How Electronic Medical Record could help to make decisions for patient - Article Example

How Electronic Medical Record could help to make decisions for patient Abstract The Electronic Medical Recorder (EMR) has been touted as the future technology in healthcare provision. However, despite much lobbying by its proponents only a marginal segment of healthcare providers have adopted this technology. This paper seeks to establish the advantages of an EMR system and further establish why so many practitioners are hesitant to take it. Introduction The electronic medical record (EMR) is a computerized system of storing medical records used by an individual healthcare provider such as a hospital or a physician (Carter, 2001). It is usually unique and is optimized to serve that particular facility or institution. The EMR was introduced in the USA in the 1990s initially, to standardize electronics healthcare transactions, to identify providers, aid in the health insurance provision, and serve employers in implementing health care schemes with a view of expanding it to include Medical practitioners (Niles, 2011). EMRs were introduced to enhance healthcare delivery and facilitate the decision making process (lavesque, 2001). The importance of quality healthcare cannot be over emphasized, it is not only valuable to the citizens, but also governments rely on it for a vibrant economy and sustainable development by ensuring a reliable human resource base. EMRs come in handy to facilitate this process. Advantages When properly utilized, Carter (2001) noted that EMRs help reduce medical errors; by storing important patient data such as drug doses administered, allergies, resistance and others. They eliminate the need for physicians to write order by hand in patients’ charts. Further, EMRs reduce the cost of healthcare provision (Carter, 2001). Some experts estimate that up to $5 is lost every time a doctor, nurse or any other member of the medical fraternity touches a chart. However, the EMRs eliminate or significantly reduce the need for chart. Since the computerized format used in EMRs utilizes printed text rather than physician crafted charts, it eases communication problems that undermine hand written text that can be illegible sometimes (Niles, 2011). The system also minimizes spelling and contextual errors and validity in case of drugs, thus minimizing data entry errors. The EMRs system also eases workflow for healthcare providers and enables the prompt provision of specialized services such as surgery. While utilizing the EMRs system, government and other public health stake holders like epidemiologists, social workers and others can protect and promote public health through surveillance, prevention and intervention especially in cases of contagious and communicable diseases. EMRs also help healthcare practitioners keep track of patients’ progress (Carter, 2001). This is so because the EMRs system can be programmed to detect abnormal laboratory results, prescriptions, and drug administration, thus helping experts intervene in time to prevent deterioration. Through computer networking, EMR systems can be accessed by multiple users, further data updates can be made in real time and backups can be stored in easily accessible ports through cloud computing (Niles, 2011). For cash-strapped patients and physicians, this facility would especially be useful in providing or accessing medical services especially for patients with chronic conditions. Where EMRs or ICT has only been utilized partially, some benefits have been observed. To begin with, where the quality of EMRs services are good, patient management is improved. This includes timely intervention where the patient seems to deteriorate, develop resistance, or needs further laboratory tests and further hospitalization or expensive procedures are avoided. Speedy storage and retrieval of patient data due to the ease of storage eliminates unnecessary costs like repeating diagnostic tests and lost data can erode the patient’s confidence in the physician (Carter, 2001). Access to accurate and timely patient data and medical records comes hardy when planning and implementing healthcare policies and can prevent loss of lives especially during epidemics. Another benefit of a computerized system is support to patients far away from the hospital, thus making distance irrelevant and since the physician has access to the patient’s medical records; the patient is able to access better healthcare. One obstacle that undermines the access to medical support online is refusal by insurance firms to cover bills accrued during online consultations thus discouraging doctors from offering those services (Karen, et al., 2009). Concierge physicians often offer patients online support and consultancy at a reasonable fee. Patients with chronic diseases can access support online thus eliminating numerous visits to the hospital. For example, remote patient management was found to lower readmission rates for patients with obstructive pulmonary disease. Tele monitoring has been suggested as a possible unobtrusive and cheaper method of monitoring the elderly at home (Rind, et al, 1997). Minute clinics operating within the precincts of retail outlets provide electronically aided treatment and store their data online; they have been found to be especially effective in treatment of children ailments like sore throats and colds and are characteristically cheap. Home based care provided to home bound patients and provided by specialists like American Physician House calls would not be effective without EMRs, which are a core feature of its operations (Skolnik, 2011). Challenges Software and hardware standardization, complexity, and different needs of each unit and department make uniform technological standards hard to maintain (Kleinke, 2005). This is because of the specific nature of technology needs in various departments. A recent study conducted in the USA revealed that there were 264 different EMRs being used by primary healthcare providers. This presents an issue of inconvenience and incompatibility where data is bound to be shared. Issues of multiple inconsistent data sources, confidentiality, security and cost also arise. Due to the capital intensive nature of EMR system, small hospitals, institutions and countries in the developing world opt out of the system preferring the traditional system. Due to reservations, phobia, ignorance and different inhibitions some practitioners and healthcare professionals reject the system (Williams & Boren, 2008). Some people argue that an electronic system could also foster errors. Over reliance on the systems accuracy could lead to a misdiagnosis and wrong treatment especially where the data entered is wrong or the test performed is wrong. This is the case especially where the EMR system is flawed or the personnel lack adequate training on utilizing the system (Karen, et al., 2009). In certain cases, rather than promoting, it can hinder communication and synchronization among the staff requiring more physical contact, thus beating the purpose. Due to interoperability errors, the software can produce incorrect prescription dosages by confusing units of measurement (Skolnik, 2011). Tackling challenges Due to the high cost in financial and human resource associated with EMR projects, it is important that stakeholders are convinced of the benefits of this system in a pragmatic manner. This is because, historically, the penetration rates of EMRs even in developed countries has been underwhelming. For example, the penetration rate in USA and Canada is below 20%. Even where there were attempts to adopt it, the implementation has been less than convincing (Kleinke, 2005). One reason for the failure has been cited as lack adequate communication by implementers. It is emphasized that the top management in the health care sector should play a key role in mobilizing, motivating and sensitizing staff on the importance of the system throughout the implementation stage. EMRs facilitate in reducing time spent on data entry and also data management thus improving service delivery and enhancing clinical efficiency by improving data capture and reducing or eliminating errors. The top management should ensure adequate resource allocation and design changes necessitated by the new system. Project champions or level managers designated to champion the project should be qualified and competent; they should serve as the link between top management and the stakeholders. They should motivate others. Their enthusiasm should radiate throughout the organization while conducting their duties in an inclusive manner. The stake holders should be well prepared by understanding concerns. Sensitization of practitioners and staff should be continuous. Consultations with the end users are critical; specialists should be familiarized with the interface and the technical complexities involved (Kleinke, 2005). The software adopted should be compatible with the core business of the organization. The data integration should be such that the existing data and old data are entered into the system such that everybody can conveniently access the data. Where vendors are involved, proper training of end users in a language they understand is critical. They should be available on call for trouble shooting and the system should allow for upgrades and modification. While maintaining confidentiality, the system should allow users to access data in a non-intrusive and secure manner. After the project has been implemented, the vendors should be always available for technical support including data recovery and disaster preparedness. EMRs in the US Despite the US being one of the leading economies in the world, trails other developed countries in the adoption of EMRs with only less than 20% of hospitals and practitioners utilizing the technology. The US government through the American Recovery and Reinvestment Act sought to accelerate the adoption of EMRs by committing $19 billion dollars to implement the program in prescription, data recording, maintenance and others. Of concern is lack of research and provision of sufficient data and financial models to back proposals with pragmatic demonstration of how the system works, the right environment, financial and technical support required to implement the system (Karen, et al., 2009). While getting more facilities connected to the system is important, emphasis should be put on the quality, efficiency and convenience of the system. Kleinke argued that the EMRs system is not fully developed for wholesale integration into the healthcare system (Kleinke, 2005). However it is important to note that some practitioners have adopted healthcare information systems to a varying degree of success. This is especially the case with pharmaceuticals and manufacturers and suppliers of medical equipment. Clinical officers increasingly adopt information technology in diagnostic procedures like the use of digital medical imaging in magnetic resonance imaging and sharing the results with fellow professionals in other parts of the world (Carter H., 2001). Kaiser Permanente and the Veterans Affairs are the two leading institutions in adoption of EMR systems, in the US, with both serving over 5 million patients using the system. Their patients can consult, contact and interact with physicians electronically and receive follow up online (Rind, et al, 1997). Diagnostic results are stored electronically and prescriptions promptly sent electronically to a pharmacy. The patients of these two institutions are perceived to receive over 60% better service, accurate diagnosis, right prescription and follow up, than those using the convectional system. Experts blame lack of incentives as the main challenge to the adoption of EMRs, further noting that while doctors and other healthcare professionals bear the cost of implementing the system, it is patients and insurers who benefit from the system. It is also clear that in some cases, the system would chew up some of their revenue, for example, making patients data available online would eliminate some repeat tests, but hospitals gain revenue from such tests (Scott, 2007). Most experts argue that federal government support and intervention is inevitable if technology is to replace the current manual data recording and storage. The mixed and contradicting research findings on the financial benefits of adopting EMR technology in Medicare have not helped solve the impasse (Skolnik, 2011). Proponents argue that the system would eliminate unnecessary tests and digital imaging thus reducing wastes, though it is unclear how much wastage would be reduced with the EMR. Further, it is argued that, it would increase efficiency through use of easily accessible records. An integrated system would complement clinical medicine with provision of data on the most effective practices. Using specially designed software, doctors can trace adverse drug interactions in patients and intervene to protect the patient (Rind, et al, 1997). Criticism of EMRs While different independent estimates suggest that the US government would save up to $75 billion dollars on adopting EMRs, there was no sufficient evidence to support those claims because of the uncertainty clouding this technology. While not discounting the benefits of an integrated database in providing information on the best treatment practices, the process will require monitoring for a long period (Scott, 2007). While EMRs can be a great tool over reliance, it can be costly even fatal if a patients record contains insufficient or false and misleading information. Due to the online nature of the system, it is prone to hacking, identity theft, illegal access or alteration. While many healthcare consultants tout the value of a EMRs system, there is lack of a coordinated research on the real cost and benefits of its implementation. There is perceived ignorance on the conditions under which they are utilized or the disincentive alienating practitioners from the system and the inherent problems arising from adopting a top down implementation policy. Many practitioners cite system complexity and high capital costs against ambiguous financial benefits (Karen, et al., 2009). Where there is no back up or in cases of inaccessibility of the electronic records due to power failure leads to deprivation of critical medication or support, which can have fatal consequences. It is recommended that software should be tailored to fit the needs of patients and physicians with an emphasis on workflow efficiency. It does not help if the system adopted in the first place is flawed or the software/hardware is defective as this will result in inconsistencies in medication or diagnosis and discrepancies in the output in various departments. It is thus recommended that the whole system should not be automated (Karen, et al., 2009). There are also issues of data quality with researchers observing that some systems offer truncated or keyhole information curtailing or inconveniencing the preparation process for a procedure. Furthermore, since most physicians only record specific data they need, relying on the system to collect patient data to implement government policies would be erroneous and cumbersome (Skolnik, 2011). Other factors that complicate use of EMRs is complexity of work and time variables, making some systems redundant in particular situations or facilities and thus a standardized system for all facilities and situations might not be practically possible to implement. With the EMR system security and privacy issues, for an integrated health system, accessible to all stakeholders and easily accessible online is also accessible to the whole world creating loop holes for hackers and criminals to exploit (Skolnik, 2011). Among the sensitive issues are cases of patients keen to hide their condition, employers and insurers avoid certain clients or workers and certain entities in the healthcare industry commercializing data. For example, there have been cases of members of the healthcare fraternity leaking conditions of celebrity patients to the media. EMRs in developing countries Owing to the capital intensive nature of EMRs, most countries in the developing world struggle with implementation. This is due to lack of financial and human resources to design and effectively implement the system (Williams & Boren, 2008). Even when pilot or fully fledged systems are implemented, there are usually technical flaws like inaccurate data and unreliable data and thus the system might fail to yield the desired results. EMRs experts also highlight the need for the designers in these countries to consider differing cultures and traditions, infrastructure, and environmental factors when designing systems for countries in different regions (Williams & Boren, 2008). This is meant to ensure compatibility, acceptance and success in the particular region. It is important that international organizations, world leaders and corporate should render financial and technical support to these countries if EMRs are to be embraced for better public health and a thriving welfare system. Even where donors have donated equipment and other materials, the projects are dogged by lack of funding to repair, maintain and sustain the system. This is why there is a call for collaboration with developed countries to share experience and expertise in this area. Conclusion If implemented properly, with the involvement of all stakeholders and proper training of the staff and all members of the healthcare and welfare fraternity, the EMR can be a useful tool for providing useful, accurate, portable and easily accessible medical data. For this to be achieved, proper training, consultation and inclusion must be done throughout all stages of implementation. Since most benefits are to be enjoyed by the ordinary citizens, it is important that the government should give incentives to the practitioners in the healthcare system. In addition, a clear pragmatic policy on implementation should be formulated, not based on hype and sensational claims, but based on a proven working model. It is the market and not politicians and lobbyists that should determine the best technology to adopt while consumer privacy should be protected. 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The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review. Informatics in Primary Care 2008; 16:139–45. Read More