Running head: HOW ELECTRONIC HEALTH RECORDS ARE IMPACTING THE HEALTHCARE INDUSTRY 1

How Electronic Health Records Are Impacting the Healthcare Industry

Steven Zhang

San Diego University

HOW ELECTRONIC HEALTH RECORDS ARE IMPACTING THE HEALTHCARE INDUSTRY 2

Abstract

Electronic Health Record (EHR) software is brining the healthcare industry into the 21st century.

For nearly a century, healthcare organizations have dependent on paper as the primary method

for patient record keeping. The creation and implementation of the Health Insurance Portability

and Accountability Act (HIPAA) in 1996 and the Health Information Technology for Economic

and Clinical Health (HITECH) in 2009 made it a mandate for all HCO to modernize to EHR

technology. This paper aims to review the history of medical record keeping, and how the rise of

computer and network technology enables patient health records to go digital. Additionally, we

will also explore the challenges of EHR implementation from a technical and logistical

perspective, and how the potential dangers associated with modernizing patient health records in

the digital world of the 21st century.

Purpose:

The issue that this paper is addressing is how the implementation of electronic healthcare

systems have changed the way healthcare organizations handle privacy of patient information in

the 21​st​ century. With modern day electronic health records, healthcare professions can now

access patient information with a click of a button, regardless of location. Clinicians will have

the confidence to know they have the most complete and up to date information regarding their

patient, therefore allowing them to make a well-informed medical decision to help treat the

patient. Lastly, the potential privacy dangers of electronic health record systems and how new

technology in addition to HIPAA and HITECH is being used to protect patient rights.
HOW ELECTRONIC HEALTH RECORDS ARE IMPACTING THE HEALTHCARE INDUSTRY 3

Background:

Medical records first surfaced during the early 1920s when healthcare organizations

started paper charting patient information. “Patient records established the details, complications

and outcomes of patient care” (Brooks, 2015). Healthcare organizations were starting to

understand that keeping track of patient information will not only improve patient care, but also

improve operational effectiveness of the healthcare organization itself. “Documentation became

wildly popular and was used throughout the nation; healthcare providers realized that they were

better able to treat patients with complete and accurate medical history. Health records were soon

recognized as being critical to the safety and quality of the patient experience” (Brooks, 2015).

As the medical record keeping gained popularity and spread nationwide, the American

Association of Record Librarians was created to establish the first standards of medical record

keeping. Today they are known as the American Health Information Management Association

(AHIMA) (Brooks, 2015).

The dawn of modern electronic health records began in the 1960s with new private

companies starting to address the ever increasing paperwork load of healthcare organizations.

These software companies teamed up with large research hospitals and universities; together,

they were the early adopters of electronic health record technology. However, it is not without

hurdles for early adopters (Brooks, 2015). Things such as patient information would be

generated and electronically recorded at a specific facility—and it was accessible only at that

specific healthcare location. “While technology flourished outside of the healthcare industry,

computerization within healthcare had hit a roadblock. Healthcare was without a communicative,

cross-departmental electronic record system” (Brooks, 2015). Despite these technological

HOW ELECTRONIC HEALTH RECORDS ARE IMPACTING THE HEALTHCARE INDUSTRY 4

hurdles, healthcare organizations understood the potential impact that electronic health records

can be for healthcare organizations in the near future. It was not until the 1980s and the 1990s in

which these types of software was made more cost effective and saw wider adoption nationwide.

Electronic health records exploded during the 1980s and 1990s as more software

companies entered the market. Due to this increase in EHR companies entering the market, this

allowed a drop in price of EHR software(Evans, 2016​)​. This price decrease allowed less funded

healthcare organizations the opportunity to upgrade to EHR. Department-specific software and

the introduction of master patient index (MPI), a highly successful database of patient

information used across all the departments of a healthcare organization “The advent of

computerized registration meant patients were able to benefit from a more efficient electronic

check-in process for the first time ever” (Brooks, 2015).

It was not until 1996, decades after the initial medical coding guidelines by the AHIMA,

that attempts for standardization and requirements were made for electronic health records.

Before the introduction of HIPAA in 1996, there were no federal regulations regarding how

HCO and third party companies handle patient information. Surprisingly, there were federal

requirements in industries that are not as sensitive as patient health records. Industries like cable

television video rental records were one of many industries that has mandantes on protecting

patient rights. (AHIMA)

Without proper regulation and an ever-increasing number of groups having access to

patient records. Technological advancement without oversight could put both patients and

healthcare organizations at risk, with both seen and unseen consequences. The U.S. federal

government believed the same way and wanted to standardize electronic health records across
HOW ELECTRONIC HEALTH RECORDS ARE IMPACTING THE HEALTHCARE INDUSTRY 5

the country. The passing of the Health Information Privacy and Accountability Act (HIPAA)

brought attention to the healthcare record industry as the government tries to modernize the

nearly century old practice. HIPAA was enacted in 1996 under the Clinton administration

(Brooks, 2015). HIPAA set the foundations of health information privacy and the rules.

Unfortunately, the HIPAA lacked the teeth to enforce these newly established regulations. “By

2008, more than 33,000 HIPAA complaints filed with OCR to date, only 8,000 investigated with

no fines issued” (Solove, 2013). Because of the lack of enforcement, the government passed the

Health Information Technology for Economic and Clinical Health (HITECH) act to reinforce the

HIPAA act by strengthening enforcement penalties, require breach notifications, and expand

patient rights (Solvene 2015). In 2013, HITECH’s HIPAA Modification final rule was released.

Before the introduction of the (HIPAA) in 1996 and (HITECH) in 2009, there were no

universal guidelines for electronic healthcare records. How each healthcare organization (HCO)

handled patients medical information varied from organization to organization. Additionally,

there was still a large technology gap between large and small healthcare organizations, as the

smaller organizations were still using paper charting (Solove 2015).

Before introduction of electronic health records, the process of moving patient

information from one healthcare organization to another was laborious and time consuming.

Patients would have to request their records to be manually transferred, and the information

could take somewhere between days to weeks (Solove 2015). Due to this cumbersome nature of

record transfers, a substantial number of patients simply did not transfer their their record to their

new HCO- thus leaving critical medical information and records behind. This incomplete record
HOW ELECTRONIC HEALTH RECORDS ARE IMPACTING THE HEALTHCARE INDUSTRY 6

of a patient's’ medical history can be dangerous. A number of patient deaths can be avoided if

clicicans had access to a patient’s complete medical records.(Solove, 2015)

Current application/discussion

Since the enactment of HIPAA and HITECH act from the federal government, majority

of healthcare organizations have already made the switch over to EHR. Large software

companies have positioned themselves to serve in the electronic healthcare industry. They have

led the way in developing further improvement to their software with new features and security

updates. As of 2015, 96% of all hospitals have certified electronic health records systems--up

from 71% just four years ago at 2011(IT Health 2019​)​. For basic electronic health records

certification between 2008 through 2015, the qualification rate went from 9.4% to 83.8%(IT

Health 2019​)​. What this means is that even though majority of healthcare organizations that

meets HIPAA and HITECH requirements, there is still a small percentage of healthcare

organizations out there that are still out of compliance. Those out of compliance will have a

limited amount of time to get certified.

Before the introduction of HIPAA and HITECH act, there are no set guidelines for medical

healthcare records across the country. Larger hospitals will have some sort of electronic medical

records for their patients, while small health care organizations and private medical offices use

paper filing. Another issue with the HCR is that there is no easy way for patients to move their

medical records from one healthcare organization to another. It creates issues when patients

move to a new location or transfers to an office that does not host their primary care physician.
HOW ELECTRONIC HEALTH RECORDS ARE IMPACTING THE HEALTHCARE INDUSTRY 7

Conclusions and Further Studies

HIPAA and HITECH were the official beginning of the modernization and

standardization of electronic health records in the United States. Since the passing of HIPAA in

1996 and HITECT in 2009, the majority of healthcare organizations now use electronic health

records software that meets minimum federal standards. Electronic health record software

enables healthcare organizations a centralized location of patient information that can be

accessed anywhere, allowing clinicians the most up to date patient information for improved

patient care and organizational efficiency. However, it is important to note that there are risks

associated with electronic health records-- data breaches by hackers. The HITECH act was

passed to hold healthcare organizations responsible for any breach of data. Because of that, HCO

includes specific securities such as user authentication, antivirus and antimalware software,

proxy servers, biometrics, and staff training. As EHR technology continues to advance, so does

the need for HIPAA and HITECH to stay updated to the ever changing landscape of healthcare

technology; this absolutely pertinent, as to allow for adjustments and to ensure patient safety.

Furthermore, EHR, HIPAA, and HITECH need to anticipate potential weaknesses in which

hackers can infiltrate databases as any potential breach could affect thousands of patients. More

research will be needed to examine how quickly HIPAA, HITECH, and EHR software is

adjusting to this ever-changing healthcare technology and security landscape, as well as and how

HITECH is effectively holding HCO accountable for reported breaches.

HOW ELECTRONIC HEALTH RECORDS ARE IMPACTING THE HEALTHCARE INDUSTRY 8

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