Electronic Health Record Formal Report

Author

Institution

Executive Summary

While numerous sectors in the world have taken up technology as an effective way of streamlining their operations and increasing their efficiency, the health sector has been lagging behind and carrying out its operations manually. However, recent times have seen the entry of the EHR systems under CDS systems, which are primarily targeting the healthcare sector. This is all in an effort to enhance the effectiveness and efficiency of their operations, as well as patient safety and quality of care. Volumes of literature have focused on the functionality and benefits that come with the incorporation of EHR systems in the healthcare sector. These issues are outlined in this paper, alongside benefits of EHR, barriers to their implementation, safety and privacy concerns pertaining to the systems, as well as policies to which healthcare firms are required to abide in their implementation of the EHR systems.

Introduction

Recent times have seen the computerization of the different tasks in different industries. Indeed, it is currently possible to undertake various tasks such as earning degrees, working and even conducting business from the comfort of one’s home. However, despite the enhanced technology in various facets of the society, the healthcare industry has remained relatively rigid with regard to the manner in which it conducts its operations. In fact, a large number of patients obtain handwritten medical prescriptions and are unable to email their physicians or medical practitioners or schedule appointments without contacting a live receptionist. Recent times have seen various legislations made to give incentives to the healthcare providers to computerize their operations through the adoption of EHR systems. The HER systems have the capacity to change the healthcare sector from a paper-based sector to a computerized one thereby enhancing the quality of care provided to the patients.

Research

Overview of Electronic Health Record

EHRs, at their basic form, are computerized or digital versions of the paper charts pertaining to patients. However, their comprehensive definition goes beyond this. EHRs are patient-centered, real-time records that allow for instant availability of information wherever and whenever needed (Weiner et al, 2012). This information pertaining to the health of the patient is presented in one place. These systems have the capacity to incorporate information pertaining to the medical history of the patient, medications, diagnoses, allergies, immunization dates, test and lab results, as well as radiology images (Weiner et al, 2012). This, without doubt, increases accuracy and organization in patient information, automates and streamlines the workflow of providers. The key feature of these systems is that they provide healthcare providers with access to evidence-based tools that they can use to made decisions pertaining to the patient’s care. In addition, it is noteworthy that the EHR has the capacity to be created, managed, as well as consulted by staff and authorized providers across numerous healthcare organizations (Weiner et al, 2012). Of importance is the fact that EHRs bring together information both from past and current physicians, pharmacies, laboratories, emergency facilities, medical imaging facilities, as well as workplace and school clinics.

Source: HYPERLINK “http://www.health.gov.sk.ca/electronic-health-record” http://www.health.gov.sk.ca/electronic-health-record

Policies Governing the Implementation and Use of EHR

Throughout the Healthcare industry, the importance and incredible benefits that come with the incorporation of Electronic Health Record have been recognized. However, the realization of these benefits for any healthcare provider is predicated on the manner in which the EHR systems are implemented and used. This has triggered the action from the government, which in 2009, came up with certain rules pertaining to the usage of EHR so as to realize maximum benefits. These rules come under Meaningful Use”.

The Meaningful Use rule comes as part of a synchronized set of regulations that are aimed at assisting in the creation of a secure and private 21st century electronic health information system so as to achieve certain improvements in the delivery of healthcare. It comes as part of the Health Information Technology for Economic and Clinical Health Act (HITECH), a legislation that ties payments ad funding to the attainment of advances in the processes and outcomes of healthcare.

The core objectives are composed of fundamental functions that allow EHR systems to support enhanced healthcare. At their most basic, these objectives include tasks that are essential to the creation of medical records, which include the entry of fundamental data such as demographics and vital signs of patients, allergies, active medications, smoking status, as well as updated list of current problems (Westin, 2005). Other core objectives may include the use of varied software applications that allow for the realization of the EHRs’ true potential in the improvement of efficiency, quality and safety if care. These features assist healthcare providers in making better decisions, as well as prevent avoidable errors. Clinicians are required to employ these decision support tools so as to qualify for the varied incentive payments (Westin, 2005). On the same note, they have to start using records in entering clinical orders especially with regard to medical prescriptions, which is the capability that underlines the value of EHRs (Weiner et al, 2012). In addition, the meaningful use requires that physicians provide their patients with electronic versions pertaining to their health information in order to extend EHRs’ benefits to the patients (Weiner et al, 2012).

Moreover, the rules come up with a menu of ten extra tasks from which healthcare providers may choose any five to implement (Fleming et al, 2011). These include abilities to carry drug-formulary checks, offer reminders to patients for necessary care, employ EHR in the support for the transition of patient between personnel and care settings, incorporate results of clinical laboratories in the EHRs, as well as identify and offer health education resources that are patient-specific (Weiner et al, 2012).

For a large number of menu and core items, the HITECH regulations specify the rates at which physicians must use certain functions in order to fit the description of meaningful users. These rates allow for considerable progress in the improvement of care and are achievable by average providers and practices in the early stages. On the same note, it is required that Meaningful Use involve electronic data reporting with regard to quality of care (Kazley et al, 2012). Clinicians are required to report data pertaining to three core quality measures including tobacco status, adult weight screening and follow-up, and blood pressure level (Rinehart & Harman, 2006). In cases where these are not applicable, clinicians should choose other measures from the varied lists of metrics ready for inclusion in the electronic records.

Source: HYPERLINK “http://www.itl.nist.gov/div897/docs/EHR.html” http://www.itl.nist.gov/div897/docs/EHR.html

Security and Confidentiality in EHR

There have been concerns pertaining to the privacy and access to information stored in EHR systems. However, it is worth noting that the implementation of EHR systems is also governed by the HIPAA Security rules that require physicians to set up technical, administrative and physical safeguards so as to protect this information (Fleming et al, 2011). In addition, EHR systems come with inbuilt safety measures including encryption capacity for stored information, access controls such as PIN numbers and passwords, as well as audit trails that record individuals who accessed information, as well as any changes modifications that are made (Rinehart & Harman, 2006).

DATA ANALYSIS

Benefits of Electronic Health Records

The benefits of Electronic Health Records stretch from the clinical outcomes to the societal and organizational outcomes. Organizational outcomes include issues such as operational and financial performance, not to mention increased satisfaction among clinicians and patients. Clinical outcomes, on the other hand, revolve around the enhanced quality of care, reductions in clinical and medical errors, as well as enhanced safety (Fleming et al, 2011). Societal outcomes revolve around enhanced capacity to carry out research, as well as achieve enhanced population health.

A large number of clinical outcomes pertaining to EHR relate to patient safety and the quality of care. Patient safety revolves around the avoidance of injuries to patients mainly emanating from the care aimed at helping them, while quality of care revolves around doing the appropriate thing to the appropriate person in the appropriate time and manner, thereby coming up with the best possible results (Rinehart & Harman, 2006). Quality of care mainly revolves around efficiency, effectiveness and patient safety. Other items include patient centeredness, equitable access and timeliness.

Electronic Health Records, especially those that incorporate CDS tools, are empirically associated with effective care and enhanced adherence to evidence-based clinical guidelines. There are varied factors that may lead to patient encounters that are not in line with the best practice guidelines including ignorance among physicians about the guidelines and their applicability, or even deficiency of time in the course of patient visits (Kazley et al, 2012). However, EHR systems come in handy in surmounting these issues through preventive services. Research shows that computerized physician reminders resulted in an increase in the vaccination rates against pneumonia and influenza among rheumatology patients that were taking immunosuppressant medications (Rinehart & Harman, 2006). In this research carried out in 2003, pneumococcal vaccinations increased by 22% from 19% to 41% of patients, while influenza vaccinations increased by 22% from 47% to 65% of the patients (Rinehart & Harman, 2006).

In addition, EHRs have been associated with efficiency in the delivery of healthcare. The term efficiency underlines the avoidance of resource wastage. This is especially with regard to redundant diagnostic testing (Rinehart & Harman, 2006). The performance of redundant tests is not only costly but may also result in false-positive results. Research shows that there exists a negative association between the utilization of EHR and redundant diagnostic testing (Gettinger & Csatari, 2012). A study done in 2002 showed that computerized point of care reminders on previous blood tests resulted in a significant reduction in the percentage of unnecessarily repeated tests (Rao et al, 2012). Further research carried out in outpatient settings showed that the use of EHR resulted in a 14.3% decrease in the diagnostic tests that are ordered per visit, as well as 12.9% reduction in the costs of diagnostic tests per visit (Kazley et al, 2012). In addition, related studies indicated an 18% reduction in tests in tests that are ordered in the emergency department for medical visits, a 24% decrease in redundant laboratory tests, as well as a 27% reduction in unnecessary lab tests for antiepileptic levels of medication in hospitalized patients (Rao et al, 2012).

With regard to the effect of EHR on medication and medical errors, research shows that CPOE (Computerized Physician Order Entry) resulted in a 55% decrease in serious medical errors in hospitals. The addition of EHR systems resulted in a reduction of medical errors by 86% (Rao et al, 2012). Similar studies show that EHR systems have the capacity to increase the number of appropriate medication order that involve dosing frequency and levels. One study showed that EHR systems resulted in a 32% reduction in the number of days by which clinicians prescribed antibiotics outside the appropriate dosage, as well as a 59% reduction in the necessity for intervention of pharmacists to correct drug doses (Gettinger & Csatari, 2012).

Barriers to Implementation of EHR

While there is widespread agreement as to the benefits that come with incorporation of EHR, their implementation has been prevented by varied barriers. First, there lacks political will among the administrators in healthcare sector, as well as the professionals in this field. These are mainly concerned about the confidentiality and privacy of information stored in EHRs, as well as fears pertaining to lost productivity (Gettinger & Csatari, 2012). Secondly, a large number of clinicians are uncomfortable with technology as they do not have the requisite training or computer literacy. This is complemented by the fact that most institutions do not have IT reliability or infrastructure as their IT departments do not have the capacity to offer reliable storage and computing support, thereby resulting in EHR downtime.

Conclusion and Recommendations

In conclusion, the healthcare sector has undergone intense computerization. However, a large number of its operations are still done in the manual manner, which led to legislations being made and incentives given to enable the implementation of EHRs. EHRs come with a range or benefits including enhanced safety of patients, increased quality of care, a reduction in medical errors, as well as enhanced organizational performance. While there are concerns pertaining to the security of information stored, EHR come with inbuilt security measures including audit trails, access codes and encryption capacity (Gettinger & Csatari, 2012). In addition, healthcare centers are required to put institutional, administrative and technical measures to protect this information. Given the barriers to the implementation of EHRs, it is imperative that comprehensive education, training and awareness is carried out on the operations of EHRs, as well as their importance. On the same note, while EHR tools are seen as beneficial in numerous cases, a large number of medical conditions may not incorporate scientifically based guidelines that providers can follow. This lowers their effectiveness and usefulness in numerous clinical situations. It is imperative that more scientific-based guidelines are developed to optimize the benefits that come with EHRs.

References

Fleming, NS., Culler, SD., McCorkle, R., Becker, ER & Ballard, DJ (2011). The financial and nonfinancial costs of implementing electronic health records in primary care practices. Health Affairs (Millwood);30(3):481–489.

Gettinger, A & Csatari, A (2012) Transitioning from a Legacy EHR to a Commercial, Vendor-supplied, EHR. Applied Clinical Informatics 3:4, 367-376

Kazley, AS., Diana, ML., Ford, E.W & Menachemi, N (2012) Is electronic health record use associated with patient satisfaction in hospitals?. Health Care Management Review 37:1, 23-30

Rao, S., Brammer, C., McKethan, A & Buntin, MB (2012) Health Information Technology. Primary Care: Clinics in Office Practice 39:2, 327-344

Rini, C., Williams, DA., Broderick, J.E., & Keefe, F.J. (2012) Meeting them where they are: Using the Internet to deliver behavioral medicine interventions for pain. Translational Behavioral Medicine

Rinehart-Thompson, LA & Harman, LB (2006). Privacy and confidentiality. In: Harman LB, ed. Ethical Challenges in the Management of Health Information. 2nd ed. Sudbury, MA: Jones and Bartlett:53.

Westin, AF (2005). Public attitudes toward electronic health records. Privacy and American Business;12(2):1–6.

Weiner, J. P., Fowles, J.B & Chan, K.S (2012) New paradigms for measuring clinical performance using electronic health records. International Journal for Quality in Health Care 24:3, 200-205