Electronic Health Records - Research Paper Example

?EHRs: Standardization and Interoperability Introduction Statistics have shown that the United s have the most expensive health care cost among other countries, but not necessarily providing the utmost quality care to patients. Considering also the present modernization of the world, technology is playing a huge part in almost every field possible, including health care. The use of health information technology (HIT) has been considered by both the public and private sectors in order to provide better health care services, as well as lower its costs. The electronic health records (EHRs) system is one of the innovations looked upon by several health institutions and organizations that could lower the expense of health care and at the same time give improved care quality. EHRs, Pros, Cons In a document from the United States Department of Health and Human Services (HHS), the benefits of adopting the use of HIT in both public and private institutions were presented, as well as the goals, vision, and changes in the system once health care delivery would integrate the use of such innovations. In 2004, former US president Bush “called for a widespread adoption of interoperable EHRs within 10 years,” and the established position of National Coordinator for Health Information Technology was tasked to develop and implement a “strategic plan” that would guide the implementation of HIT nationally in both public and private sectors (HSS 1). From here we see that such advancements in technology are supported by the federal government, and imply that they may have more advantages than disadvantages. In a publication by the National Institutes of Health (NIH) and National Center for Research Resources (NCRR), they adopt the Health Information Management Systems Society’s (HIMSS) definition of EHR where, “The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports. The EHR automates and streamlines the clinician’s workflow. The EHR has the ability to generate a complete record of a clinical patient encounter, as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting.” (1) The pen and paper system adopted in health care institutions have been blamed more than many times in errors that occur in health care delivery. In the development of EHRs, these mistakes are perceived to lessen because they say that electronic records are legible and consistent, not encouraging other members of the health care team to assume or guess medications, dosages, and other physician orders written on the patients’ charts once they get hard to read. Fragmentation of information that may be caused by paper records have the risk of increasing health care cost to manage adverse effects the patient could experience in the event that something undesirable happens when information on paper are misinterpreted. Another advantage of an EHR is its increased capabilities to store information for longer periods of time, and it is accessible, allowing immediate retrieval of information (Gurley). The system is also designed to detect abnormal results, in laboratory and diagnostic procedures, for instance, and reminds and alerts providers when such are found in the records. This feature thus enhances patient safety in the deliverance of care. One disadvantage with an EHR is its startup costs, which may be too much (Gurley). Although the system is seen to reduce health care costs, there is a need for financial capital to be invested during its initial adoption that may be a huge amount. Also, to users who are not technically knowledgeable, EHRs may become difficult, instead of convenient, to them. The issues considered when EHRs are tackled are the patients’ privacy and confidentiality. Even if records are kept and protected, any health provider involved in the care of a patient can access his or her data, posing a risk that these information be divulged, even unintentionally. There are several recommendations given on somehow restricting the accessibility of the documents, but these are still in continuous debates as this convenience is dubbed to be for the patients’ best interest. According to Jha et al., the two reasons for lack of agreement in the EHR adoption and use are: (1) absence of current standard regarding the meaning of EHR adoption in terms of EHR’s capabilities or functionalities; and (2) no unified approach to the measurement of EHR adoption (w496). This presents that even if the number or percentage of physicians who adopt EHRs is increasing, the lack of established standards on how the system should be used, as well as the ability of sharing data between different systems need to be set and delineated. There is a continuous call for action and intervention to the federal government regarding this matter. RHIOs and RHIEs A Regional Health Information Organization (RHIO) is described as a group of institutions in a specific geographical area which electronically share information that are health-related, but following set national standards. A report for the California HealthCare Foundation presents that RHIOs need to “establish policies and practices to protect the privacy and security of [that] information” (Rosenfeld et al. 2). The challenges of ensuring the privacy and security of data in the process of sharing information concern all the participants, both providers and consumers. The cited literature expresses that these challenges can be surpassed, as long as solutions are continually adapted as they evolve, not neglecting legal requirements. Similarly, Regional Health Information Exchanges (RHIEs) are seen as the actual electronic sharing or process of mobilizing health care information among organizations of a specific region. Such exchange is continuously evolving as the primary means of communicating particular health information, and experts, especially of the legal area, remind about liability and the limits of this process. More organizations in different states are having themselves involved with RHIEs, seeing that this would benefit care delivery to their clients that would be appropriate, timely, and consistent. Utilizing EHRs Fowles et al. categorized electronic measures, termed “e-indicators,” of quality and safety, focusing specifically in ambulatory care; where these five categories are: (1) translational e-indicators, (2) HIT-facilitated e-indicators, (3) HIT-enabled e-indicators, (4) HIT-system-management e-indicators, and (5) “E-iatrogenesis” e-indicators (2-4). They cite four providers that use the first four categories mentioned, namely HealthPartners, Park Nicollet, Billings Clinic, Kaiser-Portland, and Geisinger. Results from the five case studies show that there was increased clinical relevance as performance measures were HIT-based. There were barriers encountered in the case studies, but were seen to be generally amendable as made possible by the EHR. As health care institutions are exploring the use of HITs and EHRs, preoperative assessment clinics also aim to provide the best quality of care possible through the use of these systems. At Weiner Center for Preoperative Evaluation at Brigham and Women’s Hospital, they express that “standardization helps meet many goals,” and adopting it in various aspects like documentation and system checks (Bader et al. S104). On the other hand, the Anesthesia Perioperative Medicine Clinic at the University of Chicago emphasizes triage, and hopes to see technology that would spare the patient from the hassle of seeing a care provider unless really necessary, in the future (S106). The Cleveland Clinic Internal Medicine Preoperative Assessment, Consultation and Treatment (IMPACT) Center focus on a care program that “comprehensively evaluate[s] risk by taking into account patient-, procedure-, and anesthesia-related factors” (S109) and their steps to make care standardized and efficient care as much as possible through the use of HIT are outlined in the cited text. These three institutions are only a few examples of clinics that see the improvement HIT and EHRs bring to their programs and care delivery. Through standardized and interoperable EHRs, their clients are assured of consistent care, as well as consideration of past health interventions important to the present and future management they would undergo. Kanas et al. present that by using oncology-specific electronic medical record (EMR) network, there could be benefits in oncology outcomes research. With the use of such specific system, they envision that it could “provide comprehensive and accurate information in clinical diagnosis, personal and medical histories, planned and actual treatment regimens, and post-treatment outcomes,” to answer various inquiries from clients, policy makers, pharmaceutical industries, clinicians, and researchers (1). Cancer is seen as a condition that causes high morbidity and mortality rates in different countries; and the proposal of these researchers may contribute in developing the standard of care given to cancer patients. It implies that although there may be several challenges to be encountered in the implementation of oncology-specific EMRs, the benefits that would be reaped in the adaption of this system could surpass pinpointed concerns. Conclusion The use of HIT, particularly of EHRs, is seen to be of great advantage to the health care delivery system. It is perceived to enhance both patient safety and reduce costs at the same time. Despite that EHRs are contended to have more benefits than disadvantages, the hindrances of this system should not be neglected, especially those concerning privacy and security. The number of practitioners and institutions adopting EHRs are increasing, and evidences show that they have witnessed improvement in their health care delivery. Works Cited Bader, Angela M., Bobbiejean Sweitzer, and Ajay Kumar. “Nuts and Bolts of Preoperative Clinics: The View from Three Institutions.” Cleveland Clinic Journal of Medicine 76.S4 (2009): S104-S111. Print. Fowles, Jinnet Briggs, et al. Performance Measures Using Electronic Health Records: Five Case Studies. New York: The Commonwealth Fund, 2008. Print. Gurley, Lori. “Advantages and Disadvantages of the Electronic Medical Record.” AAMEDA.org. American Academy of Medical Administrators and Foundation, 2004. Web. 07 Mar. 2011. . Jha, Ashish K., et al. “How common are Electronic Health Records in the United States? A Summary of the Evidence.” Health Affairs 25.6 (2006): w-496-w507. Print. Kanas, Gena, et al. “Use of electronic Medical Records in Oncology Outcomes Research.” ClinicoEconomics and Outcomes Research 2 (2010): 1-14. Print. National Institutes of Health, National Center for Research Resources. Electronic Health Records Overview. Virginia: MITRE, 2006. Print. Rosenfeld, Sheera, Shannah Koss, and Sharon Siler. Privacy, Security and the Regional Health Information Organization. California: California HealthCare Foundation, 2007. Print. United States Department of Health & Human Services. “Office of the National Coordinator for Health Information Technology (ONC).” HHS.gov. HHS, 09 Nov. 2004. Web. 07 Mar. 2011. Read More