a business, the patient must stay anchored at the core. UHN's decision to improve patient care through its MOE/MAR implementation is an example of industry leadership for others to embrace.

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