The digital version of health-related documents of the patient is termed an electronic health record as the name suggests. These records are real-time, patient-centric record that provides information to authorized users in a secure manner. EHR not only contains the medical as well as treatment methodologies of the patient but it also contains the data that provides an enormous view regarding the care of the patient (Dilsizian & Siegel, 2014). EHR has been recognized as the most significant part of health information and technology.
The information provided by EHR can be utilized by other organizations like laboratories, pharmacies, emergency settings, schools, and clinics at workplaces to gather the clinician’s information (Health IT , 2019). In this review paper, the present status of the EHR in Saudi Arabia will be discussed. In addition to it, benefits, as well as drawbacks associated with EHR, ethical issues, and the challenges faced by the government to implement this electronic health record, will be highlighted.
The present status of EHR in the United States is slow as only 4% of healthcare professionals in the United States use this technology. However, the status of utilization of this technology has increased from 18% to 72% in 2012 (Hsiao & Hing, 2012). Thus reluctance in using this technology while working can be seen as a significant barrier. The prioritizations of electronic health and changeover from paper-based records to electronic records have been observed more in Saudi Arabia. The government of Saudi is taking initiatives to adopt the health standards in their healthcare sector thus allocating approximately 4 billion Saudi riyals for the health programs.
A survey has been done in 15 hospitals of Eastern Province of Saudi Arabia of which 7 hospitals that are 46.6% work on the basis of an EHR system. In the eastern province, the EHR system has been utilized while the entry of the order answers (51.11%) well as for chart review (41.11%) (Jabali & Jarrar, 2018). Until now there are no definitive studies that can be beneficial to estimate the EHR adoption in hospitals or other health care organizations. Due to low utilization of chart review, additional problems related to the care like hanging up of the system, involvement of additional time for data entry have been observed. In the study conducted it has been observed that utilization of monitor current and assessment of past medications in different hospitals are different. Thus due to low chart review, the problem related to the medication errors and reaction of the drug has been increased.
This EHR system contains many communication tools like emails, fax SMS which most common was email tools to communicate with each other as well as with patients. However, from the study, it has been observed that hospitals have not used any of these tools. The problem behind the least utilization has been concerned with lack of internet connection (Mahalli, 2015).
The transition from paper-based records to electronic records in many countries of the world has improved the healthcare system. These records have been implemented in the health care system to maintain the records of the patient and provide the facility to share the records with other organizations also. Many other advantages of electronic health records are firstly these records help in improving the quality of care as physicians can get the information about the patient in no time which intern reduces the risk attached with the treatment (Atasoy, Greenwood, & McCullough, 2019). Secondly, it also improves the efficiency of the medical professionals and other staff as they do not waste time sorting the information about the patient. The third importance of using EHR is that it saves storage space as no space is required to store tangible documents and at those places, more medical equipment can be stored. The fourth benefit associated with electronic health records is that patients can also access their records whenever and wherever they like. Their family members can also examine and monitor the patient’s recovery rate. Lastly, the installation of certified EHR can also be useful in fulfilling meaningful use of Medicaid and Medicare which eventually make the patient eligible to get incentives from the government (Health IT , 2022).
With possible advantages, some disadvantages are also attached to the utilization of electronic health records. For instance, first is related to privacy and safety issues as this system is technology-based and is vulnerable to hacking that might lead to a leak of sensitive data of the patient (Chen, Lu, & Jan, 2012). The second disadvantage of using electronic health records is related to their instantaneous nature. Due to this characteristic, there is a need to update the record immediately after every visit of the patient or while alteration is made in the records of the patient. If these updates are not made from time to time then it will mislead the health care professionals to rely on the incorrect data which eventually might disturb the treatment of the patient.
Additionally, these electronic health records can be recognized as the technology which might misinterpret the patient. This has been considered as the third disadvantage as patients might feel panic when they observe incorrect data (Gianfrancesco, Tamang, Yazdany, & Schmajuk, 2018). The last one is related to the liability problems related to the implementation of the EHR. For instance, while transferring the data from paper-based documents to electronic format the data might get destroyed or might become erroneous.
There are many ethical issues related to the electronic health record system as during the sharing of the data without the knowledge of the patient then its autonomy is jeopardized. Due to this problem, the patient and their family member might conceal the information from the health care professional which eventually lead to compromise in the treatment of the patient. Online theft is the major problem related to technology in the present era which requires more attention in making the policies.
The first ethical issue is related to the privacy and confidentiality of the data. Right to privacy has been considered as the fundamental right of the people of the nation thus no information of the patient must be released to other people or organizations without the permission of the patient according to the law (Layman, 2020). However, if the patient is unable or incapable to take the decision regarding the sharing of the information then the decision has to be taken by the legal representative of the patient. In order to save the confidentiality of the information of the patient is required to share the information only with the authorized individuals.
If any breach in the privacy and confidentiality of the information occurs then the burden of proof will be posted upon the authorized individual with whom the information has been shared (AHiMA , 2013). It is the duty of the government to take appropriate steps like making apt policies to control the leak of privacy and confidentiality of the information. Another ethical issue related to the EHR is the security breaches. An incidence related to the breach of data security has been observed in the Howard University Hospital where a large number of people get affected by it. The court has laid the liability on one of the medical technicians on the basis of breach of provisions of the Health Insurance Portability and Accountability Act (HIPAA). The imprisonment has been awarded to the medical technician for 6 months and a fine of $2,100. In order to secure the data from being stolen and used encryption of data must be done. Another incident took place where the chain of hospitals has agreed to pay about $275,000 due to violation of the privacy of the patient (Lustgarten, 2015).
There are a few potential challenges and barriers that are possibly faced by different nations to implement the electronic health record. These barriers if practiced appropriately help the government to meet the goals. The first barriers are related to the technical ability of the computer. Under this, the ability of the electronic device is assessed in order to retrieve and send the health care data.
The capability of the computer is affected by the age and area in which that device has been located. The cost involved in the implementation and use of EHR is expensive. Thus in order to implement EHR in the healthcare system, it is required by the authorities to first analyze the fund needed for its implementation (AlSadrah, 2020). Some technical malfunctioning regarding the use of EHR will render it difficult for the patients and care providers thus they restrain themselves to use this technology which can be observed as a barrier in implementing the technology.
The objective behind implementing the EHR in the health care facility is to maintain the workflow. However, the paid options in the EHR sometimes break the workflow which can be treated if proper demonstration of the system is given to the health care setting. For implementing EHR trained employees are needed which then requires extra time, effort, and resources to become professionally trained which could seem to be a difficult task thus has been observed as another barrier in implementing the electronic health record (RHIHub, 2020). The last and the major problem associated with electronic health records is the privacy and security issue. Many patients and health care providers are very particular about the privacy of themselves and their medical treatments thus it is required to use the technology properly.
Moreover, sometimes some information has been lost due to natural disasters and cyber-attacks which eventually lead to the loss of private information of the patient or the health care professional thus infringement of privacy takes place. This problem can be resolved by asking questions while implementing the Electronic health record in the care setting regarding the strict privacy of the system (Research Briefing UK Parliament, 2016).
Conclusion
In the end, it can be concluded that the EHR system in Saudi Arabia must be implemented in almost every hospital or health care setting. Some periodic assessment related to the status of the EHR system must be done to encourage the installation as a part of the policy in the country.
However, certain efforts have been made by the Saudi Arabia government to integrate the electronic health record into the health care system. Despite the progress, some barriers are present in implementing this system like lack of proper training, lack of customization, privacy concerns, problem-related to the cost, and many more. The problems related to the implementation of electronic health records can be reduced by enhancing the speed of the internet thus eventually making the application affordable.
Additionally, proper education and training must be provided to the health care providers so that they can use this technology efficiently. Moreover, it is the duty of the government to make alterations in the management and organization of health care facilities including smooth working and implementation of new technologies. The clinicians must adapt to the electronic health record that requires expertise. The health care providers must change their view towards the new health care technology so that they could provide appropriate care to the patients which intern enhances the efficiency of the hospital. Thus these problems must be addressed and solutions must be implemented from time to time to ensure the proper application of electronic health records in the hospitals of Saudi Arabia
References
AHiMA . (2013). Integrity of the Healthcare Record: Best Practices for EHR Documentation . Retrieved from AHiMA: https://library.ahima.org/doc?oid=300257#.Yj1NC-dBzIU
AlSadrah, S. A. (2020). Electronic medical records and health care promotion in Saudi Arabia. Saudi Medical Journal, 41(6), 583-589.
Atasoy, H., Greenwood, B. N., & McCullough, J. S. (2019). The Digitization of Patient Care: A Review of the Effects of Electronic Health Records on Health Care Quality and Utilization. Annual Review of Public Health, 40, 487-500.
Chen, Y. Y., Lu, J. C., & Jan, J. K. (2012). A secure EHR system based on hybrid clouds. . Journal of medical systems,, 36(5), 3375-3384.
Dilsizian, S. E., & Siegel, E. L. (2014). Artificial intelligence in medicine and cardiac imaging: harnessing big data and advanced computing to provide personalized medical diagnosis and treatment. . Current cardiology reports, 16(1), 1-8.
Gianfrancesco, M. A., Tamang, S., Yazdany, J., & Schmajuk, G. (2018). Potential biases in machine learning algorithms using electronic health record data. . JAMA internal medicine, 178(11), 1544-1547.
Health IT . (2019). What is an electronic health record (EHR)? Retrieved from Health IT : https://www.healthit.gov/faq/what-electronic-health-record-ehr
Health IT . (2022). What are the advantages of electronic health records? Retrieved from Health IT : https://www.healthit.gov/faq/what-are-advantages-electronic-health-records
Hsiao, C. J., & Hing, E. (2012). Key findings. Retrieved from CDC: https://www.cdc.gov/nchs/products/databriefs/db111.htm
Jabali, A. K., & Jarrar, M. (2018). Electronic Health Records Functionalities in Saudi Arabia: Obstacles and Major Challenges. Global Journal of Health Science, 10(4).
Layman, E. J. (2020). Ethical Issues and the Electronic Health Record. Health care Management, 39(4), 150-161.
Lustgarten, S. D. (2015). Emerging ethical threats to client privacy in cloud communication and data storage. Professional Psychology: Research and Practice, 46(3), 154.
Mahalli, A. A. (2015). Electronic health records: Use and barriers among physicians in eastern province of Saudi Arabia. Saudi Jurnal for health sciences, 4(1), 32-41.
Research Briefing UK Parliament. (2016). Electronic Health Records. Retrieved from Research Briefing UK Parliament: https://researchbriefings.files.parliament.uk/documents/POST-PN-0519/POST-PN-0519.pdf
RHIHub. (2020). Health Information Technology in Rural Healthcare. Retrieved from RHIHub: https://www.ruralhealthinfo.org/topics/health-information-technology
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