Literature review: The Adoption of Electronic Health Records. The implementation of electronic health records (EHR) in the healthcare industry has been an evolving concept throughout the healthcare ecosystem for some time. The term EHR is often used interchangeably with EPR (electronic patient record) and EMR (electronic medical record).
Even though the terms are mostly used to describe the same thing, the differences between them can be defined. EMR is defined as the patient record created in hospitals and ambulatory environments. EMR serves as a data source for EHR while an EPR is generally defined as an EHR that individual patient controls. The healthcare ecosystem consists of the healthcare providers such as physicians, payers such as insurance companies, patients, drug companies and IT service firms.
The process of providing healthcare involves massive data exchanges which come in different forms. This makes the execution to be very difficult and challenging. Due technological changes, the healthcare system has to stay up to date in order for it to function effectively. The ability to access, obtain and transmit patient’s information in a timely manner is crucial to the efficiency of healthcare service. This report will identify and document logics, views, benefits and problems that are associated with the adoption of EHR in the health industry Views on the Adoption of Electronic Health Records
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The adoption of this digital record system has received some mixed reviews from members of different communities. Some views this implementation as beneficial to both patients and care givers while others criticize the system for its complexity and some privacy concerns. Regardless of individual opinion about the subject, most institutions around the world believe that the transition is necessary in order to keep up with socio-technological changes. In the US for example, there has been a big push by the government to promote the adoption of the new system. In the year 2004 former president George Bush called for wide spread of EHR and put forth a cabinet to oversee the proceedings. Later in 2009 president Obama passed into law the Health Information Technology for Economic and Clinical Health (Perera, Holbrook, Thabane, and Foster & Willison 2011).
A survey conducted for a clinical trial in Ontario Canada suggested that the overwhelming majority of both patients and physicians supported the idea of computerized records. A survey involved 511 patients (man and women) and 46 physicians (man and women).
The result showed 90% of the participants were in favor of EHR. In the same survey, 38-50% of both patients and physicians showed concerns about the privacy of patient’s records. The data indicated that participants felt that the old style paper record system was more secure with regard to privacy (Perera et al 2011).
Another research study in the US showed that small private practices have been reluctant to adopt the EHR system. This is due to the high start-up costs and loss of patients contact time.
A study of about 3425 physicians who worked in small practices suggested that there is still skepticism over EHR system adoption. The study indicated that even though the government spends about 2 trillion a year on healthcare, only about 15% of the doctors use the EHR to manage their patients’ health records. This implies even with the incentives offered to care providers by the government to adopt system, the transition has been slower than anticipated. EHR Evolution and Productivity Factor.
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With regard to slow transition from paper based records to EHR, the overall transformation scale is still impressive. Data collected in the US by ONC shows that the EHR adoption in hospitals has more than doubled from the year 2009 to 2011. The increase was from 16% in 2009 to 35% in 2012. The same survey suggested that the number of primary physician who adopted the EHR system in their facilities has doubled from 20% in 2009 to 40 % in 2011. This shows that even though the transition has not been fast as anticipated the momentum is still there (Fridsma 2012).
Even with the implementation of computerized health records, there always seem to be a window for improvement to maximize efficiency.
A study collaborated by San Cecilio University hospital from Granada suggested that, by changing or manipulating the functional style of EHR system based on situations, the maximum performance quality can be achieved(Suareza, Molinab, Yanezc, & de Reyesc 2012).
This experiment was performed using a system that stores 800,000 EHR records containing more that 50 million documents. The main idea was to improve the EHR retrieval by using contexts. The students formulate a function correlation in which accessing contexts through logical data groups and the computation of pertinence was observed. This modification seemed to bring about functional improvements over the previous version of EHR in which this pattern was not followed (Suarez et al).
The implementation of EHR is mostly perceived as beneficial and productive to the overall quality of healthcare.
This notion is also subjective to speculation based on conflicting evidence regarding the performance ratio. A three year study by Texas Tech University, involving 4165 hospitals in the US suggested that, the implementation of EHR actually translated to an increase in technical efficiency by 3.6% margin, while at the same time caused the decrease in productivity efficiency by 8.87%. (Thompson, Ford, Ford, William & Huerta 2013).
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The results of both technical efficiency and productivity efficiency offset each other. This implies the data was inconclusive to determine the overall efficiency in short term (Huerta 2013).
Benefits of Adopting Electronic Health Records
The use of EHR has proven to show substantial improvements in the overall quality of health care system. A multiple case study conducted in nine residential aged care facilities in Australia indicated that, the implementation of EHR into their facilities had contributed to the overall improvement of quality their services (Zhang, Yu, & Shen, 2012).
The study observed improvement in three categories. First of all, the adoption of EHR benefited the individual staff members. The staff gained documentation efficiency. The system reduced the burden of documentation and paper work to staff. With the simplification of work, there was less pressure on staff to achieve their daily goals. Logically this contributed to a better retention rate of staff members.
The staff also benefitted from the training of the new system they received. The training grew their knowledge of information and empowered them as individual. Second, the adoption of the EHR system contributed to the improvement of residents’ health records and the quality of care they received. Third, the organization which ran the facilities gained increased ability to manage information, control the care quality in the working environment and acquire funding (Zhang et al 2012).
Furthermore the use of electronic health records has proven to reduce the amount of medical errors in healthcare facilities. This is because the EHR system ensures accurate, consistency and relevant data collection. In the past, there have been some issues with regard to patients receiving treatment which were intended for other patients (Shneiderman 2011).
This is because patients identifiers were not easily selectable or displayed on paper based system.
The EHR usability evaluation protocol focuses on reducing such errors. A report from University of Michigan Health System in 2011 suggested that the implementation of EHR had significantly reduced the amount of errors in their medical practices. A five years data evaluation indicated that, since the implementation of EHR the University of Michigan Health System, the average lawsuits due to medical errors fell from 2.13% to 0.75%. Also the number of monthly compensation claims had dropped from 7 to 4.5 per 100,000 patients’ encounters. This eliminated wasteful cost due to liabilities and compensations (Shneiderman 2011).
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Conclusion
There is more to the implementation of EHR than just installation of new computers. There is workforce training, education, different job processes, and new responsibilities. The adoption of EHR throughout the globe is a progression phenomenon, this means there is a lot of room for improvement and adjustments. A survey analysis taken from standardized EHR system in China can attest to this statement. The analysis showed, even though the system was significantly important in China’s healthcare system, it also had abundance of deficiencies which needed to be fixed. For example the Chinese system showed to lack information on privacy and security.
It also lacked support for reference data and data types (Xu, Guan, Cao, Zhang, Lu & Li 2011) Clearly further evidence is required to confirm a direct link between implementing EHR systems and reduction of in-hospitals complications. Nevertheless, there is significant evidence to support the idea that, HER adoption can improve the overall quality of health care. For example a data entered once can be used many different times without a worry of duplication. Through the use of EHR, data is more current, consistency, relevant and up-to-date. It also simplify the process of accessing and transforming data from one media to another.
