The US Electronic Health Record and its Impact on the Approaching Universal Healthcare System - Research Paper Example

A Brave New World The US Electronic Health Record and its Impact on the Approaching Universal Healthcare System The United States of America is a country with constant changing society. The constant changing modern practices often clashes with the traditional one which has its root in the religious belief of the citizen and also the political views which are often conservative. There are times when implementation of new technology raises controversies as people resist the best solution for the society. The recent controversy in the US economy is about the Health care system of the country. The life expectancy of the US population is expected to increase over the years. With the increase in the life expectancy the chronic health problems of the nation are also expected to increase. The US health care system is one of the costliest systems of the world with a spending of 16% of the gross domestic product of the country according to the statistics of 2006. It is expected to increase to over 20% of the GDP in the upcoming years. But study reveals that each year about 1 lakh people die because of medical errors and absence of health insurance. Estimates indicate that more than 50% of the population lost their health insurance because of their job cut and therefore unable to pay the premiums. Despite of being a costly health care system the disease rate in USA is much more than many other developed nations. The United States government does not provide health coverage along with the citizenship and so the health care system is available to those who can afford it. Thus the system excludes the poor population of the country. Many European nations and also Canada follow a health care system that each and every individuals of the society have equal access with centralized Health policy agency. It is called the Universal care system (Sherrow, 2009, pp. 8-10: Niles, 2010, pp. 2-11). In fact medical records are indispensable and crucial for the health care system and the providers look for fast and easy access to information. Policymakers and the lead doctors recommend the implementation of electronic health records in order to enhance the health care quality a well rejuvenate medical practice. recent reports estimate that this will “save the health care system $77.8 billion annually – 5% of total health care expenditures in the United States” (Baron, Fabens, Schiffman and Wolf, 2005, p. 222) Implementation of electronic health recording system has provided a new dimension to health care and enables the provision of a universal health care system. The conventional form of medical records in hard copies is almost fading and getting replaced by the Electronic Health Record (EHR). The providers on one hand need ready information and also do not want to adjust their interaction with the patient. The electronic health record system comprise of a longitudinal database about the patient’s medical history. In early 1990 the Geisinger organization of America decided to implement a program that will provide an integrated care that will serve the past population including those of the rural areas. The change required a huge improvement of the information management. In the year 1995 a multi-year IT strategic plan was approved by the board of the directors that will acquire the Electronic Health recording system. The system was expected to improve the ‘communication of clinical data’, increase the safety of the patients, reduce cost, increase the revenue earning of the sector and meet the requirements more efficiently. With time it is understood that the geographically dispersed large system requires consistent administrative and clinical process to unite them into ‘an effective whole’ (Walker, Bieber, Richards, 2006, pp. 3-6).The functions of the electronic health recording system generally covers four domains-recording the clinical and demographic date of the patients, managing the results of the laboratory test, supporting with clinical decisions and managing the entries through electronic prescriptions. (OECD, 2010, p. 120) It is becoming vital for the health care system which can become automated and reap the benefits of flawless integration. Despite the fact that the electronic health record technology has the potentiality of increasing the efficiency and the potentiality of the health service providers they have been slow in adopting the technology. Survey made by the department of Health and Human service reveals that from among 63.1% of the hospitals surveyed only 1.5% of the US hospitals are provided with a system of ’comprehensive electronic record’. If the federal hospitals that are run by the Veteran Health Administration the proportion of the hospitals using the comprehensive electronic record techniques increases to 2.9% .The form of ownership of the hospitals does not convey any difference to the adoption of the system. The prevalence is same for both the public hospitals and the privatized one. No differences are observed in adoption of the system comparing profitable and non profitable organizations. The barriers noted in the implementation of the technology are mainly financial constraints for purchase and maintenance of the system. There are also lack of the availability of persons used with the technology and the unclear return from the investment of capital in the implementation of the technology (Department of Health Policy and Management, 2009, pp.1628-1632). The World Health Organization (2008) reports that the health care system of USA provides care to individuals on the basis of their ability to pay otherwise they need to provide themselves with individual health insurance. According to the report the universal coverage reforms could ensure that the health system provides health equality, reduces social injustice primarily moving towards social protection (World Health organization, 2008). A report elaborates upon the results derived when Greenhouse Internists implemented a complete electronic health record framework and the problems faced during the transformation from “paper to computer”. Till this was done, computer was used for billing and schedule maintenance only. The basic requirement was to alter the management system’s ways and practice. The first challenge was the lack of knowledge in handling the complicacies of a computer network system. There was a virus attack shortly after the implementation. in the beginning competence got reduced and more effort had to be invested to get accustomed to the new ways. The reception had to learn using on-screen forms for recording messages over telephones and doctors tracked the messages on their computer instead of telephone message bin. Workload increased for all. Initially the patients complained due to longer waiting time but within four to six months both accessibility and simultaneous use of the same information made the staff and the consumers really excited about the service. Workflows had to be adjusted to meet the needs. however in terms of financial savings there was not much hope as the annual budget increased from $10000 to $40000 immediately after implementation with a carry cost of $24000 for five consecutive years. Only one staff could be eliminated which resulted in a savings of around $20000 but again this would be exhausted through other investments related to printers etc (Baron, Fabens, Schiffman and Wolf, 2005, p. 225). What basically prompted the health care system to adopt the electronic health record is that it might meet the patient’s expectations and also enhance level of job satisfaction. The main boon is the degree of communication between the doctors and patients which is not longer place dependent or localized. yet it is not rational to accept that the small health care practices such as this one (which had four physicians and one nurse) to adopt electronic record system without adequate financial support. Patients however expect a nominal level of electronic support and this is the main reason which prompted this institute to implement the system. Despite the challenges one cannot deny that such a record system can support universal health care especially since the small health centers are the most common points of access for people in US. this requires new models which can provide the required support to the management and finance of these small institutes. The implementation of electronic record system therefore can help US reap the gains from information technology by improving the general delivery system of health care. Barack Obama after coming to power took the pledge to expand the application of Electronic Health Records and has invested in an extensive plan towards “modernization and cost containment” (CMAJ, E315). An investment of $27 billion has been made to initiate the doctors to move from papers to electronic system. Another $2 billion is supposed to be spent towards the attempt in making the EHR system successful. The Veterans Health Administration of US with 23900 workers and 1400 offices, provide easy access to medical records for the patients via the Internet. Some experts however argue that this might be impractical and unsecured mainly because some technologies were not verified in a medical set up. despite an increase in investment from $20 million to $50 million, this new system would ensure as many as 50000 new occupations apart from cost saving enhancements in the health care set ups. There is an increasing demand for EHRs from patients as this helps them access their records individually. Hence a bottom up approach is required to gauge the effectiveness of this investment from the government’s side. Information regarding its implementation should be properly monitored in order to evaluate the success of the plan towards Universal Health care system through the use of EHRs (CMAJ, 2010, pp. E315-E316). Universal health care system is the belief that all individuals of a society have the equal access to High quality medical care that is easily affordable. This is ensured by the EHRs. Universal health care requires any form of government involvements which can through legislation or regulation. The law of the country will determine the type of the care that is to be provided, to whom the care is to be provided and the basis of the coverage. In some cases the government could totally manage the health care system but in other cases there can be both public and private providers. The cost of the health care facilities should be provided by the society either through health insurance policies which in that case is compulsory or through direct taxation policies or it can be a combination of the two. Electronic recording system has all these features when the idea is to make the facility available to all customers alike. it requires government investment and support for the small access point in the delivery system of health care. A single payer Health care system is one in which the government provides the finance for the health care but does not deliver the care. Many countries ensure a single payer health care system while Germany has a multi payer health care system (Sherrow, 2009). Till the eighties the Canadian system of health care and the American system followed a more or less same pattern but with increasing use of modern technologies in the system by USA increased the cost pattern of the country but that contributed little to the economic development of the country. The contribution of GNP to the health care expenditure of America was same to Canada till the sixties by 1985 the proportion increased moderately for America as compared to Canada. According to the data of 1966 the American estimate of the health cost in total GNP was 10.6 % as compared to 8.6% in Canada. Thus the health care of the country is experiencing continuous failure in providing the minimum needs of the common individuals. The Canadian government adopted a system of universal health care to the public that has been proven extremely popular among patients with the providers having free choice with no extra cost on the part of the consumers. Canada Health Infoway got access to an amount of $2.1 billion from Ottawa from the year 2000 in order to coordinate and provide financial development of building the nation’s EHR system (CMAJ, 2010, E316). Whether it is implemented by the doctors is the decision of he provinces but the US government is providing subsidies to the physicians and follow a top down approach to implement this technology towards provision of a universal health care system. Though a health system cannot be transformed from one country to the other America can learn and hence adopt the best features of the universal health care system of Canada like other developed countries of the world. (Lemco, 1994, p.33) One may say that electronic recording system has been of both social and economic benefits to the health care segment. Yet results show that this has not been adequately adopted by the doctors and health centers as desired. a survey report arrives at six factors which decide the adoption of this recording system: “user attitude towards information systems, workflow impact, interoperability, technical support, communication among users and expert support” (Castillo, Martinez-Garcia & Pulido, 2010, p.1). An analyses and assurance of these factors will provide an important insight and support to the government while implementing the electronic record system within the field of health care. In the recent years the need of a health care reform in the country is gaining more and more importance among every section of the society, the common individuals, the political leaders as well as the media houses. There has been an increasing urgency among the employers, the policymakers, consumers and also the insurers to rectify the problem of increasing cost without compromising the health care of the individuals of the society. Just like information technology has enabled cost reduction in many businesses, health care system is also not far away. While computers were already used for billing and other related purposes, EHR ensures this is used to provide a better and self dependent service to the patients or the consumers. This electronic recording system saves time for both the patient and the doctors and gives an idea about a patient’s history. It also offers the flexibility of being susceptible to changes or regular updating. Most patients access the small health centers and if these small units are subsidized in order to incorporate electronic record system, then it might help in fulfilling the expectations of the patients and increase the coverage in this respect. This recording system therefore makes life easier and the operations and delivery system faster and more efficient within the health care sector of US, thus promoting universal health care. References Baron, R.J., Fabens, E.L., Schiffman, M. and E. Wolf, (2005), Electronic Health Records: Just around the Corner? Or over the Cliff?, Ann Intern Med., 143, pp.222–226 Castillo, V.H., Martinez-Garcia, A.H. & JRG Pulido, A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians, BMC Medical Informatics and Decision Making 2010, 10.60, pp.1-17 CMAJ (2010), Electronic health records a “strong priority” for US government, CMAJ News, 182.8, E315-E316. Department of Health Policy and Management (March 25, 2009), Use of Electronic Health Records in Us Hospitals, The New England Journal of Medicine, 360, pp. 1628-38 retrieved on 21st January 2011 from Lemco, J. (1994), National Health Care, University of Michigan press Niles, N, J (2010), Basics of the Us Health Care system, Jones & Bartlett learning OECD, (2010), Improving health sector efficiency, OECD publishing Sherrow, V (2009), Universal Health Care, Infobase publishing Walker, J.M, Bieber, E.J & F. Richards (2006), Implementing an Electronic Health record system, Springer World Health Organization (2008), The World Health Report: Primary Health Care, retrieved on 21st January from http://www.who.int/whr/2008/whr08_en.pdf Read More