Implementation of Electronic Health Records Essay

How is electronic health records implemented in an institution? The purpose of this article is to answer the above question by providing two website sources and addressing various issues about the qualities of the source and also do website annotation of the two different website sources. According to Margaret Rouses blog in an electronic health record is a digitized and authenticated official health record of a person which can be shared within a health facility or multiple health agencies .. Such forms of records are very efficient, less bulky and cost effective. Their implementation is not a walk in the park hence the following two websites proved to be resourceful:

http://www.biomedcentral.com/https://www.stepsforward.org/modules/ehr-implementation

The level of resourcefulness was measured by answering the following questions: What is the purpose of the content? Who is the intended audience? What kind of arguments and information is covered? What and how is the research presented? Are there further citations and what are the credentials of the authors? Implementation of Electronic Health Records Essay.

http://www.biomedcentral.com/ is a site that for the past 15 years has been freely availing research posts published by scientific scholars. They publish various quality peer-reviewed journals biology, clinical medicine and health. The target audience is scholars and all individuals who are in the biological and medical field. For this source, a systemic literature review article on electronic health record implementation in hospitals is presented. The three authors are business and economics consultants. The source is reliable going by the databases used for the article and effective as the information is easy to understand and is clear. The article is well cited and credible going by the mentioning of the authors locality, chronological mentioning of the specific dates of receipt, posting, acceptance and publishing of the article. On the other hand, https://www.stepsforward.org/modules/ehr-implementation is a collaborative website between American medical Association that articulates various issues and modules on healthcare circles. The author for this specific module in this site is a medical doctor presenting on ease of transition from paper to electronic records. Implementation of Electronic Health Records Essay. The source is very objective as it is very detailed and reliable as it is evaluated by the American medical association professionals. It has a detailed step by step implementation process. The essay is well cited and explains the different points of views and implementation methods within an institution.

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Regarding annotation, the presentation in the site http://www.biomedcentral.com/ proves to be resourceful. This is the case since it comprehensively addresses the issue of the framework on electronic health records implementation as the information is also very detailed. Implementation of Electronic Health Records Essay. Through the information, it is evident to me that electronic systems is the way to go so as to reduce operational costs and improve on efficiency in health care facilities. One issue that it raises for me is the availability of the software systems and the cost implications on facilities especially those that are poorly funded. Compared to other sources, this source is very analytical.

Works Cited

Albert Boonstra, Arie Versluis and Janita F J Vos,

Implementing electronic health records in hospitals: a systematic literature review, 2014 Web http://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14-370

Margaret Rouse Healthcare IT Glossary 2011,

Web http://whatis.techtarget.com/definition/electronic-health-record-EHR

Michael Hodgkins, Electronic health record implementation, 2014

https://www.stepsforward.org/modules/ehr-implementation

Only 4 percent of U.S. doctors are using an electronic medical record system (EHR) because of a diverse range of barriers and perceptions involved with implementing an EHR system. The health care portion of the American Recovery and Reinvestment Act (ARRA) called Health Information Technology for Economic and Clinical Health or HITECH promotes the “Meaningful Use” of information technology in the form of EHR systems for every American by 2014 (Hoffman, 2009). Just having an EHR system is not enough; “meaningful use” means the system must improve the quality, efficiency, security, access, and communication in the delivery of health care among other functions. The United States government has provided $17 billion in available incentives to assist physicians and health care facilities implement certified EHR systems that meet Federal qualifications by the year 2014 (Blumenthal, 2009). Implementation of Electronic Health Records Essay. This important health care issue affects everyone in this country because of the nature of private health information. The U.S. government mandate for the implementation of electronic health records presents a wide variety of issues for and responses by physicians who want to retain their diversity relating to the way they practice medicine, while meeting the “Meaningful Use” requirements that will positively affect their investment and efficiency.

“Meaningful use” depends on interoperability, which means that physicians systems will be able to communicate with each other for information exchange. Currently some physicians may have systems that are interoperable, but some may have invested in software that does not provide that function. Numerous vendors often market more than one type of system. Currently, estimates of physicians using a complete, fully functional EHR system are only at four percent (DesRoches, et al., 2008). This leaves the majority in need of researching software systems, purchasing, and implementing an EHR system to meet the “Meaningful Use” requirements. The practice of medicine is a highly individualized field where every physician has their own ways to provide for their patients. A general practitioner will have different software needs than a surgeon or obstetrician.Implementation of Electronic Health Records Essay.  An issue the physicians have to address is that they have to choose a certified EHR system that will provide the functions they need for their particular practice of medicine. Many physicians are starting with a basic system and customizing it to fit their practice needs (Baron, et al, 2005). HITECH will need to certify systems that provide functions that the physicians require with enough flexibility to meet the diverse needs of every type of practice. Some EHR systems are designed for primary care practices or large hospitals and may not meet the needs of a specialist. Physicians will have to choose a certified system that will have the required functions as well as those his practice will require.

Whichever system a physician chooses will require training in order to benefit from the functions the software can provide. A basic knowledge of computer use is a skill many physicians do not even have. In fact, some physicians have technophobia when it comes to computers in their practice (Hayes, 2009). Statistics have shown that younger physicians are more apt to have a positive outlook on the EHR systems. Younger physicians also appear to have earlier adoption of an EHR system because of their prior exposure to computers.Implementation of Electronic Health Records Essay.  In-depth training to learn the functions and processes of the system are necessary to prevent severe disruptions in the workflow of the office. Many offices will train a few employees to be “Super Users” to be a resource for others in the office who have had less training. “Super Users” will be able to adjust the work processes when needed. Some physicians’ offices close for a period of days to bring the system online and prepare the office for going live. The diversity in computer abilities and comfort levels will affect the complexity, price, and amount of training required for each physician and his office staff for the chosen system.

Cost is the biggest issue in the adoption of EHR systems. Cost estimates are between $12,000 and $24,000 to implement a fully functional EHR system (Baron, 2005). The equipment, software, training and one year of support can cost $140,000 or more (Baron, 2005). The HITECH incentives will cover some, but not all the cost of the conversion from paper to electronic records. Incentive payments can total $18,000 in the first year, for physicians implementing in 2011 and 2012 and will continue for 5 years at reducing amounts. The available incentive amounts will decline each year and end completely in 2016. In other words, physicians who adopt in 2011 could collect $44,000 over the five-year period while physicians who adopt in 2013 would receive $27,000 in incentive payments over 3 years (Blumenthal, 2009). The incentives will provide more funding for physicians that implement early. Surveys indicate that the incentives are a facilitator for approximately 55 percent of physicians who see the incentives as a reason to make the transition now, and receive maximum financial benefit (Blumenthal, 2009). The diversity in size of practices will affect how the physicians perceive capital costs. Implementation of Electronic Health Records Essay.

Due to the diversity in the types and ways physicians practice, issues that need to be considered and addressed, and the many solutions available, physician’s attitudes and opinions on EHRs and “Meaningful Use” vary from very enthusiastic to resentful and wary. Studies have shown that physicians who have already adopted an EHR system are generally satisfied with their system and the benefits it provides. However, although the physicians will be the ones assuming approximately 89 percent of the cost of the system, they will not receive much of a return on their investment (Hoffman, 2009).Implementation of Electronic Health Records Essay.  The insurance companies will save money on reduced testing, streamlined billing, and overall efficiency. The government will save money on the same things as well as have a medium for monitoring fraud. Physicians will save some money on record storage, employee salaries previously paid for filing and transcribing records, and paper office supplies, but in comparison to the cost of the system, savings are minimal. Physician concern over return on investment is 50 percent for physicians who do not have an electronic system but only 33 percent for physicians who are already using an electronic system (DesRoches, 2008). The results may reflect Medicare and Medicaid patient numbers, size of the physician practice or perhaps the diverse perceptions physicians have over the dollar value versus the benefits to their actual income.

Seemingly, the biggest numbers of implementers are the larger practices who are often better able to absorb the large investment than a small practice or single physician office. Statistics show that large primary care practices are more apt to implement EHR systems than other types of practices. These large group practices of fifty or more physicians were four times more likely to have a fully functional system than with physicians in practices of three or less physicians (DesRoches, 2008). The increased cash flow from a large practice makes the large capital expense less detrimental to the practice. This diversity in the size of physician practices is a significant basis for EHR implementation.

EHR implementation itself will not provide for full Medicare and Medicaid reimbursement. In order for a physician to receive full reimbursement from Medicare and Medicaid, an EHR system must meet the “Meaningful Use” requirements. Physicians who do not have an EHR system that meets the “meaningful use” requirements will see penalties in the form of reduced Medicare payments. The reduction of payments will start at one percent in 2015, increase to two percent in 2016, and increase again to three percent in 2017 (Blumenthal, 2009). Physicians with large amounts of Medicare and Medicaid patients will have a significant reason to implement a system that meets the” Meaningful Use” guidelines. This issue will not affect all physician practices and some physicians do not feel it is a significant impediment to their practice income to warrant the large expense involved with implementing an EHR system. The diversity in the types of patients a physician or practice routinely cares for will have an effect on their financial return and willingness to implement an EHR system. Implementation of Electronic Health Records Essay.

For those who may not see a financial return there are many other benefits to adopting an EHR system for patients, insurance companies, and the government, and to some degree physicians. One benefit for physicians is a more efficient and streamlined insurance claims process, which will aid in cash flow. Physicians will also be better able to provide for their patients because the patient record will be able to go where the patient goes, including to hospitals and specialists, resulting in better coordination of the patient’s care. The EHR will provide a reduction in clinical errors because of the ability of the EHR to provide clinical decision support and monitor medication dosing and contraindications, and allergies. However, a group of physicians feel that this is questioning their judgment and do not want the interference in the way they practice medicine.Implementation of Electronic Health Records Essay.  Of physicians who are using a fully functional EHR system 86 percent appreciate the avoidance of medication error function that their system provides. The diversity in the physicians’ response to clinical decision support may be due to age of the physician, the number of years he or she has been in practice or any number of reasons including the personality of the physician.

Along with those benefits, there is disruption of the office workflow. This is a significant cause for physician concern (DesRoches, 2009). The learning curve for an EHR system slows down all the processes in the office. Some physicians are better able to deal with the chaos that ensues while converting to an electronic system. Everyone within the practice has to relearn his or her job processes. All the office procedures of the practice have to be redesigned to work with the EHR system and the practice requirements. There is a period even after implementation of changes and adjustments that must be made to customize the system to the practice. Physician practices have reduced their patient load as much as fifty percent during implementation to try to reduce the waiting time for patients (Braon, et al., 2005). Implementation of Electronic Health Records Essay. This essentially means a reduction in revenues until everyone can perform their jobs smoothly and handle the normal patient load again. Estimates are anywhere from four to six months before normal patient load is fully resumed. Physicians have reported losing patients because the wait time to see the physician was too long during the early stages of implementation (Baron, 2005). This is a major barrier for 41 percent of physicians in making the switch to electronic records (DesRoches, 2008). Physicians are very busy by nature and a slowdown in the office creates a diverse level of frustration that has caused some physicians to put off implementation or even to reverse the work already done in adopting an EHR system and return to their paper system.

Those who do make the switch from paper to electronic records will have to consider HIPAA requirements for security of an EHR system. EHR systems require the secure storage of EHRs, which contain patient’s private health information and interoperability requires secure access to patient EHRs. Some physicians will choose to be on an encrypted network to share information with their local hospital, laboratories, and other health care providers. A verification process will be required to allow authorized physicians access to patient’s private health information and to deny access to unauthorized persons. Security of patient records is a concern for many physicians. Some physicians feel this is something that needs more regulation before they will expose their patients to the risk of a breach. The diversity in the EHR systems in operation now creates issues for secured patient PHI with system interoperability.

With all the diversity involved in implementing an EHR system, physicians perceive the challenges of the U.S. government mandate for the implementation of electronic health records in different ways. Some feel there are too many barriers to address before implementation of an EHR and others feel the benefits outweigh the barriers. There are as many opinions on the issues of switching to an EHR system as there are physicians themselves. Implementation of Electronic Health Records Essay. Addressing issues such as cost, security, training without a major loss in cash flow, which stems from disruption to the workflow of the office, will all stress the doctor patient relationship at least for a time. This is important because it will effect how and when the physicians adopt and use the nationwide system. The diversity in the way physicians practice medicine is individualized and the approved EHR systems will have to be flexible enough to allow for that individuality. The one thing all physicians want is to practice medicine they way they always have and meet the required mandate for “Meaningful Use” so they may recoup some of their investment. Implementation of Electronic Health Records Essay.

References

Baron, R. J., Fabens, E. L., Schiffman, M., & Wolf, E. (2005, August 2). Electronic health records: Just around the corner? Or over the cliff? Annals of Internal Medicine, 143(3), 222-226. Retrieved from http://search.ebscohost.com/.aspx?direct=true&db=a9h&AN=17875478&site= ehost-live

This article is written by physicians in a 4-internist practice describing the processes involved with converting from traditional paper medical records to electronic medical records. Baron and colleagues address the problems and issues involved, and how they worked through them. Some topics of interest include both planned and unexpected finances, training, workflow and accommodations and the overall office environment. The article describes the realized benefits and lacking areas of standardization and interoperability. I chose this source for its overall description of actual process of implementing an electronic records system. This article also addresses computer skills and requirements.

Blumenthal, D. (2009, April 9). Stimulating the adoption of health information technology. New England Journal of Medicine, 360(15), 1477-1479. doi:10.1056/

This article describes the portions of the American Recovery and Reinvestment Act of 2009 (ARRA) that pertains to health information technology. The article addresses barriers physicians have for implementing the mandated electronic medical record. Financial issues including incentives, costs and financial penalties are of adopting the mandate are covered. Other areas to promote and ease the transition, such as support systems, state and regional medical information exchanges, education initiatives, and extended HIPAA guidelines with regard to electronic records and transmissions are included in this article. This article explains the incentives for implementing the electronic records system. I chose this article to explain the diversity involved in the governments promotion for adopting an electronic health record system.

DesRoches, C. M., Campbell, E. G., Rao, S. R., Karen, D., Timothy, F. G., Jha, A., . . . Blumenthal, D. (2008, July 3). Electronic records in ambulatory care: A national survey of physicians. New England Journal of Medicine, 359(1), 50-60. doi:10.1056/

This article is a summary of statistics and results compiled from a survey of physicians in the US regarding the adoption of electronic health records.Implementation of Electronic Health Records Essay.  Documented in the survey are physician statistics and opinions in areas of usage, implementation, and satisfaction with the electronic health record systems. Issues addressed are quality of care, age groups of physicians who have adopted an electronic system and size of practices more apt to adopt electronic health records. The positive effects on practice processes, barriers that hinder adoption of electronic health records, incentives for and reservations with switching to electronic health records are included in the survey. I chose this source because it provides actual statistics of the usage of electronic health record systems as well as the diversity in physicians’ perceptions of the process, the systems, the benefits, and problems associated with compliance.

Hayes, F. (2009, February 2). No Rx for ROI. Computer World, 43(5), 40. Retrieved from http://search.ebscohost.com/.aspx?direct=true&db=a9h&AN=36487540&site=ehost-live

In this article, the senior news columnist addresses the issue of “return on investment” (ROI) for the adoption of electronic health records. The definition of ROI is given and how it applies to aspects of electronic health record adoption for physicians and hospitals is examined. Risks to, benefits of, and improvements needed regarding electronic health records are noted. The author confirms that those assuming the expenses for electronic health records will not be the ones reaping the benefits. I chose this article because it covers reflects my opinion one of the most important reasons for physician resistance to implementing the government mandated electronic health record system.

Hoffmann, L. (2009, November). Implementing electronic medical records. Communications of the ACM, 52(11), 18-20. Retrieved from http://search.ebscohost.com/.aspx?direct=true&db=a9h&AN=45021143&site=ehost-live

In this article, a basic history of George W. Bush’s goals for every American to have an electronic health record is presented along with the progress of the government in making those goals real. Usage of electronic records is briefly mentioned. The article focuses on some major barriers and concerns of physicians for implementation and usage. The article also addresses some of the positive aspects for electronic health records. I chose this article because it provides concise overall answers to who, what, when, where, and why answers to the implementation of the electronic health record and health information technology. Implementation of Electronic Health Records Essay.

The electronic health record is a mean of organizing patient’s data making use in the field of information technology. Its purpose is to fulfill the various needs for information not only of patients and healthcare providers but also of other beneficiaries. The implementation of electronic health record system in health care organization is very complex and involves many parameters.

Introduction

Electronic health record is currently used by 12% of the physicians and 11% of the hospitals nationwide. Industry and government have promoted Electronic health record as a means of controlling costs and improving patients care. The electronic health record has become one of president obama main agenda and the investment necessary to ensure that within the coming years, all of America’s medical records are computerized. Today with the advance of globalization the electronic health record is still highly unlikely to advance in the next five years, governmental, technical and industry advances are adopting, which will drive the electronic health record in the hands of medical providers. The electronic health record (E.H.R) is a digital record of patient health information generated by one or more encounters in any care delivery setting. It contains information of the patient includes demographics, problems, medications, vital signs, past medical history, laboratory data and radiology report .

The electronic health record also promises the removal of many barriers in the medical field such as – saving lives, money, and time, but unfortunately the fulfillment of this promise in the real world application has remained with a big question mark due to many factors cost of implementation, privacy and security. The following graph is the result of survey experts at nearly 3000 group practice nationwide. Implementation of Electronic Health Records Essay. The table below lists barriers to Electronic health record adoption.

well known factors such as security and cost are cited as key factors, but other factors which is usability is not mentioned frequent is another barrier to the electronic health record adoption.

Usability is a primary concern

Usability issues are also a factor why electronic health record implementation fails. In a survey paper primary care physicians were asked the reasons why they did not use the electronic health record system. From the research finding 35% of the physicians listed specific electronic health record usability issues, the most common were: Problems with the screen navigation, and the lack of functioning and the concern that the data will be lost.

Anecdotal support for usability and Electronic health record failure comes from Cedars- Sinai medical centre of Los Angeles. They developed a $ 34 million computerized physician order entry system, but only included the input of a few physicians before launching it hospital wide in 2002 without thorough training Physicians who previously used to take notes by hand now required going through nearly a dozen screens and responding through numerous alerts for even common orders. Traditional doctors around 400 of them demanded its removal within three months of its launch.Implementation of Electronic Health Records Essay.  Poor usability can also endanger patient’s health. The electronic health record should be modernized helping the clinician workflow. In the year 1991, the institute of medicine released a report supporting the idea of implementing the Electronic health record within the coming years. In 2010, researchers believe only a small portion of health providers both public and private implementing the system. The implementation of electronic health record provides answers to many barriers in the medical world.

Background

An electronic health record is a digital or electronic record of the patient health information gathered over the history of the patient’s interaction with the health care system. An electronic health record stores all information concerning the patient health statues. Information varies and includes the following age/sex, medications, and vital signs, past medical history, laboratory data and radiology report. The concept of a medical report goes back to the fifth century B.C developed by the Greek physician Hippocrates, also known as the Hippocratic Oath. Hippocrates described two main goals behind his findings 1- a medical record should accurately reflect the course of disease 2- a medical record should indicate the problem cause of the disease. In the present days, the electronic health record first began to appear in the 1960s.Implementation of Electronic Health Records Essay.  Reported that at least 73 hospitals began to use the electronic health record system. In 1991, the institute of medicine released a landmark report recommending the electronic health record be implemented in health system within 10 years. Almost 20 years later, according to the latest researchers only a small portion of health providers have implemented electronic health record. A Meta analysis of diffusion rates of the electronic health record in the United States shows that an uptake has slowed in recent years. The study concludes Electronic health record is the future. President Obama administration has the electronic health record as one of its primarily agenda ‘the investment necessary to ensure that within the next five years, all of Americas medical records are computerized’. While still with the advance of globalization the electronic health record is highly unlikely within the next five years, governmental, technical and industry advances are adopting, which will drive the electronic health record in the hands of medical providers. The electronic health record also promises the removal of many barriers in the medical field such as – saving lives, money, and time. The question is still debatable whether the whole world will move towards the implementation of the Electronic health record. The electronic health record is one of the most important electronic patient data collection of our time and with the expanding population of the world it has become a necessity to implement the system in all public and private hospitals. The G.C.C region. Implementation of Electronic Health Records Essay.

Literature review

The opinions concerning the positive effects an E.H.R can have on patient’s health and whether all the healthcares in the world should step in and implement the system. The collection of personal health data is described to have many formats when speaking of systems that manage it. Reduction of the storage necessary to keep paper charts is also a noted as a reason to leverage an E.H.R freeing up of space better used for revenue generation. Paper charts have their own risk associated with them in terms of getting lost, productivity impacts to maintain and retrieve paper records and the resulting negative patient care (Carpenter 2002). An electronic health record system is the collection of data that is central to the patient (Rishel, Handler &Edwards, 2005). These opinions agree the importance of the E.H.R and implementation of the system. An E.H.R system exists to facilitate the storage, revival and continuity of the record itself (Gans, Kralewski, Hammons & Does, 2005). These opinions also strongly agree with the improvisation of the Medical record with the advances with science and technology. reversing the scenario, an E.H.R system can collect and aggregate information from other sources such as laboratory, X-ray and unstructured data like faxes or handwritten notes ( Wojcik, 2006) the scholar Wojcik agrees strongly with the use of E.H.R talking about the positive of the E.H.R reduces the storage of handwritten notes and stacks and piles of paper. The near term presents providers with realizing the digitization of the boxes of paper that is generated by patient encounters. These paper databases represent the clinical data that is ultimately needed to take EMR systems to the next level. The near term presents providers with realizing the digitization of the boxes of paper that is generated by patient encounters. These paper databases represent the clinical data that is ultimately needed to take EMR systems to the next level. Clinical data is the baseline in which all healthcare processes subscribe including decision support, health outcome analysis, billing and claims processing and health maintenance. Implementation of Electronic Health Records Essay.Correlation and access to this data is what EMR systems seek to facilitate (Handler & Hieb, 2007). Electronic health record systems, once materially implemented across the healthcare spectrum, will itself become the framework in which more overarching goals can be accomplished, such as the centralization of a person’s health history. With Clinical data as a basis, further utilization of EMR systems can occur. EMR systems, once materially implemented across the healthcare spectrum, will itself become the framework in which more overarching goals can be accomplished, such as the centralization of a person’s health history (Gartner. Currently, about 25 percent of U.S physicians are using systems that facilitate electronic health records (Murdock, 2007). E.H.R has become a primary concern in the medical world and the according to past literature review in this generation we find that it some of the scholars are concerned with the paper works as they say that the E.H.R will help save doctors a lot of time and makes the process more efficient. Some scholars say that paper based system is very negative as it leads to losing important patient data which might confuse the doctor in prescribing proper medication to the patient. There are differences of opinion but according to most scholars the E.H.R is a vital tool in solving many of the issues that both public and private hospitals face around the world. Implementation of Electronic Health Records Essay.

Questionnaire Results

The questionnaire focuses on the importance of the E.H.R system and its implementation in the United States of America at a nation wide level. With growing medical demands around the world

Hypothesis one results

Our research finding indicate that the U.S government is encouraging the country medical networks to start using the E.H.R

Hypothesis two results

Our research finding according to 430 surveyors say that 55.1 % of their medical practices use the Electronic health record system

Hypothesis three results

Our research finding shows that majority of the surveyors have a positive outlook that majority of the medical practices will start using the E.H.R between the next 1 to 2 years

Hypothesis four results

Our research finding shows that 41.8% of the surveyors believe that their medical providers will qualify for the Medicare and Medicaid programs. Implementation of Electronic Health Records Essay.

Hypothesis five results

Our research finding again shows a positive outlook of the near future as 65% of the surveyors say that their practices will qualify for the Medicare and Medicaid programs by the end of 2011

Hypothesis six results

Our research finding again shows that the U.S government financial incentive can upgrade the performance of E.H.R surveyors helped us with the conclusion that government financial backing to the Medicaid and Medicare programs can improve the medical performance in the near future

Hypothesis seven results

Our research finding states the importance of the U.S government testing the E.H.R program before purchasing them according to the surveyors 71% agreed the importance of testing the systems before implementing them nationwide. Implementation of Electronic Health Records Essay.

Hypothesis eight results

Our research finding concluded that most of the clinicians hire 1-5 physicians which is low according to the demands of medical needs of our current era

Case Study

Questions and answers regarding on implementing the electronic health record (Case Study).

The case study focuses on the systematic reviews and the effects of electronic health record system can have in the medical sector if implemented at nationwide level. In the G.C.C the electronic health record is still new and according to our case study taken from the united states we want to find whether implementing the electronic health record system will add value to the medical sector or not.

Will electronic health record improve patient’s health outcome?

In a review evidence results in two study cases came up with the following result

In 2004 a systematic review conducted 3 study cases that reported patient’s outcomes, no benefit was the conclusion

In 2008 an analytical survey of several U.S patients found very few data or no association between the use of electronic health records and the improvement of patient’s outcomes

In the end of the study there was no evidence linking between electronic health record with better patient outcomes. Implementation of Electronic Health Records Essay.

Will electronic health record improve the quality of care?

Evidence proves that the following result might occur on the electronic health record if implemented in practice

In 2004 a review of 26 studies analyzed several outcomes related to the quality of patient physician encounters and with the research it discovered a sharp incline in provision of preventing care

In 2006 a review on health information technologies and their impact on quality, efficiency and cost findings were: Increased adherence to guidelines based care, advanced surveillance and monitoring and a decline in medication errors

In 2007 a study of data from some community health centers over the course of one year concluded that while electronic health record related costs had not been recovered, the quality of care improved In 2008 a review on the advantages and costs of electronic patient Concluded that concerning the influence of EPRs on the quality of care The studies did not clearly identify a clear answer to the questions of Benefit. Implementation of Electronic Health Records Essay.

In 2009 a review of 7 countries experience implementing health information systems concluded that they had a neutral experience where neither benefit nor harm between the system implementation and quality of care

The conclusion of the study indicates that the electronic health record has a positive effect on the quality of care; however some of the reviews still find it neutral so the opinions of the doctors and physicians are still conflicting.

Will the Electronic health record be cost effective?

In 2003 cost benefit analysis on the electronic health record in primary care settings concludes that electronic health record can result in positive return on investment

In 2007 review on informatics system designed to improve care of chronic disease found that both cost effectiveness and adherence were significantly improved

In 2008 report on the United States budget office summarized evidence supporting the practice of health information technologies describes the benefits on cost saving as limited

In 2010 assessment on the quality of care resulting from hospital computerization concludes that currently implemented hospital computing might improve process measures of quality but not administrative or overall costs

The research cite modest cost benefit associated with electronic health record, however based on results for small trails or projections based on modeling: empirical evidence supporting the cost effectiveness on electronic health record remains limited or conflicting. Implementation of Electronic Health Records Essay.

Will the electronic health service save time and improve the efficiency of health services delivery?

In 2006 a review of quality measures on the use of electronic health records indicated that the lack of implementing health services has been demonstrated, but the author notes that the outcome is limited to a wider health service provider

A systematic review in the year 2008 analyzed six studies that addressed electronic health record with respect to consultation time, one study found the decrease in consultation time and the other found no difference

A 2008 report from the United States congressional budget office summarized evidence supporting the adoption of health information technologies described the evidence around efficiency as conflicting

In 2009 a review examined the impact on regional health information system and figured that, studies were of variable scope and quality improves the medical data access, timely information, and medical data exchange and improvement in communication and coordination within a region between health care professionals

While there are some evidence supporting an association between the electronic health record and efficiency, there is also evidence which does not support this conclusion. Implementation of Electronic Health Records Essay.

Will electronic health record improve physicians and patients satisfaction?

In 2004 a review found that results were mixed with both the patients and physicians expressing enthusiasm for electronic health record and on the other hand expressing significant concerns about the impact of their use on a variety of outcomes

A 2009 review of seven united based studies examined patient satisfaction with the electronic health record and figured that: one out of seven studies reported a positive effect on patient satisfaction, five out of seven studies reported a neutral effect and one out of seven studies reported a negative effect

Evidence on patients and physician satisfaction is scarce

An interview with Dr Michael Shuskho on the electronic health record

As a professional in your field how do you find the electronic health record system?

Michael: the E.H.R is an advanced system which is very useful for doctors especially in the current Era. It provides better patient care, and makes a permanent record that is legible that other doctors can review the system and also actually streamlines patient care

Will the electronic health record improve efficiency and reduce time

Michael: yes, the electronic health record is a valuable system to most of the doctors because it replaces the piles of paper and with a few click on your computer screen the doctor can view all the patients past medical record and send all the information to the other doctor within minutes. Implementation of Electronic Health Records Essay.

Is the electronic health record system better than the manual paper based system?

Michael: yes, the E.H.R is clearer and safer than the manual system provided that it is used carefully. Exg: a doctor can view patients X-Ray, picture of his electro cardio graph in a much clearer and digitalized form while in the paper based system the pages might wear or get old and by the time the picture of the X-Ray gets more aged, it makes it hard for the doctor to identify the exact diagnosis

Is it cheaper to implement an electronic health record?

Michael: The electronic health record system is expensive and the start up cost of the Medicaid and Medicare programs is high but in the long term it will eventually become cheaper for the clinics and hospitals to use them

What are the barriers that prevents the electronic health record system by being in practice at a larger scale

Michael: some doctors who aren’t familiar with updated technology and use practical manuals prefer not to implement the E.H.R in their clinics. Another barrier to the electronic health record is the upfront cost which is expensive and the some doctors find it hard adapting to the system

Dr. Michael one last question before we conclude our interview. In your personal opinion will the E.H.R be mandatory by 2015 in the U.S

Michael: I assume the probability that the electronic health record system might be mandatory in the U.S and the government might take actions in seeing that all the practices and clinics use the system. Implementation of Electronic Health Records Essay.

The implementation of the E.H.R IN Kuwait and Bahrain

Based on our research we have found that the electronic health record still needs to adapt at a global scale and the system is new to the G.C.C countries compared to the western countries such as United States, United Kingdom. Kuwait started using the E.H.R in 2005 in private and public clinics replacing the paper based system. According to the hypothesis questions and results in the U.S case studies it shows clearly that the E.H.R is on the way of improving and use the E.H.R rather than the traditional filing system. Bahrain is also taking a step further in implementing the system and the public and private clinics and with the help of the MGA methodology and the case study we have come with proposed solutions and the benefits that the kingdom of Bahrain and other G.C.C countries will achieve through the E.H.R

December 2010

The health ministry in Bahrain will launch its national e-files project early 2011. It will cost the ministry between BD 25 Million to BD 30 million. Files of patients at salmaniya Medical complex and health centers will be converted into e-files. The first phase will cost BD 1.5 million and include all SMC and health care patients. Private hospitals and clinics can also be part of the system by paying a fee

The health minister stated that many countries were struggling to meet the challenges of providing adequate health care for citizens. ‘ Changing demographics increased patients expectations, a global shortage of health professionals and rising costs associated with innovative technologies and new drugs means that healthcare is consuming an increasingly large proportion of gross domestic product and is becoming a priority for most governments’.

The minister also discussed Bahrain healthcare agenda through some strategic objectives which includes health promotion and prevention by strengthening primary healthcare services, the provision of quality health services by maintaining international accreditation of facilities and enhancing access to all health care services (Gulf Daily News- [email protected]) Implementation of Electronic Health Records Essay.

Plan for online health service

Patients in Bahrain may soon be able to manage their healthcare online. Patients know best (PKB) enables people to communicate securely with doctors and nurses, access their medical records and send and receive health data. The medical group was founded two years ago by Bahraini Dr Mohammed Al Ubaydli in the United Kingdom. He has more than 15 years of experience in the medical software and trained as a physician at the Cambridge University. The expert worked as a staff scientist at the national institutes of health and was a management consultant to US hospitals at the Advisory board company and is the author of six books. PKB is the first company to integrate into Britain’s NHS secures connecting for patients to work online with clinicians. The group was voted as the best social innovation start up at tech crunch europas European start up awards 2010. At least two hospitals in Bahrain as well as others in the UAE and Malta have shown interest in signing up to the initiative. In the U.K, PKB affiliates includes great Ormond St hospital, Thalidomide Trust, Cure Parkinson and Two NHS hospitals will also sign up soon

Access

Dr Al Ubaydli said hospitals and medical centers that have affiliated with the PKB give their patients an online ability to securely access their medical documents, history and test results, have online consultations with their doctors and receive prescriptions. Once you give the medical record to the patient they can give them to their GP, relatives, social workers and so on he told the GDN. Implementation of Electronic Health Records Essay. The patient can start an online consultation with any doctor they have added, it works a bit like the face book. They can also reach their doctor at any time say, for example, their child is taking medication but develops a fever at 3am and they can go online and ask the doctor how to adjust their medication. ‘The system asks automated questions that your doctor would ask so that when the doctor sees this in the morning it saves them a lot of time and they can quickly respond with advice’. ( Gulf Daily News 8 Dec 2010)

The articles concludes the following results

The kingdom of Bahrain is taking new measures in implementing the E.H.R in the G.C.C and mena region

Many of today healthcares can be solved through networking

Globalize E.H.R System

Networking communication is an intermediary between practicing doctors implementing the E.H.R in their private clinics or public clinics. The information process is much faster through communication networks which reduces time, saves lives and improves efficiency Exg: Steve Dr Akram Favorite doctor has a patient and needs emergency solution to a problem through a communication network can achieve his goal browsing the Globalize E.H.R network finding solutions through other Doctors specialized in that field. Implementation of Electronic Health Records Essay.

An E.H.R system that works like a face book

Doctors can log on their account and log on the system with other health professionals and discuss emergency situations and provide solutions

The problems can be solved through fast communication and accurate knowledge the tacit knowledge

key challenges to health practitioners implementing the E.H.R in the GCC countries

Cost of implementation is not offset by the efficiencies in the E.H.R

Technical support needs to be modified due to the advancement in IT

Stress on staff and the practice in general was significant

A 2007 review article recommended strong physician leadership and a staged approach to successful implementation

In 2010 an article challenged conventional assumptions that the physicians were to blame for low uptake of electronic health record. Electronic medical records vary greatly in capability, quality, and cost. Doctors will become enthusiastic users if the electronic medical records are helpful in the care of their patients. Implementation of Electronic Health Records Essay.

There are significant challenges associated with implementing E.H.R in the Mena or G.C.C countries

Benefits of networking for the G.C.C Region

Improves patient care through greater access to information

Reduces test result times

Decrease paper work for clinicians

Integrate communication

Helps ensure that patient medical data and stats are there when patients need to find his/ her test results

Compliance with privacy regulations

Proposed solutions for the electronic health record

A 2008 synthesis of 3 qualitative studies identifies essential components of successful electronic health record implementation

A project champion

Realistic expectation of the challenges of implementing an electronic health record

Addressing existing staff attitude towards IT

Provide adequate training to staff

A systematic review of 7 countries experience implementing health information system in primary care identified the following factors

Quality of the graphical user interface and feature functionality

Quality of implementation project management

User’s previous experience with information technology systems. Implementation of Electronic Health Records Essay.

The Electronic health record today application

The adoption of the electronic health record is difficult to overcome due to the lack of the return on investment. Scholars and writers on the subject noted that health care decision makers find it difficult to demonstrate return on investment to undertake a comprehensive electronic health record system within their organization. The health care costs continue to increase and the fact that the initial investment on equipment can be quite expensive. Another fact that complicates the adoption of the electronic health record is that the data is heavily structured, being recorded in the allotted space. Training is an important issue and this is required by a large amount of population. One should keep in mind that the population has different levels of computer literacy (Upham 2004). These contributors of the electronic health services contributed to a slow increase in the adoption of such systems in many hospitals. In a survey question regarding the E.H.R and the implementation of the method out of 436 who have responded to the question, 35.6% said that they have already implemented the electronic health services. The percentage is expected to grow in the coming years of application. The G.C.C is taking all the necessary step in implementing the system with an enhanced knowledge in the field and the governments should test all the Medicare and Medicaid programs before implementing the system

The Evolution of the Electronic Health Record

The electronic health record is an open field of debate amongst the doctors, physicians, clinicians and scholars. In the electronic implementation of such records, we may also expect to find populations of patients, integrated access to biomedical literature and interactive environment for offering clinical guidelines or consultative advice. Throughout ages the world is becoming more globalized and in the age of science and technology the computer is being the number one tool. The (local area network) is connected to the full internet, with an integrated access to a wide variety of information sources that are geographically distributed well beyond local institutions.

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The electronic health record system is expanding worldwide and some of the future implementation

An enhanced internet: an internet with much higher bandwidth and reliability, increased response time and financial models that makes the application cost effective and practical is required.Implementation of Electronic Health Records Essay.  Major research effort is underway to address some of these concerns, including the federal next generation Internet activity in the United States exploratory effort that continue to push the state of art in internet technology, and all significant implication for the future of health care delivery in general for computer- based health record in particular

Better Education and health care training for health care providers: there is a difference between computer literacy (familiarity with computers and the routine users in society) and the knowledge of the role that computing and communication technology can and should play in our health care system. More medical information training programs and the expansion of existing programs are needed. Junior faculty in health science schools who may wish to seek additional training in this area should be supported

Changes in the management and organization of health care institution: health care provide some of the most complex organizational structures in society, and it is simplistic to assume the off shelf products will be smoothly introduced into a new institution without major analysis.

Discussion

The project mainly discusses on electronic health record system that the implementation of the idea goes back to Hippocrates who laid the foundation in the 5th century and by the following years doctors, physicians, pharmacists and clinicians tried to improvise the idea of the health record system on paper but in the 1960s the standards of the paper based changed to the electronic health record systems and hospitals welcomed the new system which was more efficient and reduces paperwork and time. The electronic health record according to numerous researches and articles emphasized that the system should be introduced worldwide. the G.C.C region is expanding in both size and capacity since the countries like Bahrain, Kuwait, Qatar, Uae opened door to foreign investment in their respected countries. Our research focuses on the implementation of the E.H.R in the U.S and the results of the case study gave us a better understanding on whether to implement the system in the G.C.C countries. The results were positive and the need of the system is becoming compulsory in our world today.  Implementation of Electronic Health Records Essay.