Will Electronic Medical Records Really Improve Health Care - Research Paper Example

HERE YOUR HERE HERE HERE Will Electronic Medical Records Really Improve Health Care? Outline I. Introduction II. Advantages of EMR a. Storage space improvement b. Workflow process efficiency c. Cost savings d. Federal funding incentive support III. Disadvantages of EMR a. No singular software package in industry b. Data security and integrity c. Date and time stamp liabilities d. Lack of industry-accepted social framework e. Lack of cooperation opportunity IV. Conclusion Works Cited Introduction There are multiple advantages in the health care organization for implementing an electronic medical records system, designed to replace paper documentation pertaining to patient care, patient history, and clinical practice related to the organization. The electronic medical records system (EMR) consists of various or stand-alone software packages in which vital clinical information and patient data are input into a computerized system. EMR allows the health care organization to input exacting patient interventions, insurance information, keep track of referrals, and a host of other documentation that has traditionally been maintained in paper format. It is designed to facilitate more timely patient responses during patient/physician interventions and improve the total efficiency of the organization and those support staff members involved in the health care service cycle. However, despite the advantages, there are large-scale complications and problems associated with EMR that could easily offset gains of this type of capital expenditure for the health care organization. The research evidence on the subject of electronic medical records tends to indicate that EMR does, in fact, maintain the potential to improve health care, but only when vital circumstances leading to potential liability have been sufficiently addressed. Advantages of EMR In health care organizations that provide health services to a large volume of patients, tangible space is a legitimate issue both for ensuring profitability and providing timely and quality care to multiple patients. The electronic medical record provides opportunities for health clinics and hospitals to remove their dependencies on physical paper and documentation storage which continue to plague organizations. Growth in insurance documentation, depth of clinical analyses, and other important supplementary documentation require a significant storage space within the organization. For instance, in a typical patient/physician intervention lasting seven to ten minutes, physicians spend twenty-five percent of this time searching through paper documentation (NASBHC 1). In an organization without an EMR system, retrieval times for accessing paper charts can be extensive especially for organizations requiring 300 square feet of storage for these documents. Common problems with maintaining traditional paper systems are lost charts and poorly coordinated billing information. By installing EMR, the prevalence of lost charts can be reduced from an average of eleven percent to under one percent by facilitating more effective document retrieval (NASBHC 2). Removing large-scale storage needs allows the organization to allocate rooms to better and more efficiently serve patients rather than having a complicated paper storage system within the business. Physicians that are forced to spend twenty-five percent of their time searching for paper documentation rather than intervening with patients diminishes productivity and can also lead to patients defecting to another health care provider due to high wait times to meet with health care staff. Simon Fraser University supports this, offering that productivity is known to increase and frequency of lost patient data is reduced with adoption of EMR (SFU 2). In terms of storage and data retrieval times, the benefits appear obvious toward implementation of the EMR system. The electronic medical records system also maintains advantages in terms of increasing workflow process efficiency. In a typical health care facility maintaining paper documentation, there are often data input redundancies that occur between health care professionals. Many organizations have on-site or outsourced medical transcriptionists that convert recorded physician data onto electronic and paper documentation when appropriate. Within the organization, staff must accurately complete patient information into paper format, increasing the opportunity for redundant input to occur. By establishing a singular and streamlined data entry system associated with EMR, redundancies are reduced (Erstad 53), which allows health care staff members to accomplish more productive work related to quality care provision. Furthermore, many health care organizations pay salaries to medical transcriptionists of approximately $26 per hour or $70,000 yearly (Miller 2). Thus, a health care organization maintains the ability to save between $70,000 and $140,000 yearly in relation to labor costs by investing in the EMR system. For a smaller health care facility with high overhead, these savings can be better allocated to improving staff motivation with bonus provisions or other incentives programs that will ultimately benefit long-term patient care quality. There are also significant cost benefits of implementing electronic medical records. Growth in this technology and improvement in health care software, as well as new technology market entrants, have reduced the implementation costs of the EMR packages. Implementation of mid-grade EMR software (those without supplementary packages allowing for mobile data transfer and sophisticated wireless technologies) will cost the health care organization only approximately $3400 (Wang et al. 398). In addition, the software license only runs between $800 and $3200 (Wang et al. 398) with very little maintenance and service costs for the software and hardware. Many health care organizations that can no longer store their records on-site must pay outsourced storage professionals to maintain their archived patient documentation, which can exceed the costs of implementing EMR. Furthermore, the reduction of potential liabilities for inadequate data storage that can occur in a paperless system are greatly reduced, thus providing long-term economic security for the health care organization and staff. Another economic advantage of the EMR is the level of support for its implementation that is provided by the federal government. In 2009, President Obama enacted The American Recovery and Reinvestment Act, which authorized incentive expenditures under the supplementary Health Information Technology for Economic and Clinical Health Act for those organizations that provide service under Medicaid and Medicare (CMS 3). Thus, there is opportunity that implementation and service costs for the EMR can be completely or largely eliminated by federal investment. In this case, the costs that would have been spent on EMR can be better allocated throughout the organization for more quality patient care instruments or upgraded testing and analysis procedures. Because of the federal role in facilitating more effective records management, it would seem that the quality of healthcare, from an economic lens, can be greatly improved. Disadvantages of EMR There are also many known and potential disadvantages of the EMR. First, there is currently, on the software market, no singular template of software package that is streamlined throughout the health industry (Mohd and Mohamad 76). Some health care organizations have multiple electronic data needs and therefore must be supported by multiple software vendors, which can dramatically increase implementation costs of the EMR system. Having multiple software programs can also, long-term, increase the costs of maintenance and support that is uncommon in small-scale EMR systems. A health care organization could be investing significant capital that could be better applied to establishing quality patient care practices and tools if their data and documentation needs are complex and wide-ranging. Data security and integrity is also a significant concern for electronic medical records systems. Having a paper copy of patient information gives a health facility much more control over the transfer of this data and ensures patient privacy under various federal laws. Once the information is put to electronic format and EMR with online storage capacity and capabilities, it runs the risk of being exposed to hackers and even internal staff with access privileges that can exploit this information. Elizabeth Cohen, a CNN reporter, illustrated on-air how easily medical information could be retrieved using the Internet. Using only a patient’s social security number and birth date, Cohen was able to access 18 months worth of confidential and private patient information that had been uploaded to an EMR system (HIMSS 4). This illustrates the potential widespread liability that a health care business could face in an environment where data integrity and privacy is a legitimate problem. Furthermore, a similar situation occurred at Henry Ford Hospital in Michigan in 2010. A physician maintained private information about patients on their business laptop, which was subsequently stolen during the course of regular practice (IB Times 1). At the California Department of Healthcare Services in 2010, 50,000 patients had their social security numbers accidentally printed on a variety of mailing labels that were generated by the EMR (IB Times 2). At Blue Cross and Blue Shield of Tennessee, a hard drive was stolen by internal employees in which over one million members had their social security numbers exposed as well as their diagnostic codes and birth dates (IB Times 2). As illustrated by these case studies, the EMR provides a unique opportunity for mass theft of private and legally-protected information that maintains significant legal liabilities to the health care facility. Such theft is nearly impossible when using paper records. Research also did not identify an existing data integrity system supported by local, state, or federal governance policies and legislation that protect the health care organization from ongoing data fraud and hacking scenarios. There seem to be no guarantees stemming from various software and hardware vendors that guarantee maintaining the utmost privacy and protection of these systems, which was largely proven by the CNN reporter, who was able to quickly and easily access data over a worldwide online network in front of the national viewing audience. The potential liabilities related to data integrity and security are substantial. Why is liability such an imperative when determining the effectiveness of EMR to health care? One of the most expensive costs to a health care provider is liability insurance which increases with each instance of malpractice or other negligent judgments against the physician or facility. In one case involving malpractice, EMR was actually the deciding factor that led to a multi-million dollar payout to the plaintiff alleging malpractice. The case highlighted a patient undergoing specialized surgery that was left a quadriplegic due to suspected negligence of the surgeon. During pre-trial, it was believed that the patient did not have adequate proof of malpractice. However, the attorney was able to produce a court-ordered subpoena to bring to court all EMR records related to service cycle of this particular patient. After scanning the electronic records, various date and time stamps, which are part of user access profiles in most EMR systems, it was proven that the anesthesiologist was not present during the entire surgery (Vigoda and Lubarsky 1799; Dimick 25). Though it is assumed that all health care facilities attempt to meet all ethical and moral guidelines of positive patient care, the EMR program puts significant accountability on individuals and the facility associated with patient care. End user date and time stamps record every detail of patient intervention from preliminary examination until completion of the services. Organizations and staff that make common errors could lead to very costly litigation that leans in favor of the patient, which could degrade available capital to provide future quality health care services. The recurring theme of liability could lead to costly training imperatives or organization restructuring that would have significant volumes of implications on patient care. Another major problem of the EMR is that there is no singular industry-accepted social framework guiding implementation of the software and hardware packages (Voelker 2). Even though the software is available, poor organizational planning could lead to various templates that provide for poor data presentation. Why is this? Before the implementation phase, it is best practice to examine the roles of employees in the health care facility, their function, and the cycle of service care occurring between professionals and the patient. Usually, this is conducted in the form of a workflow process chart or diagram. Because not all health clinics are experts in pre-development IT processes, ineffective EMR systems could be developed by having no respected social framework for reference. Ultimately, lack of an industry-accepted framework for workflow mapping could lead to medication errors, poorly informed physicians and support staff, and unnecessary referrals (Voelker 2). Thus, it might be necessary for a health care provider looking to improve paper records by installing EMR to hire information technology professionals or management experts to identify the most appropriate social framework for implementation. In essence, it could be more costly in terms of lost labor and training than simply keeping the paper documentation system. Even more disappointing about the EMR system are real-life professional testimonials about the effectiveness of these systems in real-world health service environments. A recent study involving a sample of ambulatory professionals, physicians and non-physician support staff identified a problem with EMR in facilitating cooperation between various divisions within the organization. According to one physician respondent in the study, “most interaction is between the individual clinician, the EMR database, and the patient. There is not nearly enough inter-provider or team communication” (O’Malley et al. 6). An ambulatory expert in the study stated that “the best way to ensure good coordination of care is for physicians to speak with each other directly” (O’Malley et al. 6). Expert in this study maintained a higher-grade EMR system that allowed for direct communications using a variety of mediums installed with the package. Individuals were realizing that traditional face-to-face discussion or consultation over the telephone maintained more productive outcomes than using online communications tools in the EMR. Electronic medical records do not seem to, based on real-world sentiment, facilitate a more cooperative and interactive environment that is required to establish higher-quality patient outcomes and professional practice. Even respected leadership theory reinforces that in order to build collaboration and effective team methodology in the health care organization, inspiring a shared vision through direct communications is necessary (Kouzes and Posner 68). Even though the ease-of-access of various patient information and records is available for multiple professionals in a health care system, the EMR does not replace traditional collaboration required of direct discussion. It does not appear that organizations desiring to use EMR as a cross-competency tool will meet with much return on the capital investment. Conclusion Though there are many benefits to the EMR, the depth of significance of the disadvantages outweighs advantages in critical areas of health care security and long-term strategic and economic position. It would seem, from a practical lens, that EMR would improve overall efficiency and provide the health care organization with much more productive and accurate records management processes. This would actually be difficult to refute considering the volume of time and inefficiency in lost documentation and retrieval gaps identified in the research literature. However, many of the threats to establishing EMR have long-term cost implications for the organization that could impact quality of patient care or even longevity of the organization itself. With no formal, industry-supported framework for implementing a system that is customized for a health care facility come ample opportunities for ineffective planning and design that could overwhelm or confuse multiple staff members in the health care service cycle. Add to this the tangible liability implications for common health care errors that provide ample evidence for failures in litigation scenarios, EMR seems to have long-term hindrances to organizational protectionism with serious financial consequences for inefficient staff and physicians within the EMR documentation cycle. Based on the evidence, can the electronic medical records system really improve health care? Yes. However, there are many mitigating circumstances that must be considered and subsequently addressed in order to gain the expected return on investment in the expense before being of value to the organization, its staff members, and, ultimately, the patient. Works Cited CMS. The Official Website for the Medicare and Medicaid HER Incentive Programs, Centers for Medicare and Medicaid Programs. 2005. Web 21 September 2012 Dimick, Chris. “E-Discovery: Preparing for the coming rise in electronic discovery Requests.” Journal of AHIMA 78.5 (2007): 24-29. Erstad, Tricia L. “Analyzing Computer Based Patient Records: A Review of Literature”. Journal of Health Information Management 17.4 (2003): 51-57. HIMSS. Security and Privacy of Electronic Medical Records White Paper. Web. 21 September 2012 IB Times. 20,000 Patients’ Medical Records Breach at Stanford Hospital: A Report on Similar Cases. International Business Times. 2011. Web. 22 September 2012 Kouzes, J.M. and Posner, B.Z. The Leadership Challenge, 5th ed. Jossey Bass. Miller, Michelle. Is Medical Transcription for You? Web. 20 September 2012 Mohd, Haslina and Sharifah M.S. Mohamad. “Acceptance Model of Electronic Medical Record”. Journal of Advancing Information and Management Studies 2.1 (2005): 76. NASBHC. History of EMR. National Assembly on School-Based Health Care. 2008. Web. 23 September 2012. O’Malley, Ann S., Joy M. Grossman, Genna R. Cohen, Nicole M. Kemper and Hoangmai H. Pham. Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices, MPH Center for Studying Health System Change, Washington DC. 2006. Web. 23 September 2012 SFU. Information about the Electronic Medical Record (EMR). 2012. Web. 22 September 2012 Vigoda, Michael M. and David A. Lubarsky. “Failure to Recognize Loss of Incoming Data in an Anesthesia Record-Keeping System may have Increased Medical Liability”. Anesthesia Analgesia Journal 6.1 (2006): 1798-1802. Voelker, Kirk G. Electronic Medical Record. EMR Primer. 12 January 2004. Web. 23 September 2012 Wang, Samuel J., Blackford Middleton, Lisa A. Prosser, Christiana G. Bardon, et al. “A Cost-Benefit Analysis of Electronic Medical Records in Primary Care”. The American Journal of Medicine 114.2 (2003): 398. Read More