CHAPTER

u s i n ga r n

Shared Care and q u a l i t y

4
differen

of
the.

Electronic Health Records q u i

The
c k e r

have to

time th
chores

World

still rec

ELEC
Electre

At the end of this chapter, student will able to learn about: such a

Electronic health records patier

Features of electronics health records
Challenges relatedtoelectronic health records implementation.
How to implement successful electronic health record system
Goals of electronic health records standards
Latest trends in electronic health records
Benefits of electronic medical records
Standard for electronic health records

TERMINOLOGIES
o Protected health information Pati
(PHI): Protected Health
a
person's health status, the delivery of healthcare, orInformation (PHI) is any data about A pa
generated or gathered by a covered entity. payment for healthcare that was
oElectronic health record (EHR): An
electronic version of a
is kept up to date over
time by the patient's medical history that
administrative clinical data relevanthealthcare
to that
provider. It may include all of
the essenna
as
demographics, progress notes, issues, person's care under a specific provider, sucu
immunizations, laboratory information, and medications, vital signs, past medical historne
Electronic medical record (EMR): An radiology reports.
to the
software's actual clinical antiquated but still used word. It now
features, generally Te
allergies, encounter
documentation, etc. including those that screen for drug interacno
INTRODUCTION
The healthcare industry
decades. The electronic has seen an increase in
the health record is one
electronic health record worldwide technical innovation in recent
over a excellent
little period of illustration of this. The fast evolution
time has made it fast evrmfot
an
indispensable plalatforn
 Shared Care and Electronic
Health Records
usinga n ds
ing health information. In order to 63
is utilized all over the world as aimprove patient outcomes
na quality

the
of rand
1hcare
tho
differenth e a
professionals,
ological
most significant technological develn
developments,
means of
trackng a patient's
through safety and
sharing health information
progress, and trending test
the
across
findings.
electronic health record serves One
replacement
r
more secure for the
conventional handwritten asa
tha comes vith using
The complexity technological platforms, however, means that
spend ore time dealing with it. The time it
more
paper charts.
have to
have beer
een spent
takes to experts
operate devices and technology,
time hat could providing direct and indirect
chores atthe bedside, is a roblem that healthcare patient care through nursing
WorldHealth Organizatio ion acknowledges the value ofpersonnel frequently run into.
Although the
electronic health records, more
still require
to guarantee that moral, secure, and high study is
quality criteria are upheld.
ELECTRONIC HEALTH RECORDos
ronic health records refer t0 storing patient data and information on a
Elect
digital platform,
suchas computer, that authorized hospital employees can access and use it. It covers the
a so

natient's diagnosis, course of treatment, drugs, lab results, and any other pertinent data.

Patient Patient record

portals management E-prescribing

Medical Charting and

Reminders
history lab analytics

Task Payment
Communication
management management

Fig. 4.1: Features of electronic health records.

Patient Portals
A patient portal contains information of patient, such as:
Dut
as Patient
portals
a

Medical
OPD records
appointments

Immunization

records
Lab reports

Information
on allergies
Medication
e-records.
information system on
4.2: Patient
Fig.
 Records
Electronic
Health
Shared Care and
Clinical
history
Patient Record Management
consists of Figure 4.3.
Patient record management

E-Prescribing an Past medical Medical

offer
records may records
electronic health history
Software for to
electronically
a doctor
that allows
e-prescribing capability
prescription.
give a patient's faxed prescriptions,
prescriptions and
In place of paper generation, P a t i e n t record
management

e l e c t r o n i c prescribing
is the computer-based A doctor Fig.4.3:
prescription. system.
medical
transmission, and filling of a transmit a
fresh
electronically
or nurse practitioner c a n

prescription by using e-prescribing.

Prescribers (Doctors)
Prescribers (Doctors)

Refill requests

Rx change
New
requests
prescription

e-Prescription
server

New Rx change
prescription requests
Refill requests

Pharmacyy Pharmacy

Medicines Medicines

Patient
Fig. 4.4: E-Prescription process.
 irical
ory Shared Care and
Electronic Health
Medical History Records
65
edical The
medical history featu in an EHR will
include:
y a Past medical conditions
a Specific medical problems
Teords a Treatments given in the past

atient record managena HALLENGES RELATEDTO ELECTRONIC HEALTH

IMPLEMENTATION RECORDS
system. ImplementationNotcost: 'The cOst of electronic health records in
somewhat high. all hospitals have the financial means healthcare settings is
s (Doctors) electronicpatient records. Everythingis dependent on the healthcare
to set
up, implement, and optimize
Unexpected costs may also arise during the organization's finances.
deployment implementation.
One of the
EHR
necessary funding, especially for smallerbiggest obstacles to
is finding the
Implementation of electronic health
records needs
following planning:
companies.
Setting up the hardware
.Software costs
.Implementation assistance
.Training for the staff
Ongoing network fees
.Maintenance of data server
o Staff reticence: Not all medical staff members are on board with using such a database to
store patient information. The effectiveness of such
computerized records is in question.
Few lack knowledge and require training to manage electronic records. The deployment
of electronic health records is delayed as a result of all these factors. They might appear
hesitant to abandon the documentation process. In certain circumstances, the workforce is
unaware of the most recent technology developments and their many advantages.
ange
Training takes time: Because medical staffneed specialized training to handle such things,
sts implementing the electronic health records system is quite challenging. Programs for faculty
growth or training take a lot of time, and extra time is required for system training. Small
hospitals with little resources cannot afford to spend so much extra on systems and training.
O Poor usability: The adoption of electronic health records varies throughout departments
different. This reduces the software's
Since the workflows of a dentist and a cardiologist are
the system. The programme is less simple
to
usability and makes it a little harder to adapt
use because of design defects or inadequate trainin8 in the adoption ofan
and data leaks are another difficulty
ata privacy: Data privacy over the concern
fact that the stockholders express
health record. Despite the
ectronic of a security breach,
the healthcare business
reach caused by a cyber-attack. In case
the
d now has a major duty to guarantee
into legal issues. As a result, the provider
8et
electronic health records' data protection. implemented, the difficulty
is to export
records are

a migration: After electronic health Large of

ones.
amounts paperwork detailing
from paper-based platforms to digital data entry a laborious
ata will be present, making
hundreds of patients
edical histories of
the hospital stalt. hnical team to
can hire a techn.
ime-consuming operation for with a high budget
A hospital to justify the
Technical resourc r c e limitations:
database, but
small hospitals find it challenging
hardware is expensive,
the electronic record purchasing
ge internal technical staff and
O n g so. Building a n
 Electronic
Health Records
Shared Care and
healthcare organizatio ns for
colls

mid-sized
small and
given by
efe

which is a common justification electronic record data.

of
implementation electronic health record svsta. Ens

postponing the
This is the inability ofvarious
mar

c a n u s e it. Inter-departmene
I n e f f e c t i v e interoperability: various providers ental
information so that
to obtain a complete pictureeof
heal

or software to exchange record systems

electronic health
that permits the movementtof
exps
essential in
networking is networking system
information among various an effective
providers is stilla big challenge for healthcare providers. Notto ent Mee

the client's health. Building

is necessary for the clien the

coordination between various providers l o w

add that appropriate care

to have better health
results.
of electronic
health records entails more ofa Ens-

introduction
The As a result, the introduction of
effe-
Inadequate planning: technical one.
the than a purely will
culture shift within company
barrier in terms of change
management. All
a significant doit
electronic health records presents is required in preparation. Without
be committed, and significant planning the
partners must
and sustainability of the electronic
successful implementation
extensive preparation, the
remain a pipe dream.
health records system would
an electronic
health record system that produces excellent GOA
a Poor communication: Building technical team and the healthcare
communication between the
results requires two-way be consistent to ensure that the The gC
the time period, it should
provider. For the duration of met. Suf
of healthcare personnel are
technical requirements and expectations Pro
Infrastructure issues
Enc
Poor power supply Kee
Poor internet connectivity and availability
o Upe
Inadequate ICT facilities

Challenges to the
LAT
implementation of the EHR
The b
in general hospitals
healt
preser
Political issues Human factors issues recorc
Poor administration Inadequate computer skill among of the
non-medical and non-clinical staff
Corruption
Low level of awareness on e-Health
Financial constraints proce
Resistance from staff
wet ba
Fig. 4.5: Challenges related to electronic health records. Lettus-

Autor
HOWTO IMPLEMENT SUCCESSFUL ELECTRONIC HEALTH RECORD SYSTEM? availa
Have a strategic strategy: Creating a thorough strategic plan is the first step in implemenin emula
a cust
an electronic health record. Establish a team around the doctor who excels in technica
as hea
tasks by assigning tasks and responsibilities to the team members. For individuals who are
new to electronic health records, offer regular training and other incentives to pique thet Tim
interest. Make sure the team has contingency plans in place and is prepared. During tn finger
implementation phase, staff productivity may drop, workflow may become chaotic, or eve espec
patients may become irritated. Here, it's crucial to keep in mind that successful adoptionO
electronic health records depends on planning.
Pract
Vo
a Forms an interdisciplinary team: The deployment of an electronic health record isa Ma
collaborative process that calls for thededication of all team members, including sofrware Cu
engineers, IT personnel, consultants, nurses, and medical professionals. Make the teamS ane
 Shared Care and Electronic Health
Records
67
aal to achieve the process larger vision
ollectiv a team goal. This facilitates timely,
ffective, and usableimplemen entation completion. cost
a Ensure strong ng
leadership: Leaders
should take
ont in order to build the team for the aggressive measures to modify the
nta organization's
eof manage ds. To direct the implementation team, form a implementation of electronic
IT subcommittee of leaders with
t of in installing new
systems in various
t to experttise odline: As the electronichealth record disciplines.
ent MCadlines can be difficult. By implementation process is underway, meeting
developing practical plan, try to reduce timeline
a

feasible. Inform your team or the cost to the implementation team of each slippage
as
y as
fa r e dequate training: The goal of using electronic health records is to day of delay.
of tiveness and efficiency. Make sure the personnel is properly trained. The increase
A objectives
will remain unachievable it staft don't use the system properly and stick to the old ways of
doing things. Utilize a thorough training programme for the employees, explain to them how
the new system would improve patient care and make their jobs easier.

re GOALS OF ELECTRONIC HEALTH RECORDS STANDARDs

The goals of electronic health records standard are as follows:
Support the evolution and timely maintenance of records and e-portal.
Promote technical innovation using adopted standards.
Encourage participation and adoption by allvendors and stakeholders.
Keep electronic health portal implementation cost as low as possible.
oUpdate the best practices and policies for electronic health records standards.

LATEST TRENDS IN ELECTRONIC RECORD TECHNOLOGY

The brain of a hospital is its medical records department, which is a developing division in the
healthcare sector. The department maintains a database of all ofthe hospital's patients, both
present and past. Medical professionals and hospitals can undoubtedly use well-kept medical
Tecords to their advantage when defending themselves in cases of malpractice. The majority
Or the time that healthcare workers are at work is spent on paperwork and standard operating
doctor'soffice, it's no longer necessary to dash down to a
procedures. When a patient enters a
wet basement to dig through a stack of paper files.
Let us understand the recent advancements in this upcoming lield
chatbots and voice messages are
omated chatbots and voice messages: Automated
aila Chatbots are conversational software. To
standalone apps or online applications.
human speech. Offering
conversational agents imitate
aa C
custor numan conversation, these utmost relevance for
healthcare professionals
Zed and
satisfying experience is of the
cnealth services become more patient-centric. treatment at their
can obtain quick
1s crucial in the healthcare industry. Patients
C also crucial in an emergency
situation,
the chatbot. Chatbots are
es with aid of a medical
especially for older patients.
Practical applications: and the doctor.
contact between the patient
O
a MaSSIstants act as the first point of chatbot's are exceptionally
helpful.
Many users prefer messagir ging than calling.
On this front,
to a n s w e r
customer inquiries
on websites

use chatbot's
eSOcial nany healthcare
systems
and
u
media platforms like Facebook.
 Shared
Care and
Electronic
Health Records hilgnosed
nhance
pDa

health record
and analhrzo

patient
68 to t r a c k treatment, and.
it is easy
ulamated
O D O HpcD r

for diagnosis,
W i t h the
help ofchatbot, the
clinicians

thathelps in healthcare are mostlr

clinical
application
advancements
workable answrere
ers to a
possible MaIÁeMl o

AR and VR in
healthcare:
Technology
and VR in
healthcare
provides
inclu cluding general
number of M i h
b n e
n e c

by AR and
VR. The
use
of AR
and a wide range
of options
for deployment,
statisticsi
diagnostics.
the simplest approac
systemic
problems
data with the
potential for real-time have ongo
Patients who
c h for
BENEFITS
Visualizingpatient healthcare system.
into the homes. A doctor car
augmented reality to integrate relaxing
them while
in their o w n perfo 3docuracy
adminom
how to manage or quickly
on
conditions can keep an eye the patient e Mcurate
reality walkthrough to show
AR is utilized to speed up certain nroe
virtual
a assistance. Additionally,
require on a doctor's examinatio
medication ifthey information and vital signs

such the
real-time overlay of patient Bettergo

t h p
ea t i e r

a patient. is
technology, cloud computing a new wn
new Betterdats
Instead than being a
the.
Cloud computing: u s e cloud computing for
healthcare institutions patient
ca
r e s o u r c e s . Many
to supply computer It provides the ability to communicate
infrastructure management
and administrative tasks. 1 Convenie

information, and different therapies

for improved
such as medical histories, billing
anydevice
files,
healthcare administration. medicalpa
lntegratic
Practical applications
clinicians have access to information about
o When a patient visits
the healthcare institution, indluding
the treatments provided, and several other crucial
the patient's medical history, allergies, electronic

criteria. Ha a Single
Medical experts and patientlocated far can easilyshare
a
information to provide an accurate 1Better cor
diagnosis and treatment thanks to cloud computing. heathcare
to take
Portal technology: The use of portal technology is one method that encourages patients Saves these
an active role in their own healthcare. Medical professionals and patients can communicate
take a personnel.
online thanks to portal technology. With the help of this technology, patients can
more active role in and learn more about their care. Portal technology can provide patients uicker tr
more control and accountability while also improving access to and availability of medica ecions, h
information. It is effective because a patient can function as an outstanding source and acuvc
and cuts d
participant in their treatment. Adirional.
of DAuNnan dat
Blockchain and future healthcare technology: Accessibility, portability, and integriyo
information in a complicated setting are issues that blockchain addresses. The loss or agnosis.
of medical records cot l
kept in clinic databases is a constant possibility. Blockchain has the pole
to
upend the status quo, because it gives patients control over who can access thelr ic ords.
Who has access to the records
IANDARC
When a patient is
Without the patient
traveling
and how they are utilized are both
to a different
country, blockchain
fully transparent
healthcare systems au access
effective.
ader ronic
needing to
medical records when a medicalverbally supply the information, clinicians can qu
intervention is urgently
Introduction of artificial required.
intelligence
gaining popularity as it facilitates the
data to produce
precise and quick
to data
automated
processing: The use of artificial intelligence is
manipulation of massive amou ts cial data
o fc o l l e c t e d Beshsners
from unstructured data, results. Additionally, it aids in the
including text, photos, and videos. AI-based extracto
EMKS W"
able
to
 alndyzemore,the da Shared Care and Electronic Health Records 69
osthy made y diagnose diseases more quickly by reducing the need for human intervention, which will
enhance patient outcomes and lower costs associated with duplicative work and manual entry.
wersto an
general di
implongoing
est appae Robotic process automation: Because of enhanced workflow and increased accuracy,
a1tomated data capture is becoming more and more common in the electronic medical record
market. Robotic automation (RPA) assists in achieving the requisite accuracy by doing away
ave with the necessity for manual entry.
doctor can
ickly admini BENEFITS OF ELECTRONIC MEDICAL RECORDS
up certain pr o Accuracy: Because manual data entry isn't involved, electronic medical records are quite
ctor's examinz accurate. It implies that there is no possibility of inaccurate or stale data being saved in the

system. With no space for error, patients receive better care and have better outcomes.
Bettergovernance: In a system with a single point of access, medical professionals can view
puting is
l computing ne
a the patient's medical history, ensuring that they are informed of any previous treatments.

Better data governance results in better macro and micro decision-making, which enhances
ility to com patient care.
erapies for i D Convenient view: Patients can easily access their medical records
from any location and on
to track information and makes it convenient
for
any device at any time. It makes simnple
it
medical practitioners to review patient data.
medical records (EMRs) with other systems
s to informationa Integration: By integrating their electronic
software for lab tests, imaging tools, and
d several othe including practise management software, ordering can access aggregated patient data
electronic health records (EHR), healthcare professionals
care will be improved.
via a single interface. The procedure of providing patient
toprovideanam Better communication: Using EMRs
and HIPAA-compliant encrypted messaging apps,
their patients more effectively. The EMR system
healthcare providers may connect with
an additional layer of protection
for patients and healthcare
saves these messages, adding
urages patens immediate responses.
to text their doctors and get
ents can com personnel. These apps allow patients data entry
insurance claim forms with pre-populated
3 patientscan Quicker transactions: By processing
can save time and effort. Itspeeds up compensation
sections, healthcare practitioners
pa
patient care to be delayed.
pointless delays, which frequently
provide cause
can
and cuts down on
3y
availabilitya included in EMRs, which eliminates errors brought on by
Additionally, billing software is codes for a certain treatment or
automatically calculating the billing
d i n gs o u r c e a

human data entry by

diagnosis.
ability,andine
s.Thelossoran STANDARD FOR ELECTRONIC HEALTH RECORDS
notified by the Ministry of Health
standards for India were
k c h a i nh a s
the

-an
access
thera
ne electronic health record (EHR) 2013. Keeping in mind
their suitability for and
and Family Welfare (MoH FW) in September there were selected from the best accessible
in India, the set of standards provided world. Experts,
transpare 4pplicability electronic health records
from around the
are
systenms
ae ana utilized standards applicable to from business
representatives, technologists, and representatives standards
C I a n s
c a nq u i a

Prdctitioners, government
the standards. The declared
on the committee
formed to recommend and social
epresented direction by a number of
technical
praised positive start in the right and
were regulatory bodies, stakeholders,
as a

in addition to professional organizations,

SIVeamoins
f artiiciail
nte

DServers
stakeholders themselves.
ed
Taction
EMRs
wil

e x t r
 Shared Care and Electronic Health Records
70
Standard Name Intended Purpose
MARY
ingupdecISIOn-makine 1gnt
noW
fa

Type
Identification and
Health informatics-identification of Basic identity details of 0ption provide r s

demographics
subjects of healthcare patient h s t

EMRs
w i l l

Demographic (Person ldentification and Complete demographic s

or
alhistory,maintained
inals
t

t
n

o
e

r
y

land region codification) version 1.1

interoperability with E-Governan egrowth
( E H R ) .A n E H

systems ance care

UIDAI Aadhaar Preferable identifier where paita

1ecora p e r s o n ' s

Patient Identifiers Local ldentifier Identifier given within availabla that V i t a l

sigrn

to
clinic/lab institution hamedications,
t
The
E H R
a

es effi
Government issued photo identity card Identifier used in conjunction reports m o r e

alegy workilow

number local in absence of Aadhaar with an&

o t h e r
ca

support

Architecture Health informatics-requirements for an

System architectural requirements
e n i d l e n c e - b a s e dd e c i s i o n

iRdirectly

Requirements electronic health record architecture

Functional Health informatics-HL7 electronic System functional requirements
Requirements health records-system functional model
p E V I E WQ U E S T I O N

Reference Model and Health informatics-system of concepts health recc

Concepts for care, actors, activities, Mhatiselectronic
Composition to support continuity of care
process, etc. 1 recorc
electronic health
Health informatics-electronic health 1How
Information model architecture and trends in
record communication
communication
Mhat are the latest electroni
Terminology Clinical terms
How to implement
Primary terminology i What are the key componen
Coding System Logical observation identifiers names Test, measurement, observations
and codes
WHO family of international
IMULTIPLE CHOICE Q
Classification and reporting 1. What was the
classifications
Imaging Digital imaging and communications in Image, waveform, audio/video
The expansidriving force
on of the hea
medicine Better medical
care for
Scanned or captured
Coding of audio-visual objects Audio/video capture format
tI.mprovi
The
ng the pa
working er
records
L development of com
Data exchange
Health informaticselectronic health
record
communication-part5: interface
EHR archetypes exchange [Also,
refer to openEHR Service Model
Wihatinformation is moreea
. Drug dosages

specification
specification] t.Alergies
An
application protocol for electronic Event/message exchange
Whatis one
.Usng Podadvanced
data exchange in healthcare
Discharge/ treatment
environments Pay yoaurkeyboar d to
met
summary
Medical Council of India
regulation 3.1 of ethics (MCI) under Composition as prescribed
4Ernploy voice recognitype
tion
E-Prescription Mading useof
Pharmacy practice regulations, 2015 Mrich of
Notification No. 14-148/
2012-PCI as
specified by Pharmacy Council of India
Composition as prescribed
Erhoprancoeued tdhetaccesoloatsirntaonsgilictyritbOé
.

fear
Rased dient
Detreased quaihidtyenysafediaenntd of
h Records

Intended Purpose
Basic 71
identity details Shared Care and Electronic Health Records

of pate
Sot
Complete demographic SUMMARY

interoperability with EGD

systems The best
sDeeding
option right for effective healthcare management is an EMR. In addition to

up decision-making
now

and lowering expenses to make it affordable for all

healthcare
care. Future

Preferable identifier whe nrofessionals,

market growth
they provide reliable data gathering to e n s u r e improved patient
EMRS i l l be fueled
for these factors. An electronic version
by of a patient's

Identifier
clinic/lab given within ingh medical history,
maintained over time by the healthcare provider,
An EHR may contain all of the essential administrative
electronic
is known
clinical
as an
data
health record (EHR). notes,
care under a specific provider, such as demographics, progress
Identifier used in
local in absence
relevant to that person's
vital
results, and
signs, past medical histories, immunizations, laboratory make the
ofconjuntin
issues, medications, to
EHR automates information access and has the potential
Aadha
System architectural requi radiology reports. The
efficient. Through variety
a of interfaces, the EHR can also directly
clinician's worktlow more outcomes reporting,
care-related activities, such as quality control,
quirene or indirectly support
other
decision support.
System functional require and evidence-based

REVIEW QUESTION
Concepts for
cepts care,actor
for care,
actors,athme records? What are the challenges in implementing
the EHR system in nursing
process, etc. 1. What is electronic health patient care?
record system helps nursing services to give optimal
2. How electronic health
Information model architeta in electronic health record system?
3. What are the latest trends services?
communication electronic health record system in nursing
4. How to implement
of electronic health record system? Explain any three.
5. What are the key components
Primary terminology
Test, measurement, observat MULTIPLE CHOICE QUESTIONS
health records (EHRs)?
1. What was the
behind the requirement for electronic
driving force
Classification and reporting a. The expansion of the health
insurance market

b. Better medical care for patients

environment for medical professionals
I m a g e , waveform,audioMde C. Improving the working
d. The development of computer science
available to doctors because of
the inception of EHRs?
Audio/videocapturefoma 2. What information is more
b. Side effects
a. Drug dosages
d. All of these
ge
Aka . Allergies
EHR archetypesexchange EHR?
Servie
N
. What is one advanced method used to input data into an
o p e n E H R

a. Using a keyboard to type

refer
to
specification)
b. Play your iPod
E v e n t / m e s s a g ee x c h a n g e C. Employ voice recognition technology
d. Making use of a transcriber
attribute of EHRs?
Tibed
which of the following features is not a positive
Compositiona s
presc a.b. Enhanced accessibility to clinical information
Improved client safety
C.a. Increased
Decreased
quality of client care
efficiency and savings
C o m p o s i t i o n
a sp r e s c n o e