ElectronicHealth Records Pros and Cons
ElectronicHealth Records Pros and Cons
Technologyhas impacted human life in both positive and negative ways. However,its positive impacts are more than the negative ones, which isconfirmed by the increase in the level of efficiency, a decline inthe cost of operating businesses, and the accuracy of the datacollection as well as storage (Menachemi & Collum, 2011). Theapplication of the modern technology in the health care sector hasbenefited the health care providers, patients, the hospitals, whichis an indication that it enhances the well-being of all stakeholders.It has been applied in many operations in the health care sector, butthe development of the electronic health care record (EHR) systems isthe most popular one. The EHR system is defined as an electronicversion of medical information that is collected from differentpatients (Menachemi & Collum, 2011). The adoption of the EHRsystems marks the departure from the application of the hard copiesin the processes of gathering, sharing, and storing patientinformation to data that can be stored electronically. This paperwill provide a discussion on the pros and cons of the EHRs. The paperwill focus on the EHRs background, their use in the health careindustry, and privacy issues as well as the need for security.
Thehistory of the EHR can be traced back to the 1960s when the firstclinical information system was developed by Lockhead Corp (Atherton,2011). The successful development of a system that could be appliedin the health care settings motivated researchers to do more work.They intended to produce systems that could be used by more people,increase accuracy in recording of the client information, and enhanceefficiency in the delivery of health care. The first EHR that hadsimilar functionality to modern electronic health records waslaunched in the 1970s and it was used in the Department of VeteranAffairs (Atherton, 2011).
Themost significant developments that led to the establishment of themodern EHR systems were done between the 1980s and the late 2000s.More emphasis was made on training in order to ensure that allphysicians and nurses could be able to key in and store patientrecords using computerized systems by 2007. With more researchersestablishing the association between the use of EHR and an increasein efficiency as well as a decrease in the cost of delivering care,the adoption of the EHR systems rose from 34.8 % in 2007 to 71 % in2012 (Atherton, 2011). Since then, the number of hospitals using theEHR systems has continued to increase exponentially.
TheEHR systems have many uses, but their applications can be put intothree categories. The first category is their usage is the collectionand storage of information. These systems allow the health carefacilities to collect voluminous information from their clients andstore it for a long time without the need to expand the physicalspace (Menachemi & Collum, 2011). This data is kept in hard discsthat are linked to computers, which simplifies the processes ofretrieval and sharing.
Secondly,the EHR systems are linked through the internet, which facilitatesthe sharing of information among the health care providers. Thesystems make it possible for the information to be shared inreal-time and in a more efficient way (Atherton, 2011). The ease withwhich information can be shared contributes towards an increase inefficiency with which health care can be delivered.
Third,EHRs are used to develop the treatment plan for individual patients.For example, the ability of physicians, nurses, and other health careproviders to access patient information makes it easy to plan whenthe client will be served without the need for these professionals tomeet physically (Atherton, 2011). In overall, the use of EHRsaddresses the needs of both the health care providers and patients.
TheEHR systems are implemented in order to help the health carefacilities achieve four major purposes. The first purpose is toenhance the level of patient outcome. This is achieved through anincrease in the level of patient safety and compliance withprescription. The increase in the level of safety is attributed toefficient and an accurate patient record keeping process that is madepossible by the application of EHR system (Menachemi & Collum,2011). The level of outcome increases following the enhancement inthe ability of the patient to comply with the medication. Forexample, the adoption of the EHR systems has been shown to enhancethe level of compliance by 35% to 50 % (Menachemi & Collum,2011). The high level of compliance increases the success of thetreatment process.
Thesecond purpose of EHR is to increase patient participation in thetreatment process. The EHR systems are connected to the internet,which help the patients to access information about their healthprogress and treatment at any time (Menachemi & Collum, 2011).The ability of the patients to access information empowers them byallowing them to make informed choices regarding their health. Forexample, patients suffering from the long-term illnesses (such asdiabetes and asthma) are able to collaborate with the health careprofessionals and make their contribution towards the management oftheir illnesses. The process of sharing of information between thetwo parties, the health care providers and patients, is made possibleby the use of EHRs. Patient participation also increases thecoordination of care.
Third,the health care facilities implement the EHR technology, with theobjective of increasing efficiency and enhancing cost savings.Efficiency is achieved when the health care facilities are able tohelp their providers share information within departments. Thesystems also facilitate the process of sharing information betweendifferent branches of the hospitals without the need for physicalmovements (Boonstra, Versluis & Vos, 2014). This efficiency helpsthe health care facilities reduce the cost of delivering the healthcare. In addition, the EHR systems reduce the number of health careprofessionals required to serve a given number of patients, whichhelp the hospitals minimize the costs associated with the payment ofwages.
TheUse of EHR
Theformat as well as the content of the EHR implementation plan variesdepending on the needs and expectations of different health careorganizations. However, there are six steps that each organizationmust observe. The first step involves the assessment of the readinessof individual organizations. The process of assessing the level ofreadiness should consider the needs, goals, technical, and thefinancial capacity of an organization (Boonstra, Versluis & Vos,2014).
Thesecond step involves the design of the plan of approach. Theinformation gathered in the first step is used in the process ofdesigning a plan that will lead to a successful implementation of theEHR system (Boonstra, Versluis & Vos, 2014).
Thethird step involves the selection of the EHR system. There are manyvendors and types of EHR systems in the market, which creates theneed for an organization to take time and select the one that meetsits specific needs (Boonstra, Versluis & Vos, 2014).
Fourth,the actual implementation of the EHR system should include the pilottesting and training of the members of staff. The two activitiesshould be conducted concurrently in order to ensure that the membersof staff are empowered before the system is used in the management ofactual health records (Boonstra, Versluis & Vos, 2014).
Thefifth step of the implementation process involves the assessment ofthe strengths as well as the weaknesses of the system. The EHR systemis updated depending on the information gathered in this step(Boonstra, Versluis & Vos, 2014).
Lastly,the organization should embark on continuous quality improvement.This step should involve the evaluation of the goals of practice inthe post-EHR implementation, with the objective of maintaining thefunctionality of the system and improve it with time (Boonstra,Versluis & Vos, 2014).
EHRand privacy concerns
Therisk of the electronic data being accessed by unauthorized persons isone of the key factors that limit the implementation of the newtechnology. Electronic records are more vulnerable than the hardcopies because they can be accessed by hackers or transported outsidethe hospital using small gadgets without being noticed. It isestimated that cases of data breach that affect EHRs account forabout 40 % of all incidents of theft of electronic records in theworld (Thomson, 2012). About 562,577 patient health records werestolen in 2013, which accounted for about 62.9 % of all cases ofbreach that involved the theft of private information (Thomson,2012). The same study indicated that about 58 out of 146 cases ofdata breach that occurred in 2013 affected the health care facilitiesor individual health care providers. The patient data that isaccessed by unauthorized persons is used to acquire health careservices illegally or steal money from the affected individuals. Thehigh prevalence of the incidents of data breach suggests that the EHRsystem subjects patients to the risk of losing their privacy.
Barriersfor EHR adoption and implementation
Thereare many barriers that discourage the health care facilities fromadopting and implementing the EHR systems, but four of them are quitecommon. Many organizations find the high costs of buying andmaintaining the system as the key barrier. Some of them cannot affordthe $ 162,000 for installation and $ 85,000 for maintenance expenses(Ajami & Begheri-Tadi, 2013). The stakeholders can reduce thesignificance of this barrier by determining the potential benefitsthat they will enjoy after implementing the system.
Thelack of proper computer skills is a barrier that affects theimplementation as well as the use of the EHR systems. Health careprofessionals need to be highly trained for them to be able tocollect data from patients and type it on the computer at the sametime (Ajami & Begheri-Tadi, 2013). The need for a high level ofconcentration, coupled with the fact that many health care providersdo not have the required skills leads to staff resistance to theimplementation of EHR systems.
Theneed for technical support during and after the implementation of theEHR systems is also a key barrier. It increases the cost of adoptingthe system since the health care facilities are required to recruitadditional people who are competent in computer skills (Ajami &Begheri-Tadi, 2013). The lack of support staff can lead to errorsthat can affect the credibility of the entire system.
Studieshave also shown that the application of EHRs interferes with therelationship between patients and the health care providers.According to Ajami & Begheri-Tadi (2013) the process of huntingfor buttons and menus disrupts the health care providers, whichaffects their relationship with patients negatively.
Itis difficult to discuss the implementation of EHR without mentioningthe concept of interoperability. It refers to the possibility ofusing different components of the EHR to share informationseamlessly. For example, the doctors working in different departmentsor health care facilities may need to share information, but the factthat they could be using EHR systems from different vendors becomes akey barrier to interoperability. This challenge is associated withthe lack of structured data definitions and standards that can beused to regulate the adoption as well as the use of the newtechnology.
Itis estimated that the health care facilities operating in the U.S.have spent about $ 28 billion within a period of one decade in theimplementation of the EHR systems and an extra $ 16 billion annuallyto address issues related to the lack of interoperability (Noraziani,Ain, Azhim, Eslani, Drak, Ezat & Akma, 2013). Therefore, alimited interoperability reduces the effectiveness with which theorganization can make the use of EHR systems. The lack ofinteroperability also increases the cost of delivering health careand running the hospital operations. The additional cost and thecomplexities associated with the limited interoperability are a keyfactor that discourages the adoption of the EHR in the contemporaryhealth care system.
TheEHR, similar to other types of technology is subject to a high riskof obsolescence. The need to change the EHR systems frequentlyincreases the cost of adopting and using this technology, whichdiscourage the stakeholders in the health care sector (Noraziani etal.,2013). In addition, the software and hardware used in the system iscomplicated to an extent that some health care providers needadditional training before they can utilize the EHRs. However, thefact that technology keeps on changing creates the need for regulartraining of the health care providers, who spend most of their timestudying diseases and their treatment. Even simple software andhardware can seem complex to the health care providers.
Afailure on the part of technologists who provide EHR systems tocompete with those who develop technology in other economic sectors(such as the banking industry) is another type technology limitation.For example, the technology-based systems used in the banking sectorare able to communicate with each other, which allow differentdepartments, branches, and companies to share the information. Thefact that technologists who design and deliver the EHR systems havelagged behind is confirmed by the lack of interoperability in theirEHRs (Noraziani etal.,2013).
Thereare two major issues that are addressed by the Health InsurancePortability and Accountability Act with respect to the adoption andthe use of EHR. The first issue is the patients’ right to accesstheir health information. HIPAA holds that patients have the right tobe given information about their health, irrespective of the form inwhich it was recorded and stored (Mirom-Shatz & Elwyn, 2013). Inother words, patients have the legal right to ask for informationthat is stored electronically or in hard copies. Under the privacyrule that is contained in HIPAA, patients have the right to be givena copy of their health records, to have mistakes corrected, be toldhow their information is used or shared, file complaints regardingthe violation of their privacy, and determine when as well as howthey wish to be contacted by the doctors (Mirom-Shatz & Elwyn,2013). The EHR helps the health care facilities meet the requirementsof this act by reducing the time required to track the patientrecords and produce copies for them. However, the vulnerability ofelectronic data to cybercrimes increases the risk of conflictsbetween the health care facilities that adopt EHR and the lawenforcers.
Secondly,HIPAA provides guidelines that should be followed by theorganizations that adopt the EHR system in order to ensure thatpatient privacy is guaranteed. For example, HIPAA requires the healthcare facilities to demonstrate that they put in place suitable accesscontrols (such as PIN numbers and passwords), encrypt their storedinformation, and conduct the audit trail in order to determine anyrisk of unauthorized retrieval of information (Mirom-Shatz &Elwyn, 2013). Although organizations do not like being micromanagedthrough legislation, the provisions of HIPAA are useful because theyprotect organizations that observe them from the risk of losing thepatient records to hackers and other criminals.
PrivacyIssues and the Need for Security
TheEHR technology faces many challenges and barriers, but the high riskof losing privacy is the most significant drawback. It is estimatedthat over 55 % of all physicians in the U.S. had adopted the EHRsystems by the end of the year 2011 and over 70 % of the patientswere willing to be served using the new technology (Patel, Hughes,Savage & Barker, 2015). However, more than 72 % of all patientsfeared that the innovation could subject them to a higher risk oflosing their privacy as well as the medical records (Patel, Hughes,Savage & Barker, 2015). This data indicate different dimensionsof the process of adopting the EHR systems, including the enthusiasmamong the health care providers and fear among the patients. However,other studies have shown that at least 562,577 patient records arebreached each year (Thomson, 2012). These empirical results suggestthat there is a high level of perceived and real threat of losingprivacy when the EHR is used to gather and store patient data. Theserisks create the need for the implementation of security measures inorder to protect patients.
Thefear that patients will lose their personal information when it isstored in the EHR could jeopardize the delivery of effective healthcare. Some patients might refuse to supply the health care providerswith the correct information. For example, most of the patients whohave been affected by cases of data breach in the past lost personaldetails, including their physical address, social security numbers,mobile phone contacts, names, and diagnostic inform that landed inthe hands of hackers (Boonstra, Versluis & Vos, 2014). With thistype of personal data being held by criminals that one does not knowhow they will use it, patients might fear going to the hospital orproviding accurate information. Therefore, the implementation ofadequate security measures (such as access control and encryption)will restore patient confidence and trust in the EHR systems.
Theapplication of electronic health records has revolutionized thehealth care sector by helping the health care facilities stop keepingpatient records in hard copies. The EHRs are computer-based systemsthat enable the stakeholders in the health care sector to gather,process, share, and store patient information in a more convenientway. The desire to develop the EHR system that isusedin the modern health care facilities started in the 1960s when thestakeholders in the industry found the need to increase efficiency,accuracy, and contain the cost of delivering medical care. One of thekey benefits associated with the adoption of the EHR systems is anincrease in the participation of patients in the process of deliveryof the health care and the management of their medical conditions.This benefit is attributed to the fact that EHR systems make itpossible for patients to see their information online and makeinformed decisions regarding their health. The successful adoption ofthe EHRs should follow certain steps in order to ensure that thetechnology that is implemented meets the specific needs of the healthcare facility.
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