E-health: Implementing Electronic Patient Record - Research Paper Example

Introduction The implementation of electronic patient records is a software based solution that provides for the digital computerization, recording, and maintenance of patient and medical practice information and it deals the need to set up excellence in patient care and practicality in medical practice. It is one of the main tools currently being used to fix the ailing health care system in the developed world through patient monitoring which will enable doctors to shift from only curing ailments to preventing them instead. One of the main goals for using this system is to increase efficiency within the healthcare system to the point of significantly reducing health care costs while saving millions of lives. Over the past five years, health-care providers, insurers, drug companies and research institutions have been encouraged to initiate a massive transformation from a paper-based health-care system to one that increasingly relies on electronic records to manage patient information. While this has been easy in developed countries, the same cannot be said concerning developed countries, especially those in Africa. The increasing number of those who are expected to be regular users of the health care system in Africa has been touted as one of the reasons why digitizing the medical data of patients is very important in managing the already burdened health care system. Putting people’s health information in databases will not only reduce redundancies but is already shifting the way people receive and seek health care. With better contact to an individualized health record, whether it is through an official electronic record by a doctor, a private record created by an individual, or a fast instant messaging contact with a doctor, the customary roles of doctors and patients are experiencing swift changes. It is expected that in the future, patients will arrive for appointments with their doctors having gone through their medical records and the recommended articles about their health concerns. It is believed that even more people will be able to skip the hospital visit altogether due to their busy schedules and will instead prefer to stay in touch with their doctors through text messaging and emails in order to receive answers for their health concerns. Electronic medical records are the future because in emergencies, such as attending to a patient with a heart attack, finding and reading the paper medical records of a patient costs a lot of time, and this time might be crucial in the saving of the life of this patient. If electronic data is available, then it would be easier to treat whatever medical condition a patient has because the doctors have almost instant access to their medical records, and in fact, the chances of such a patient living would be significantly higher. Electronic medical records are here to stay because they reduce the chances of physicians making errors in their diagnosis of a patient’s illness due to the fact that they will have the patient’s entire medical history before they start attending on him or her. Although electronic medical records have been said to have saved the lives of many and that there are even higher possibilities of their doing so in future, it still has the problem of cost. Installing an electronic medical records system in a hospital or clinic, for example, can be very expensive and many doctors opt not to do it because of the cost. Unless cheaper ways are found to ensure that electronic data systems are more available to doctors in Africa at cheaper prices, then the future of electronic medical records within it is threatened, not only increasing the risk to the lives of the patients but will also continue to burden the already strained medical health care system as it is today, making medical services even slower. The problem with having electronic medical records currently is that although many medical practitioners keep electronic records, they have no centralized system through which the patient’s information can be shared and this leads to the same problem as that experienced by the use of the paper system, that is, the loss of time. It is estimated that only a handful of doctors in Africa have the necessary technology to share their patients’ medical information with other medical practitioners and it is believed that the efficient sharing of this information will not be in place for quite a number of years. The main beneficiaries of the electronic medical records, if implemented in African countries, will be the patients themselves because sometimes, medical and diagnostic errors occur because complete patient information is not available at the time of patient care and doctors are forced to provide care based on a patient’s recollection or in worst cases no information at all. An integrated electronic medical records system could help resolve this problem because doctors will have all the information they need about a patient’s medical history hence reducing the chances of errors occurring. Furthermore, the use of electronic medical records protects the patient’s privacy from eavesdropping because these records are password protected hence limiting their access to only the patient and their doctor. It has been found that adequate technology is available to protect the patient’s privacy and this can be found cheaply. However, the making of medical records electronic can have some unforeseen effects in the future because even though it is safer in matters of privacy, any breach in the security of the electronic system can completely compromise the privacy of a patient and their information might be available for all to see especially online. With very few controls over the internet, the patient’s medical history and personal information can no longer be kept private. Plenty of literature has been written on this subject with each expressing a different view concerning the future of the implementation of the electronic patient record, especially in Africa. Such literature is based largely on the belief that the use of electronic records is meant to serve two main purposes, mainly to preserve the medical history of the patient, as well as for the purpose of billing the patient once a service has been rendered to him or her. Some of the literature has been seen to challenge the long standing belief among the proponents of electronic records that the latter is more efficient than paper records. This has raised a lot of debate concerning whether it would be preferable to retain the use of manual records instead of electronic ones because of the little difference that has been perceived in the use of both these records. In this paper, we shall consider diverse literature on this subject and come up with a conclusion concerning it. Literature Review Glasgow, Kaplan, Ockene, Fisher and Emmons (2012 497) state that recent legislation in the United States encouraging the use of electronic patient records has contributed a great deal to the implementation of this system in the country. It has ensured that the evolution of the electronic records in the health care system will encourage the development of records which will help in the swift development of diagnosis as well as treatment for the patients. They state that the United States will finally join those countries which have electronic patient records, such as Britain where ninety five percent of the medical practitioners keep such records. While they believe that the development of electronic records is essential for the improvement of patient care for all of the patients who are included in the electronic database, there is also a real danger that some of their unique medical conditions may not be included unless the physicians who are dealing with them take some initiative in adding such information in the system. They recommend that a list of data detailing the patient behavior and psychosocial data in the electronic records so that a better diagnosis can be made concerning their physical condition; whether a health condition they may have may have been caused by a psychological condition which they might have. In this article, it is stated that most of the electronic health records capture aspects of medical encounters between patients and doctors, but only from the view of providers and payers. These authors believe that a complete understanding of health and most favorable treatment of patients requires additional types of information. This is because of the fact that most of the factors that influence life expectancy and health related quality of life tend not to be related to the physical aspects of the health care system. As a consequence, in order to understand and improve the health outcomes of patients, it is necessary to include the information which patients have reported concerning their social and environmental circumstances, their health routines, such as the use of tobacco and other substances, the frequency of their physical activity, as well as their diet. Furthermore, it is stated that data concerning the patient’s mental health and his or her views and preferences for matters such as their involvement in the making of decisions and communication should also be included in the electronic data. The capturing of this information requires that the medical practitioner gets the patient to be actively involved in the process. A lot of attention should be given to issues such as psychosocial functioning of the patient, and these may include their being distressed about illness and other behavioral conditions, such as their displaying symptoms of depression or anxiety. Glasgow, Kaplan, Ockene, Fisher and Emmons (501) state that the main hindrance to the inclusion of non-physical data that has been reported by patients into regular use as performance measures and as part of the electronic health record is the lack of political will. The standardization of useful behavioral and psychosocial data and their inclusion among the regularly accumulated data collected for electronic health records has the potential of improving the health of those involved, decrease their suffering, improve the relationship between the patients and their doctors, and develop better information for addressing important problems in medical care and population health management. The article by Jensen and Aanestad (2007 29) deals with how health care practitioners respond to the adoption of the electronic patient record system. In this study, these authors consider two case studies in Danish hospitals where the practitioner’s perceptions of technology and how it relates to the improvement of their work is analyzed. It is stated that the electronic patient record is one of the most sought after technologies by medical practitioners who believe that it would greatly improve their assessment of their patient’s condition and make a correct diagnosis of the same. Furthermore, it is believed that such records would be mush easier to access than paper based records because of the fact that electronic records are perceived to be almost instant. While this has been the case, the authors have found that while this technology is most sought after, its implementation is not as easy as was previously thought. The practitioners have to be extremely careful when designing the record system and should be conversant with how it works in order for it to be effective. In many cases, despite the fact that the electronic record system may have been implemented, the difficulty which some practitioners have in using it has made it a complete failure in some institutions. These institutions, because of the lack of expertise in the use of electronic record technology have chosen to fall back on the use of paper records for the sake of keeping records of their patients. Among the reason for the failure of the electronic record system in some medical institutions is the fact that many doctors often find it to be too complex and unsuitable for their needs. This has created a situation where these doctors have chosen to return to keeping their records on paper since the electronic record system was too slow to meet the need for speed in their work procedure. Sujansky (1998 176) states that since electronic records are going to be the future means of keeping data on the medical history of patients, it is absolutely necessary for there to be development of tools to facilitate it. He states that these records will be able to enhance the means through which medical practitioners will be able to treat their patients more efficiently and will ensure that fewer mistakes are encountered while doing so. However, in order to achieve this, the electronic record system should not be based on the regular word processing format and instead, new specialized software has to be developed to ensure that the system is more efficient. Furthermore, the design of this new software has to be so efficient that it can be able to capture all the necessary clinical information in a manner that is accurate and consistent with the medical history of a patient. The different programs that have been or are in the process of being developed are those which are concerned not only in the keeping of records, but also in the making of a diagnosis of the patient’s condition and making recommendations of the preventative measures to be taken, and if this does not work, then the treatment of the patient is recommended. Sujansky therefore believes that the use of electronic patient records is not only useful to the medical practitioner, but also to the patients themselves who will benefit through the early detection of their medical conditions and have them treated swiftly. Beller (1997 23) states that with the improvement of networking and the increase in the security of electronic records, then the possibility of the widespread use of electronic medical records has become a reality. He states that while these records are useful to patients as well as their doctors, they are also useful to insurance companies which make use of the data to determine the various aspects of the insurance cover. The keeping of electronic records ensures that the insurance companies are able to save a lot of money in the form of the reduction in the use of paper as well as the costs of physically finding out the records of patients. Moreover, the electronic patient records are designed by the healthcare provider for the use within this provider’s institution. This ensures that the patient’s records remain confidential even when the health care provider chooses to claim reimbursement from an insurance company. The patient’s insurance company does not have to view the patient’s entire medical history on order to provide the reimbursement, and instead, it often only has to see the record for a specific claim before making payment to a healthcare provider. While this may be the case, Beller warns that the availability of a patient’s medical history from multiple health care providers creates a situation where there is a risk to the security of such a patient’s record. This creates a potential for the breach of the patient’s privacy and confidentiality especially in a situation where the electronic patient record system has been compromised. Theory/Conceptual framework Many health care facilities are adapting to new technologies and implementing electronic patient records, but these efforts need to be aligned openly with goals for patient improved patient outcomes. While electronic patient records bring the risks of both technical failures and inappropriate use, but they can also help to monitor and improve patient outcomes (Sittig and Singh 2012 1854). Patient outcomes are variations in the condition of the health of an individual or patient due to an intervention. It is, therefore, a fact that the implementation of electronic patient records might have an impact on achieving good patient health outcomes in Africa, which is the basic purpose of the provision of healthcare. The keeping of electronic records to improve healthcare outcomes in Africa can be applied not only for individuals but also for whole populations as well. The measurement of patient outcomes, which has over the years, facilitated the development of electronic patient records, has become a multi-million dollar industry and this has been due partly to the growing anxiety of the society about their health. The measurement, reporting, and comparison of these outcomes can be considered to be one of the most important steps towards making sure that there is a rapid outcome improvement and that good choices are made about the reduction of costs ("Frost & Sullivan: Patient Monitoring Market Presents Opportunities in South Africa" 2008). The measurements of quality are very common in the production processes but this can be translated poorly in the African health sector because the links between the actions and their outcome are much less direct and there is also the fact that there are some characteristics which make comparison between these two sectors very difficult. Because of this, risk adjustment is a very essential part of the outcome measurements in healthcare and there is evidence that a validated risk adjustment illustration improves the precision of the analysis of outcomes. Because of this, the use of electronic records has been found to be extremely important in the reduction of errors made by medical practitioners when dealing with their patients. The concept of practice based on evidence is founded on the evidence from studies and trials, however, when it comes to outcomes, a very different way of thinking is created. A methodical examination of outcomes can have many advantages by creating performance based verification. An outcome measure has to be valid in order to be useful, that is, it has to assess only what it is supposed to and be reliable, only showing a minimal error. An outcome also needs to be easy to administer, be sensitive to what is being measured and be specific when it comes to indentifying those measurements that may be false. The simplest measures to administer are those dealing with process because they rarely show the outcomes of clinical interventions and instead, they only show those dealing with administration. As a basis of healthcare targets, payment for performance schemes often give many hospitals the incentive to focus on administrative processes as opposed to clinical process. The outcomes of clinical processes are very difficult to develop and to implement, although it is a fact that the reported outcomes of patients are much easier to use. Since this is the case, it has become important that the keeping of electronic patient records be instituted in many health care facilities so that even though these facilities concentrate on the administrative records, the clinical records of the patients can be kept electronically so that they can be easily accessed for the improvement of the patient outcome. The measurement of healthcare outcomes has now become an essential part of African healthcare and those, who might use this information, ranges from the patients involved to those who make policy on healthcare. No single outcome is sufficient in the measurement of any aspect of healthcare since the various instruments needed to come up with a conclusive measurement have to come from multidisciplinary sources. The best thing is to have a sufficient number of these measures that have been appropriately risk adjusted which can then be measured in order to provide a continuous feedback to those who require the information. Electronic records provide the best means through which this can be achieved because it would be able to facilitate the keeping of the various measurements of patient outcomes, and this will ensure that the chances of predicting future outcomes are increased (Gerber, T., Olazabal, V., Brown, K. & Pablos-Mendez, A. 2010 235). Deutscher et al (2008 270) state that the improvement of clinical outcomes requires continuous measurement and interpretation in conjunction with treatment process and patient characteristics. In relation to the improvement of patient outcomes, a study conducted by the team of Deutscher and his colleagues was conducted for the purpose of describing the implementation and integration of electronic functional status outcomes into an electronic health record so as to promote clinical practice improvement processes. The second purpose of this study was to make an examination of the effect of ongoing outcomes data collection in a large physical therapy service in relation to the burden of the patient and the clinic. The results of this study indicated that the routine compilation of outcome data was practical in a large public physical therapy service and could be successfully integrated with electronic patient information to produce a valuable clinical practice improvement platform for service evaluation and outcomes research. For quite a number of years, the keeping of electronic medical records has been linked to the positive outcomes of patients. It has been noted that adequate electronic records have an effect on the length in which patients stay in hospital as well as the efficiency of their treatment. It has also been found that there is a decrease in the number of medical errors made concerning patients. Furthermore, the quick access to electronic patient records also has an impact on the medical staff attending to them because the latter become more motivated in their work, which increases their efficiency. This efficiency helps the patient as it improves the care which they are given, and this leads to the patient’s swift recovery. The availability of adequate electronic patient records in health facilities reduces the patients’ mortality rates because of the fact that a proper diagnosis, based on their medical history tends to be made, and this ensures that proper treatment is given to enable a swift recovery. It is, therefore, important for health facilities to ensure that they adopt the use of electronic patient records so that only the best possible care can be quickly provided for patients, without making their staff undergo the tedious task of looking for paper based patient records, as is often the case in African countries ("Medical Records; Research on medical records described by scientists at Nelson Mandela Metropolitan University" 2010 2465). Moreover, with an efficient electronic patient record system in place, the need for a balanced nurse to patient ratio in health care facilities will no longer be required since nurses will be able to swiftly serve patients based on their medical records. In most African health care facilities, the ratio of nurses to patients is very low, and this contributes to an extremely low quality of patient care since nurses often have to shoulder the burden of finding paper based patient records before attending to them. This not only interferes with patients’ recovery, it also discourages the nurses who are attending to them. However, with the implementation of electronic records, the task of the nurses and other medical practitioners in African health care facilities will become much easier and this will ensure that the patient outcome in such facilities will be immensely improved ("HIV/AIDS Quality of Care; Researchers from Regenstrief Institute, Inc. detail findings in HIV/AIDS quality of care" 2010 126). The use of electronic patient records does indeed have an impact on the quality of care that patients receive. This applies even to cases where the ratio of medical staff in health care facilities does not match that of the patients within them. The use of electronic records in Africa would nullify the need for the health care facilities to seek to increase their medical staff to cater for their patients, despite the number. In essence, this means that even though there are fewer nurses in relation to the patients they serve, then the latter will not have to endure poor services, ensuring that the patient outcome remains high. If fact, their recovery rate will end up being extremely high while their mortality rate will decrease significantly. It is therefore essential that electronic patient records be given priority when dealing with matters concerning healthcare in Africa to ensure that services of good quality are provided for patients (Electronic patient records will boost health-care 2002). Research design This research will adopt a design that will explore the various aspects of implementation of electronic patient records in Africa, as an example of the developing world, and will be based on a qualitative analysis of the available material. The decision to adopt this approach when carrying out the research was made mainly because it is the best option through which to explore electronic patient records and how it comes to affect how services to patients in African health care facilities is provided. This way, the research will be able to obtain the most relevant information that could be used to develop quantitative studies on the subject matter. The findings of this study will be complimented by a survey of a range of related literature on the effect of electronic patient records in the facilities within which it is applied as well as show how it is received by those whom it affects directly, most especially the medical practitioners and the patients. A preference will be given to the most recent literature in order to align the substance of the study to the prevailing challenges of the implementation of this system as understood together with the objectives of the study. The information will be organized according to the specific themes that relate to the specific objectives of the subject. Findings and Analysis The implementation of electronic patient records has become an essential part of ensuring that the patients’ data is available to all those medical practitioners who are dealing with them. There have been enormous strides in the development of therapies to deal with the various medical conditions which exist in the twenty first century. The patients who undergo such therapies have to have proper and detailed records in order for their treatment to be successful. The most common use of therapies is in the treatment of certain types of cancers, and these therapies are known to have adverse effects on the patients. With efficient records, then these doctors dealing with these patients can be able to measure and decide on medications which are best suited for their patients, so that the adverse symptoms can be prevented or reduced. However, this is still not possible in developing countries in Africa and this is because of the lack of funding for the implementation of electronic patient records in health care facilities. Discussion & Conclusion In the twenty first century, there are medications for almost every medical condition which is known to medical practitioners. These medications are based on a long period of research, and most have been proven to work extremely efficiently. Many of these medications have been designed to treat ailments and are continuously being improved to achieve the best result. However, most of the medications which are used in the twenty first century are dedicated to medical conditions, which are currently prevalent, and rarely are medications developed to deal with diseases which are thought to have been eradicated. This is highly risky because it enables such diseases as smallpox, which was thought to have been eradicated, to form new strains, which would be virtually untreatable using modern medicine. It is therefore essential that electronic records on such diseases be kept so that in case of any reoccurrence, detailed records will be available to ensure the development of a cure for the new strains of diseases. These records, are however, lacking in Africa when compared to developed countries despite the fact that Africa tends to be a haven for new strains of diseases to develop and emerge. While Africa should be one of the places where electronic records of patients with these diseases should be kept, the lack of funding as well as political will has made it extremely difficult to develop the said records. In conclusion, it can be said that medicine has come a long way from the 1960s as is evidenced by the high rates of successful treatments that are currently being witnessed. Some of the most cutting edge medical technology has either been created or improved in the twenty first century, and this trend is not likely to stop any time soon. Some medical conditions, which were utterly untreatable in the past years, can be effectively treated today, and this has led to a huge advancement in the life expectance of a majority of the world’s population. Furthermore, it is the research which was started in the early twentieth century which led to the development of medicine as it is seen in the contemporary world. Without such research, as well as the information gathered concerning certain diseases in those years, then it would have been impossible to develop suitable treatments and therapies to deal with them. Hence, it is extremely important to ensure that electronic patient records in Africa are kept today to ensure that in future, they are used not only to treat individual patients, but also for the sake of future medical research, because the value of electronic records is quite high when dealing with diverse diseases. The poverty, which is a reality among the majority of the world’s developing countries, is one of the most fundamental reasons why the implementation of electronic patient records has not become a universal reality in Africa. All of the causes of poverty in African countries are within the human means to solve as long as there is a bit of dedication and support from their more developed counterparts. However, most of the people with the power to make a difference are either unwilling or unable to do so because they do not want to disturb the status quo as it is. The excuse that is usually made, especially by leaders of those countries which practice capitalism, is that acquisitiveness is a part of human nature and they use this excuse to exploit the poor people for their own benefit. They further make use of the misguided theory of evolution that states survival of the fittest to justify their ruthlessness without any consideration for the plight of the poor. It is these kinds of perceptions that world leaders struggle to fight in order to rediscover their humanity because if they do not, then a path will be opened that will lead to chaos in the healthcare system of Africa through the lack of the electronic patient records. References Beller, L. 1997, "The future of an electronic patient record", Insurance & Technology, vol. 22, no. 4, pp. 23-24. Deutscher, D., Hart, D.L., Dickstein, R., Horn, S.D. & Gutvirtz, M. 2008, "Implementing an Integrated Electronic Outcomes and Electronic Health Record Process to Create a Foundation for Clinical Practice Improvement", Physical Therapy, vol. 88, no. 2, pp. 270-85. Electronic patient records will boost health-care 2002, , IC Publications, Inc, London, United Kingdom, London. "Frost & Sullivan: Patient Monitoring Market Presents Opportunities in South Africa", 2008, Wireless News . Gerber, T., Olazabal, V., Brown, K. & Pablos-Mendez, A. 2010, "An Agenda For Action On Global E-Health", Health affairs, vol. 29, no. 2, pp. 233-6. Glasgow, R.E., Kaplan, R.M., Ockene, J.K., Fisher, E.B. & Emmons, K.M. 2012, "Patient-Reported Measures Of Psychosocial Issues And Health Behavior Should Be Added To Electronic Health Records", Health affairs, vol. 31, no. 3, pp. 497-504. "HIV/AIDS Quality of Care; Researchers from Regenstrief Institute, Inc. detail findings in HIV/AIDS quality of care", 2010, AIDS Weekly, , pp. 126. Jensen, T.B. & Aanestad, M. 2007, "How Healthcare Professionals "Make Sense" of an Electronic Patient Record Adoption", Information Systems Management, vol. 24, no. 1, pp. 29-42. "Medical Records; Research on medical records described by scientists at Nelson Mandela Metropolitan University", 2010, Health & Medicine Week, pp. 2465. Sittig, D.F. & Singh, H. 2012, "Electronic Health Records and National Patient-Safety Goals", The New England journal of medicine, vol. 367, no. 19, pp. 1854-1860. Sujansky, W.V. 1998, "The benefits and challenges of an electronic medical record: Much more than a "word-processed" patient chart", Western Journal of Medicine, vol. 169, no. 3, pp. 176-183. Read More