Current Medicine Research and Practice 8 (2018) 67–70

Contents lists available at ScienceDirect

Current Medicine Research and Practice

journal homepage: www.elsevier.com/locate/cmrp

Review Article

Electronic health records: A general overview

Ruby Sahneya,* , Mukesh Sharmab
a
Deputy Medical Superintendent, Sir Gangaram Hospital, Old Rajinder Nagar New Delhi, India
b
Department of Microbiology, SGT University, Gurugram, Haryana, India

A R T I C L E I N F O A B S T R A C T

Article history:
Received 6 November 2017 Electronic Health Records (EHR) is a digital collection of patient health information in an electronic
Received in revised form 7 March 2018 format. It is the need of the hour because it improves the quality and cost of health care, thus adopted by
Accepted 13 March 2018 many developing countries. Despite of the positive effects of the EHR system in medical practices, the
Available online 13 March 2018 adoption rate in India is very slow, the main hurdle is clinicians. For successful adoption many steps have
been initiated, and several new steps has to be taken. It requires a coordinated effort from all the
Keywords: stakeholders. Information technologies can be hazards so its security should be always concern. The
Electronic health record purpose of this article is to increase awareness and valuable uses of EHR in health system.
Paper record
© 2018 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Sir Ganga Ram Hospital.
Security
Physicians
Hospital information system

Contents

1. What is an EHR? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
2. Global vs national scenario . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
2.1. Global scenario . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
2.2. National scenario . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
3. Benefits with EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
4. Better practice management with EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
5. Better revenue management with EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
6. Efficient prescription management with EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
6.1. Security and privacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
6.2. How to ensure security and privacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
7. Challenges in implementing EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
8. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Conflicts of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

1. What is an EHR? health care settings. EHR includes demographic and personal
statistics like age, weight, and billing information as well as vital
Electronic Health Records (EHR) is a digital collection of patient signs, pervious and current medical history, family history,
health information in an electronic format. EHR is increasingly medication and allergies history, immunization status, laboratory
being implemented in many developing countries. These records test results, and radiology images. EHR systems are designed in
can be shared through well connected network across different such a way which reduces paper medical records to store data
accurately and legible in a digital format. Digitally health records
reduce the risk of data replication as file can be shared across the
* Corresponding author.
different health care systems and can be modify and update which
E-mail addresses: ruby.sahney@sgrh.com (R. Sahney), reduce the risk of lost paperwork. EHR programs directly benefit
sharmadrmukesh@gmail.com (M. Sharma). the physicians, patients, and obviously the hospital management

https://doi.org/10.1016/j.cmrp.2018.03.004
2352-0817/© 2018 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Sir Ganga Ram Hospital.
68 R. Sahney, M. Sharma / Current Medicine Research and Practice 8 (2018) 67–70
authority. EHR system can be beneficial in population based
studies and effective when extracting medical data for the
examination of possible trends and long term changes in a patient.
2. Global vs national scenario
2.1. Global scenario
 Canada launched an initiative in 2001 to modernize its health-
care system. In 2015, EHRs were created for 91% of Canadians,
and 91,000 clinicians were using EHR system successfully.1
 In 2001, England started a national initiative called the “National
Plan for IT” (NPfIT) for modernizing its healthcare system. Under
the initiative, 96% of the population covered by EHR system. 2,3
 In Germany, about 90% of physicians in private practice are using
EHR systems. Patient privacy has been given adequate attention
in the initiative.4
 New Zealand has achieved an EHR adoption rate of 97%. At
present, there is no central or single EHR system, but a
distributed EHR system, which can be accessed from any entity
across the nation. The country is aiming to have a single EHR
system by mid-2018.5
 United States, 76% of civil hospitals and 97% of the acute care
hospitals have adopted certified EHR systems by 2014.6
2.2. National scenario
India has a mixed healthcare system consisting of a large
number of hospitals run by the Central Government and State
Government as well as the private sector. Increased utilization of
information technology (IT) in health settings is one of the key
components of “digital India” initiative by Government of India. In
year 2013 Indian Government has started initiative the use of
information technology in health care system, and for that
Ministry of Health and Family Welfare notified EHR standards
for India.7 There are big private organizations like Max, Apollo,
Fortis, Sir Ganga Ram, and Sankara Nethralaya have been adopted
electronic records while rest is still in the planning phase.8,9
Government of India has increased its budgeted to $19.2 billion to
improve the health care system by using information technolo-
gy.10,11
3. Benefits with EHR
EHR is a great tool to manage lengthy and labor-intensive
paperwork more efficiently and thereby significantly reduce the
cost of transcription, re-filling, and storage. EHR enables patient
management with enhanced and accurate reimbursement coding.
Since the software has all patient-related information it signifi-
cantly reduces the occurrence of a medical error and also helps in
the improvement of patient health with better management of the
diseases. Here we discuss five important benefits of EMR vs. Paper
Medical Records.
1. Costs: To start the EHR the initial costs is higher due to large and
digitally setting of IT network but the costs over time will
decrease significantly. While manually storage of paper records
require more personnel to manage and maintain paper files,
accesses and organize countless documents which increase cost
substantially over the time. EHR can save man power, time and
physical storage space which reduced the cost in long run.
2. Storage: Electronic health records can be stored in a secure
cloud, providing easier access by those who need them, however
paper medical records required large warehouses for storage.
Paper records are not only taken up space, but they are not
environmentally friendly and tend to decay, when handled by
many individuals over time, which increased the cost of storage.
3. Security: Security is a great concern for both paper and
electronic storage system; both are equally susceptible to
security threats. If a facility stores records electronically without
proper and effective security systems they are vulnerable to
access by unauthorized individuals which can be misuse the
information. If records are stored in paper form, they can be lost
or damage or stolen due to human error. Natural disaster such as
a fire or flood also plays an important role in the concern the
security of health records.
4. Access: Accessibility of electronic health records take clear
advantage over paper health records. Digital health records
allows healthcare professionals to access the information
instantly, whenever and wherever they need almost, which
makes healthcare professionals more efficient, however paper
medical records to be shared with healthcare professional
required physically provided to them or scanned and sent via
email, it is a time-consuming which increase the cost.
5. Readability and Accuracy: Electronic health records are often
written with the use of standardized abbreviations which make
them more accurate and readable across the globe which
decreased the chance for confusion however handwritten paper
medical records may be poorly legible, which can contribute to
medical errors. Paper medical records provide insufficient space
for healthcare professionals to write all necessary information.
4. Better practice management with EHR
In terms of appointment management, EHR performs the
excellent task. EHR improved medical practice management
through integrated scheduling systems that link appointments
directly to progress notes, automate coding, and manage claims.
This platform smoothly handles queries about the patient
condition and manages graphs, specific to each and every patient.
A Report published by Jamoom E. et al.,12 National conference on
health statistics “claimed:
 79% of EHR users practice functions more efficiently.
 82% of EHR users save time while sending prescriptions
electronically (e-prescribing).
 75% of EHR users receive lab results faster than usual.
EHR enhanced communication with other multi-disciplinary
physicians, laboratories, and between different hospitals which
enables faster patient service. Since it’s a digital platform with
online connectivity doctors can access the patient information
anytime anywhere and assigned task to support providers which
includes labs, and other physicians.13
Follow checkups are often an integral part of better patient care;
with EHR, automated checkups are easily scheduled by the
electronic program. Since the program is integrated with test
reports and images, timely access is readily enabled. Moreover,
such test can be ordered through this multipurpose EHR system.
Moreover, such system prevents unnecessary duplication of
medical testing. The best part of such electronic records is that
they are integrated with national and international disease
database and registries. Thus, it helps the physicians track the
epidemiological status of the current disease under treatment and
be prepared for emergencies.
5. Better revenue management with EHR
EHR are equipped with the technology that enables the
management track and efficiently channelize the revenue model
 R. Sahney, M. Sharma / Current Medicine Research and Practice 8 (2018) 67–70
of the hospital. The program lets the user reduce any delay or lag in
medical and treatment charges. It also helps in preventing any
denials by the life insurance companies that may occur due to late
e-filing. The software also helps in detecting laboratory tests that
are ordered at lower frequencies. The digital platform of EHR has
the provision so that the hospital management can be vigilant over
the quality assessment of the physicians on the panel. Moreover, it
also helps the management to reduce or recover lost charges with
more efficient billing and coding. The article published by Bell, B,
Thornton, K.14 ‘From promise to reality achieving the value of an
EHR’ claimed that EHR implementation can increase.14 A study by
Price water house Coopers for EHR Intelligence offered the most
promising news. They found: EHR promotes greater administrative
efficiency – This saved the Canadian government just under 800,
000 US dollars. EHR reduces care redundancies to the tune of over
560,000 US dollars with fewer duplicate tests and a reduction is
adverse drug reactions.15
6. Efficient prescription management with EHR
First of all, EHR reduces the chance of loss or misplacement of
the paper prescription. Directly prescribing with EHR enables the
quick update to the pharmacy thereby reduces time to assort
medicines for each and individual patient. Such e-prescriptions
also help in reduction of the cost burden. At the same time, such
electronic filing speeds up the procedure because of faster
comprehension of the information.
6.1. Security and privacy
Justice Samuel Dennis Warren and Justice Louis Brandeis define
privacy as the right “to be let alone.”16 EHR systems have concerns
of breach as with any online digital format. There have been couple
of cases reported in which medical information has been accessed
by unauthorized personal, while this does not occur all too
frequently, the occurrences are enough to plant some suspicion in
the minds of physicians and patients. If confidential records end up
in the hands of a person not authorized could lead to identity theft,
which can destroy a person's finances, credit and reputation. This is
why reputable records management companies have worked hard
to provide top-quality security within their software in order to try
to eliminate the risk of breach. There is a potential for
misplacement of data throughout this process of conversion from
a paper to electronic health records. However, professional
electronic health record vendors formulate transition strategies
in order to essentially eliminate data misplacement.
6.2. How to ensure security and privacy
1) Enhance administrative controls
 Update policies and procedures
 Guide employees through the stringent privacy and security
training process
 Run background checks on all employees
2) Monitor physical and system access
 Create physically inaccessible systems to unauthorized individ-
uals
 Have exigencies in place for data recovery or restoration
 Provide identification and verification requirements to all
system users
 Access the list of authorized users
 Supply passwords and personal identification numbers (PINs)
 Provide automatic software shutdown routines
69
7. Challenges in implementing EHR
In spite of being widely acknowledged EHR system, pose several
challenges in its adoption in India. The uppermost challenge is not
getting overwhelming support from clinicians. Many physicians
are reluctant in this system as they feel that it will reduce the
clinical productivity. There are many companies providing
software for hospital information systems, but none of them
taking serious efforts to educating the medical community. An
important challenge in implementing EHR is “customization,” as
each health care facility working differently. And It is difficult to
create a “one-size-fitsall” EHR system.
8. Conclusion
It is clear that implementation would be possible only with the
joint efforts of all the stakeholders which include the Central
Government, State Governments, healthcare providers, medical
associations, IT industry, etc. The Ministry of Health & Family
Welfare has issued guidelines for EHR standards and meta-
standards. It is also in the process of creating the National e-Health
Authority (NeHA)17 which will look after standards of EHR and
related matters. Another initiative in the area is use of IT in the
healthcare sector.18
Creating a useful EHR system will require the expertise of
physicians, technology professionals, ethicists, administrative
personnel, and patients. To conclude EHR system can improve
the use of our health care resources more efficiently, providing
information about the patient by click of a mouse. EHR need of the
medical community and is essential for the development and
procurement of future medical informatics to prevent failure of any
clinical information systems. Multiple strategies are available to
reduce risks and overcome barriers in the implementation of
digital health records. Leadership, teamwork, flexibility, and
adaptability are keys to finding solutions. EMRs capacities must
be maximized in order to enhance improve the quality, safety,
efficiency, and effectiveness of health care and health care delivery
systems.
Conflicts of interest
The authors have nothing to disclose.
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