Introduction
The Electronic Medical Records (EMR) is a comprehensive longitudinal electronic record of patients and depending on the individual system’s design; it may incorporate the patients’ demographics, progress notes and other relevant medical records thus providing a streamlined workflow for the clinician. With proper design and implementation, the EMR can be able to produce a full record of the clinical patient encounter. A new design that incorporates a service-oriented architecture (SOA) and combines with web services promises new benefits of interoperability of EMR systems. The benefit of having web services for the system is that there already exist several standards for web services whose systems having a web service provision can be ported or interlinked with other similar systems.
The use of EMR heralds a chance for improving international cooperation in the medical field as technology becomes affordable and widespread. Electronic health records help to improve the quality of care while saving the implementation cost. EMR provide a converged single system for managing eight components designed to enhance patient’s safety namely; health information and data, management of results and order entry, decision support, electronic communication and connectivity, patient support, administration and reporting and population health management (Wang et al., 2003).
Strengths
Implementation of the electronic health records provides the benefits of a faster and accurate delivery of guideline based care whilst providing surveillance and monitoring capabilities. Electronic records eliminate the difficulty of interpreting poorly handwritten records by medical staff. It increases the turnaround time for lab results in emergency departments as well as the administration of the first dose of antibiotics for in-patient nursing units. Other areas that benefit from electronic health records are the cardiac related risk factors in patients and patient recalls which are more effective in the ambulatory care. Electronic Health Records make it easy to identify patients qualifying for research studies, a task that is otherwise difficult to accomplish. The system reduces duplication and makes health information better to consumers (Barey, 2009).
EMR is an opportunity for the nursing profession to build on their understanding of research, evidence-based practices and innovation as they optimize patient care and health outcomes. This is because EMR is a transformation from a disconnected, inefficient paper based segments of care delivery to a nation-wide interconnected and interoperable system (Barey, 2009).
Weakness
Implementation of EMR stretches the capacity of change for health organization because of its multidisciplinary requirements. Currently, there are very many standards for EMR and therefore integration of one system is difficult because of the human flexibility factor. Individual vendors develop systems based on the requirement of their clients, regardless of their compatibility with the systems of other vendors. Secondly, security concerns make EMR designs rigid in their support for on-demand computing. An ideal system has to offer a provision that allows discovery of application level services such that there is a just-in-time integration possibility for newly reconfigured, assembled and delivered on demand services.
Chaudhry et al. (2006) indicate that other than the direct benefits over paper records, there is little information that is helpful for stakeholders wishing to adopt the EMR on other ways that they can increase their benefits of having a quality and efficiency improvement of the complete patient care. Furthermore, the database management programs in use on most EMR designs have no capacity for scaling up to become multi-functional and be commercially viable in a large-scale distributed setting.
The EMR implementation is technical and requires users to acquire additional knowledge on how to work with electronic documents and devices. Informatics nurses become invaluable to this process of healthcare organization learning through all aspects of selection, design, testing, implementation and development of the health information systems. The need for Informatics nurses presents additional costs to the implementing agencies as well as additional challenges in the task of coordinating the learning experience (Murphy, 2010).
Opportunity
The uniqueness of healthcare and its need in the lifetime of patients offers opportunity to develop more EMR to cater for the need to converge different aspect of health care management. An existing need to be able to monitor and evaluate health threats in a community, disease trends warrants the use of a system that improves the planning, decision making and care delivery of the health system and the EMR fits this description. An integration of geographic information systems with EMR makes it possible to view the prevalence of diseases in real-time standpoint (Kraft & Androwich, 2009).
The EMR is a comprehensive longitudinal electronic record of patients and depending on the individual system’s design; it may incorporate the patients’ demographics, progress notes and other relevant medical records thus providing a streamlined workflow for the clinician. With proper design and implementation, the EMR can be able to produce a full record of the clinical patient encounter. A new design that incorporates a service-oriented architecture (SOA) and combines with web services promises new benefits of interoperability of EMR systems. The benefit of having web services for the system is that there already exist several standards for web services. These systems having a web service provision can be ported or interlinked with other similar systems.
As described by Raghupathi and Kesh (2007), when the EMR design incorporates a SOA, then its usefulness is increased because of the single type instance where each user accesses the system without preventing access of other users. In addition, the design can ensure that multiple services have the same interface and a single service can implement several interfaces. The whole architecture is loose and allows integration of additional services as needs arise. In the SOA design, consumers do not need to be conversant with the platform running services such as the middle layer, the application layers and the communication protocols. The design should ensure that services remain independent of their implementation, making it possible for system integrators to build applications without necessarily having the knowledge of the underlying implementation.
Open source architectures present the missing option for just-in-time integration capacities. The Eclipse Platform developed by the Open Healthcare Framework seeks to eliminate the issues of interoperability of EMR systems, reduce the provision that force the implementing agency to source the system from a specific vendor, increase the flexibility of EMR and provide universal standards for development and extension of the system and other related systems (Raghupathi & Kesh, 2007).
The enactment of the HIPPA privacy act that governs electronic health care record systems, which was formulated as a protection of the rights of individuals as they access healthcare, presents a solution to some of the security threats of the EMR system. The act provides security measure obligations for the entities covered and sanctions for staffs violating them in any way. Integrity of information and its protection is enhanced by the requirement of noting the access from the perspective of what information was accessed and by whom (McGonigle, Mastrain & Farcus, 2009).
Threats
Widespread adoption of EMR is limited by the fact that most community practices and hospitals lack the necessary resources to implement an EMR. As EMR becomes widespread and interlinked among health care institutions, security and privacy concerns increase and the task of solving these cases magnifies. An initiative to have a statewide or nation-wide health exchange for EMR has to overcome the hurdle of gaining the public trust on security and privacy of patient information. The benefits of the EMR cannot be fully realized without widespread clinician adoption of the EMR because of lack of optimization, in such a case, the system becomes a poor investment choice (Barey, 2009).
The lack of a standard coding and vocabulary for EMR threatens its interoperability among agencies at the state and national level as well as within departments of hospitals. Hospitals are located in diverse geographic regions having different ethnic languages yet their records need to be interoperable by staffs from other hospitals that use a different local language for communication. Therefore, EMR have to use a standardized international language. The computerization of physician order entry and other safety procedures implemented in EMR alter the present workflow design and present problems to physicians and nurses, thus adversely affecting the patient’s health care quality. The possible advance benefits of EMR can only be realized when patient records include their demographic variables like insurance and literacy level or their socio-economic status, which influence the choice and time of patient to seeking healthcare (Crosson et al., 2007).
In EMR implementations, focus has been on rational databases providing inter-enterprise applications but their scope has not been expanded to provide a fully functional and scalable distributed system. The idea of service compels health care organizations to change their health care processes and this includes changes in the organizational, cultural, political and technical changes. The lack of robust development tools coupled with the requirement that multiple providers at different levels of health care must work together to deliver quality care makes it difficult to adhere to the numerous security issues that arise with the implementation of EMR with incomplete standards.
According to Gans et al. (2005), there are many EMR systems making it hard for small practices to identify those that would meet their practicable needs. In addition, most practices are concerned with the stability of the various vendors when it comes to long-term after sale technical support. In their survey on the adoption of EMR, the authors note that most practices already implementing EMR cite barriers as a relatively weaker negative influence than for practices yet to implement EMR, thus highlighting the role of perception as a threat to EMR implementation. Small practices will cite their lack of capital to invest in EMR and the insufficient return on their investment given their small-scale operations. In other cases, the administration may not be fully engaged in the implementation process of EMR and therefore negatively affect their staff training in the skills necessary for efficient use of EMR. The lack of an assurance on the return on investment contributes majorly to the lukewarm adoption of EMR systems by administrators.
The damage arising out of malpractice is significantly increased with the availability of patient data across different practice in the whole system. Therefore, for EMR, the threat of a security breach or negligence is real (Smith, n.d.).
Conclusion
The concept of EMR and more particularly as a service-oriented architecture is a recent one; therefore, methods of measuring its efficacy are limited. In addition, personnel with the relevant expertise in designing the SOA systems are hard to find. The movement of the current EMR system to a service based system that offers interoperability presents a challenge on deciding the right amount of services that can be pooled together into a single system, which affects the reusability of the design in other facilities. The large number of health care provider organizations complicates the interoperability of an EMR. Furthermore, the use of simulated data in testing may not be truly reflective of the processing demands of health care services.
References
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