Electronic Health Records in Saudi Arabia - Coursework Example

?Electronic Health Records in Saudi Arabia of Electronic Health Records Systems Electronic health record (EHR), as its sake implies, is health record complied through a series of electronic means. In proper definition, EHR is illustrated by the NHS as “longitudinal record of patient’s health and health care--from cradle to grave” (Cunningham, n.d., p. 2). There is, then, a concentric compilation of all health information that patients had availed from the time they were born up to their present existence, in any health-related fields and for different individualized pathological condition. With its encompassing concept, its principal functions distinctively set it apart from other subtypes of electronic records. On a general scale, this type of recording system prompts direct access to key health information on the level that can be both personal and population-based. Such actions are solely executed by permitted health personnel as authorized users of the system. In whole, it is a significant provision of necessary data sets that supports the decision-making process for “quality, safety, and efficiency of patient care...(in) efficient processes for health care delivery” (Lehmann et al., 2006, p. 3). Broadly speaking, the system adapted in EHR serves as fundamental parameter in which health care team base the category of care to be provided, as past information are profound on how present health status should be approached in clinical settings. As EHR is an electronically run, it largely involves both hardware constructs and software applications. In particular, connections are managed through workstations of computer sets and servers for large database storage and application settings, which must be affiliated by a telecommunication services for further assistance inter-departmental network interactions within and outside the clinical zone (please see Figure 1 in Appendix A). As the hardware part of the infrastructure is presented through routers, PCs and related electronic devices, softwares are the application mechanics that run the programs needed in entering data information in computer equipments. To establish a valid link in all computer programs in different clinical departments, a “local area network (LAN)” must be installed in each computers, or “wide area networking (WAN)” in multiple site connections, uniting strategic users (billing/accounting, administrative and recording sectors) who require copies of basic and/or patient information (Walker, Bieber, & Richards, 2006). As the structural side of EHR have been explained, it is important to note that the internal flow of organization management is also a critical point in the success of the whole system. In Figure 2 (please see Appendix B) a sample of customized work flow of organization communication and function of both health care and IT teams involved in the system of electronic recording are presented. Basing from the diagram, one can surmise that the simple arrival of a clients for a check-up requires an extensive flow of functional work. In the absence of a systematized work flow structure, the whole organization may face delays as information storage and retrieval are backlogged by inappropriate system of recording. The large volume of data stored through EHR makes it an ideal system for promoting an intensive communication pattern that is both comprehensive and accurate in form. As unique identifiers, this type of system has been largely encouraged in first world countries due to its unique characteristics. It is an identification medium that can easily be accessed from internal and external data systems, efficiently discriminating between similar demographic information from potential receptors of health care (Cunningham, n.d.). The idea of storing bulk of information starting from birth to the dying moments is essential in order to trace how individuals maintain their well-being during their whole life. This is an epidemiological tool that inventively personalizes health services provided by one clinician to other associated medical providers (Iyer, Levin, & Shea, 2006). With its multi-dimensional functions and large informational space, it is little wonder that health care administrators chose this kind of recording system compared with others. Advantages of EHR A number of benefits have been viewed with EHR, both for the providers and receptors of care. On the part of health care providers, there is increased efficiency in the systematic storage and retrieval of necessary information for patient assessment and health management. Simply entering basic key word and clicking on familiar bars promote speedy location and recovery of patient files. Its ability to easily accumulate large information sets in limited electronic space lightens the filing load for most medical practitioners, and even the recording section of clinical institutions. Consequently, such events give more time for interaction with patients, rather than be occupied by looking for past files, providing immediate care where it is needed most. Communication patterns are easily established from clinical setting to another, through the interface networking available in the electronic system. Aside from economizing space and reduced redundancy in sectoral recording, the quality of stored and retrieved electronic files is assured, as standardized formats in recording and documentation of patient information are followed in continued care concepts. In line with quality management, barriers in effective communication between health team are substantially reduced with consistent recording formats. As an informational safeguard, errors in medical and nursing functions can be minimized through bedside prompts provided by some forms of EHR (Iyer, Levin, & Shea, 2006). At large, the filing and functional workload carried by most health care professionals are assuaged through the efficiency generated by the recording system adapted by EHR. In significant terms, it also assists health professionals in competently delivering health services that have assuredly passed necessary quality requirements. On the part of patients, they can directly or indirectly gain from the full implementation of EHR in both government and private health institutions. On direct terms, the system will provide convenience for patients, as well as boost their confidence on the comprehensiveness of medical care that they are receiving. It is considered convenient for the simple reason that patients will no longer keep on repeating basic personal information, such as personal profile and the health history. In emergency cases, the easy retrieval of past health history can mean speedy and more accurate provision of medical care and treatment. Knowing such things, the patients are more assured that every care received is evidently-based. Indirectly, they are also placed at better advantage for outcomes in care are said to be improved with the help of EHR. This is executed through better decision-making schemes when the health care team can thoroughly review the extensive data provided by the electronic system, where they are privy to past health activities and can be well-updated by any medical interventions performed in recent times, prior to and during clinical consultation. In integrated context, clinical efficiency is raised higher with the utilization of EHR, giving due cause for better health care services delivered to potential clients (Cunningham, n.d.). After all, comprehensive patient information forms the basic groundwork where medical team gains professional foothold on where to start and directs the course for evidence-based practices in health treatment. Disadvantages of EHR As much as the medical field can professionally gain from the EHR system, there are still a number of nonconstructive impacts that seem to negate the positive points that the system is said to generate. On account, its involvement in legal and ethical issues bars the full application of the recording system in hospital institutions. Legally speaking, the records rendered from medical documentation can be used to substantiate lawsuit claims in court; yet, such events can have a lasting effect in most of the patients. As soon health care professionals have unwittingly known of such legal suits in later health consultations, more often than not, they tend to discriminate these patients, possibly branding them as difficult to medically handle. In consequence, some of these patients suffer and may have to look for willing clinicians who may accept them despite their legal records (Iyer, Levin, & Shea, 2006). The autonomic access of EHR given to health care providers may open patients to professional prejudice, leaving the public at a disadvantage as dependents in health care provisions. On the ethical side of EHR system, public advocates have expressed concerns on the privacy risks entailed with the full access to medical information by several health care providers. Admittedly, all health care personnel have professionally sworn to keep all health records and information related to patients care in strict confidentiality. This is a part of their ethical code that assures patients that every information they divulge will not be readily disclosed without their explicit information. Yet, with the shared utilization of such recording system is fraught with confidentiality breach, distant computer sites can privy to pertinent information in the instance of security guardrail failures. In cases of intentional breach of EHR system for vested self-interest, innumerable effects can ripple towards the patients whose information are publicly divulged. On such incidence, possibilities of “career destruction, public ridicule, social rejection, and economic destruction” can be reaped by patient as victims of such system violations (Iyer, Levin, & Shea, 2006, p. 136). With the innovative and broad concepts presented by the EHR system, its constructive purpose of healing physiological conditions can paradoxically backfire, rendering the patients socially ostracized, and giving them social stigma instead of mental and emotional peace during recuperating stages of undergone disease process. The initial set-up and maintenance of such technological arrangement is elaborate in infrastructure, from hardware, software and management applications, as well as its sustenance with the necessary training the health care and administrative team as full users of such storage set-up. All of these activities require large financial funding (Sanbar, 2007). With several extended protraction with the complex technological mechanisms accompanying health service functions, EHR is said to be costly in initial and subsequent application runs. Yet, the financial side of the system is considered a minor glitch compared to the inconvenience that the said technological procedures provide for health care providers. The extra training during actual adaptation of the system can be trying for health personnel (Thomas-Brogan, 2009). In the adjustment periods, there can be delays in the promised services that should be immediate and speedy, where health care team have to fully grasp all the procedures in actual service provisions--compounded by mental stress and frustrations if some computer applications have been left out in medical consultations. As the technology that assists the public and medical sectors is not a perfect man-made creation, there are several operational setbacks seen with such storage system. Software applications are vulnerable to malicious virtual attacks, including system failures through application hacking acts with viral cyber infections and Trojan horses contamination (Sanbar, 2007). These unmitigated breakdown crashes in the electronic system can interrupt the documenting and other related functions of the health and administrative management. Overall efficacy of service delivery is affected, emphasizing the disadvantages of over-dependence with the efficiency promised by EHR. EHR in Saudi Arabia The Kingdom of Saudi Arabia (KSA) is a widely-populated region, as such, the need for excellent health care provisions is necessary to aptly cater with the booming Middle East territory. Billions of dollars had been spent in order to realize such health goals, where government funding from the Ministry of Health relegated majority of the budget (60%) on services related to health (Altuwaijri, 2010). Recognizing the need for prompt technological actions, the said government launched an elaborate multi-dimensional plan in restructuring the “Information and Communications Technology (ICT)” as the key sector in laying the groundwork for electronic concept integration in health systems and related functions. Despite the best intentions of the government in creating strategic health initiatives in delivering standardized quality care, a number of setbacks seemed to bar the full implementation and success of the said multi-phase care program. As emphasized by Wootton, Patil, Scott, and Ho (2009), the full utilization of e-health projects (including EHR) are numerous, including “lack of expertise, infrastructure, technical knowledge and skills...(and) reluctance to change traditions methods of practice” (p. 81). This is especially true in KSA, where problems in clinical operations have surmounted, as with the passing decades, most health institutions in the region still employ the traditional recording systems in paper recordings, disparate interoperability mechanisms, and shortages in qualified health informatics experts. A related proposal had been ensued by the government’s health reform task force, where the committee sought to address these by enhancing a specialized area of health informatics that constructs a structure in improving the launch of EHR systems and linkages in the country’s telemedicine updates (Altuwaijri, 2010). These ideals promote the sensible solution to the near-obsolete clinical procedures dominating the country’s health sectors; yet, the embodiment of such health care proposals seems far from what the reality in KSA presents. In a study on health care personnel several hospital institutions in Riyadh, outcomes yielded unfavorable results for EHR. As presented by Mohamed and El-Naif (2005), majority of sample physicians (68.7%) believe that the traditional paper-based medical records are more credible than electronic records. Moreover, most view the latter recording system as added burden, with the tendency to reduce functional productivity, 91.4% and 81.6% respectively. Accordingly, skills in computer manipulation (8.7), typing (4.8), and prior experience (2.8) are quite low in the total number of 105 sample physicians. With such outcomes, it is safe to say that the practical involvement of medical personnel with computer-related experiences and proficiency can account for their low preference in converting the medical recording mechanics from manual writing to electronic management. The resistant attitude manifested by health teams shows that the development of EHR in such institutions will be difficult and slower in progress. In another study, the opinion of the public towards EHR and other electronic services are obtained, where certain distinctions with the results are observed. The citizens are quite agreeable with the use of electronic systems in health services, specifically, 85.5% of 100 randomized samples are in favor of full employment of electronically-controlled medical reports. Regardless of identified factors (“gender, computer proficiency, and educational attainment”), most are said to lack the necessary knowledge and skills in computer, accounting for the misplaced optimism in information and communications technology (ICT) programs (Qurban & Austria, 2008). With such appeal, shortages of actual experience on technical skills further restrict the full utilization of EHR in strategic health sectors. As reality sinks in, it is now prudent to say that readiness of the public for EHR is counteracted by reluctance from a number of health care professionals to cooperate. Conclusions Summary The electronic health record (EHR) is a step above the traditional recording system that dominated health institutions for several decades. The concept of sharing relevant medical information through a more accessible means makes EHR efficiently ideal compared to the time-consuming and space-occupying mechanics in manual writing and filing of medical records. Advocates of EHR support its establishment for a number of reasons: speedy delivery of health services, low storage maintenance with reduced data redundancy in medical and administrative departments, and positive outcomes of readily available medical history in implementation of treatment schemes. Yet, others contradicts these by pointing the high expenditure needed to fully employ EHR in hospital institutions, as well as legal and ethical conflicts in privacy and confidentiality threats generated by such system. Yet, Saudi Arabia is still undecided with how to proceed with EHR and related health services. The lack of computer exposure and applicable electronic experiences in both the public citizens and health care teams may account for diminished preference of modernizing the recording and storage of medical data sets. These events show that the biased opinions against EHR should be eliminated first before further developmental steps are taken with full EHR implementation in KSA’s clinical institutions. Recommendation In relation with the aspiration to implement an EHR system in KSA’s health sectors, those actively involved in the movement must realize that public and health professionals should be willing enough to take part in the said technological program. The only way of achieving this is to widely educate them, not only on the whole EHR concepts, but also on fundamental subjects in computer mechanics and its operational systems. Sufficiency in technological awareness may improve informational dispositions, and later on, their attitudes and behaviors towards the efficacy of EHR in delivery of health services. After attaining their constructive approval, it would be prudent to choose a standardized EHR system that best fits the needs of clinical institutions in the region. As there are numerous facilities in the area, a networking scheme such as WAN, can cater to multiple-site locations that most health care teams maintain in delivering quality services. As these feats are established, the usual procedures on how the EHR functions can then be followed (as discussed above). With sufficient funding, employing EHR is feasible in KSA--through the concerted efforts between government and private sectors concerned in improving the way quality health services should be attained and provided. Bibliography and References Altuwaijri, M.M. (2010). Supporting the Saudi e-health initiatives: the master of health informatics programme at KSAU-HS. EMHJ, 16 (1), 119-124. Retrieved from http://www.emro.who.int/emhj/1601/16_1_2010_0119_0124.pdf Carter, J.H. (2008). Electronic Health Records: a guide for clinicians and administrators (2nd ed.). United States of America: ACP Press. Cunningham, E. (n.d.). An investigation of electronic health records. Dublin Institute of Technology. PDF File. Iyer, P.W., Levin, B.J., & Shea, M.A. (2006). Medical legal aspects of medical records. United States of America: Lawyers and Judges Publishing Company. Lehmann, H.P., Abbott, P.A., Roderer, N.K., Rothschild, A., Mandell, S., Ferrer, J.A., Milller, R.E., & Ball, M.J. eds. (2006). Aspects of Electronic Health Record Systems (2nd ed.). Canada: Springer Science. Mohamed, B., & El-Naif, M. (2005). Physician’s, nurses’ and patients’ perception with hospital medical records at a military hospital in Riyadh, Saudi Arabia. Journal of Family and Community Medicine, 12 (1), 49-53. Qurban, M.H., & Austria, R.D. (2008). Public perception on e-health services: Implications of preliminary findings of KFMMC for military hospitals in KSA: European and Mediterranean Conference on Information Systems 2008. Dubai. Retrieved from http://www.iseing.org/emcis/EMCIS2008/Proceedings/Refereed%20Papers/Contributions/C%209/emcis2008_Qurban_and_Austria_final_revision.pdf Sanbar, S.S. (2007). Legal medicine (7th ed.). United States of America: Mosby Elsevier. Thomas-Brogan, T. (2009). Health Information Technology basics: a concise guide to principles and practice. United States of America: Jones and Barlett Jones. Walker, J.M., Bieber, E.J., & Richards, F. (2006). Implementing an Electronic Health Record System. United States of America: Springer-Verlag. Wootton, R., Patil, N.G., Scott, R.E., & Ho, K. eds. (2009). Telehealth in the developing world. United Kingdom: Royal Society of Medicine Press. Appendices Appendix A Figure 1. Networks in Database Sharing (Carter, 2008, p. 80) Appendix B Figure 2. Workflow of Appointment Consultation (Walker, Bieber, & Richards, 2006, p. 38) Read More