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EHR Implementation to improve Safety and Patient Outcomes

EHR Implementation to improve Safety and Patient Outcomes

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Published by Robin Bowen
A position paper that promotes full usage of EHR in the US healthcare system.
A position paper that promotes full usage of EHR in the US healthcare system.

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Published by: Robin Bowen on Apr 26, 2012
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10/05/2014

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April 19, 2012
The Concept of a medical record was initiated by Hippocrates B.C. and it was designed to serve two mainobjectives: 1) Description of the presentation of the disease process in the patient and 2) the most likely course of illness(Bemmel, J., 1997). Since that time there have been further developments in the documentation process and informationincluded about the patient, went hand in hand with the advancement of the medical field.
EHR past and present
 
During the 20th century there has beensignificant advances in computer andinformation technology affecting so manysectors of society. Areas ranging from onlinedegrees to business transactions have becomemuch more efficient and productive for both thegeneral population and industries. Thehealthcare system in the United States hasbeen experiencing a concerning lag in keepingup with these changes especially over the last10 years. It is time for a change and the UnitedStates is evolving the landscape of itshealthcare sector by implementing an allelectronic health record (EHR) system replacingthe current paper system.The early computerized systems tomaintain medical records were called clinicalinformation systems and were initiallydeveloped in the 1960s at the University of Utahand Massachusetts. They were called HealthEvaluation through Logical Processing (HELP)and Computer Stored Ambulatory Record(COSTAR) respectively (Atherton, 2011). Fromthe 1970s until now the EHR has graduallyevolved to become more complex andcomprehensive in nature. Some of the currentsoftwares include VistA (used by the VA), Epic,and WizErd. The current paper based system of handling medical records has multipledisadvantages in comparison with EHR. Themost significant being the inefficiency withtransfer of information between healthcareprofessionals in a timely and accurate manner.Having the ability to retrieve the completehistory of the patient including pasthospitalizations, visits, allergies, medicationsand consultations at any point by any healthcare provider aids in the quick decision makingprocess and the reduction of errors associatedwith relaying information from one person toanother. Consider a scenario where the on callphysician is contacted to make decisionsregarding a new admission. Having all theinformation available visually via EHR wouldmake it much easier for an accurateassessment and management decisions rather than solely relying on verbal report by the housestaff.Since the change to EHR is necessary,the Government has stepped in to acceleratefull integration by instituting laws and policiesspecific to the portability and privacy of medicalrecords. The Health Information Technology for Economic and Clinical Health Act (HITECH),which is considered a part of the AmericanRecovery and Reinvestment Act of 2009(ARRA), is pushing for all medical providers toconvert to an all electronic system. The Office of the National Coordinator for Health InformationTechnology (ONCHIT) is responsible for settingminimum standards and composing theinfrastructure of HIT and incentives have beenput in place for providers to adopt the newcriterion. Some examples of these programsare the EHR incentive program and HITECH.In 2009, Congress began to improvethe privacy and security rules under the HealthInsurance Portability and Accountability Act(HIPAA). HIPPA regulations are considered andenforced with the process to maintain thepatient's privacy as health informationtechnology evolves.
EHR Implementation to improve Safety and Patient Outcomes
A Position Paper  Nicole Firsich, Nadia Kamagate, and Robin Bowen RN
 
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In light of the recent advancements ininformation technology along with thedisadvantages of the traditional paper basedmethod we fully support the implementation andapplication of EHR. This will result in asubstantial improvement in the outcomes of patients and efficiency as well as costeffectiveness of the healthcare system.Unfortunately, there have been some obstaclesto EHR fulfillment due to high initial start upcosts and a potential threat to patients’information privacy and misuse for researchpurposes. The supportive reasons to propel theHITECH Act and develop EHR are: 1) reductionin medical errors due to increased efficiency. 2)lower long-term costs, and 3) Improved patientoutcomes and reduced mortality rates due toaccurate and efficient transfer of patientinformation.
Exorbitant Initiation Costs Impede EHR
The current push for EHR is causingskepticism for many. The leading reasons thatdeter companies from the conversion of EHRare due to the initial start up cost, patientprivacy and secondary uses of medicalinformation.The start-up costs vary depending onthe equipment and training needed and cantranslate into loss of productivity and revenue. A research study estimated the projected costof a seven year EHR installation program to bearound 19 million US dollars in an acute carehospital (Schmidt & Wofford, 2002). Researchconducted in an outpatient setting shows theinitial cost was between $50,000 and $70,000dollars per physician (Agrawal, 2002). As a result of the significantly highsetup costs, many healthcare providers havebeen resistant in applying EHR into their practice. While this has been an obstacle, mostproviders did not appreciate the long termfinancial benefits. Utilizing EHR in a healthcareorganization or group has been shown tomarkedly reduce medical errors including wrongtreatments, unnecessary imaging studies andlab tests. Furthermore, it greatly enhancesefficiency in communication and accessibilitybetween healthcare personnel reducing timespent by patient per visit. At a national level,savings have been projected to be around $81billion annually for both inpatient and outpatientcare if compliance with electronic records is atthe 90% mark (Hillestad et al., 2005). Thesesavings are directly related to the efficiency of data storage and transmission and thereduction of errors produced.
Compromising Patient Privacy CausesHesitancy in Using EHR
A major concern arising is how patientprivacy will continue to be protected when allhealth records become electronic. Those whooppose the transition to EHR fear that“entrusting our most private and potentiallycompromising information to ‘black boxes’ andopening ourselves up to privacybreaches” (Jacques, 2011). Patient privacy hasalways been important to healthcare providers,and the potential of records becoming moreaccessible is a major concern. With newtechnology comes software that must beupdated and professionals who must be trainedto operate the systems. If issues with thesystem transpire, physicians and other providers will have to turn to computer technicians to fix the problem. This exposesinformation to people who may not fully respectpatient privacy. Another issue with electronic recordsis the demand to publish for secondary use,such as medical research (Fengiun, Xukai,Peng, & Chen, 2011). One study found howsome patients were not comfortable with their health information on a computer.
 
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Some felt as though this makes it easier for anyone to look up their information, therefore,paper records seemed safer (Shield, Goldman, Anthony, Wang, Doyle, & Borkan, 2010).Surveys have also found that patients seemmore accepting of a transition to EHR if theycan be more proactive in the role of ownershipof their records (Berk, Cohen, Callaly, & Lauder,2008). Considering the fact that more peoplecould have access to EHR, patients are morecomfortable with the notion of knowing whosees their medical information.The Government is aware of the fearsassociated with patient privacy and security andhave been working to add provisions to privacypolicies. In 2009, Congress began to improvethe privacy and security rules under HIPAA.Congress realized that for the medical industryto switch from paper to EHR, new enforcementmechanisms must be enacted for ensuring therecords’ privacy and security (Health andHuman Services [HHS], 2009). According toHealth and Human Services (HHS), theHITECH Act, in Title XIII of the ARRA wascreated to make changes to the HIPAA privacypolicies. These amendments to HIPAA intend tomake protected electronic health information“unusable, unreadable, or indecipherable tounauthorized individuals” (Jacques, 2011).Provisions found in subtitle D of the HITECH Act aim to support the enforcement of HIPAAprivacy regulations concerning EHR (HHS,2009). Subtitle D establishes four categories of violations and sets penalty amounts for eachtier. Healthcare lawyers believe that along withthe HITECH Act, enforcement of privacypolicies will increase causing healthcareproviders to prioritize patient privacy protection.With rigorous laws and regulations being setforth for EHR, patient privacy should notbecome a risk associated with the transition toEHR.
Accuracy and Efficiency in Transfer of Information
 
Technology has advanced but inhealthcare the systems used became archaic.Everything was kept separate and records werestockpiled. It took weeks and even months totransfer records from facility to facility. With theexecution of the HITECH act companies canupgrade to a stealthy system that has enhancedefficiency and functioning.Electronic records allow all patientinformation to be kept together, so that thewhole patient could be seen and treated, rather than bits and pieces. EHR allows thedevelopment of a comprehensive database of structured patient information including allactive medical problems and diagnoses,hospitalizations, office visits, admission anddischarge summaries, as well as lists of currentmedications and allergic reactions. All thisinformation is stored in chronological order preventing confusion and mistakes when data isinterpreted. In addition, any lab tests or imagingstudies are uploaded electronically and can beaccessed from any location. The primaryadvantage of this is the high accuracy inrelaying the information between healthcareprofessionals. For example, a primary admittingphysician could be discussing findings on a CTscan with a surgical consultant while incompletely different locations. Information couldalso be accessed at bedside or the physician'shome via computer which leads to promptupdates and no lag in the care process. A qualitative prospective interventionstudy was conducted to investigate the benefitsof EMR implementation at the private practicelevel. The study involvedthe introduction of EMR in six private practices,which weresubsequently followed over a sixteen-monthperiod. 

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