Electronic Health Records Essay
Implementing a new electronic health records (EHR) system to replace manual records is an extremely complicated task. EHRs use complex algorithms to exchange patient data among different physicians and departments such as a pharmacy and laboratory. EHRs are becoming popular because employees and patients can access records anytime and anywhere. Patient drug alerts are also part of the system to warn emergency room and intensive care nurses about potential drug reactions. A needs assessment is a systematic procedure to determine what components are required for EHR implementation to prevent failure of the highly costly investment. Although EHR systems have been shown to dramatically reduce human error, proper assessment before undergoing the implementation process is critical or errors and costs could actually increase.
An EHR assessment must be completed before the software packages can be selected to ensure it is conformed perfectly to the specialized needs of the hospital. According to the California Medical Association the assessment has two steps: 1.) Readiness Assessment; and 2.) Work Flow Analysis (Ginsberg et al., n.d.). The assessment should be done by a seasoned group of engineers, physicians, lab workers, billing staff, pharmacists, and nurses to collaborate so that each department increases patient safety and efficient care. The assessment should include a web-based demonstration that allows all stakeholders to identify gaps that would hinder their job responsibilities.
Once the needs assessment has been done and vendors chosen as potential suppliers, the readiness assessment should begin. One of the most important data to collect is financial resources. Are more physicians going to be hired that will increase training costs? Can the organization truly afford the upstart investment and ongoing computer support? Space considerations are also critical to evaluate because most closets are too small for the new EHR platforms that have huge servers. High-speed internet capabilities are a must for EHR data exchange between stakeholders. Moreover, are existing medical records planned to be thinned to put the data into the new system? If so, data needs to be destroyed according to HIPP protocol to protect patient confidentiality.
The work flow analysis portion of the needs assessment looks at step-by-step procedures. Examples are scheduling, diagnostic tests, and reviewing tests, prescribing medication, clinical notes, and billing data (Ginsberg et al., n.d.). Other data to be analyzed for the EHR system should be medical history forms, lists of current medications vital signs, insurance, and referrals. The flow of steps in this planning process involves network upgrades, expanding server room space, a Medicare fraud plan, selection of three EHR vendors, visiting other hospitals using the systems, negotiating, and finally select the model that is best suited to all stakeholders.
A 10-year study done by the Canada Health Info way about who should be consulted during adoption of an EHR system looked at 29 key stakeholders involved in establishing policy (Rozenblum et al., 2001). They found that stakeholders should be consulted from a bottom-up, clinical needs approach first because they will be the heaviest users of the system. This means physicians, nurses, certified nursing assistants, billers, lab workers, and pharmacy employees need to have significant input into selecting what aspects are most important. The number one reason for implementation failure is inadequate involvement of line-worker clinicians (Rozenblum et al., 2001).
Therefore, the informatics team must work very closely with these stakeholders. Other critical stakeholders to consult are the finance department to ensure how much funding is available. Patients are also important stakeholders because no one wants their health information linked to a huge system that is insecure and prone to hacking confidential medical records. Policy makers at the executive organizational and governmental level also have powerful sway over which EHR is chosen. Lack of collaboration among these diverse groups can delay implementation of the system for decades.
Appropriate needs assessment provides relevant feedback to upper management. This helps these higher-ups make wise decisions based on financial resources, training needs for staff, vendor choice, and whether or not EHR is even necessary (Hartzler et al, 2013). Upper management is also provided with the ability to analyze which employees should have access to the system (or what parts of the system) to complete their designated tasks. Gaps between “wants” and “needs” can also be identified so that valuable resources are analyzed in cost-benefit analysis. Training needs or additional hiring of employees can also be anticipated to prevent glitches in the system due to human error. EHR systems can increase profit margins and protect patients from human error if assessed closely prior to purchase and implementation.
Ginsberg, D. (n.d.). Successful preparation and implementation of an electronic health records system. Best Practices: A guide for improving the efficiency and quality of your practice. Retrieved December 26, 2014 at https://www.cmanet.org/files/pdf/ehr/best-practices-7.pdf. Hartzler, A. et al. (2013). Stakeholder engagement: A key component of integrating genomic information into electronic health records. Genetics in Medicine, 15, 792-801. Rozenblum, R. (2001). A qualitative study of Canada’s experience with the implementation of electronic health information technology. CMAJ, 183(5), E281-E288.
Electronic Health Records Essay
Electronic health records (also known as ‘e-notes’) have commonly replaced the conventional paper records used in medical facilities. This discussion describes how electronic health records have provided a solution to a range of health care procedures, have offered cost savings and benefits, and still have greater potential for improvement through future efforts. Overall, this discussion documents the progress and demands for further convenience in regards to electronic health records, presenting concepts, statistics, and recent analyses published by authorities on the topic. Through this, it is evident that electronic health notes still have shortcomings that are commonly noted and targeted, but as they have solved many more problems inherent in previous systems, they are the ideal path for development and improvement in this area.
Electronic Health Records
Since the development of electronic health records, healthcare managers have been able to reach numerous solutions to previous problems in their systems; this has included improved capacities to record and store the clinical and demographic information patients, the capacity to observe or manage the results of laboratory tests, the capacity to give prescriptions, improved ease of managing billing data, and improved facilitation of analysis for clinical decisions. These improvements reveal the nature of challenges and demands relevant to operations using the previous form of records (paper), with electronic health records being substantially more organized, convenient, and manageable. According to Al-Ubaydli (70), the use of paper records “had several implications.
On the one hand, writing on paper fast and easy, so it fits well with clinical workflow. On the other hand, notes are only useful to the person who reads them, no to the one who writes them. When writing, speed and brevity are essential as there are always more patients to visit and care for. But for the reader, speed means illegible handwriting and brevity means incomplete notes. This leads clinicians to ask patients questions to which the answers already exist in the notes” (Al-Ubaydli 70). Moreover, as the author pointed out, paper is more difficult to transfer or copy, leading to it ultimately becoming easiest to keep the records confined to one central place. With this, they cannot move as easily as the patient, and the chore of copying tended to result in the patients being without a complete set of easily accessible records. Meanwhile, there are substantial space and cost requirements associated with storing paper records.
The development of computer hardware, software, and improved data storage techniques eventually led to the development of efficient and effective software capable of storing patient data in secure databases, further allowing all data to be stored in a size-efficient manner that could also be easily transmitted. With the development of the internet, patient files could even be stored and transmitted online, providing an ideal backup for databases while improving the capacity for patients to have complete record sets sent to a range of facilities.
The general motivation for creating these electronic health records was to address the problems inherent in the paper records, with the most convenient aspect being the cost-effective nature of storage and transmission; the nature of this being a virtually free cost and nearly instantaneous transmission made the desire and changes especially significant. Moreover, electronic health records would allow users to improve the capacity for users to index, sort, and search through records faster than the time demanded to sort through the paper files manually (Al-Ubaydli 70). An additional benefit is the reduced potential for illegible notes, as the nature of the systems means that all data is entered in using clear computerized text characters.
As mentioned, similar to the nature of demands and problems evident in the paper records, there are now demands for improving aspects of the electronic records. However, these problems can be addressed through improved organization, software, and other means that does not demand a drastic change in mediums, as was required to address the problems of the paper records. Al-Ubaydli (71) reported that electronic health records “must include checks and balances to audit and control access.
Second, the user interfaces for adding to the records must become easier to that they fit better into clinical workflow and allow clinicians to do more in less time. Speech recognition continues to improve, and the designers of templates continue to innovate.” The author further points out that similar to the improved search engines of the internet (first challenging and then drastically improved with developments like Google), electronic health records can be similarly improved without restructuring comparable to restructuring paper records.
Other researchers have analyzed the nature of electronic health records, further elaborating on the nature of solutions and remaining demands. DeVoe et al. (351) pointed out that the clear and detailed recording of all received and recommended services should be considered the most vital aspect of health records, which is most effectively addressed through electronic records rather than paper records. This further assists with insurance aspects, as the detailed and accurate aspects of recording services can improve coordination with claims and related demands. DeVoe et al. (352) further asserted that electronic health records have the potential to assist researchers and policy makers with overcoming prior restrictions in examining services provided in CHCs.
Meanwhile, Hoffman and Podgurski (425) reported on the growth of health care and pharmaceutical costs, frequency of unnecessary medical procedures, evoked healthcare reforms, and critical roles of records in all of these processes. With this, comparative effectiveness research (CER) has commonly been coupled with electronic health records to show that many expensive procedures have had less desirable outcomes for comparable conditions that less expensive ones, pointing out the nature of some health care facilities and physicians. Meanwhile, however, some have argued that CER is likely to lead to limited patient choices, improper rationing of health care, homogenized care, and potentially refusal of needed treatments (Hoffman and Podgurski 425).
Congress allocated $1.1 billion to CER through the American Reinvestment and Recovery Act, which included other aspects of improving and restructuring facilities. Soon it became evident that a unique application of CER could allow physicians to improve their decisions regarding treatment, as when coupled with electronic health records, physicians could conduct computer inquiries across a large database of patient records. Naturally, this would provide a valuable supplement to the patient’s history and literature. Hoffman and Podgurski (425) recommended that software be designed to summarize findings of queries by presenting the most relevant outcomes of patients with the most comparable conditions, while records be developed and stored in a manner which facilitates this. Thus, personalized comparison of treatment effectiveness or PCTE could become a phrase more common than CER in the future.
Electronic health care records have solved many of the problems that could not be effectively addressed through developments in the paper systems, with major improvements in the capacity to copy and transfer records, cost of storage, and clarity of information. Although this has led to implications for security and excessive copying, databases have been developed to improve the concerns in these areas. Moreover, researchers have proposed additional improvements in development as well as use, with records having the potential to serve as an informal accessible databank, thereby improving understanding and decision making.
Al-Ubaydli, Mohammad. Personal Health Records: A Guide for Clinicians. John Wiley & Sons: New York, NY, 2011.
DeVoe, Jennifer, Rachel Gold, Patti McIntire, Jon Puro, and Susan Chauvie. “Electronic Health Records vs Medicaid Claims: Completeness of Diabetes Preventive Care Data in Community Health Centers.” Annals of Family Medicine 9.4 (2011): 351-358.
Hoffman, Sharona and Andy Podgurski. “Improving Health Care Outcomes through Personalized Comparisons of Treatment Effectiveness Based on Electronic Health Records.” Journal of Law, Medicine & Ethics 39.3 (2011): 425-436.
Electronic Health Records Essay
The electronic health records fits seamlessly with a central cost-saving of health care reform: to shift U. S. health care from an expensive, pay-per-service system based on quantity to one that emphasizes quality. The goal now is to have medical payments reward good care — in a way that’s difficult to do with paper records. “You really can’t have accountable care without electronic records,” says Judy Hanover, a research director for IDC Health Insights, a health care research and marketing firm based in Framingham, Mass. “It provides the data and information foundation you need to implement accountable care.
Why should you care about how your doctor keeps records? Because, thanks to the technological push, you’ll soon have online access to your complete medical records for the first time. The government says not only can electronic health records reduce unnecessary tests and procedures, help your doctor coordinate your care with other providers and avert medical mistakes due to incomplete or incorrect information, but they also may save your life by enabling you to carry all of your own health records on your cell phone or mobile device.
Medicare and Veterans Affairs beneficiaries already can access their claims records through the federal “Blue Button” online service. “This is going to rock! ” says Dr. Farzad Mostashari, the national coordinator for health information technology and the captain of the federal electronic records initiative. “This is going to change things in a pretty fundamental way. ” Getting America’s health care providers to go digital has been no easy task. Mostashari notes that there are hundreds of medical software vendors of all sizes and more than 1,000 software systems in use, and few of them communicate with one another.
Some physicians continue to view electronic note-taking as time-wasting rather than time-saving. To ease the pain of transition, Congress allocated $27 billion for financial incentives, including Medicare and Medicaid bonuses to be doled out to hospitals and physicians able to demonstrate “meaningful use” of digital records and meet program milestones. Researchers found that only one in 10 doctors with an electronic health records system satisfied the U. S. government’s requirements of “meaningful use” by early 2012.
The ultimate goal… is a widespread adoption that results in broad interoperability so a lot of physicians are using systems and sharing data that result in better quality care,” said Catherine DesRoches, the study’s lead author from Mathematica Policy Research in Cambridge, Massachusetts. The Centers for Medicare and Medicaid Services (CMS) oversees the incentive program that pays individual doctors up to $44,000 through Medicare – the government-run insurance for the elderly and disabled – and up to $63,750 through Medicaid – the government insurance for the poor – to use electronic health records.
To receive a payment, doctors must meet 19 of 24 “meaningful use” objectives that include tracking patients’ medications and allergies, sending reminders, sharing lab test results and producing summaries of a patient’s office visit. More than 295,000 healthcare providers have received a total of $14. 3 billion in “meaningful use” incentive payments as of April, according the CMS website. “We’re making a tremendous public investment in electronic health record adoption… We want to be sure this public investment really pays off to benefit patients,” DesRoches said.
For the new study, which was funded by the Commonwealth Fund and Robert Wood Johnson Foundation, DesRoches and her colleagues sent surveys to about 3,000 family doctors and specialists around the U. S. between October 2011 and March 2012. About 44 percent of the 1,820 doctors who returned surveys met the requirements of having a basic electronic health records system, but only 10 percent met the first stage of criteria for “meaningful use. Those measures include the ability to encode a patient’s health information, track key conditions and share information for the purposes of coordinating medications and other aspects of treatment. They also include mechanisms for generating useful population-level data, including the ability to use common standards to assess the quality of healthcare being provided to all patients and the ability to cull from records to report on public health trends in the patient population.
Some of the most difficult objectives to meet, according to the new study published in the Annals of Internal Medicine, are the capacity to exchange data with other doctors, to generate reports on care quality and to provide patients with a summary of their visit. “If we want to see broad interoperability that improves care, we’re going to need some more focus on these usability issues,” DesRoches said.
Debora Goetz Goldberg, who has studied electronic health records but was not involved in the new research, told Reuters Health in an email that she’s not surprised y the findings because doctors face a number of challenges in meeting the criteria. “Meaningful use standards require physicians to make major transformations to the structure and functioning of their practice, which include considerable changes to care delivery processes, staffing, and reporting,” wrote Goldberg, from the George Washington University School of Public Health and Health Services in Washington, D. C.
Despite these challenges, DesRoches told Reuters Health that many doctors were close to meeting the requirements and she expects the number of basic electronic records and of meaningfully used records to increase next year. “I would expect that our next wave of data collection will see a big increase in that number,” she said. In May, CMS announced that more than half of eligible doctors and more than 80 percent of eligible hospitals had received payments for the adoption or meaningful use of electronic health records.The medical and healthcare field is characterized with the cumbersome practice of obtaining and maintaining extensive documentation of patient information. Medical staff, physicians and healthcare practitioners are legally responsible to maintain a comprehensive, efficient as well as effective way to collect, maintain and archive patient information. Traditionally, this process of information collection and maintenance was accomplished manually resulting in an endless paper trail of information.
Everything from patient encounters to informational charts to billing was executed in a paper based environment and soon this record keeping method became too overbearing and tedious to manage. The integrity of this manual paper-based process continued to be compromised with issues surrounding the convenience, data mining ability, cost and safety of this method.
The advent of new health care disciplines such as nursing, medical technologists and associated health care disciplines, and the emergence of hospitals, infirmaries and clinics as formalized structures of health care delivery expanded the scale of interaction between health care providers and health care consumers. However, in spite of these and associated developments, the tradition of privacy and confidentiality remained.
Operationally, the new health care professions were seen as extensions of, and as subsidiary to, the medical profession and similar injunctions concerning privacy and confidentiality applied. (Doyle, 2001) Further, health care decision making continued to centre in the direct and interpersonal relationship between the professional and the client that had characterized it from its very beginning.
An important step in the transformation of this scenario occurred with the introduction of electronic means of storing and manipulating patient data. The pace of this transformation was accelerated by the development of advanced computer-based information technology. At first glance, these developments may seem like purely technological improvements: mere steps, as it were, along the road to the greater ease of collecting, storing and manipulating patient data. However, what actually happened was more profound.
The advent of electronic means of data storage, retrieval and manipulation facilitated the evolution of health care decision-making structures away from the small-scale immediate-contact model that had characterized medicine and health care from the beginning to a new model that no longer dealt with the physician-patient encounter as sole decision-resource but instead centered on the information package that described and defined the patient from a decision-making perspective.
That is to say, considered in one way, the modern electronically based data package that describes the patient can be seen as a mere variation on the traditional package that was paper-based and that involved the manual manipulation of a material medium. From that perspective, electronic records do not differ fundamentally from paper-based records. While electronically based records may be more compact, more easily available, etc. , this is merely a peripheral difference as far as their nature as records is concerned.
Therefore in this sense, there is nothing about electronic patient records that in principle makes them different from paper based records. It’s a normal trend for clinical departments to work for years with their own people, budget, and vendors to come up with a method of capturing their patient and billing data electronically, and that personalized method is one definition of an EHR. In actual fact, one point of argument regarding EHRs is simply a question of semantics. There are various definitions for an EHR. At one end of the scale, an EHR includes everything from patient’s past medical history to diet and lifestyle preferences.
At the other end, it can be as simple as an e-mail message to a fellow clinician. Our definition of an EHR is simply a repository of clinically important data that may be accessed and searched with relative ease and in a rapid manner. Today, the use of EHR systems has revolutionized the medical field industry by facilitating a more efficient record keeping process and a more effective communication medium for medical personnel to exchange information. Many healthcare personnel now understand the importance and the impact these EHR systems are having on the overall delivery of customer service and the general administration of healthcare.
Medical practitioners are constantly faced with challenges including the need to improve the quality of care, adhere to new clinical restrictions and processes, reduce waste and reduce errors. In recent times these challenges have been less of a burden as automated integrated systems help coordinate such process much better. Computerized systems like EHR systems help in reducing the amount of paperwork for medical offices, providing an easier way to access patient information, promoting more uniform delivery of processes and in some respects suggesting appropriate diagnosis and treatment for certain conditions.
While the health care information superhighway has brought such benefits as detailed health and medical information and has increased the efficiency of managed care organizations in data collection and analysis, outsiders who have access to patient s’ medical histories are using them as tools of discrimination in employment, promotions, insurance coverage, and even politics.
Dr. Denise Nagel, president of Coalition for Patient Rights of New England, state, “The traditional right of medical privacy, protected by the Hippocratic Oath, is being eroded as our medical records become transformed into commodities desired by insurers, employers, researchers, and yes, even police. ” (Gellman, 2002) She goes on to give the example of a woman, who with only average computer skills, was able to access information about the psychiatric condition from her medical record in an insurance company’s database.
Concerned that future employers would obtain it as easily as she had, she requested its removal, but was turned d own by the company (Tobler, 2002). When a confidential list of 4,000 AIDS patients wound up in newsrooms in Tampa, Florida, last year, it was discovered that the computerized medical records had been tapped by a major pharmaceutical company (Bennett, 2002). These examples arouse concern about how private medical data really is. Patients have the right to keep their medical history private for their own protection, but that privacy is increasingly being threatened by the growth of the information superhighway.
There would have to be a provision that even for legitimate purposes, the subjects of the records would have to be notified if patients’ records were to be accessed, the reason why they were being accessed, and the extent to which such an intrusion into the privacy of the individual was going to take place. This would have to go hand-in-hand with the right of the subject of the record to challenge the claim that privacy must be breached by the duly empowered social agency.
Similar remarks apply to the activities of other duly authorized social institutions. For example, some jurisdictions have started to construct networked data sharing agencies that monitor the filling of medical prescriptions. (Bennett, 2002) The alleged purpose of such a surveillance network is safety: It is to ensure that the prescriptions that are actually being filled for a given patient do not conflict or synergetically interact with each other, or otherwise have a deleterious effect on the patient’s health.
Another, ancillary purpose is to control the misuse of drugs, to prevent physician-shopping for multiple prescriptions of controlled substances that are then sold illegally, etc. Specifically, one may distinguish between social harm that would be avoided or minimized and personal harm for the individual patient. If the claim is that societal harm would be minimized by such an intrusion into personal privacy, certain considerations must be borne in mind.
First, any action that limits the application of a principle has consequences that extend beyond the immediate action itself. Thus, abandoning the principle of privacy on a given occasion has the tendency to undermine the sense of trust that people have in social institutions and in the maintenance of their rights. Consequently, when such an intrusion for security purposes occurs, care must be taken that the potential harm in undermining confidence in societal protection of individual privacy is outweighed by the harm that it is intended to prevent.
Second, the Principle of Equality and Justice would entail that any such abrogation of the individual’s right of privacy must be demonstrably necessary and could not be achieved by a less intrusive course of action. Third, any such abrogation of the individual’s right of privacy would have to be limited in extent, such that it may not go beyond the limits necessary to achieve the otherwise legitimate aims that have been justified by the preceding two considerations.
In other words, it must adhere to the principle of the least intrusive alternative. By contrast, intrusions into privacy that focus in the welfare of the individual patient could not be justified in such a fashion. The reason is to be found in the Principle of Non-Malfeasance itself. The core of the Principle of Non-Malfeasance is not simply that harm should be minimized, but harm should be minimized where the nature of that harm is determined not by the agent but by the intended recipient of the action.