Electronic Health Records (EHR) has been widely implemented for data management in medical institutions across the United States ever since the enactment of Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 (HealthIT, 2019). The very obvious benefits of EHR cut across the general positive impact of any digital system which include increased speed and improved data security. The widespread use of EHR has been aided by the increased computerization in all areas of life and the improvement in computing abilities of modern technology. Even with already great changes in the healthcare industry attributed to Electronic health record systems, there is still potential to immensely revolutionize the industry. It is important to examine the benefits of EHR systems that go beyond functionality and focus on outcomes attributed to use of EHR in the healthcare industry.
Evolution of electronic health record systems has been influenced by the advancement in quality and speed of computer processors within the past few decades. Initial the use of EHR was a preserve of large healthcare facilities handling research work due to huge cost of the hardware needed, but since computer hardware became cheaper and smaller, most medical institutions have adopted some form of EHR system. Challenges related to use of EHR have also significantly changed over the years from frequent technical malfunctions to procedural and ethical issues. 1992 was the year of radical transformation for EHR when the Institute of Medicine proposed the shift from paper to electronic based records management in health facilities. Initially, adoption of EHR was hindered by extrinsic challenges like cost of hardware, inefficiency of resources and limited network capabilities (CDC, 2020). The advancement in technology experienced during the early 90s was a deciding factor in implementation of the proposal by Institute of Medicine.
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The EHR systems of the 90s included document scanning, data entry and interchange functionalities to speed up the processing of information. Widespread use of personal computers also enhanced the work of medical practitioners who begun using them to record and retrieve patient notes, make diagnoses, follow medical procedures and interpret laboratory results. Development of software applications that provided interface and automated some administrative and clinicians’ roles was another significant change in EHR. The advancement in electronic health record systems not only improved quality of service but contributed to reduction in operation cost of running health facilities in the United States . Purchasing the hardware for EHR was initially the most expensive part of EHR systems, but rise of propriety software development shifted the significant cost to software purchase for healthcare organizations. Additionally, the use of EHR systems had outcomes in management of physical spaces for healthcare facilities since unlike paper records which occupied large filing space, EHR systems took very little space. Reduction of errors in data management of patients’ information significantly has become evident due to higher accuracy of EHR especially pertaining pharmacy records (HealthIT, 2019).
These benefits attributed to EHR were evident enough to mandate a review to determine the value of using in epidemiology. It was unanimously agreed that the use of EHR has numerous merits outweighing the drawbacks in both medical research and care. However, it is important to point out that a cautionary approach should be adopted since EHR systems do not completely eliminate human error present in management of data (Wilson-Vanmeter & Courtney, 2019). Security of data has also been an issue that has been in the limelight given the fact that remote access of data could lead to breech of any security measures to gain unauthorized access.
The invention of compact disc (CD) made the implementation of EHR systems portable since data could be safely stored in the CDs and used in different workstations. Focus shifted to databases of information being stored in the CDs with disease index, drug catalogue and laboratory information being key data utilizing CDs. Replication of data was avoided by use of Medical Logic Modules as a sharing mechanism aiding in evaluation of what data has been recorded. All these rapid changes in EHR necessitated that development of standards in their use and specifications. Health Level Seven (HL7) was soon developed as international standards guiding the use and transfer of medical data between EHR systems and healthcare workers (Evans, 2016). The ‘level seven’ in the naming of these standards indicate they relate to standards for the application layer. These standards were adopted by many international standardization bodies to have common systems and syntax for health facilities around the world. Further development of the proposed standard IEEE P1073 for medical information bus provided common platform for metrices used by medical equipment to be used by EHR systems. Current EHR systems have adopted the three-tier server-client system with a relational database for storage. Custom made systems have declined in use with widespread use of propriety vendor systems manly to continue the standardization efforts already put in place (Seymour et al., 2014). The increase in internet speeds has also made it possible for remote control of medical equipment like ventilators and ultra sound machines with patient data shared via interconnected electronic health record systems.
The main general merit attributed to EHR has been efficiency in management of information. Clinicians are able to enter and retrieve data in a more convenient manner than was ever possible with paper-based record system. Laboratory results are sent to the EHR system where they can be accessed by healthcare providers for diagnosis real-time. Cutting edge technology like voice recognition and image capture by smart phones have been integrated into EHR systems to make it more efficient in entry of records. This efficiency of use has improved communication among different cadres of healthcare workers and reduced errors made in patient care. The efficiency has also cut across to include space required to store collected data with EHR systems occupying minimal space compared to paper-based records system. Health facilities previously required huge store rooms to store the incremental medical information on patients that have used their service. Management of this information was a nightmare especially for huge facilities with high workloads, but due to EHR medical institutions barely need any space to store high quantities of data. Sharing of data among physicians has also grown over the past few decades (CDC, 2020). Integration of decision-making tools to EHR has also eliminated redundant administrative tasks in patient care that were time consuming, ensuring clinicians dedicate their time fully to care.
Apart from the general functional benefits, health practitioners have also been able to directly benefit from EHR. The increased data sets have enabled more information about patients to be stored and made accessible to providers allowing better decisions to be made. Personal records systems have enabled patients to give more information about their medical histories which can be transferred to electronic health records systems to be accessed by providers. Information related to family health history and key life events can be very useful in early stages of patient care. Providers can also access information on treatment guidelines through the EHR system making treatment procedures to be more accurate and reduce risk of patient harm (Shah & Khan, 2020). Updates on drugs and regiments for treatment of disease ensure that EHR not only act as a database for quality data management, but as a learning system to continuously educate themselves (D’Amore, 2020). Additionally, Clinical Decision Support (CDS) tools have been developed and integrated with EHR to further aid in mitigating risks related to patient harm.
Certified EHR systems must incorporate proper security protocols in the access of data stored. Security of EHR systems has been a growing concern since conceptualization of the idea. Patient information is critical private matter that is protected by the law in all states and a key ethical consideration for healthcare providers. The cloud approach of modern EHR has brought about greater risk in security of this information. In my opinion, it should therefore be mandatory for EHR systems to implement the highest standards of security possible. Access and authorization should be granted to verified individuals with proper tracking mechanisms put in place to identify users who accessed some information (Gayathri et al., 2020). Additionally, training on security of EHR systems should be offered to all users of the system to cover any knowledge that may be exploited by malicious people to gain unauthorized access.
In conclusion, the use of EHR has become a key component of modern-day healthcare and its adoption should be embraced by all stakeholders in the industry. Despite concerns on its limitations, it is evident that they provide invaluable merits in management of data in healthcare institutions. EHR systems not only offer functional benefits in efficiency, but through CDS, they improve quality of services that are rendered by healthcare providers (D’Amore, 2020). However, given the critical nature of the information that is stored in EHR systems, greater attention should be directed to improving security of the systems.
References
Centers for Disease Control and Prevention. (2020, March 3). FastStats - Electronic Medical Records . Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/electronic-medical-records.htm
D’Amore, J. (2020, August 19). Electronic Health Record Data Governance and Data Quality in the Real World . HIMSS. https://www.himss.org/resources/electronic-health-record-data-governance-and-data-quality-real-world.
Evans, R. S. (2016). Electronic Health Records: Then, Now, and in the Future. Yearbook of Medical Informatics , 25 (S 01). https://doi.org/10.15265/iys-2016-s006
Gayathri, N., Latha, G. C., & Priya, A. (2020). A Model for Xml-based Electronic Health Record System. International Journal of Psychosocial Rehabilitation , 24 (5), 5785–5807. https://doi.org/10.37200/ijpr/v24i5/pr2020286
Seymour, T., Frantsvog, D., & Graeber, T. (2014). Electronic Health Records (EHR). American Journal of Health Sciences (AJHS) , 3 (3), 201–210. https://doi.org/10.19030/ajhs.v3i3.7139
Shah, S. M., & Khan, R. A. (2020). Secondary Use of Electronic Health Record: Opportunities and Challenges. IEEE Access , 8 , 47–65. https://doi.org/10.1109/access.2020.3011099
What is an electronic health record (EHR)? HealthIT.gov. (2019, September 10). https://www.healthit.gov/faq/what-electronic-health-record-ehr
Wilson-Vanmeter, A., & Courtney, L. (2019). The Electronic Health Record, Electronic Medical Record, and Personal Health Record. Fast Facts in Health Informatics for Nurses . https://doi.org/10.1891/9780826142269.0006
