The electronic health record is a mean of organizing patient’s data making use in the field of information technology. Its purpose is to fulfill the various needs for information not only of patients and healthcare providers but also of other beneficiaries. The implementation of electronic health record system in health care organization is very complex and involves many parameters.
Introduction
Electronic health record is currently used by 12% of the physicians and 11% of the hospitals nationwide. Industry and government have promoted Electronic health record as a means of controlling costs and improving patients care. The electronic health record has become one of president obama main agenda and the investment necessary to ensure that within the coming years, all of America’s medical records are computerized. Today with the advance of globalization the electronic health record is still highly unlikely to advance in the next five years, governmental, technical and industry advances are adopting, which will drive the electronic health record in the hands of medical providers. The electronic health record (E.H.R) is a digital record of patient health information generated by one or more encounters in any care delivery setting. It contains information of the patient includes demographics, problems, medications, vital signs, past medical history, laboratory data and radiology report .
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The electronic health record also promises the removal of many barriers in the medical field such as – saving lives, money, and time, but unfortunately the fulfillment of this promise in the real world application has remained with a big question mark due to many factors cost of implementation, privacy and security. The following graph is the result of survey experts at nearly 3000 group practice nationwide. The table below lists barriers to Electronic health record adoption.
well known factors such as security and cost are cited as key factors, but other factors which is usability is not mentioned frequent is another barrier to the electronic health record adoption.
Usability is a primary concern
Usability issues are also a factor why electronic health record implementation fails. In a survey paper primary care physicians were asked the reasons why they did not use the electronic health record system. From the research finding 35% of the physicians listed specific electronic health record usability issues, the most common were: Problems with the screen navigation, and the lack of functioning and the concern that the data will be lost.
Anecdotal support for usability and Electronic health record failure comes from Cedars- Sinai medical centre of Los Angeles. They developed a $ 34 million computerized physician order entry system, but only included the input of a few physicians before launching it hospital wide in 2002 without thorough training Physicians who previously used to take notes by hand now required going through nearly a dozen screens and responding through numerous alerts for even common orders. Traditional doctors around 400 of them demanded its removal within three months of its launch. Poor usability can also endanger patient’s health. The electronic health record should be modernized helping the clinician workflow. In the year 1991, the institute of medicine released a report supporting the idea of implementing the Electronic health record within the coming years. In 2010, researchers believe only a small portion of health providers both public and private implementing the system. The implementation of electronic health record provides answers to many barriers in the medical world.
Background
An electronic health record is a digital or electronic record of the patient health information gathered over the history of the patient’s interaction with the health care system. An electronic health record stores all information concerning the patient health statues. Information varies and includes the following age/sex, medications, and vital signs, past medical history, laboratory data and radiology report. The concept of a medical report goes back to the fifth century B.C developed by the Greek physician Hippocrates, also known as the Hippocratic Oath. Hippocrates described two main goals behind his findings 1- a medical record should accurately reflect the course of disease 2- a medical record should indicate the problem cause of the disease. In the present days, the electronic health record first began to appear in the 1960s. Reported that at least 73 hospitals began to use the electronic health record system. In 1991, the institute of medicine released a landmark report recommending the electronic health record be implemented in health system within 10 years. Almost 20 years later, according to the latest researchers only a small portion of health providers have implemented electronic health record. A Meta analysis of diffusion rates of the electronic health record in the United States shows that an uptake has slowed in recent years. The study concludes Electronic health record is the future. President Obama administration has the electronic health record as one of its primarily agenda ‘the investment necessary to ensure that within the next five years, all of Americas medical records are computerized’. While still with the advance of globalization the electronic health record is highly unlikely within the next five years, governmental, technical and industry advances are adopting, which will drive the electronic health record in the hands of medical providers. The electronic health record also promises the removal of many barriers in the medical field such as – saving lives, money, and time. The question is still debatable whether the whole world will move towards the implementation of the Electronic health record. The electronic health record is one of the most important electronic patient data collection of our time and with the expanding population of the world it has become a necessity to implement the system in all public and private hospitals. The G.C.C region
Literature review
The opinions concerning the positive effects an E.H.R can have on patient’s health and whether all the healthcares in the world should step in and implement the system. The collection of personal health data is described to have many formats when speaking of systems that manage it. Reduction of the storage necessary to keep paper charts is also a noted as a reason to leverage an E.H.R freeing up of space better used for revenue generation. Paper charts have their own risk associated with them in terms of getting lost, productivity impacts to maintain and retrieve paper records and the resulting negative patient care (Carpenter 2002). An electronic health record system is the collection of data that is central to the patient (Rishel, Handler &Edwards, 2005). These opinions agree the importance of the E.H.R and implementation of the system. An E.H.R system exists to facilitate the storage, revival and continuity of the record itself (Gans, Kralewski, Hammons & Does, 2005). These opinions also strongly agree with the improvisation of the Medical record with the advances with science and technology. reversing the scenario, an E.H.R system can collect and aggregate information from other sources such as laboratory, X-ray and unstructured data like faxes or handwritten notes ( Wojcik, 2006) the scholar Wojcik agrees strongly with the use of E.H.R talking about the positive of the E.H.R reduces the storage of handwritten notes and stacks and piles of paper. The near term presents providers with realizing the digitization of the boxes of paper that is generated by patient encounters. These paper databases represent the clinical data that is ultimately needed to take EMR systems to the next level. The near term presents providers with realizing the digitization of the boxes of paper that is generated by patient encounters. These paper databases represent the clinical data that is ultimately needed to take EMR systems to the next level. Clinical data is the baseline in which all healthcare processes subscribe including decision support, health outcome analysis, billing and claims processing and health maintenance. Correlation and access to this data is what EMR systems seek to facilitate (Handler & Hieb, 2007). Electronic health record systems, once materially implemented across the healthcare spectrum, will itself become the framework in which more overarching goals can be accomplished, such as the centralization of a person’s health history. With Clinical data as a basis, further utilization of EMR systems can occur. EMR systems, once materially implemented across the healthcare spectrum, will itself become the framework in which more overarching goals can be accomplished, such as the centralization of a person’s health history (Gartner. Currently, about 25 percent of U.S physicians are using systems that facilitate electronic health records (Murdock, 2007). E.H.R has become a primary concern in the medical world and the according to past literature review in this generation we find that it some of the scholars are concerned with the paper works as they say that the E.H.R will help save doctors a lot of time and makes the process more efficient. Some scholars say that paper based system is very negative as it leads to losing important patient data which might confuse the doctor in prescribing proper medication to the patient. There are differences of opinion but according to most scholars the E.H.R is a vital tool in solving many of the issues that both public and private hospitals face around the world
Questionnaire Results
The questionnaire focuses on the importance of the E.H.R system and its implementation in the United States of America at a nation wide level. With growing medical demands around the world
Hypothesis one results
Our research finding indicate that the U.S government is encouraging the country medical networks to start using the E.H.R
Hypothesis two results
Our research finding according to 430 surveyors say that 55.1 % of their medical practices use the Electronic health record system
Hypothesis three results
Our research finding shows that majority of the surveyors have a positive outlook that majority of the medical practices will start using the E.H.R between the next 1 to 2 years
Hypothesis four results
Our research finding shows that 41.8% of the surveyors believe that their medical providers will qualify for the Medicare and Medicaid programs
Hypothesis five results
Our research finding again shows a positive outlook of the near future as 65% of the surveyors say that their practices will qualify for the Medicare and Medicaid programs by the end of 2011
Hypothesis six results
Our research finding again shows that the U.S government financial incentive can upgrade the performance of E.H.R surveyors helped us with the conclusion that government financial backing to the Medicaid and Medicare programs can improve the medical performance in the near future
Hypothesis seven results
Our research finding states the importance of the U.S government testing the E.H.R program before purchasing them according to the surveyors 71% agreed the importance of testing the systems before implementing them nationwide
Hypothesis eight results
Our research finding concluded that most of the clinicians hire 1-5 physicians which is low according to the demands of medical needs of our current era
Case Study
Questions and answers regarding on implementing the electronic health record (Case Study).
The case study focuses on the systematic reviews and the effects of electronic health record system can have in the medical sector if implemented at nationwide level. In the G.C.C the electronic health record is still new and according to our case study taken from the united states we want to find whether implementing the electronic health record system will add value to the medical sector or not.
Will electronic health record improve patient’s health outcome?
In a review evidence results in two study cases came up with the following result
In 2004 a systematic review conducted 3 study cases that reported patient’s outcomes, no benefit was the conclusion
In 2008 an analytical survey of several U.S patients found very few data or no association between the use of electronic health records and the improvement of patient’s outcomes
In the end of the study there was no evidence linking between electronic health record with better patient outcomes
Will electronic health record improve the quality of care?
Evidence proves that the following result might occur on the electronic health record if implemented in practice
In 2004 a review of 26 studies analyzed several outcomes related to the quality of patient physician encounters and with the research it discovered a sharp incline in provision of preventing care
In 2006 a review on health information technologies and their impact on quality, efficiency and cost findings were: Increased adherence to guidelines based care, advanced surveillance and monitoring and a decline in medication errors
In 2007 a study of data from some community health centers over the course of one year concluded that while electronic health record related costs had not been recovered, the quality of care improved In 2008 a review on the advantages and costs of electronic patient Concluded that concerning the influence of EPRs on the quality of care The studies did not clearly identify a clear answer to the questions of Benefit
In 2009 a review of 7 countries experience implementing health information systems concluded that they had a neutral experience where neither benefit nor harm between the system implementation and quality of care
The conclusion of the study indicates that the electronic health record has a positive effect on the quality of care; however some of the reviews still find it neutral so the opinions of the doctors and physicians are still conflicting.
Will the Electronic health record be cost effective?
In 2003 cost benefit analysis on the electronic health record in primary care settings concludes that electronic health record can result in positive return on investment
In 2007 review on informatics system designed to improve care of chronic disease found that both cost effectiveness and adherence were significantly improved
In 2008 report on the United States budget office summarized evidence supporting the practice of health information technologies describes the benefits on cost saving as limited
In 2010 assessment on the quality of care resulting from hospital computerization concludes that currently implemented hospital computing might improve process measures of quality but not administrative or overall costs
The research cite modest cost benefit associated with electronic health record, however based on results for small trails or projections based on modeling: empirical evidence supporting the cost effectiveness on electronic health record remains limited or conflicting
Will the electronic health service save time and improve the efficiency of health services delivery?
In 2006 a review of quality measures on the use of electronic health records indicated that the lack of implementing health services has been demonstrated, but the author notes that the outcome is limited to a wider health service provider
A systematic review in the year 2008 analyzed six studies that addressed electronic health record with respect to consultation time, one study found the decrease in consultation time and the other found no difference
A 2008 report from the United States congressional budget office summarized evidence supporting the adoption of health information technologies described the evidence around efficiency as conflicting
In 2009 a review examined the impact on regional health information system and figured that, studies were of variable scope and quality improves the medical data access, timely information, and medical data exchange and improvement in communication and coordination within a region between health care professionals
While there are some evidence supporting an association between the electronic health record and efficiency, there is also evidence which does not support this conclusion
Will electronic health record improve physicians and patients satisfaction?
In 2004 a review found that results were mixed with both the patients and physicians expressing enthusiasm for electronic health record and on the other hand expressing significant concerns about the impact of their use on a variety of outcomes
A 2009 review of seven united based studies examined patient satisfaction with the electronic health record and figured that: one out of seven studies reported a positive effect on patient satisfaction, five out of seven studies reported a neutral effect and one out of seven studies reported a negative effect
Evidence on patients and physician satisfaction is scarce
An interview with Dr Michael Shuskho on the electronic health record
As a professional in your field how do you find the electronic health record system?
Michael: the E.H.R is an advanced system which is very useful for doctors especially in the current Era. It provides better patient care, and makes a permanent record that is legible that other doctors can review the system and also actually streamlines patient care
Will the electronic health record improve efficiency and reduce time
Michael: yes, the electronic health record is a valuable system to most of the doctors because it replaces the piles of paper and with a few click on your computer screen the doctor can view all the patients past medical record and send all the information to the other doctor within minutes
Is the electronic health record system better than the manual paper based system?
Michael: yes, the E.H.R is clearer and safer than the manual system provided that it is used carefully. Exg: a doctor can view patients X-Ray, picture of his electro cardio graph in a much clearer and digitalized form while in the paper based system the pages might wear or get old and by the time the picture of the X-Ray gets more aged, it makes it hard for the doctor to identify the exact diagnosis
Is it cheaper to implement an electronic health record?
Michael: The electronic health record system is expensive and the start up cost of the Medicaid and Medicare programs is high but in the long term it will eventually become cheaper for the clinics and hospitals to use them
What are the barriers that prevents the electronic health record system by being in practice at a larger scale
Michael: some doctors who aren’t familiar with updated technology and use practical manuals prefer not to implement the E.H.R in their clinics. Another barrier to the electronic health record is the upfront cost which is expensive and the some doctors find it hard adapting to the system
Dr. Michael one last question before we conclude our interview. In your personal opinion will the E.H.R be mandatory by 2015 in the U.S
Michael: I assume the probability that the electronic health record system might be mandatory in the U.S and the government might take actions in seeing that all the practices and clinics use the system
The implementation of the E.H.R IN Kuwait and Bahrain
Based on our research we have found that the electronic health record still needs to adapt at a global scale and the system is new to the G.C.C countries compared to the western countries such as United States, United Kingdom. Kuwait started using the E.H.R in 2005 in private and public clinics replacing the paper based system. According to the hypothesis questions and results in the U.S case studies it shows clearly that the E.H.R is on the way of improving and use the E.H.R rather than the traditional filing system. Bahrain is also taking a step further in implementing the system and the public and private clinics and with the help of the MGA methodology and the case study we have come with proposed solutions and the benefits that the kingdom of Bahrain and other G.C.C countries will achieve through the E.H.R
December 2010
The health ministry in Bahrain will launch its national e-files project early 2011. It will cost the ministry between BD 25 Million to BD 30 million. Files of patients at salmaniya Medical complex and health centers will be converted into e-files. The first phase will cost BD 1.5 million and include all SMC and health care patients. Private hospitals and clinics can also be part of the system by paying a fee
The health minister stated that many countries were struggling to meet the challenges of providing adequate health care for citizens. ‘ Changing demographics increased patients expectations, a global shortage of health professionals and rising costs associated with innovative technologies and new drugs means that healthcare is consuming an increasingly large proportion of gross domestic product and is becoming a priority for most governments’.
The minister also discussed Bahrain healthcare agenda through some strategic objectives which includes health promotion and prevention by strengthening primary healthcare services, the provision of quality health services by maintaining international accreditation of facilities and enhancing access to all health care services (Gulf Daily News- Sandy@gdn.com.bh)
Plan for online health service
Patients in Bahrain may soon be able to manage their healthcare online. Patients know best (PKB) enables people to communicate securely with doctors and nurses, access their medical records and send and receive health data. The medical group was founded two years ago by Bahraini Dr Mohammed Al Ubaydli in the United Kingdom. He has more than 15 years of experience in the medical software and trained as a physician at the Cambridge University. The expert worked as a staff scientist at the national institutes of health and was a management consultant to US hospitals at the Advisory board company and is the author of six books. PKB is the first company to integrate into Britain’s NHS secures connecting for patients to work online with clinicians. The group was voted as the best social innovation start up at tech crunch europas European start up awards 2010. At least two hospitals in Bahrain as well as others in the UAE and Malta have shown interest in signing up to the initiative. In the U.K, PKB affiliates includes great Ormond St hospital, Thalidomide Trust, Cure Parkinson and Two NHS hospitals will also sign up soon
Access
Dr Al Ubaydli said hospitals and medical centers that have affiliated with the PKB give their patients an online ability to securely access their medical documents, history and test results, have online consultations with their doctors and receive prescriptions. Once you give the medical record to the patient they can give them to their GP, relatives, social workers and so on he told the GDN. The patient can start an online consultation with any doctor they have added, it works a bit like the face book. They can also reach their doctor at any time say, for example, their child is taking medication but develops a fever at 3am and they can go online and ask the doctor how to adjust their medication. ‘The system asks automated questions that your doctor would ask so that when the doctor sees this in the morning it saves them a lot of time and they can quickly respond with advice’. ( Gulf Daily News 8 Dec 2010)
The articles concludes the following results
The kingdom of Bahrain is taking new measures in implementing the E.H.R in the G.C.C and mena region
Many of today healthcares can be solved through networking
Globalize E.H.R System
Networking communication is an intermediary between practicing doctors implementing the E.H.R in their private clinics or public clinics. The information process is much faster through communication networks which reduces time, saves lives and improves efficiency Exg: Steve Dr Akram Favorite doctor has a patient and needs emergency solution to a problem through a communication network can achieve his goal browsing the Globalize E.H.R network finding solutions through other Doctors specialized in that field.
An E.H.R system that works like a face book
Doctors can log on their account and log on the system with other health professionals and discuss emergency situations and provide solutions
The problems can be solved through fast communication and accurate knowledge the tacit knowledge
key challenges to health practitioners implementing the E.H.R in the GCC countries
Cost of implementation is not offset by the efficiencies in the E.H.R
Technical support needs to be modified due to the advancement in IT
Stress on staff and the practice in general was significant
A 2007 review article recommended strong physician leadership and a staged approach to successful implementation
In 2010 an article challenged conventional assumptions that the physicians were to blame for low uptake of electronic health record. Electronic medical records vary greatly in capability, quality, and cost. Doctors will become enthusiastic users if the electronic medical records are helpful in the care of their patients
There are significant challenges associated with implementing E.H.R in the Mena or G.C.C countries
Benefits of networking for the G.C.C Region
Improves patient care through greater access to information
Reduces test result times
Decrease paper work for clinicians
Integrate communication
Helps ensure that patient medical data and stats are there when patients need to find his/ her test results
Compliance with privacy regulations
Proposed solutions for the electronic health record
A 2008 synthesis of 3 qualitative studies identifies essential components of successful electronic health record implementation
A project champion
Realistic expectation of the challenges of implementing an electronic health record
Addressing existing staff attitude towards IT
Provide adequate training to staff
A systematic review of 7 countries experience implementing health information system in primary care identified the following factors
Quality of the graphical user interface and feature functionality
Quality of implementation project management
User’s previous experience with information technology systems
The Electronic health record today application
The adoption of the electronic health record is difficult to overcome due to the lack of the return on investment. Scholars and writers on the subject noted that health care decision makers find it difficult to demonstrate return on investment to undertake a comprehensive electronic health record system within their organization. The health care costs continue to increase and the fact that the initial investment on equipment can be quite expensive. Another fact that complicates the adoption of the electronic health record is that the data is heavily structured, being recorded in the allotted space. Training is an important issue and this is required by a large amount of population. One should keep in mind that the population has different levels of computer literacy (Upham 2004). These contributors of the electronic health services contributed to a slow increase in the adoption of such systems in many hospitals. In a survey question regarding the E.H.R and the implementation of the method out of 436 who have responded to the question, 35.6% said that they have already implemented the electronic health services. The percentage is expected to grow in the coming years of application. The G.C.C is taking all the necessary step in implementing the system with an enhanced knowledge in the field and the governments should test all the Medicare and Medicaid programs before implementing the system
The Evolution of the Electronic Health Record
The electronic health record is an open field of debate amongst the doctors, physicians, clinicians and scholars. In the electronic implementation of such records, we may also expect to find populations of patients, integrated access to biomedical literature and interactive environment for offering clinical guidelines or consultative advice. Throughout ages the world is becoming more globalized and in the age of science and technology the computer is being the number one tool. The (local area network) is connected to the full internet, with an integrated access to a wide variety of information sources that are geographically distributed well beyond local institutions.
The electronic health record system is expanding worldwide and some of the future implementation
An enhanced internet: an internet with much higher bandwidth and reliability, increased response time and financial models that makes the application cost effective and practical is required. Major research effort is underway to address some of these concerns, including the federal next generation Internet activity in the United States exploratory effort that continue to push the state of art in internet technology, and all significant implication for the future of health care delivery in general for computer- based health record in particular
Better Education and health care training for health care providers: there is a difference between computer literacy (familiarity with computers and the routine users in society) and the knowledge of the role that computing and communication technology can and should play in our health care system. More medical information training programs and the expansion of existing programs are needed. Junior faculty in health science schools who may wish to seek additional training in this area should be supported
Changes in the management and organization of health care institution: health care provide some of the most complex organizational structures in society, and it is simplistic to assume the off shelf products will be smoothly introduced into a new institution without major analysis.
Discussion
The project mainly discusses on electronic health record system that the implementation of the idea goes back to Hippocrates who laid the foundation in the 5th century and by the following years doctors, physicians, pharmacists and clinicians tried to improvise the idea of the health record system on paper but in the 1960s the standards of the paper based changed to the electronic health record systems and hospitals welcomed the new system which was more efficient and reduces paperwork and time. The electronic health record according to numerous researches and articles emphasized that the system should be introduced worldwide. the G.C.C region is expanding in both size and capacity since the countries like Bahrain, Kuwait, Qatar, Uae opened door to foreign investment in their respected countries. Our research focuses on the implementation of the E.H.R in the U.S and the results of the case study gave us a better understanding on whether to implement the system in the G.C.C countries. The results were positive and the need of the system is becoming compulsory in our world today. Kuwait have already
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