Inappropriate Usage of Electronic Health Records - Essay Example

Inappropriate usage of Electronic Health Records Summary An electronic health record (HER) is an increasing evolving concept use for gathering electronic health information about patients or population. The U.S. is among countries that have adopted the concept and many hospitals and healthcare providers are increasing adopting the technology in line with the American Recovery and Reinvestment Act of 2009. The increased adoption of the concept is linked to the fact that the technology is capable of improving the safety of patients. However, recent findings have shown that EHRs have certain risks that result from its improper usage. This risk reduces the reliability and effectiveness of the technology and as such need to be identified and remedial action taken where appropriate. At the same time, a consulted effort of the Office of the National Coordinator for Health Information Technology [ONC], the Joint Commission, the AHRQ, and Centers for Medicare and Medicaid Services is vital for adoption of future HER use. Introduction The adoption and use of electronic health records (HERs) has become a major national policy priority in the U.S. in the recent times as means of improving patient safety (Sittig and Singh 1854). The issue of adopting this system has received bipartisan backing, which compelled the U.S. Congress to give out about $30 billion in response to the American Recovery and Reinvestment Act of 2009 as a way of advancing the adoption of interoperable, certified EHRs (Sittig and Singh 1854). In fact, today, several hospitals and health care providers throughout the U.S. have adopted the use of HER system with many still in the process of introducing the system in order to enhance the efficiency and quality of health systems. A study conducted in 2009 shows that certified EHR vendors have increased from significantly in the U.S. to more than 1000 up from 60 the number of certified EHR vendors that were available in mid 2008 (Sittig and Singh 1855). Despite the increased adoption of the system in the U.S. hospitals and health care institutions, evidence has linked the use of EHRs to certain risks. Therefore, it is essential that the peculiar safety issues attached to the use of EHRs should be looked into alongside the benefits of EHRs. This paper will explore concerns associated with the inappropriate usage of EHR in hospitals, in the U.S. and related laws regarding its usage. To begin with, an electronic health record (HER) refers to an electronic system of gathering health information of patents or population. The records are kept in a digital format that can easily be shared across multiple health care settings. For instance, in some health care institutions, the information is shared using networks exchanges that relay information from one department to another. There are quite a number of data that can be shared using EHRs and includes among other things demographics, allergies, laboratory test results, medical history, important signs, medication, immunization status, patient’s age, eight, hospitalization record, as well as billing information (Rao et al. 271). The technology is still at its developmental stages and many countries in the world are rushing with speed to adopt it as a way of enhancing the quality and efficiency of health systems. This has particularly been witnessed in the U.S. where the technology is widely used since its introduction few years ago. Report indicates that the widespread use of EHRs in the U.S. hospitals was prompted by several advantages associated with the technology such as the fact that EHR is capable of preventing certain patient harms when used appropriately. For example, EHRs are capable of facilitating and standardizing the information transfer between health care providers thereby closing the communication gap by timely notifying health care providers of the test results, whether normal or abnormal. The technology has also received a rousing welcome in the U.S. since it has the ability to share and update information among different departments and organizations automatically. In addition, HER is effective because it makes sharing of multimedia information among different locations possible. Further, HER also makes it easier for users to standardize services and patient care (Sittig and Singh 1856). However, such benefits are only assumed to arise when EHRs are used appropriately as per the guidelines. This is because some providers tend to use it inappropriately thus increasing risk on patient. For instance, if a computer-based provider orders entry (CPOE) system were to be utilized in a section of nursing departments and not in others, then clinicians would be required to check for orders and confirm results in different locations, which increases the possibility of some information being ignored. At the same time, other incomplete uses of CPOE may end up making noncomputerized processes more susceptible to errors. For instance, if medications are ordered using CPOE instead of laboratory tests, then having a closed-loop electronic relay of test results to the ordering providers would be impossible thereby leading to loss of some test results. In addition, a danger can also arise if providers circumvent structure CPOE data fields, but instead use EHR-based free-text communication for medical prescription or stoppage of medications because of lack of standardization of free-text orders and are susceptible to miscommunication (Rao et al. 273). Secondly, research indicates that the use and implementation of HER’s complex clinical-decision support (CDS) systems are prone to cognitive constraints and human error. Therefore, it is very crucial for providers to conduct a periodic evaluation on decisions associated with CDS interventions. For instance, despite the fact that point-of-care CDS interventions are vital for the realization of the full benefits of EHRs, as well as stages 1 and 2 of reasonable payments of the Centers for Medicare and Medicaid Services (CMS), it is crucial for providers to use judiciously, alerts that interfere with the workflow of clinicians. In spite of the fact that this is the right thing to do, many organizations throughout the U.S. resort to using alerts with low specificity resulting in increased rates of clinician override. Overrides are mostly linked to ‘alert fatigue’, which is likely to make clinicians ignore vital information accidentally (Kopala and Mitchel 86). Report also shows that, despite increased safety issues linked to dictated reports, integration of free text, radiographic images and other related test results into EHRs, many institutions still fail to code some vital data required for safety maximization. However, lack of coded data makes it difficult for the system to provide the user with a reasonable interpretation and feedback. This has the potential of leading to inaccurate information regarding a patient in the hospital, which may be detrimental as far as medication and treatments are concerned (Sittig and Singh 1856). Data inaccuracies are also another area of concern in the implementation of the EHRs system. Basically, EHRs are perceived as one means of improving the safety of patients by reducing errors. However, inappropriate usage of the device has proved otherwise in many institutions that have adopted the EHRs system. This is because many errors have been detected in data entered using the EHRs system thereby raising concerns regarding the accuracy and reliability of data keyed in using EHRs. Since EHRs records are naturally longitudinal, they have the potential of containing high amount of data, which may not be useful or required by patients or multiple care providers under interoperable personal health record (PHR). For example, research indicates that many providers tend to use the ‘cut and paste’ method as a way of increasing the efficiency and ease of use, but this method is prone to errors thereby resulting in inaccurate representation of the current condition of a patient and treatment. Moreover, there are also high chances of data loss or destruction during data transfer, which is of concern to many people raising a lot of questions regarding the accuracy of database that providers rely on when making patient care decisions (Rao et al. 274). Evidence also shows that EHRs can easily be populated with incomplete or inaccurate data particularly in the event that data sharing occur among multiple systems. At the same time, EHRs is highly susceptible to fraudulent activities that compromise the integrity of information in the database. In fact, research shows that the U.S. spends huge sums of money in health care fraudulent activities. The figure is estimated at about 3%, which translates to about 68 billion dollars annually. The study also found out that small health care professionals mainly engage in fraud-related activities such as diagnoses falsification and or exaggeration of the condition of a patient or billing of services not provided. During the research, it was also noted that most nonhealthcare professions tend to engage in large-scale frauds including billing of Medicare, Medicaid, as well as private companies for services not offered to patients (Kopala and Mitchel 85). An inappropriate use of EHRs can also lead to loss of privacy and confidentiality of patient information. For instance, a report by the Los Angeles Times showed that about 150 people, which includes doctors, technicians, nurses and billing clerks accessed at least a section of patient’s records in hospitals (Pritts 11). At the same time, the report revealed that more than 600,000 providers, payers and those concerned with billing data had access to patient’s information (Pritts 11). However, the use of EHRs is likely to increase the risk since data is shared among multiple locations. Some users in the event may end up using the patient’s information for selfish interest thus compromising on the integrity of patient information. Monitoring and improving patient safety using EHRs In order to achieve the objectives of many national programs to enhance the safety of patients and to aid prevention of safety issues, EHRs should be used as a means of detecting, managing, as well as learning potential safety threats in real-time. As a result, there are a number of organizations and agencies that ensure effective implementation of EHRs to guarantee safety of patients. The organizations include the Joint Commission, Agency for Healthcare Research and Quality (AHRQ), and the recently constituted Partnership for Patients. Reports indicate that the present method used for determining the safety events over rely on the incident reports, which has the capacity of detecting only a small proportion of events. However, research indicates that systems can be programmed in a manner that automatically detects any overlooked or underreported omissions or errors with ease using HER trigger approach. At the same time, HER-based trigger techniques are also effective in detection of errors of commission that are linked to preventable drug events, misidentification of patients and postoperative complications. At the same time, organizations must take steps geared towards leveraging EHRs in order to enhance detection of common errors, track trends over time and to follow up the occurrence of high-priority safety happenings. In addition, an organization can us e-PSG tool to identify, monitor and report any issue found with the EHRs system as this will make detection and reporting easy (Kopala and Mitchel 87). Conclusion It is certain that EHRs has brought a lot of benefits to many hospitals in the U.S. that has embraced the technology in its health care system. However, the technology has also proved to be associated with a lot of risks that affect its reliability and effectiveness as far as safety of patients is concerned. Therefore, it is important for an organization that have adopted the system as well as those in the process to introduce the system to ensure that the risks are identified and eliminated so as to maintain the effectiveness of the system. At the same time, HER needs to be optimized so as to improve the effectiveness of health care delivery system in hospitals. Work Cited  Kopala, Beverly, & Mitchel, Mary E. Use of Digital Health Records Raises Ethics Concerns: JONA's Healthcare Law, Ethics, and Regulation. July/September 2011.  13(3):84 – 89. Web. http://www.nursingcenter.com/prodev/ce_article.asp?tid=1238212 Pritts, Joy. Privacy and Security of Electronic Health Records: New Challenges, New Protections. The Office of the National Coordinator for health Information Technology. July 26, 2012. Web. http://www.slideshare.net/HealthIT/privacy-and-security-of-electronic-health-records-ehrs-new-challenges-new-protections Rao, Sowmya, DesRoches, Catherine, Donelan, Karen, Campbell, Eric, Miralles, Paola & Jha, Ashish. Electronic Health Records in Small Physician Practices: Journal of the American Medical Informatics Association: JAMIA.  2011. 18(3):271-275. Web. http://www.medscape.com/viewarticle/743777 Sittig, Dean & Singh, Hardeep. “Electronic Health Records and National Patient-Safety Goals”. The New England Journal of Medicine. 2012. 367:1854-1860. Web. http://www.nejm.org/doi/full/10.1056/NEJMsb1205420 Read More