Introduction
Medical records are a crucial tool for clinicians in the provision of health care to patients. For more than a century, these tools have been used to record observations, provide knowledge, justify the proposed medical intervention, and monitor the performance of a patient. Traditionally, doctors all over the world have utilized paper-based medical records (PMRs) in their practice. In spite of their long use, PMRs suffer from significant shortcomings including poor legibility, disorganization, and incompleteness. Using PMRs therefore has a negative impact on the efficiency of the doctor and this has led to the provision of lower quality care for the patient.
As the health care industry has grown over the decades, new technology has been utilized to increase efficiency. Medical records have evolved to exploit technological innovations and today many nations are starting to rely on Electronic Medical Records (EMRs) in place of PMRs. Lau et al. observes that increased investments are being made for electronic medical records by hospitals in developed nations (1). It is therefore worthwhile to investigate if EMRs are indeed the wave of the future. The paper will undertake an informative research into EMRs and their impact on physicians. It will conclude by noting that while electronic medical records are not yet matured, they are a great improvement to the paper based medical record system.
What are Electronic Medical Records?
By definition, an electronic medical record is a digital version of the paper based medical records and it fulfills the requirements of recording and communicating patient information. EMRs contain data on a patient’s medical history and the doctor is able to enter real time data on diagnosis and treatment of the patient (Rustagi and Singh 142). EMRs are supposed to replace paper based medical records (PMR) which have been used traditionally by clinicians. PMRs have been essential tools for documentation and communication in relation to patient care delivery. However, these traditional means have suffered from the major demerits of illegible handwritings, incomplete date, and date fragmentation leading to problems in the quality and continuity of care.
A basic EMR acts as a simple electronic storage system with all the information of a PMR system entered into the EMR database. More sophisticated EMR systems contain system-generated templates into which the doctor enters medical information (Terry et al. 509). A typical EMR system comprises of an initial history of the patient, fields for inputting clinical notes, an exhaustive list of medical conditions, and fields highlighting the tests carried out and the results obtained (Furukawa 297). EMRs help to deal with the inadequacies of PMRs and include more detailed information on the patient’s history. EMRs also provide computer-generated health care suggestions based on the problems recorded by the physicians and the test records. The doctor also gets automated reminders for patients who need to be attended. The EMRs documenting method has gained increasing popularity in the recent years with its supporters stating that it will be the documentation tool of the future.
Benefits of Electronic Medical Records
EMRs have significantly reduced the risk of medical errors. Doctors using EMR systems have a greater and easier access to medical reference information and they are therefore able to prescribe the relevant medication to the patient. Since the patient’s medical information is easily accessible, the doctor can check on detailed patient issues such as drug tolerance, allergy information, and drug interaction (Kahn and Ranade 188). Medical errors can therefore be avoided since the physician has all the relevant information. The switch to electronic medical records by most doctors and hospital in the US has already resulted in improved safety.
There is evidence that EMRs improve quality in guideline adherence by medical practitioners. Lau et al. state that use of EMRs results in increased consistency and accuracy of patient record content (1). Furukawa notes that EMRs encourage physicians to adhere to evidence-based guidelines leading to greater consistency in health care and better health outcomes for patients due to the use of best practices by doctors (298). Using EMRs ensures that the health care services provided by the doctor are consistent with current professional knowledge therefore increasing the positive health outcomes for the patient.
EMRs assist in the communication between doctors therefore improving the quality of health care provided to the patient. When paper based medical records are used, clinicians might put down inaccurate and incomplete information. By their very nature, EMRs force doctors to enter accurate information since inaccurate information will be deemed invalid by the system (Tang, LaRosa and Gorden 246). The information presented will also have to be complete since there are templates and the doctor has to fill in data in each field. If the doctor does not fill in each field, the system will flag this as an inconsistency. The transfer of patients across and within the health care settings can therefore occur in a seamless manner since the new doctor will be presented with a complete medical record of the patient enabling him/her to have a comprehensive and accurate medical history of the patient.
Doctors are able to make more informed decisions especially in the cause of returning patients with the help of EMRs. With the traditional record keeping system, the decision-making capability of physicians was hampered by lack of access to relevant patient information. Greiver et al. acknowledge that PMRs are easy to replace and even when they are found, they might lack compete patient information (2). Physicians using PMRs are therefore forced to delay their decision until they can retrieve the necessary information, or make decisions with incomplete information on the patient. EMRs provide the doctor with complete information and in a timely fashion making it possible for him/her to make competent decisions based on good information.
EMRs can help to promote preventative health care and therefore increase the health outcomes of patients while reducing the costs associated with health care. EMR systems have proved to be potent tools in the prevention of childhood obesity. This is an important contribution considering the fact the prevalence of childhood obesity has risen from 5% to 17% over the past 30 years and one-third of children today are overweight or obese. Childhood obesity has negative health outcomes and is estimated to cost the country an excess of three billion dollars each year. Bode and Roberts reveal that EMRs help improve in the documentation of preventable disease such as obesity (115). EMRs improve the quality of preventive care by having prompts that indicate when a patient has a higher BMI facilitating diet treatment and exercise in good time therefore reducing the risks of the disease. By observing the data on BMI percentiles and BMI growths through the EMR, a doctor can diagnose the risk of overweight and obesity during the early stages. Preventative care can then be recommended therefore addressing the imminent problem.
EMRs have the potential to reduce the overall health care costs. Health care in many developed nations continues to be excessively high making universal access to health care impossible in some cases. While EMR systems do not purport to cause major reductions in health care services, these systems can foster modest reductions in health care (Rustagi and Singh 143). By making patient medical records easily accessible across health care providers, EMRs will foster coordinated care and avoid duplicate tests that lead to higher costs of health care.
EMR systems make the sharing of patient clinical data between facilities easy which increases the efficiency of health care provision. Current EMR systems are built with interoperability in mind and systems in hospitals are supposed to easily read data inputted from systems in other hospitals. Carrying out of research is also aided by these systems since comparing electronic data across the health care sector is easier. As far back as 1873, the celebrated founder of modern nursing, Florence Nightingale pointed to the inadequacy of PMRs in helping clinicians to detect trends and compare notes across the health care system (Tang et al. 246). EMRs do not suffer from this setback making them potent tools for medical research. Studies on the effectiveness of medical treatments are easier to carry out using EMRs.
Disadvantages of Electronic Medical Records
EMR technology is expensive and doctors must make a substantial initial investment when moving to this system. In addition to the initial high cost of getting the system, there are other expenses that have to be incurred. The system needs regular maintenance, and this cost has to be provided for by the doctor or the hospital administration. In addition to this, technology is constantly changing and upgrades will have to be undertaken along the way. Maintaining an EMR system is therefore very expensive compared to the PMR system where all the doctor needed where paper files and cabinets to store the file. Gill contends that if a doctor is not able to fully utilize the EMR in his practice, there is great possibility of it becoming “just an expensive system for storing patient charts” (514).
This system can lead to negligence by the doctors due to the automation of some of the aspects of record keeping. This is especially evident when it comes to filling in test values. EMRs can lead to pitfalls as health care professionals rely more on templates, which can automatically fill in laboratory values (Gill 514). Instead of running laboratory tests to come up with the independent test values for the patient, doctors can make use of the values provided by the EMR with catastrophic results. Patients will suffer if the doctor relies on auto-generated data instead of running the tests by themselves.
EMRs can overwhelm physicians due to the availability of too much data. The ease with which data can be entered into EMR systems may lead to the input of excessive data. This will make it harder for the doctor to identify meaningful data as they have to shift through the vast amount of data recorded. Kahn and Ranade agree that EMRs can be a rich source of highly detailed clinical data but that this level of detail makes it harder for doctors to use the data in a clinically meaningful way (186). The efficiency of the doctor might therefore be reduced because of EMRs.
EMRs are more prone to tampering by a third party compared to PMRs. Gill observes that access to electronic records by unauthorized persons is easier than access to paper based records (514). Some EMRs make it possible for hospital data to be stored at a central location making it accessible to more people. Even with password restrictions, the data is more likely to be obtained by unauthorized personnel than if it was in paper files. This presents a privacy concern as well as the concern about tampering where the intruder might alter the medical records.
EMRs have contributed to the presence of incomplete information as health care providers make the move from PMRs. Physicians have not fully adopted EMRs and most continue to rely on PMRs in their practice. In health care settings where EMRs have been fully implemented, PMRs continue to play a role in medical data recording (Greiver et al. 1). A national survey of physicians in Canada revealed that most physicians continued to use paper and electronic medical records simultaneously. This leads to a scattering of data across the two different systems therefore increasing the amount of incomplete and duplicated data (Greiver et al. 6). Incomplete data leads to poor services being offered to the patients.
Implementation of Electronic Medical Records
Implementation is the most challenging part in the adoption of EMRs in health care settings. To begin with, it requires health care providers to invest in the necessary infrastructure. Doctors need to be provided with hand held devices for the real-time entry of medical data. Private practitioners have to buy these devices on their own making it significantly expensive to shift from paper based medical record keeping to EMRs. The move to EMRs necessitates the digitization of old patient files for storage in the EMR database (Fisher 1). Health care providers have therefore had to engage in the labor-intensive task of transcribing data from PMRs into EMRs. This task has made the implementation of EMRs more complicated due to the inherent financial and time requirements of the activity.
In recognition of the challenges inherent in switching to EMRs, the Federal government has provided financial incentives for hospitals and doctors to encourage them to adopt EMRs. Gill documents that in 2009, the government allocated $20 billion to help the health care industry adopt IT systems including electronic medical record systems (513). This financial incentive will help reduce the cost that health care providers will face as they move to the electronic system.
In addition to the financial incentives, the federal government has also set up regulations to catalyze the deployment of EMR systems on a national scale. The federal government will require all health care providers to adopt EMRs by the year 2015 (1). Deployment of these systems has proved to be a challenge since it requires computer literacy and additional training for the user. However, doctors have started to make the gradual change to EMRs and familiarize themselves with the system.
Impacts on Standard of Care
The move from paper-based records to EMRs has led to expectations that there will be significant improvements to the quality of care provided to patients. EMRs improve communication between health care professionals, therefore improving the quality of health care provided to the patient (Gill 513). Doctors are increasingly required to work in a collaborative fashion. The ease of access to medical records among collaborating doctors will ensure that the patient is offered the highest standard of care.
EMRs assist in the early identification of mistakes by health care professionals and corrective measures can be taken in good time. These systems have inbuilt alerts which are issued when inconsistencies are noticed or when the doctor commits an error. For example, EMRs will help in the identification of potential drug interactions and abnormal laboratory values therefore preventing negative outcomes for patients (Kahn and Ranade 188).
The move to EMRs will encourage quality assurance in the health care industry. There is increased focus on using performance data to measure quality and foster accountability among doctors. Technology can help to facilitate the attainment, monitoring, and implementation of quality-oriented services by doctors. EMRs enable health care providers to assess the quality of health services by making these services measurable. These systems make it possible to measure the quality of care that patients receive from health care providers. The ability to quantify services makes it possible to improve on the activities undertaken by the health care professionals. As a result, the quality, accuracy and completeness of information in medical records become integral to the provision of good care to patient and the improvement of quality (Greiver et al. 1).
Standards of care provided are raised as doctors have to be more attentive when they are using EMRs. When the old paper based medical recording system is used, doctors may lack motivation to be meticulous in their work. This is because in the event of significant error that causes great damage to the patient, the doctor can amend his records to protect himself medically and legally. EMRs offer a safeguard against such a lack of accountability by health care providers (Rustagi and Singh 143). Records inserted into the EMR system are time locked which means that the doctor cannot tamper with the records by amending them in case he/she made an error. The accountability of physicians has therefore been enhanced by EMRs since the clinicians know that their mistakes are easy to identify during an investigation. EMRs have therefore increased the level of services that patients receive from their caregivers.
Safety Concerns
Electronic systems are not flawless and they might contain bugs that will lead to errors. If the system is not monitored constantly, these errors might go undetected. The impact of system errors in EMR system is more damaging that errors made through the PMRs (Terry et al. 510). Concerns have been raised that small mistakes in the programming logic of EMRs could have negative impacts on many patients.
The requirement by EMRs for information to be provided in appropriate fields can lead to safety issues. Patient safety might be compromised if the clinician enters information in the wrong field (Tang et al. 246). A different doctor reviewing the patient file will not be able to get the information entered in the wrong place and this might lead to ignorance of important diagnosis leading to wrong medication.
EMRs might increase patient safety by reducing the number of corroborative tests that doctors undertake. Under the paper-based system, doctors could run tests to confirm the results of a diagnosis. EMRs encourage doctors to make use of historical information and avoid running duplicate tests. This might compromise patient safety since the proficiency of all doctors is not similar. Greiver et al. assert that the usefulness of the information provided through EMR is dependent on the quality of data entered into the EMR (6). This quality is dependent on the skills of the doctor and when unreliable information is inputted, the health of the patient will be affected.
There is a risk of error propagation through EMRs leading to safety issues. EMR systems are fitted with auto-fill and “copy forwarding” functions to enable physicians enter data faster (Furukawa 299). These functions are meant to reduce the amount of typing needed and therefore save on time and effort on the part of the physician. This presents a major risk since in most cases; doctors do not correct or update the new information being made. As such, any previous misinformation may be propagated.
The Effects on Doctors
EMRs have increased the level of effectiveness and efficiency by most physicians. Doctors feel that they are able to make better use of their time when they are using EMRs. By their very nature, PMRs are time consuming and doctors use up a significant amount of time retrieving, recording, storing, and updating patient records. A report by Tang et al. indicated that the tasks associated with paper based record keeping took up to 38% of the doctor’s time when dealing with returning patients (247). Considering how busy doctors are, any reduction in time spent record keeping would be desirable. EMRs assist physicians to realize this goal therefore increasing the level of satisfaction. The systems have also improved efficiency by assisting in the tracking of relevant information when doctors are working in collaboration. These record keeping systems have improved legibility and organization of data making it easy for a doctor who is familiar with the system to find information.
EMRs decrease the level of frustration that doctors feel in their work. The traditional record keeping systems are cumbersome and led to delayed decision-making due to incomplete or unavailable patient records. This increases the level of efficiency for clinicians causing them to be frustrated as their efforts to provide patient care are hampered. The dissatisfaction felt by physicians because of the limitations of traditional record keeping systems is highlighted by empirical studies which indicated that physicians regard PMRs as an inadequate tool to support their activities of patient care provision (Tang et al. 247).
The systems have led to increased attentiveness leading to improved quality of care to patients. Doctors perceive that EMRs enable them to provide improved care especially for outpatients through the reminders and tracking features of the systems. EMRs enable doctors to easily monitor and keep track of their patients. EMRs can be configured to provide automated reminders and prompts indicating that a test is due or follow up needs to be done on a certain patient (Rustagi and Singh 142). Doctors do not need to go through their records searching for patients who need follow-up or who require testing.
EMRs have eased the task of billing for doctors ensuring that they are adequately compensated for their services. While health care provision is the primary concern for health care practitioners, billing is an integral part of the health care system. Kahn and Ranade note that EMRs provide detailed level of data which makes it possible to accurately calculate medications charged and the tests undertaken (186). EMRs also help avoid fraud by incorporating the rules regarding billing and documentation.
In spite of the inherent advantage of EMRs, some doctors feel that they have to enter too much irrelevant information in the system. When a patient visits a doctor with specific symptoms, the EMR requires the doctor to obtain a significant amount of background information from the patient. Fisher confirms that EMRs require physicians to key in “ever-increasing amounts of in information of no relevance to the patient’s presenting problem” (2).
Transition to the system increased the efforts required by the doctors leading to resistance. On introduction, EMRs lead to a slowdown in productivity as doctors get to familiarize themselves with the new system and gain proficiency. Doctors also had to undergo training on how to use the new system A study by Terry et al. revealed that in most settings, EMRs received an initial negative reaction from doctors due to lack of familiarity with the system (512).
Patient Perspective
Patients perceive that EMRs have an adverse effect on the privacy of their medical records. They have therefore raised concerns about their privacy when these systems are utilized. Patient privacy is especially an issue of concern for individuals with psychiatric conditions or those being treated for substance abuse. This data is then stored in the hospital computer systems where it can be retrieved easily by the authorized personnel. A reality with electronic data is that copying and transmitting files saved in an electronic format is easier than doing the same for paper records. In the event of a health data security breach, this information which is regarded as personal by the patient, might be available to unauthorized persons (Rustagi and Singh 144). While an intruder can break into the physician’s office and steal medical records, the likelihood of this happening are very low. Patients are therefore apprehensive that their private medical records will find their way into the public sphere if the hospital’s computer system is compromised.
Patients perceive that EMRs will reduce their rights in the health care system. One of the purported advantages of EMRs is the ease of clinical data across health care providers. This advantage might come at the expense of patient rights as the data could be used without the informed of the patient (Fisher 1). Doctors using EMRs have to ask patients a lot of sensitive medical information and input the same to the system. This information might then be used to run medical research that will benefit the community. Without receiving consent from the patient, such activities will be a violation of patient rights.
Patients perceive an increase in efficiency when they visit their health care providers due to EMR systems. The time that a doctor takes to trace a patient’s record is greatly reduced when using EMRs (Furukawa 300). The patient therefore spends less time waiting for the doctor to retrieve his/her records and more time being served by the doctor. In addition to this, the ease of record retrieval has led to increased access to health information by the patient.
Discussion
Medical records are integral for many tasks including documenting complicated treatment protocols, assisting in decision making when ordering for tests, pharmacy intervention, supporting billing, and communicating information to patients and other doctors. Effective methods of keeping medical records are integral to improving the standards of health care provision. EMR systems have emerged as the means for ensuring efficiency and therefore promoting quality health care. The adoption of EMRs by physicians in the country is picking up pace and it can be expected that these systems will be the standard in the near future. In the US, billions of dollars worth of financial incentives has been provided to the health care industry to catalyze the deployment of EMR systems on a national scale. These systems are projected to be fully implemented in all health care facilities by the year 2015.
This paper has observed that EMRs have many advantages to the patient and the doctor. However, for the full benefits of the EMR to be realized, the doctor has to have an advanced knowledge on the use of EMRs. The implementation process has major barriers and the efficiency of doctors during the early stages will be reduced. The transition process is bound to be frustrating for some and it might lead to a slowdown in work and productivity by the doctors. However, as the doctors overcome their reluctance and learn how to work with the system, they are able to integrate it into their everyday practice and reap its benefits.
Conclusion
This paper set out to argue that EMRs are the wave of the future. It begun by defining what the EMRs are and proceeded to highlight their merits and demerits. From the discussions provided, it is clear that the advantages of the systems far outweigh the disadvantages. The overall impact of EMRs on the health care system is positive and as such, the system should be embraced universally. The paper has observed that while EMRs are prone to human errors just like PMRs, the level of errors in EMRs is markedly low and furthermore, there are continuous efforts in play to build safer systems. Although EMR systems have a number of significant challenges to overcome before they can be fully beneficial, these systems have already proved to be a great improvement to the paper based medical record keeping system.
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