Executive Summary

Technology has been advancing till this very day and has brought us much convenience in our daily lives. With such technology available, it has yet to branch out its arm fully to the healthcare sector. Considering the needs from the technology savvy crowd, it should be made in a way in which it satisfies both the practitioner and the patients to ensure that they have a hassle- free medical journey.

“E-health captured a center position on the political stage in 2004 when President Bush announced a strategic initiative to radically increase the adoption of EHR systems in the United States by 2014” (as cited in National Economic Council, 2006). However, based on the findings so far, many clinicians are still not adopting this electronic health records and thus affecting the communications between their partners in similar fields.

Electronic health records are one of the technologies that aim to bridge the gap in between practitioner and the patients such that information of specified patients can be obtained within short period of time. With the flexibility of information of the patients, diagnosis can be done more accurately and efficiency.

Through the revolution in the healthcare industry, new technologies have been introduced to carry out surgeries and cure for patients more effectively. What remains unchanged is the way on how health records are being stored in the data as well as the repetitive action that patients have to do before they can get diagnose or seek cure from the physician- the manual way.

Thus this report will aim to identify the need of the electronic health records in the current technology advanced society as well as the impacts it bring about. By looking at the evolution of historical health records till the current electronic health records, it will then shed a light on the importance of electronic health records. An in- depth evaluation will be done to elaborate the pros and the cons of electronic health records and the future direction on how it will then cause change in our lives.

Background/Introduction

This paper explores this newly introduced technology which is yet to be widely used - the Electronic Health Records (EHR) which is similar to electronic patient records (EPR). To prevent confusion, EHR will be used in this report to represent both.

Online prescription and health screening have been made available but in actual, when one goes to a healthcare centre or any hospital, they will have to go through the hassle to fill in the form about their past medical history and relevant particulars in order to proceed further. Not only that, upon meeting any new medical personnel or doctors, they will have to repeat the same process again.

Appropriate care for people with multiple chronic conditions requires that clinicians be able to communicate with one another about their patients (Burton, Anderson, and Kues, 2004). It was also reflected that ineffective care coordination is a cause of poor care and a series of reports recommends that electronic health records is one of the ways of improving its quality ( as  cited in Institute of Medicine 2003b; Institute of Medicine, Board on Science Technology 2001).

What EHR does is that it enables clinicians treating people in a variety of settings to exchange and continuously update a patient's clinical data and then present that information in logical clinical groupings that other clinicians can access easily (Burton, Anderson, and Kues, 2004). This will improve productivity in any clinics that the patient visits. It also helps to highlight the important medical information to different physicians to prevention allergies or wrong prescription for cure.

Historical Perspective

It all started with John Kennedy’s vision of wanting man to travel to the moon and he founded NASA and the development of the space program. Lockeehed Corporation was the major beneficiary of grant money but with the mass amount of money that was granted to them, they have to extend it for in order for it to become a common good for the society (Pawola, 2011).

With the technology that they have in hand which was developed for the space program, Lockheed developed software to manage patient care so that it will be extended to the society (Pawola, 2011). Having this idea, they approached El Camino Hospital to work with industrial engineers to find out and analyze the flow of data before coding for the EHR system (Pawola, 2011). This is due to the reason being in the past, there are no computers available yet and thus without the technology, they have to do on site and experimental methods to understand how data can be transported from a place to another.

In the mid 1970’s, several major companies have heard of this new innovation and thus chose to implement it. However, due to the amount of limited resources, the system could not be expanded into full patient records (Pawola, 2011).

In the early 1980’s, companies who wish to adopt this new technology has increased. This includes several partners in the healthcare industry which tries out the system. But due to the lack of technology to support the mass amount of data as well as the management of the new system, many companies gave up this investment.

In order to support such innovation, technology is one of the main core components needed to support its functionality. It was also known that in order for smooth facilitation of such massive data, processing power was one of the major factors (Pawola, 2011). However, at that point of time, there were mid- range computers were housing limited systems which are unable to support such EHR system and thus lead to failure.

Moving on, with the technology introduced at the later years, it made possible for such EHR system to exist and it was better managed. This is because during the 1990’s,powerful PCs and servers was created and Microsoft was more focused on Desktop computing. “Overall cost of computing lessened with new emphasis on client-server technologies and communication network” (Pawola, 2011).

Therefore, this is how EHR is formed and the revolution of its growth to what it has become today.

Current Situation

Even at this advanced technology society that we are in, we often find ourselves still using the manual way – writing on paper, whenever we visit a new clinic or hospital. In a Health policy conference, participants reflected that they agree that the paper-based information systems still used by most clinicians are not well suited to good-quality care, especially for persons with multiple chronic conditions (as stated in Raymond and Dold 2002).

Another negative thing about paper- based information system is such that information storage is limited and retrieval systems have high rates of failure in retrieval and illegibility (Burton, Anderson, and Kues, 2004). It was also mentioned that human memory-based medicine is increasingly unreliable as human errors are almost unavoidable.  

At the same time, people are aims to use the EHR system for other usage as well instead just plain transferring of medical records and history. Other functions of the systems has to capture of clinical data which has become necessary for billing, appointment scheduling, prescription refills, and results reporting. All these factors and improvements of the systems drives out a main point- consumer' expectations for improved care and service are rising.

Although EHR has once been a “rising star” to many of the organizations in the healthcare industry, but without the appropriate platform for support and the technology available for further improvement, it has gradually became a “falling star”. Despite all the flaws it experience in the past, EHR is once again being introduced and now its position is currently situation at the rising star once again. This is due to the reason of the advance platform that we have right now and also with the increasing customer’s expectations.

Thus, with constant improvement and innovation available for EHR, it will definitely be a “dominant player” in the healthcare industry in no time. In figure 1, it shows how exactly per EHR looks like (NIH NCRR, 2006). Whenever or wherever the patients go, as long as the organization has implemented the EHR system, they will be able to get accessed to the information of the patient. There will be different applications that will be made available for the providers to update or check information of the patient base on the areas that they need. Figure 1 also clearly shows how data is being managed and updated by the providers. With the presence of the EHR system, data is always made accessible and it will thus lead to higher accuracy of prescription based on the different physician they go to.

The negative impacts of the EHR

EHR has shown tremendous positive effect on the healthcare industry, many of the physicians and patients are highly receptive of the implementation of such technology. However, EHR is not only positive; it has a negative side upon implementation too.

Firstly, looking from the patients’ perspective, there are several concerns raised. As we know that as long as the organization has signed a contract with the National Center Research Resources (NCRR), they will be entitled the permission to access to patients records and confidential information. But patients do not actually have a say in whether they approve or disapprove the clinic or hospital in getting their personal information through the system. Other than that, patients are also unable to limit the amount of information that is made available to the physicians or nurses.

Thus, confidentiality and security issues are concerns which are already prevalent in times when the paper- based information was used and it applies the same for EHR. As we understand how technology enables us to gather information within short period of time, the same applies for EHR too. EHR is “accessible from remote sites to many people at the same time” (as cited in Young 99) and retrieval of the information is almost immediate. Confidential and personal information can be updated and made easily accessible for organizations under the NCRR.

With such high accessibility, there will be chances that this confidential information might be leaked out accidentally in the course of transfer. Hence, this is one of the reasons why patients might stick to the old paper- based information system- they know what information they have provided to the organization and they have a larger control on what information is being shared.

Secondly, the implementation of EHR also concerns the physicians. From the feedback from the organizations which have not join NCRR, cost and return of investment (ROI) was their main concern in implementing the EHR system. The financial and time costs vary, depending on the extent of the clinical and administrative functions to be managed by the system (Burton, Anderson, and Kues, 2004). In a study of the financial benefits to insurers from primary care doctors in ambulatory care settings using an EHR, the cost per primary care physician of establishing and using an EHR ranged from $5,500 to $16,500 (as cited in Wang et al. 2003). Therefore, it might be quite impossible for small organizations or clinics to adopt the EHR.

Lastly, from a general perspective it is widely known that the technology that EHR uses is quite complicated as it encompasses different application for different users in one system. Hence, the readiness and the ability to adapt to this change is very important before deciding if EHR will really be useful to both the patients and the physicians. 

Physicians need to be convinced that the EHR will enable them to provide better medical care to their patients (Burton, Anderson, and Kues, 2004). While doing so, their level of adaptability must be also be high so that they will get use to the transition from the paper- base information system to the current technology of EHR. So one of the points mentioned by Gurley is such that the system has to play part as well- it must be user- friendly. Otherwise, even if such technology is presented to provide high efficiency and higher accuracy in cure will cause more harm and widespread of irrelevant information to the rest of their partners.

An article states that an interview with the early adopter of the EHR system, Miller and Sim (2004) found that a big obstacle is the extra time it takes physicians to learn how to use EHRs effectively in their daily routine (Gurley). Therefore, in order for EHR to serve as a tool to enhance overall performance in the healthcare industry, in- depth training must be provided to all staff to equip them with the knowledge of the system. In this way, with the information that the physician has updated, the other staff will be able to find it during times of need without hassle.

The positive impacts of EHR

The EHR enables clinicians treating people in a variety of settings to exchange and continuously update a patient's clinical data and then present that information in logical clinical groupings that other clinicians can access easily (Burton, Anderson, and Kues, 2004). This will enhance the overall customers satisfaction as shorter time will be taken for diagnosis and physicians has accurate information about based on the records in the EHR.

Other information about the patients which might be needed during emergency times can also be found in EHR. The following functions are found in the EHR: health information and data storage, results management, order entry and management, decision support, electronic communication connectivity, patient support, administrative processing, and reporting and population health management (as cited in Institute of Medicine 2003a).

This information will help the physician to understand the patients’ medical history including the allergies and special medicine prescription, which of the hospital or clinics that the patient have visited, point of contact during emergency. Convenience is this case was being enhanced as the procedure was being shortened from filling up the application form all the way till the end of the doctor’s prescription. Customers can also get their medicine at a faster rate without consulting the doctor while having the advantage of getting the correct cure. It also prevents some of the major problems faced when organization are still using the paper- based information system.

One study showed that Medicare beneficiaries with four or more chronic conditions were 99 times more likely to have an unnecessary hospitalization during the year than was a beneficiary without a chronic condition (as cited in Wolff, Starfield, and Anderson 2002). Therefore, with the usage of the EHR system, such problem includes unnecessary hospitalization, duplicate tests, conflicting clinical advice, and adverse drug reactions (Burton, Anderson, and Kues, 2004) will be lessened or even eliminated.

Furthermore, it also helps doctors and physicians by increasing their productivity as well. Doctors now can understand their patients within the shortest period of time and this will increase the amount of patients that they attend to per day. With EHR system, even if the new clinic or physician updates information of different patients, the system will automatically update the system instantly.

Future Considerations

In Figure 2, it shows how the future EHR will evolve into, modifying some of the purpose to suit different organizations. It might move towards the direction of suiting everyone’s needs, now including the patients themselves as well. Patients can update their health or syndrome that they experience in the data and send it over to their physician. All these activities and the updating of information can be done easily via the internet. From there, the information gathered will be able to help the country’s healthcare group in conducting clinical research to generate better cure and prescriptions to the patients. The information has to be approved by the patients beforehand and will only be carried out with the consent of both the patient and the physician. Thus it will ensure that the research is done ethically and no subjects will be harm or any information will be misused in any other way.

The future EHR will also help to address one of the problems faced now. As the cost of EHR is high, private clinics will be unwilling to participate in the implementation. However, with the presence of internet, EHR can also be used even in private clinics. This will eventually lead to high convenience for patients and private physicians too.

With the technology available, data can be transferred to the physician almost instantly. Therefore, X- Ray results can be done at a cheaper place and transferred at home to the hospitals for further prescriptions which will help patients in saving their medical fees. Besides that, patients will et to save their time in traveling down to and fro the hospital just to get the X- Ray done and to visit the physician after weeks. This also helps to enhance the storage of such data as the X- ray results will now be less likely to be lost.

Finally, EHR can be a part of M- commerce in the future too. With smart phone and the different ranges of high tech application made available for the phones, EHR might also be introduced and managed via phone. What patients have to do download an application which helps to identify relevant information (temperature, pulse rate, blood pressure etc) and their analysis will be done and sent it to their physicians for examination.  

Conclusions

In conclusion, the introduction of EHR has been a good start in the 1970s but due to the lack of support and technology, it ended up in no vain. With the current technology and the improvement that EHR has been evolved into, it is becoming a rising star once again. EHR is no longer a new technology or platform to share information; it will be widespread across the healthcare industry in no time due to the improvement of the technology and the boost in the economy that made it affordable to many as compared to the past.

In the near future, every place will choose to use EHR including private and small clinics. Besides keeping up with the latest technology, it was also implemented in order to satisfy customer’s expectations in the healthcare system even in those private and small clinics.

Last but not least, M- commerce which is on the rise currently will be incorporating such technology in the future to satisfy the future generation who are more technology – savvy than those in the 21st century. Especially when technology has moved on in such a rapid pace, EHR will definitely be incorporating in mobile, regardless if it is for the need of the patients or the physicians.

References

1.      National Institutes of Health, National Center for Research Resources (2006). Electronic Health Record Overview.

2.      Lynda. C. Burton, Gerard F. Anderson, and Irvin W. Kues. (2004). Using Electronic Health Records to Help Coordinate Care. The Milbank Quarterly, Vol. 82, No. 3 (2004), pp. 457-481.

3.      Brian E. Dixon. (2007). A roadmap for the adoption of e-Health. e-Service Journal, Vol. 5, No. 3, Special Issue: Practices and Outcomes in e-Health (Summer 2007), pp. 3-13 

4.   Lori Gurley. (2011). Advantages and Disadvantages of the Electronic Medical Record (2011). http://www.aameda.org/MemberServices/Exec/Articles/spg04/Gurley%20article.pdf