Executive Summary
The need for a faster way of sharing information between various specialists in the medical field has made people explore the idea of having Electronic Health Records (EHR). On the same note, the continuum of care requires an easy method through which patients’ information would be retrieved whenever required. Consequently, EHR has been suggested as a possible way through which accuracy and reliability of health information can be ensured. Manual record-keeping is cumbersome because of the paperwork involved which not only takes a lot of time to compile but is also costly. Moreover, the efficiency of health care is hindered by the use of manual records.
It is expected that EHR will enhance efficiency in the health sector thus increasing the quality of care. On the same note, the system will ensure that the confidentiality of health information is upheld. Moreover, EHR will ease the process of retrieving information thus enhancing the productivity of health personnel. Similarly, due to the credibility of information in an electronic system, medical errors are bound to reduce. EHR will also enhance tracking and follow up of patients thus enhancing the continuum of health care.
Furthermore, interoperability which is essential for any integrated system is incorporated in EHR making it very effective. However, the system is faced with many challenges that make it’s future uncertain. The challenges include; a lack of trained personnel, lack of willing investors due to the huge initial costs and the fact that the health sector is highly fragmented.
Introduction
A patient’s past health information is very crucial to medical practitioners. In this regard, medical officials usually want to know the medical history of patients before administering any treatment to ensure that quality service is given. Unfortunately, patients are not good at giving all the necessary information that medical practitioners will want to know. On the same note, manual medical records are so cumbersome that people cannot walk around with them.
This matter is worsened by the fact that mobility of people has been enhanced nowadays and people are unable to visit specific health specialists each time. Therefore, health records need to be kept in a manner that will be easy to retrieve in any part thus easing the health provision process. Consequently, Electronic Health Records (EHR) system is very crucial in ensuring that continuum care is easily achieved.
Definition
EHR is defined as an electronic record keeping system where patients’ health information from various institutions is collected and recorded. The information is usually past, present or future health information that patients have given to various health institutions that they have visited. This is achieved through integrating health systems of various health institutions (Carter, 2008). Patients’ information that is usually contained in the EHR include; demographics, medications, vital signs, past medical history, immunizations and laboratory data.
EHR is important in automation of drug utilization review, vital sign graphing and tracking, as well as reporting of lab and radiology test results. On the other hand, continuum of care refers to the process of tracking the health information of an individual through an integrated system that encompasses all intensive health care services given (Porter-O’Grady, 2009).
The necessity of EHR in Health Care
It is quite essential that medical practitioners can track all the medical history of their patients and be able to retrieve it as and when the information is needed. In this regard, the systems of manually keeping the medical records of patients are becoming outdated. As a result, EHR is very crucial in enhancing the quality of care and integrating all communications that are essential in health care. Moreover, paperwork is very cumbersome and filling out required information can take a lot of time. In this regard, EHR is highly required to eliminate the paperwork thus increasing the amount of time spent attending patients. This will enhance the productivity and efficiency of health institutions (Lahmann, 2006).
On the same note, manual records are vulnerable to distortions and misplacement. It is not peculiar to hear of situations where patients are complaining that their lab results got mixed up or part of their medical information cannot be traced. EHR ensures that the credibility of any medical information is ensured and all information can be retrieved when needed. Moreover, the EHR system is less expensive to maintain which reduces the cost of health care. To maintain a high degree of medical privacy, manual records must be eliminated and the only other option is the EHR. Given the possibility to have passwords on the electronic records, the confidentiality of patient information is enhanced (Roach, 2006).
Advantages
It is important to note that EHR has made it possible for medical practitioners to get not only precise but also credible information about patients. This has led to better medical decisions that are made with complete information about the patient. On the same note, due to the availability of previous medical information about patients, cases of significant variations in the treatment that patients receive have been reduced. More importantly, EHR provides precise information about patients thus eliminating the idea of trial and error on the part of medical practitioners (Negelkerk, 2005). This has greatly reduced instances of medical errors because medicine is given based on available evidence. All these lead to enhanced quality of health care.
Medical information stored electronically is easily available and can be retrieved very fast whenever patients visit health institutions. On the same note, information from different health institutions is integrated making it available in one place. This reduces the time spent searching for records and the workload of health care personnel whenever patients visit health institutions. In this regard, EHR has helped to increase the productivity of health care professionals.
Additionally, the continuum of care requires that information from various visits of the patient be collected and be recorded in one place to enable tracking of patients’ status. Electronic recording of information ensures that this aim is achieved thus boosting the continuum of care. Moreover, EHR gives patients to access and the ability to manage their medical records. This is essential in ensuring that patients are encouraged to take care of their health conditions.
Arguably, EHR has highly reduced the cost of health care both on the part of patients as well as the health institutions through many ways. Firstly, the cost of filling patients’ information, the cost of purchasing stationery for paperwork and the cost of having many records staff is either eliminated or reduced. Secondly, EHR leads to evidence based medical decisions thus reducing cases of patients going back to health institutions to seek further medical care. Moreover, EHR has made the whole process of health care provides effective and efficient thus reducing costs that have to be incurred (Carter, 2008).
Similarly, the use of EHR can enhance communication and sharing of information between various health personnel. This improves teamwork among various professionals in the medical field. Moreover, this is influential in improving the continuum of care and helps in ensuring that patient safety is promoted. Additionally, EHR eases the process of tracking and reporting health concerns about patients. Lastly, the system makes information easy to read because it is always typed, unlike manual records where handwriting can be problematic.
The Influence of EHR on Continuum of Care
Continuum of care entails making critical information about a given patient available for easy administration of medication. It is important to note that patients can sometimes be very ill to the extent that they are not able to provide information about their medical history. Moreover, patients receive treatment from very many different health professionals some of whom might not be aware of the patients’ medical history. According to the continuum of care principle, intensive care services given to any patient must be easy to retrieve whenever required (Hovenga & Kidd, 2010). However, it would be impossible to get any medical information if the same is recorded manually. Besides the fact that it would be practically impossible for everybody to move around carrying his or her medical records, this method will highly jeopardize the principle of confidentiality.
EHR comes in handy to help in boosting the continuum of care. EHR cannot only record but also enable tracking of patient information. The electronic mode of record-keeping can easily consolidate information about a patient which makes retrieving quite easy and precise. On the same note, the continuum of care is about enhancing the quality of care. The decision support system that is incorporated in HER ensures that the quality of care given is within the continuum of care.
Furthermore, EHR gives health care providers the opportunity to key in the correct information about a patient thus enhancing credibility. It is important to note that EHR records are difficult to manipulate thus they give information with a high degree of accuracy which is vital for a continuum of care. In line with the continuum of care requirements, EHR is vital in improving patient follow up even after they have left health institutions (Roach, 2006). Moreover, the ability of EHR to store data regarding patients’ symptoms is crucial in informing health care practitioners what to do in case of an emergency. Consequently, the continuum of care and EHR are two inseparable issues.
Stakeholders and their Roles
Any system can only succeed if its stakeholders are willing to work towards ensuring its proper implementation. Medical practitioners are obviously among the major stakeholders both in electronic health records and the continuum of care. They are supposed to ensure that they enter the correct information whenever a patient comes to seek health services. Procedures of EHR should be tested by medical practitioners to ensure that they are up to standard. It is important to note that medical practitioners are the main people who need to share information to improve the services they give to patients. Consequently, their needs should be taken into consideration whenever EHR is designed (Busch, 2008).
Arguably, patients are the core of the system. Without their support, the success of the system will be very limited given that the information stored in all about patients. As a result, patients’ needs should be given emphasis. To begin with, patients are expected to give correct information regarding their health status to help in enhancing the credibility of information stored. Sensitive information is recorded in databases and it can easily get its way into unauthorized personnel. It should be noted that patients’ information should be confidential and only released to legalized people. As a result, the EHR system should ensure that patients’ information is confidential.
The government is also another stakeholder in this whole system. It is the role of the government to set out guidelines that must be adhered to by the software. Security of patients’ information should be ensured while at the same time away should be found to ensure that patients’ consent is sort whenever necessary. In short, all legal requirements regarding patients’ information must be adhered to. A legal framework is necessary to make certain that the continuum of care and EHR does not violate any law (Carter, 2008). All these can be achieved through the involvement of the government when designing the systems.
EHR and Interoperability
The system of EHR improves the process of sending and receiving data thus making it more secure and reliable. A patient’s information can be sent from one health institution to another very fast without passing through very many people thus reducing the probability of the information being tampered with. The ability of any system to transfer information between any given institution along a standardized data protocol is referred to as interoperability.
This ensures that all health information is recorded using a common language that is understood by everybody across the board while taking into consideration the legal requirements of security and confidentiality. Interoperability is very crucial in the continuum of care given that tracking of patients’ information is paramount (Negelkerk, 2005). EHR databases are designed while taking into consideration all these factors because interoperability is among its aims.
For interoperability to be effective, certain factors must be put into consideration. To begin with, there must be guidelines in place to regulate the process of sharing information and ensure that various legal aspects are adhered to. This will also ensure that there is a common understanding regarding what to expect from every stakeholder. Moreover, it will be crucial to outline the protocols that should be followed and the role that each stakeholder will play. On the same note, demand for Interoperable applications should be taken into consideration so that the system designed can accommodate the diverse needs of stakeholders (Porter-O’Grady, 2009). Most importantly, it would be vital to test and access the applicability of the system before rolling it out. This will ensure that the possibility of the system breaking down is minimized.
Challenges Facing EHR
Implementation of EHR has not been very successful because of various challenges. To begin with, the system needs state-of-the-art technology and this has been hard to develop because of the high number of needs to be catered for. On the same note, the technology used requires that medical practitioners be trained on how to use it for easier application. Unfortunately, people are not ready to attend training sessions. It is hard to implement a system that many users do not know how to use.
Moreover, various institutions want as minimal disruption to their daily activities as possible to reduce losses (Hovenga & Kidd, 2010). In this regard, they will avoid any activity that will disrupt their operations or increase their expenses. These institutions argue that EHR will cause a lot of disruption to their activities thus causing harm and expansion of budgets. Therefore, they are unwilling to support its implementation.
Furthermore, some clinicians have argued that their productivity will drop significantly in the early periods of rolling out the system because they will take much of their time learning how to use it. On the same note, they state that there are bound to be a lot of mistakes that will consume a lot of time correcting thus affecting their output. Worse enough, some administrators have supported these clinicians and together they are working to oppose the implementation of EHR. Similarly, designing of EHR has not been able to boost the transfer of information among the concerned parties without any problem. Exchange of data is usually faced with hiccups thus challenging the basic aim of EHR (Busch, 2008).
Arguably, the law itself is another major challenge to EHR. It is expected that EHR will be integrated among various states and meet the demands of every stakeholder. Moreover, EHR is supposed to abide by all the legal requirements regarding information records of patients. However, this is difficult given that the legal requirements are different in various states. Moreover, the infrastructure needed to enhance the implementation of the system should be reliable because retrieval of information is done round the clock. Regrettably, information technology departments of many organizations have failed to provide a credible infrastructure which has led to frustrations (Lehmann, 2006). These have demoralized many stakeholders from using the system.
Furthermore, various specialists in the medical field have unique workflow requirements. These require the use of specific software to cater for them. In some instances, even the hardware to cater for these different and sometimes special needs is different. Consequently, there is a challenge when it comes to choosing the products to use in the implementation of the EHR system since each special need is supposed to be taken into consideration.
Additionally, the system will require huge capital investments before it starts running while its benefits will start trickling in much later. However, the stakeholders are reluctant to tie up their money in a project that will not quickly bring in returns given that they are not even sure that it will work. On the other hand, medical personnel are not ready to commit their time and help in the implementation of the system (Busch, 2008). Without this support, it will be quite difficult to roll out the EHR system.
Future Issues of EHR
EHR will have to be more inclusive in the future. The system must be designed in a manner that will accommodate the diverse needs of each stakeholder, especially the specialists. It would also be important to note that besides the needs of stakeholders being different, they keep on changing with time. As a result, the EHR system will have to be flexible to allow for any future adjustments. Moreover, the system will require continuous quality improvement even after implementation (Carter, 2008). Therefore, it would be prudent to put in place a mechanism to ensure that software and hardware maintenance is done regularly.
Furthermore, technology keeps on changing with time. What is useful today might be redundant tomorrow. However, information technology is an important component of the continuum of care and EHR. As technology changes, there would be a need to either advance or completely change the technology used to offer services. Therefore, information technology departments of various institutions should be prepared to ensure a smooth transition in case of technological changes. Moreover, to motivate stakeholders to embrace EHR, phase implementation will be crucial. The initial phases should be able to produce returns in a relatively short time to motivate people to be ready for the long term phases.
On the same note, the health care industry is highly fragmented making it difficult for a common EHR system to be implemented. The relationship between various stakeholders is known to change regularly making it difficult to know which type of need to consider. Therefore, there is a need to harmonize the health care sector so that the needs will be more or less uniform and relatively stable (Hovenga & Kidd, 2010).
Conclusion
EHR is crucial not only for the continuum of care but also for the whole health care sector. It will enhance information sharing which will lead to informed decisions thus enhancing patient safety. However, implementation of the system will only remain experimental if all stakeholders will not cooperate to ensure implementation succeeds. The fragmentation that is currently prevalent in the health care sector will have to be eliminated or EHR will forever be fit for a selected few.
References
Busch, R. S. (2008). Electronic Health Records: An Audit and Internal Control Guide. Hoboken: John Wiley & Sons.
Carter, J. R. (2008). Electronic Health Records: A Guide for Clinicians and Adminstrators. Philadelphia: ACP Press.
Hovenga, E. S. & Kidd, M. R. (2010). Health Informatics: An Overview. Amsterdam: IOS Press.
Lehmann, H. P. (2006). Aspects of Electronic Health Records Systems. New York: Springer.
Negelkerk, J. (2005). Study guide for Leadership and Nursing Care Management. Amsterdam: Elsevier Health Sciences.
Porter-O’Grady, T. (2009). Interdisciplinary Shared Governance: Integrating Practice, Transforming Health Care. Burlington: Jones & Bartlett.
Roach, W. H. (2006). Medical Records and the Law. Burlington: Jones & Bartlett Learning.