International Journal of Quality and Service Sciences

Electronic medical record use and perceived medical error reduction

Sushil Kumari Jindal, Faryal Raziuddin,
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Sushil Kumari Jindal, Faryal Raziuddin, "Electronic medical record use and perceived medical error reduction", International
Journal of Quality and Service Sciences, https://doi.org/10.1108/IJQSS-12-2016-0081
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 Electronic medical record use and perceived medical error reduction

Abstract
Purpose – The purpose of this article is to present the findings of a research study conducted to
find the perceptions of medical professionals about reduction in medical errors using electronic
medical records (EMR). It presents the relationship between EMR use in medical facilities and
reduction in medical errors. The use of EMR can lead to competitive advantages in the
healthcare environment.
Design/methodology/approach – This paper is based upon perceptions of 99 medical
professionals who use EMR in their practice in Arizona, USA.
Findings – The paper presents the medical professionals who use EMR reduced medical errors,
wrong site surgery, improper dosage delivery to a patient, wrong medication, etc. by 50 to 60%.
Research limitations/implications – This paper is limited to perceived reductions in medical
errors because the actual number of errors is either unavailable or medical professionals are
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unwilling to provide. Future research should seek conducting database searches to find medical
malpractice lawsuits, unexpected costs, or any reference to quantifying losses due to medical
errors. Once the expenses are reported, relating to medical malpractice legal costs with the cost
of investing in electronic medical records system would prove an excellent observational study.
Practical implications – Medical professionals, medical facilities, and patients should be aware
of the impact electronic medical records have on the health care provided as well as safety of
patients enabled by the electronic medical records.
Social implications – Healthcare industry is operating in a crisis mode and before it turns
chaotic, there needs to be a consistent product used by every healthcare organization or practice.
Electronic medical records can automatically update patients’ information that is required on a
routine basis via different computing systems such as cloud, minimizing the need for IT
professionals to handle the issues. This leads to reduced cost, increased efficiency, effectiveness,
and better management of the patients’ health and wellness outcomes, with perceived reduction
in medical errors.
Originality/value – The value of this research report is to provide the various features EMR
offers and how they help to reduce medical mistakes that help in avoiding repetition of different
tests, incorrect dosage delivery, and interaction of various medicines a patient is taking.
Keywords- Electronic medical records, Nano medicine, medical errors, Competitive advantage,
and Quality of healthcare.
Paper type Research study

1. Introduction

There is an estimate of 400,000 deaths and a range of 4 to 8 million occurrences of

serious harm per year due to medical errors. The deaths due to medical errors and jeopardized
patient safety each year are associated with a cost of $17 to $29 billion (Encinosa & Bae, 2012),
for health care industry. Medical mistakes prove to be a major concern for health care industry
demanding an ongoing effort to minimize error and improve the quality of care rendered to
patients. Patient safety, cost-effectiveness, and prevention of medical errors are prime goals set
 forth by healthcare professionals (Ulrich & Kear, 2014). Scientific researchers are implementing
improved solutions to prevent compromised patient safety, through combined use of available
innovations such as nanomedicine and use of Electronic Medical Records (EMR) system (Ulrich
& Kear, 2014).

Technology is touching virtually every aspect of our lives to the extent of creating
dependency. Entry of technology in the healthcare industry is a recent development and hence is
still in developing stage. Electronic Medical Record system (EMR) is considered as the one of
the most significant changes to healthcare practice in the 21st century, and it has been met with
both enthusiasm and healthy skepticism (Tierney, Pageler, Kahana, Pantaleoni, & Longhurst,
2013). EMR is a digital version of a paper chart and a software application designed to aid health
care providers in guiding best practices and safer patient environments (Tiwari, 2012).
Additionally, EMR systems provide leveraging clinical decision support tools which are baked
into the electronic environment (Tiwari, 2012). The EMR systems are used by healthcare
professionals to maintain patients’ medical records, billing information, prescription history, and
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diagnostic results in a digital, rather than paper format (Alagoz et al., 2010). Miller and Sim
(2004) posited that the electronic medical record (EMR) has the most wide ranging capabilities
of all the health information technology (IT) currently available and has the greatest potential for
improving quality. Based on their survey of physicians, they concluded that the greatest financial
and quality benefits can be achieved when most physicians use EMR capabilities for most of
their daily tasks. They also suggested policy interventions, like financial reward for quality
improvement, by using EMR. EMR systems are multi-function systems, offering a variety of
benefits to those involved in health care delivery (Alagoz et al., 2010). There are many versions
of EMR available in the markets which are customizable based on each specialty’s requirements
(Alagoz et al., 2010). Although adoption of interoperable EMR systems could produce
efficiency and safety savings of $142–$371 billion; most medical records are still stored on paper
that cannot be used to coordinate care, measure quality, or reduce medical errors (Hillestad et al.
(2005). EMR systems are intended to reduce medical mistakes, Harrington, Kennedy, and
Johnson. (2011) based upon their findings concluded that computerized physician order entry
can increase the coordination load among clinicians which can result in new sources of errors.

Healthcare Information Systems (HIS) are groups of integrated applications that have a
tremendous potential for improvements in healthcare, not only in the operation and delivery of
health care but also in the field of health communication and education (Alagoz et al., 2010). The
“Hospital Safety Score” (HSS 2015) website reported, the third leading cause of death, in the
United States of America is attributable to preventable medical errors. About 440,000 deaths
equivalent to the population size of Miami, are reported each year due to medical errors (“HSS”,
2015). Ulrich and Kear (2014) reported an annual estimate of 4 to 8 million occurrences of
serious harm per year, advocating reason for Safer Health System and EMR systems
respectively. Despite many efforts underway by hospitals, the rate of reducing medical errors is
still slow (“HSS”, 2015). Retchin, and Wenzel (1999) posited that “electronic medical record
(EMR) systems appear to offer substantive advantages over paper records for both containing
costs and improving the quality of care”. It is important to understand the relation between EMR
system use and perceived reduction in medical errors (“HSS”, 2015). The understanding is quite
crucial as technological innovations are at the forefront of modern medical practices (“HSS”,
2015). Nanomedicine, is another application of technology to human healthcare that offers
 numerous potential pathways to improve medical diagnosis and therapy and to regenerate tissues
and organs. Healthcare organizations and practices are adopting nanomedicine rapidly due to
benefits of use as; improved quality of life, reduced societal and economic health care costs,
early detection of pathologic conditions, and reduced severity of diseases (Malhotra & Singh,
2010).

Most common errors healthcare professionals see during audits include hand-written
prescription misinterpretation, adverse effects of drugs, improper dosage delivery to a patient,
and repetitive tests, to name a few (Sykes, Venkatesh, & Rai , 2011, p. 11). The common
mistakes are claimed to be major causes for raising the cost of care and jeopardizing patient
safety (Sykes, Venkatesh, & Rai, 2011). Healthcare organizations such as hospitals, physician
practices, and nursing facilities, not using EMR systems, possibly do not have the ability to
access and share detailed information about individual patients (Lindstrom, 2013). Physicians
cannot record diagnoses accurately, miss out on timeliness and clarity of communication among
providers, and ultimately miss out on safer and more effective care (Lindstrom, 2013). As
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Beseth (2015) reported, despite the government mandates to implement EMR systems, medical
practices are still faltering and consider EMR systems to be a costly burden rather than an
effective system in patient safety. Mintz, Narvarte, O'Brien, Papp, Thomas, and Durning (2009)
based on their study concluded that reducing financial barriers for EMRs will be critical for their
implementation into clinical practice. Nanomedicine is a specialty of medicine that is gaining
popularity and EMR systems are tools that healthcare professionals can use to track and maintain
patient data, conduct daily audits, and implement corrective actions based on audit results
(Beseth, 2015). Hence, a combined use of nanomedicine and EMR can prove beneficial for
health care providers and patients equally (Beseth, 2015). According to Urban (2009), some
healthcare professionals have claimed the cost savings of implementing an EMR system offset
the initial investment, increase efficiency, free up staff time, and lead to organized medical
records that can be archived and retrieved with ease. Also, long-term savings and cost-
effectiveness for health care organizations and practices, and the overall economy are perceived
(Urban, 2009).

2. Review of Literature

Every industry has its set of mandates and regulations to abide by and to protect public
interests, stakeholders’ interests, and set limitations on legalities to prevent lawsuits (“U.S
Department of Health and Human Services – Health Information Privacy”, 2013). The Health
Insurance Portability & Accountability Act (HIPAA) was designed with patient privacy in mind.
HIPAA defines the extent to which data can be accessed, in addition to what levels are
permissible for data access, and who can access the information. An analyst expresses that
HIPAA is intended to give government insurance to private data (“DHHS – HIP”, 2013). As part
of HIPAA, improvement of a national standard for electronic information exchange is expected,
and HIPAA is advocated by the US Department of Health and Human Services. HIPAA planned
a consistent, intentional display supported by clinics, protection plans, and specialists. However,
there are security promoters and some wellbeing industry investigators that scrutinize the
methodology (“U.S DHHS – HIP”, 2013). As part of HIPAA a model is designed to handle
affirmations as - individual medicinal subtle elements which are wrongly uncovered, data that is
crudely ensured, and a larger number of points of interest that can be unveiled than would
 normally be appropriate. The model can handle legitimate approval that was not obtained, or
patients had issues getting their particular records about EMR framework inadequacies (“U.S
DHHS – HIP”, 2013).

EMR system adoption continues to be a challenge for healthcare industry (Brooks &
Grotz, 2010). Brooks and Grotz asserted the cost of EMR system, lack of training about EMR
system use, productivity issues due to lack of know-how about using EMR system, and
integration of latest technology with existing technology pose challenges. EMR system is the key
component to eliminating many forms of medical errors (Brooks & Grotz, 2010).

The need for instant access to patient information is considered decisive to plummeting
medical errors and enhancing the possibility of accurate treatment for a patient. The lack of
immediate access to patient data is a critical factor, which contributes to the adoption of IT
systems intended to capture the required data at a healthcare facility (Kudtarkar, DeLuca, Fusaro,
Tonellato, & Wall , 2010). Healthcare providers at Mayo Clinic, the world leader in healthcare,
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identified options of using EMR system for obtaining patients’ baseline information for effective
treatment; EMR systems also have capabilities of a computer simulation modeling to evaluate
different scenarios related to staffing models, assessing the number of operating rooms used,
hours of operation, and impact of reducing variation in case length (Dunkbar & Hayward, 2012).
Dixon (2011) reported without an EMR system; there are probabilities of increased work for
healthcare professionals. The information overload has led to the proliferation of a situation
whereby the medical personnel find themselves swamped by administrative jobs (Dixon, 2011).
The administrative responsibilities lead to increased workload and creation of a backlog. Without
the EMR system, storing the patient information is accomplished in the physical form of paper
files leading to the situation where some of the information about a patient’s medical history was
lost. Losing patient’s historic information is particularly detrimental for patients whose current
treatment highly depends on the ability of the hospital to store such records safely (Dixon, 2011).

Bhattacherjee and Hikmet (2007) posited that the EMR system is a promising application
that incorporates features that can potentially lead healthcare towards a more consistent and safe
environment for patients and healthcare professionals alike. The EMR system is a serious topic
of discussion in the field of medicine. Changes in technology and growing implementation of
EMR system force healthcare environments to evolve (Rhonda, Victor, & Sherry, 2012),
Furukawa (2010) noted information technology (IT) in healthcare changes the environment of
practice, clinical workflows, and technological infrastructures. IT is closely interrelated, and the
research is a model of strategic alignment between IT, clinical operations, and healthcare
professionals. The use of EMR technology additionally can better position organizations and
providers in a competitive landscape as changes continue to evolve healthcare. EMR system is
known to offer a wide variety of functionalities. Swain (2014) described telemedicine, tele-
mentoring, telemonitoring, are all possibilities due to the dominant presence and proper
utilization of EMR system in the field of medicine. Many communicable and non-communicable
diseases require consistent monitoring for toxicities in nursing facilities (Swain, 2014). As
reported by authors Holtzman, Gallagher, Bettiker, and Samuel (2013), EMR plays a vital role
with patients suffering from HIV/ AIDS. The patients receive antiretroviral therapies (ART).
ART patients have a tendency of being subjects for medication errors (Holtzman et al., 2013).
When EMR system is used for invigilating medication dosage and for drug administration
 purposes, chances of medication errors are reduced considerably. Additionally, the patient’s
outpatient medical records are readily available for care facilities, to streamline care, and provide
quality service (Swain, 2014). Although EMR is not the complete solution to the problems of
high costs, poor safety, and quality, certainly these problems cannot be solved in a paper-based
environment.

3. Purpose of the Study

The primary purpose of the quantitative study was to examine if the overall use of EMR
system, the years of experience using EMR systems, and the extent of using the various
functions of EMR system, relate to perceived reduction in medical errors. The perceived
reduction in errors is studied because actual data on error reduction is either unavailable or the
medical professionals were unwilling to share. The number of years EMR system was used
assists in understanding the experience of an individual with the technological innovation
(Fleeter & Sechrest, 2014). The greater the years of experience, the better the estimation as to
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whether EMR system use can influence the perceived reduction in medical errors (Fleeter &
Sechrest, 2014). The frequency of the various functions of EMR system used was another
variable whose influence was studied.

As stated by Kokkonen, Davis, Lin, Dabade, Feldman, and Fleischer (2013) there are
many variations in EMR system use; system’s functional use is dependent upon the necessity of
the medical specialties. Four functions of EMR included in the survey were- telementoring,
telemedicine, telehealth, and billing. Telementoring is EMR function which refers specifically to
remote clinical services where a specialist or a surgeon guide or train new techniques from remote
location facilities. Telemedicine refers specifically to remote clinical services; it employs
telecommunications tools and infrastructure to connect patients with providers and improve
access to care. Telehealth refer to remote non-clinical services, such as provider training,
administrative meetings, and continuing medical education, in addition to clinical services. Billing
function includes capturing all evaluation and management codes at the point of care to ensure
complete invoices eliminate down coding, and it includes automated patient statements and
collections letters.

4. Research Questions and Hypotheses

RQ1: What is the relationship between years of experience in using EMR, and the perceived
reduction in medical errors?
Ho1: There is no significant relationship between years of experience in using EMR system, and
the perceived reduction in medical errors.
Ha1: There is a significant statistical relationship between years of experience in using EMR
system, and the perceived reduction in medical errors.
RQ2: What is the relationship between use of various EMR functions, and the perceived
reduction in medical errors?
Ho2: There is no significant relationship between use of various EMR system functions, and the
perceived reduction in medical errors.
Ha2: There is a significant relationship between use of various EMR system functions, and the
perceived reduction in medical errors.
 RQ3: What is the relationship between the overall use of EMR system, and the perceived
reduction in medical errors?
Ho3: There is no significant relationship between the overall use of EMR system, and the
perceived reduction in medical errors.
Ha3: There is a significant relationship between the overall use of EMR system, and the
perceived reduction in medical errors.

5. Method

In 2016, we surveyed a randomly selected sample of 100 medical professionals practicing

nanomedicine in Phoenix area in Arizona State. The survey instrument was pilot tested before
use for the research study. The validated survey questions were used to assess the degree of
EMR system use, and perceived reduction in medical errors. The EMR system use items on the
survey were designed to collect information on years of experience with EMR system use, the
frequency of various functions of EMR system used, and overall extent of EMR system use, and
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reduction in medical errors. The survey instrument allowed voluntary participation in answering
the survey questions. The survey was administered to the participants electronically. If
participants consented to Informed Consent by checking ‘yes’ the participant was directed to the
survey questionnaire. In the 12 questions survey, the first six questions were in reference to
independent variables - years of experience with EMR system use, the frequency of the various
functions of EMR system used, and the overall use of EMR system. The other six questions of
the survey were the 5-point Likert scale questions pertain to the perceived reduction in medical
errors.

6. Pilot Testing

The survey instrument was pilot tested to establish validity and reliability of the
instrument. The pilot study participants completed three supplementary questions specifically
about the appropriateness of the survey questions for the research study. Additionally, a text box
was provided in case there were some suggestions or comments the participants wanted to add
for correcting the survey instrument. The rationale for conducting the pilot study was to
determine the validity of the survey instrument (Edwin, Teijlingen, & Hundley, 2011). The
participants in the pilot study conferred whether the survey instrument is valid for the research
study and meet the research protocols (Edwin, Teijlingen, & Hundley, 2011). Surveys have to
yield consistent results to be considered reliable, and an accurate survey is seen as valid
(Tourangeau & Yan, 2007). The survey developed was reviewed by three experts in the field to
determine the suitability of the survey in meeting research purpose.

7. Study Results

The purpose of survey was to examine if the overall use of EMR system, the years of
experience using EMR systems, and the extent of using the various functions of EMR system,
relate to perceived reduction in medical errors. In the first part of the analysis, the nominal and
ordinal data collected was analyzed in the form of frequencies of the years of experience using
EMR, perception of effectiveness of EMR in reducing medical errors, and Pearson Chi-square to
 test hypotheses of relationship between medical errors reduction and years of experience and
function used.

Table 1

Frequency Distribution – Years of experience using EMR system

Years of Experience Using EMR System Frequency
Less than 1 Year 35
1 – 3 Years 33
4 – 6 Years 15
7 – 10 Years 7
Greater than 10 Years 9
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Total 99

Of the medical professionals surveyed, more than 68% had up to three years experience
in using EMR and remaining had four years or more years of experience. The professionals who
participated in the study had sufficient experience to provide their perceptions about the benefits
of using EMR. About one-third of the respondents (30%) reported using billing feature of EMR,
one-fourth (25%) use telehealth and telemedicine functions, while telementoring is used by 20%
of the professionals surveyed. These frequencies show the survey participants were not only
experienced in using EMR but also used four functions (features) of EMR system they had.
Billing function of EMR provides a way to streamline the billing process for the patients. It
improves the efficiency of office accounting staff, and assists with the reduction of coding errors
that can result in payment delays, costing health professional both time and money.

About medical errors tracking using EMR, majority of the healthcare professionals
surveyed (73%) agree to strongly agree that they frequently use EMR at medical practices and
organizations to track medical errors. On the frequency of EMR usage, as many as 70% of the
participants surveyed indicated using EMR 25% to 99% times. It indicates that health
professionals frequently use EMR in their practice. About 59% of the professionals surveyed
agree to strongly agree that EMR system tracks medical errors 99% of the time. The potential
for accuracy is so clear that federal law requires doctors and hospitals to start using electronic
records by 2015.

On medical errors reduction, majority of the healthcare professionals surveyed (70%)

agree to strongly agree that EMR systems use reduces medical errors by more than half. And
70% agree to strongly agree that the reduction in medical errors is based upon the extent to
which EMR functions are used. On medical errors of wrong site surgery, majority of the
respondents 62% agree to strongly agree that EMR system helps reduce medical errors of wrong
site surgery by 60% and 71% agree to strongly agree that EMR system helps reduce medical
errors of drug delivery dosage by 60%. Further, 71% agree to strongly agree that EMR system
helps reduce wrong medication errors by 60% (Fig. 1). Central for Disease Control (CDC) data
 shows that in 2013, 611,105 people died of heart disease, 584,881 died of cancer, 149,205 died
of chronic respiratory disease, and 251,454 died due to medical errors. This shows the medical
error is the third leading cause of death in US (Makary & Daniel, 2016). The reduction in
medical mistakes will save lives.

Figure 1
.
Percentage of Proessionals who Agree to Strongly Agree on the EMR
Role in Medical Errors Reduction

Medical errors of wrong medicine error reduction by 60% 60

Medical errors of wrong drug delivery dosage reduction by 60% 71

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Medical errors of wrong site surgery reduction by 60% 62

Medical error reduction based upon extent of use 70

Medical error reduction more than half 70

Track medical errors 99% times 59

EMR usage 25 to 99% times 70

Medical errors tracking using EMR 73

0 10 20 30 40 50 60 70 80

Hypothesis Testing

RQ1: What is the relationship between years of experience in using EMR, and the perceived
reduction in medical errors?

There is a statistically significant relationship between years of experience in using EMR

system, and the perceived reduction in medical errors (Table 2). The results indicate the years of
experience in using EMR system has a direct effect on perceived reduction in medical errors.
Based on participant responses, the years of experience using EMR system has a significant
correlation in perceived reduction of medical errors regardless of whether it is due to tracking
medical errors 99% of the time, or due to prevention of wrong-site surgery, or due to drug
dosage errors, or due to administration of wrong medication errors. Potential positive
explanations are attributable to the respondents’ recognition that constant use of EMR system
helps maintain records about medical errors and aids leadership in implementing corrective
actions to prevent recurrence of such errors. Overall, the research study results indicate positive
relation thus permitting retention of the alternate hypothesis 1.
 Table 2

Crosstabs and Pearson Chi-square Result Pearson Chi Sq Sig

Years of experience using EMR system and

Reduction in Medical Errors is based upon functions used 25.483 .013

EMR Tracks Medical Errors 99% of time 24.674 .076

EMR System reduces wrong site surgery by 60% 33.976 .005

EMR System reduces drug dosage delivery error by 60% 29.416 .021
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EMR System reduces wrong medicine error by 60% 20.675 .191

RQ2: What is the relationship between use of various EMR functions, and the perceived
reduction in medical errors?

In the surveyed population, out of four features of EMR surveyed, only Telemedicine
plays significantly role in reducing medical errors. Telemedicine allows health care professionals
to evaluate, diagnose, and treat patients at a distance using telecommunications technology
(Table 3). It is especially useful in rural areas but it is also useful in responding to medical
emergencies by sharing patient health records immediately. There is significant relationship
between extent to which EMR function Telemedicine is used and reduction in wrong medication
errors by 60%, Tracking medical errors 99% of the times, and reduces medical errors by half.
The extent to which Telemedicine function is sued is significantly related to tracking and
reducing medical and medicine error (Table 4). Telemedicine function of EMR is extremely
useful when medical professionals (especially primary care providers) are unavailable or a
hospital immediately needs a specialist to consult

Table 3

Telemedicine Function used Pearson Chi Sq Sig

 EMR Tracks Medical Errors 99% of time 19.360 .001

EMR System reduces wrong site surgery by 60% 14.396 .006

EMR System reduces drug delivery dosage error by 60% 9.775 .044

EMR System reduces wrong medicine error by 60% 20.787 .054

Table 4

Crosstabs and Pearson Chi-square Result Pearson Chi Sq Sig

Extent to which Telemedicine Function used

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EMR System Reduces Medical Errors by half 35.108 .000

EMR Tracks Medical Errors 99% of time 25.482 .013

EMR System reduces medicine errors by 60% 20.787 .054

RQ3: What is the relationship between the overall use of EMR system, and the perceived
reduction in medical errors?

There is statistically significant relationship between the overall use of EMR system, and
reduction in wrong site surgery by 60%, and reduction in dosage delivery error by 60% (Table
5). The answer to research question also was for the alternative hypothesis.

Table 5

Crosstabs and Pearson Chi-square Result Pearson Chi Sq Sig

Overall use of EMR system and

EMR System reduces wrong site surgery by 60% 8.817 .011

EMR System reduces drug dosage delivery error by 60% 14.834 .005

8. Conclusion

The studies cited in the institute of Medicine report, “44,000 to 98,000 Americans die
each year as a result of medical errors”; medication errors can occur anywhere in the healthcare
system from prescriber to dispenser to administration and finally to patient use, but many errors
are preventable using electronic prescription. In survey conducted, the relationship between use of
 EMR and medical errors reduction was investigated. The data provided by 99 medical professionals using
EMR in their practice supports the hypothesis that using EMR leads to reduction in medical errors.
Structural competencies and changes are essential for medical leadership as medical practices are
modernized. Medical leadership is modest and better managed when physicians take up leadership roles.

9. Recommendation

U. S. healthcare professionals must understand the significant role the healthcare information
technology can play in improving the quality of care, and reducing the cost of providing the care. The
results of the current study have a direct implication for the healthcare leadership as the results
demonstrate a positive relation between use of EMR system and perceived reduction in medical errors.
McBride (2012) has found a multi-physician healthcare facility spends an average of $162,000 towards
EMR system for five years. The average cost of human life amounts to $5 million throughout the span of
life or $70,000 each year (Wolchover, 2011). If executive leadership considers these numbers, it becomes
much easier to realize there is a greater benefit to the adoption of EMR system. Cost, though it may
appear high initially, EMR system has a great potential for the long-term return on investment. EMR can
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save costs to individual healthcare practices and to the overall US economy. Hillestad, et al. (2005)
estimated a cumulative efficiency and safety savings from hospital systems with $371 billion
over 15 years and cumulative potential savings from physician practice EMR systems are $142
billion. Also, an EMR system can integrate evidence-based recommendations for preventive
services with patient data to identify patients needing specific services. The system can remind
providers to offer the service during routine visits and remind patients to schedule care. Kumar
and Aldrich (2010) posited that widespread adoption of EMR and related technologies could
greatly improve healthcare in the US, while yielding significant savings. Healthcare providers,
who do not have EMR, need to switch to EMR and train their employees for technology upgrade.
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