Introduction
Technology advancement and application is an inevitable element that has found application in almost all fields of the economy. Technology is associated with both positive and negative effects depending on a specific situation and what it is able to achieve. Various institutions have adopted different technologies in an effort to enhance efficiency, effectiveness as well as economy in their operations. The health sector is not an exception and has adopted various technologies including Electronic Health System/Record (EHR). This piece of work gives an in depth discussion of the concept of Electronic Health System/Record (EHR). Various issues associated with the topic of discussion will be evaluated. For instance, some background information, components of an electronic health record, the major commercial electronic health records and their features and functions, the benefits and drawbacks associated with electronic health records, other alternatives to the electronic health records as well as the emerging trends and the way forward.
Definition and Background Information of Electronic Health System/Record (EHR)
An Electronic Health Record can be defined as a computerized health record that is created in an a health providing organization for instance a hospital or physician’s department with an aim of creating efficiency and effectiveness as opposed to the use of manual or paper health records. Electronic health records are usually a component of a local stand-alone information system that is charged with a variety of roles such as allowing for proper storage, retrieval as well as manipulation of records.
According to the Health Information Management Systems Society (HIMSS), an electronic health record can be defined as a longitudinal electronic record in regard to a patient’s health information. It is produced through encounter(s) in any health care delivery unit. Some of the information contained in an electronic health record include a patient’s demographics for instance age and gender, health problem, progress notes, the medications undertaken, past health history, vaccinations, any alarming signs and symptoms, radiology reports, laboratory data among others. This shows how comprehensive an electronic health record is.
Just like any other issue, the concept of electronic health records was not thought of and developed in one day but rather it has some history and paths it has passed through right from the creation of the idea to its development and utilization in the current times. The first health record is associated with Hippocrates and he developed it in the fifth century BC. Hippocrates had two main goals while creating the record. They include the fact that any given medical record ought to reflect the course of a disease in an accurate manner and that the medical record should clearly show the probable cause of a given disease. Although electronic health records in the current times have got other additional goals and functions, these two goals still remain.
After the Hippocrates development of a paper based record, it took a lot of years to come up with electronic records. It was not until in the mid 20th century that the first electronic health records appeared. From this time, the progress was good and by the year1965, it was reported that approximately a total of 101 electronic health records projects were being set up. These included 73 hospital and clinical information projects and 28 projects that were aimed at offering storage and retrieval services for health related records as well as other information that is deemed to be clinically relevant. Today’s electronic health records base their roots from the academic medical centers (AMCs). Some of the notable pioneer projects from which some concepts have been drawn to develop current electronic health records include health evaluation through logical processing (HELP), the medical record (TMR), the composite health care system (CHCS), the TDS, the De-centralized hospital computer program (DHCP), THERESA and the computer stored ambulatory record (COSTROR) (National Institutes of Health National Center for Research Resources, 2006).
Despite the fact that the above named early projects had some technical and program related limitations for instance in regard to vocabularies and system interfaces, they are attributed to the successes that are achieved in the current electronic health records since they offered ideas which were improved for better performance. This does not however mean that today’s electronic health records are without some limitations but rather, they still experience some implementation challenges.
Components of an electronic health record
There are various components that make up an electronic health record system. Each component usually plays certain roles leading to the success of the overall system. An electronic health record could be developed for each and every service that a patient gets from a health institution department for instance the laboratory. However, some systems are more diverse and thus they allow for taking into account other relevant information such as physician orders, and physiological signals. These records have a limitation of not being integrated as they remain in silo systems. Another alternative lies in commercial electronic health records where most of them are designed in a manner that allows for a combination of data from different services such as the pharmacy and radiology with some clinical care components to allow for maximum efficiency. “The number of total components and features to be involved in a given system is dependant on different factors for instance the data structures and systems that are implemented by the technical personnel” (National Institutes of Health National Center for Research Resources, 2006).
Some of the general components include the administrative system components, the laboratory system components, radiology system components, computerized physician order entry, pharmacy system components as well as clinical documentation. All these components are charged with different tasks and roles, as their names suggests. The different tasks are however integrated in an appropriate manner to bring about efficiency, effectiveness and success of the overall electronic health record (National Institutes of Health National Center for Research Resources, 2006).
Major commercial electronic health records and their features and functions
With respect to electronic health records, there has been some developments that have taken place, all aimed at enhancing efficiency, effectiveness as well as economy in the provision of different health care services. For this reason, there are different commercial electronic health records each having distinctive features and functions. Some of them include, Allscripts electronic health records, eClinicalWorks, greenway primeSUITE 2011 and sage Integrity.
What is clear from a health record system is that the electronic health record network usually integrates data from the systems of the involved institutions in an effort to create the electronic health record for a particular subject or rather a specific patient. Some of the functions of an electronic health record include networking and related services such as data discovery, general data management, and production of an electronic health record patient index, electronic health record security and stipulation of electronic business rules.
Some of the basic functions of commercial electronic health record include management of clinical documents and notes, identification and maintenance of patients records, generation and documentation of patient’s specific instructions, presentation of protocols, guidelines and care plans, management of patients history, capturing of external clinical documents, management of medical and problems lists as well as capturing and managing of a patient’s demographics among others. All these functions are aimed at bringing about success in the electronic health records through facilitation of efficiency, effectiveness and economy in all the practices and processes involved in the provision of health care (Gerald, Donna, Jennifer and Phillip, 2006).
Benefits of Electronic Health Record
When compared to paper based records, an electronic health record is a crucial tool that has considerable benefits in the health facilities. This is more so because it has the ability to produce an absolute record with respect to a clinical patient happening. In addition, an electronic health record is in a position to support other health care processes either directly or indirectly. This is made possible through utilization of a variety of technologies such as quality management, outcomes reporting and evidence-based decision support among others.
Apart from accurately reflecting the course of a certain disease or ailment and indicating the probable cause, electronic health records also have got other functionalities that make the provision of health related services efficient. This includes interactive flow sheets, interactive alerts to clinicians as well as tailored order sets among others. All these are functions that can not in any way be provided by paper based records systems (Hayrinen, Saranto and Nykanen, 2008).
Electronic health records improve quality of health care. The utilization of electronic health records assists in lessening the patient sufferance. This is because medical errors and poor quality of services associated with paper based record systems are taken care of by the electronic health systems. This can be attributed to the fact that electronic health records provide the health care professionals with decision support capabilities. Application of information technology used in automation of health processes help reduce inefficiency and administration costs. This therefore follows that there is usually adequate time and money that can be used in provision of health care services (Pereira, Tamblyn and Kawasumi, 2005). Electronic health records also enhance evidence based medicine in the health facilities. The systems offer access to exceptional amounts of clinical information and data for research. This is extremely useful in enhancing the level of knowledge in regard to effective health care practices, an aspect that is made possible through information sharing (Rick, 2006).
Electronic health records also promote appropriate record keeping and mobility. There is the ability to connect to a variety of electronic health related record systems. This is especially useful to the effects of globalization in the medical field. For instance, there are usually cases of international patients traveling to the United States of America for various reasons such as taking part in clinical trials. This requires strategic coordination that can only be achieved efficiently through the electronic health records as paper records would take a relatively long period of time (Patricia, Margaret, Melissa and Joan et al., 2006).
Drawbacks of Electronic Health Record
Every aspect is usually associated with both benefits and drawbacks. Despite having a considerable number of benefits, an electronic health system or record is also associated with some drawbacks. Most of them are however related to implementation. Some of the drawbacks accrued to electronic health record include cost; despite the fact that electronic health records are deemed to save cost used in provision of the health care services, they may be expensive to purchase and implement on the side of the health care institutions and facilities. Some electronic health systems are relatively expensive especially those that have many capabilities, are robust and allow many providers to use them at a time. Cost can also be understood in terms of the time used in initial data entry to the system. There are also costs related to staff as there is a need to increase information technology related staff for system maintenance. However, cost could be saved in case of large integrated organizations because of economies of scale (Margaret, 2006).
Security and privacy is also an issue that is linked to electronic health records. There are various security related threats when it comes to electronic information due to ease of access and manipulation by many people as compared to paper record which could be confined to a certain room and access could be limited to only the authorized personnel. There have been some instances of patients expressing their worries that their privacy is more at risk when electronic health records are used (Blobei, 2004).
Time is another issue of concern when it comes to electronic health records. Human beings tend to resist change especially where some efforts are required. Some medical practitioners are not usually ready to learn and utilize new systems and therefore prefer using of the common paper records. Some even have the belief that the adaptation of electronic health systems is associated with a decrease in the level of clinical productivity. Legal and regulatory compliance issues are also of concern. To set up and implement an electronic health system, health facilities have to comply with some legal and regulatory factors. This is even serious when it comes to the issue of legal interoperability where there are across-nations operations. This is because different nations could have varying legal requirements in regard to the general concept of electronic health records (Brian, 2006).
Alternatives to the electronic health records
Apart from utilization of electronic health records in medical institutions and facilities, there are some alternatives which are either preferred or used instead of electronic health records. Despite the fact that the academic medical centers (AMCs) were among the founders of automated electronic health records, the availability of options have brought about some form of confusion in decision making regarding whether they should upgrade or replace the electronic health records they use or not. Some alternatives are preferred for various reasons for instance cost and ease of use. Some of the notable alternatives include commercial off-the shelf systems (COTS). These systems are considered to be cost effective and attractive as compared to the ordinary electronic health records. Apart from this, the commercial off-the shelf systems are usually more comprehensive and they define some relevant data structures, interfaces and vocabularies that are useful for clinical research and other uses. This makes them desirable since they are capable of enhancing data collection and sharing in a way that fosters better clinical trials management as well as allow for scientific discovery. All in all, it is still believed that electronic health records that are custom- built are better than commercial off-the shelf systems due to the concept of being tailored for specific organizations (Catherine, Eric, Sowmya and Karen D., et al., 2008).
Trends and way forward
There are trends that can be seen in regard to the utilization of electronic health records. The trends could be looked at in terms of the rewards, successes as well as intervening pain that have been experienced in health institutions that have utilized electronic health records.Generally; organizations have reported having both positive as well as negative attributes in regard to using electronic health systems. With respect to rewards, electronic health records have been deemed to bring about efficiency and accuracy in the processes involved for instance data collection, storage, retrieval, analysis as well as dissemination as compared to paper based records systems.The rewards are associated with the elimination of the need to manage cumbersome paper records. Pain on the other hand is connected to the implementation challenges linked with electronic health records for instance in relation to integration and interfacing. There are also other costs that go hand in hand with implementation of electronic health records for instance purchasing of some apparatus and employing some additional staff for the systems maintenance.
Success has been achieved in regard to efficiency, effectiveness and economy in carrying out the health care processes. This is more so for electronic health records systems that are more advanced and integrated for instance at national or international level (Jennifer and Jane, 2000).
The way forward entails the advent and development of a nationwide health information network with an aim of integrating considerable amounts of relevant information that will help in enhancing the health care services in one way or the other. Some of the issues such as interoperability are also to be well implemented. Emerging technologies ought to be adopted to enhance functionality.
Conclusion
Form the above discussion, it is evident that electronic health records are significant tools that have brought about some considerable positive changes in the functioning of health care facilities and institutions. Electronic health records are not a new concept but rather it is a technology that has been practiced for a considerable number of years. Although there are some drawbacks associated with the electronic health records, the benefits surpass the drawbacks to a great extent and hence the need to perfect the systems. The benefits include improved quality of health care, enhancement of evidence-based medicine in the health facilities and promotion of appropriate record keeping and mobility among others. This is more so when comparing the electronic health systems with the paper based record system. There are also major commercial electronic health records each being associated with some benefits and limitations depending on their functionality. Although there are some alternatives to electronic health records, it is still believed that electronic health records that are custom- built are better than commercial off-the shelf systems (COTS) due to the concept of being tailored for specific organizations. Further research aims at improving the situation of electronic health records in future through adaptation of relevant technologies.
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