Health Informatics and Emerging Technologies - Research Paper Example

?Electronic Health Record Introduction Technological advancements have taken place so rapidly that most people are caught unaware with some of these changes. These technologies have cut through all the aspect of human life ranging from social, personal, professional, etc. aspects of life. Among these different aspects, Medical field has become one of the inseparable aspect for human life or people from all sections of society. Medical area has experienced optimum changes technology wise, and one among those technological changes is the introduction of electronic health records. Electronic Health Record (HER) is a form of a longitudinal computerized health record that comprises of digitalized health information about a population or individual patients (Smaltz, 2007). Statement The health data in electronic form is generated and stored in medical institutions with the help of microchips, smart cards, etc. Then, such records can be accessed or be shared across within several healthcare settings through a network connection of information systems. The data contained in such records are in summary form and may include; laboratory test results, billing information, medical history and other essential medical data. This advancement in technology in medical field has enabled competent health record keeping, streamlined work flow, quality management, and safety and evidence based decision with supporting documents. Effective maintenance of electronic health records is a key component for the efficient functioning of healthcare organizations. As these records contains very sensitive information and personal details about the patients, leakage of which could adversely affect the patients’ personal as well as the professional life and also the organization’s standing. However, there are certain disadvantages with this Health informatics based system particularly related to high cost involved in installing and implementing the system, legal issues, etc. Although, there are demerits, there are many more merits for this system, and this paper will discuss how those merits can aid in the optimal functioning of Healthcare organizations. In addition, even the demerits can be managed, if correct steps are taken. Reduced Health Care Costs Imaging is a major contributor towards the increase in health care costs. Irrespective of the medical insurance safeguards, spending on imaging makes a lot of people avoid accessing medical services. However, this problem can become a thing of the past if the health care providers adopt the electronic health records system, as it is an effective way of averting the normal at the same time expensive duplicating imaging procedures. Apart from the cost factor, by going for electronic storing and transfer of imaging outputs will also increase the efficiency of the doctors in correct diagnosis. This was validated by a study conducted by Garrido et al. (2005) in Colorado and Northwest regions of Kaiser Permanente, a US integrated healthcare delivery system, using the population of 367, 795 members in the Colorado region and 449, 728 members in the Northwest region as the sample size. The results showed that after “more recent increases in general use of imaging inside and outside Kaiser Permanente…The chief of radiology in the Colorado region believed strongly that availability of electronic records to all carers improved interpretation of films.” (Garrido et al. 2005). Storage of physical records requires large amount of space which translate to expensive storage, costs which can be easily cut down with the usage of EHRs. In addition, physical medical records may be stored in different areas and therefore induces the cost of transporting them where they are required. Bringing them to a single location for usage by health care providers is not only time consuming but also costly. Some times such records might be needed in multiple locations at the same time whereby there must be faxing or transporting costs incurred. All these can be taken care of by using the EHRs. Quality Health Care Electronic health records have reduced several types of errors. Poor legibility brought about by handwritten medical records contributes to medical errors. In addition, there could be errors related to tests and procedures, preventive and emergent care, and drugs prescription among others. These errors can be avoided or managed by incorporating EHR, as EHR has features like, the standard drug dosage, allergy checks, patient education information and the food-drug interaction checks. Accessibility of clinical guidelines for disease management through the use of EHRs has reduced errors during the process of treating people. It has also helped in the tracking of the patients referrals and test results for effective preventive care. All these is brought about by the accessibility of patients records at any health care site as there is adoption of interoperable EHRs ( Smaltz, 2007). This aspect of quality is important in the day to day activities of health care providers. The EHR has helped to provide a basis for supporting any medical decisions made by health care providers. This is because there is a fast and efficient access to medical records and other literature, thus improving the efficacy in health care settings.. This is because there can be standardization of abbreviations, forms data input and other medical terminologies. This fact of how EHR have reduced medical errors can be seen in the book Preventing Medication Errors: Quality Chasm Series, written and edited by Aspden et al. in 2007. It has pointed out how a study conducted at Brigham and Women’s Hospital, Boston, Massachusetts, examined the impact of EHR regarding the medications errors and ADEs (Adverse Drug Event). “The first found that nonintercepted serious medication errors decreased by 55 percent, from 10.7 to 4.86 events per 1,000 patient-days (p = 0.01). Preventable ADEs declined by 17 percent.” (Aspden et al., 2007). The EHRs have enabled digitization which has facilitated data collection for clinical use and epidemiology. This interoperability, which is actually exchanging of patient information electronically, has facilitated healthcare delivery to help health care facilities which are non-affiliated. Such data are widely used by medical practitioners in resource management, health care quality improvement and in the surveillance of communicable disease in the public health domain (Laura, 2007). Electronic medical records are said to improve efficiency by six percent per annum. (Laura, 2007). The EHRs have also led to the offsetting of monthly cost by reducing the number of unnecessary tests and admissions. It is estimated that one out of seven admissions in hospitals were as a result of unavailability of physical medical records, which lead to repeating of medical lab tests. Promote Clinical Research The EHRs provides unprecedented amounts clinical data on any health condition or disease, thus increasing the level of knowledge of medical practitioners. This will be realized when there will be the adoption and acceptance of the EHR in a wide spectrum e.g. nation wide, regional or international. This will lead to a free flow of information which in turn will improve accessibility of clinical data leading to advance research by medical practitioners. There will the sharing of information by various systems which is one of the goals of globalization, which in turn will lead to free transferability and accessibility of information by different stakeholders in the medical field. Global medical environment with the use of EHRs have provided many academic research centers with information in different clinical trials, thus helping in coordinating and advancing clinical research world wide (Laura, 2007). Storage Physical medical records (X-ray films, paper notes, photographs, etc) are problematic as far as storage is concerned. They require different types and sizes of storage spaces, as there are no uniform physical storage options to fit all these documents. All these problems can be avoided by the use of EHRs because when digitizing of all these medical records are done, it will result in standard file format, which can be stored in IT based storage devices and accessed smoothly. In addition, fine-tuning EHR can further compress the imaging files, so it occupies less of the storage page. Although, digital image files will be in a small and compact size in digital form, when compared to the physical files, while storing in the IT infrastructures, it could occupy a larger storage space. These large chunks of files will also lead to inefficiency as the transmission of these large files could be tedious. To counter this issue, compression can be carried out and it is being done in many countries including Canada. As stated by, Hagens et al. (2009) “as the volume of data generated by new imaging modalities continues to increase, the use of irreversible compression will improve the efficiency of transmission over networks and significantly decrease the cost of storage.” As stated by the Canadian Association of Radiologists, compression of imaging files as part of EHR will enable more cost effective and efficient management of medical imaging data. (Hagens et al, 2009). Globalization has made people to seek medical attention from any part of the world .Therefore, they travel with their medical history records, traveling with such large documents with them is not only expensive but cumbersome .Patients, who travel to different countries and regions for specialized treatment or to participate in clinical trials can now carry with them personal Electronic health records easily Problems Associated With the Use of EHRs Not only the system is costly to install but it also involves training of the users thus dissuading healthcare providers from using it aptly. When applied to the small healthcare setups, it is uneconomical and this discourages them from investing in it. As the total costs will included both the hardware and the related software costs, it could inflate the budgets of the small health care units, thus making it unviable for them. The American Hospital Association (AHA) did a survey of all community hospitals in 2005 to analyze the extent of EHR or even IT implementation and importantly to understand the barriers that are preventing its fullest adoption. Thakkar and Davis (2006) state that CEOs from 900 community hospitals (19.2 percent) participated in the study, and based on their response they found out that the healthcare facilities which are not using EHR are the ones which are “primarily small, rural, nonteaching, and nonsystem hospitals”. Thakkar and Davis (2006) further add that according to the same survey, “cost was the number one barrier to the adoption of EHR systems; 59 percent of the hospitals found that initial cost was a significant barrier; with software costs being the greatest barrier” (Thakkar and Davis, 2006). In addition, lower end health care facilities will try to avoid this EHR because most of these hospitals get revenues by carrying out tests as many times on the same patient. However, when these EHRs are employed such tests become irrelevant because the patient may have had the same test earlier or somewhere else, thus doing it again will not be necessary. This creates reduction in profits and thus little financial incentive. To support the EHR system there must be a change in the practice and management system as far as billing and scheduling is concerned. Most of the medical personnel from earlier times are used to write notes by hand, and therefore by introducing the use of wireless equipments, it will complicate their mindset and their working style. The cost for training the staffs to the installed EHR also leads to further financial burden. This will also call for redesigning of the existing system. The work of redesigning work flow accumulated years and years is extremely costly and stressful especially when done within a short interval. Ethical and Legal Issues Privacy and confidentiality is one of the core ethical values of health care providers. However, the EHRs has the risk of being created, edited, viewed and at the same time be used by a number of people or multiple entities. This affects the structure of ownership of such important medical documents, with the privacy of the patient being compromised. Effective maintenance of electronic health records is a key component for the efficient functioning of healthcare organizations. As these records contains very sensitive information and personal details about the patients, leakage of which could adversely affect the patients’ personal as well as the professional life and also the organization’s standing. This is where the role of Multifactor Authentication (MFA) assumes importance. This MFA can be incorporated with the EHR and it strengthen the EHR’s security aspects. Under the MFA, more than one form of authentication will be implemented as part of the security system to verify the legitimacy of any operation. For example, a user wanting to retrieve sensitive medical records had to provide multiple means of identification including physical card, security code, biometric verifications like finger scanning, iris identification, facial recognition or even voice ID. Through this multi level security, all the records can be protected and prevented from falling into the hands of illegal persons. Thus, having tamperproof electronic health records will enable new efficiencies in the health care system, improving the quality of care for patients; create efficiencies for doctors and save money for the government, insurance providers and the individual patient. Conclusion Technology has helped or is helping the health care institutions to meet the expectations of the patients in a better and efficient manner, thereby relieving them from the tedious work and a lot of paper work processes. Several issues must be addressed for the effective adoption of EHRs and these issues include; interoperability, financing, technical support and training, standardization, connectivity of clinical information system, help in redesigning of work flow for the small organization and help in management change. Despite the challenges and the costs of electronic health records implementation, this system is the best to use as its advantages outscore the disadvantages. There is also the need to put into consideration long term preservation mechanism of the EHRs, so as to ensure accessibility and compatibility incase of any change in system management due to technological advancement. References Aspden, P., Wolcott, J., Bootman, J. L and Cronenwett, L. R. (2007). Preventing Medication Errors: Quality Chasm Series. The National Academic Press. Garrido, T., Jamieson, L., Zhou, Y., Wiesenthal, A and Liang, L. (2005). Effect of electronic health records in ambulatory care: retrospective, serial, cross sectional study. British Medical Journal, 330(7491), 581 Hagens, S., Kwan, D., Savage, C and Nenadovic, M. (2009). The Impact of Diagnostic Imaging Investments on the Canadian Healthcare System. Electronic Healthcare, 7 (4), 1-8. Thakkar, M and Davis, D. C. (2006). Risks, Barriers, and Benefits of EHR Systems: A Comparative Study Based on Size of Hospital. Perspectives in Health Information Management, 3 (5). Laura, D. (2007). Electronic Health Records: Interoperability Challenges and Patient's Right for Privacy. Journal of Computer and Technology 3 (16). Smaltz, D. et al. (2007). The Executive's Guide to Electronic Health Records. New York: Health Administration Press. Read More