Issues in Electronic Health Records (EHR)

The Health information technology (HIT) such as Electronic health records (EHRs) system promise to improve effectiveness and efficiency in the delivery process of health care, to improve quality care and to reduce health care related costs (Ben-Assuli, 2015). EHR is a patient-oriented intelligent system, which compiles the medical records and data of patients to support ultimate decisions and core processes. National Coordinator for Health Information Technology (ONCHIT) main objective is to implement EHRs nationwide (Ben-Assuli, 2015). In a healthcare setting, EHR is expected to help in making clinical decisions and care process while at the same time capturing, storing and recovering digital patient data in the required format. Just like information systems, EHR systems increase strategic roles in a health care system with the aim of offering quality care. Just like any information system, EHR has many essential barriers such as security and privacy concerns, changes in workflow, financial issues, task dependency on data quality (Ratwani, et al. 2015). To support healthcare organizations, EHR systems should be used in multiple patient care departments and processes to help healthcare practitioners with their jobs. However, nurses may have different objectives and expectations from the use of HER system to support their decision making and support their information needs (Ben-Assuli, 2015). Therefore, HER systems can transform the health care system from a paper-based firm to a digitalized firm that used a patient's information to deliver high-quality patient care.

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Why we Need EHRs

The electronic information systems have unlocked diverse possibilities and replaced paper-based healthcare data management system that is important in providing quality care and during clinical research. Many studies have shed light on qualities (currency, plausibility, concordance, correctness, and completeness) of data contained in EHRs (Ratwani et al. 2015). EHRs as an electronic record includes data and patient's health information such as patient's past medical history, laboratory data, vital, signs, immunizations, medications, problems, progress notes, and radiology reports. HER systems have many capabilities of reducing costs and improving patient's care such as health information exchange (HIE), computerized physician order entry (CPOE) systems, and clinical decision support (CDS) tools (Ozkaynak et al. 2017).

The clinical decision support (CDS) tools help in the decision making process during patient care including alerts for drug interactions, cross-referencing a patient allergy, and other potential patient issues (Ozkaynak et al. 2017). This functionality ensures care is delivered more efficiently and safely. The CPOE systems allow nurses for keying in laboratory tests, physical therapy, radiology and drug tests. Such of computerization process reduces chances of dangerous medical errors (Ozkaynak et al. 2017). It also makes the process of ordering more effective since pharmacy and nursing staffs do not have to solicit missing information and need to seek clarification from incomplete or illegible orders. Once the patient's data and the information are available electronically, information is shared securely, and it reduces costly redundant tests. This means that EHR not only provides quality care but also provide efficient, effective and quality care (Ben-Assuli, 2015). The quality of documentation is not only important to patient care but also to the organization's financial status. Such systems offer the potential of enhancing efficiency, quality, and safety during the provision of health care (Ozkaynak et al. 2017). Thus, the use of EHRs presents significant opportunities that improve patient outcome.

EHR Value and Benefits

EHRs have many potential benefits compared to paper-based record keeping systems. The main advantages of EHRs range from financial savings to health benefits most of which result from efficiencies when using EHR systems. Some direct benefits of EHRs include better collaboration and communication, legibility, accuracy, completeness, and consistency. For these benefits to arise, EHR must be easily available, accessible, flexible and user-friendly (Ben-Assuli, 2015).

Most clinical outcomes that have been linked to EHRs are linked to patient safety and quality of care. Quality care results from doing the right thing the right way at the right time, which leads to patient safety and best results. Therefore, EHR focuses on efficiency, effectiveness, and safety of patients. HER with CDC tools are believed to increase patient's adherence to adequate care and evidence-based clinical guidelines. EHRs try to overcome issues such as nurses not knowing the guidelines, lack of time during the patient visit, and nurses not realizing the kind of guideline that applies to a particular patient (Ben-Assuli, 2015). Instead EHRs focus on preventive services such as how to improve the rate of adherence among patients.

EHRs also allow nurses to access easily patient's clinical information during care. For example, Ben-Assuli (2015) in her study shows that subspecialty referrals that need interactive communication and coordination among nurses have been facilitated using HER in the US. According to Ozkaynak, et al. (2017), the EHRs can also be used to communicate with patients over long distances. Besides, Ozkaynak also found that the use of EHRs improves the accuracy and completeness of records. Further research also shows that EHRs is one of the major areas used in aged care to deliver safe and effective quality aged care (Ratwani et al. 2015). Thus, EHRs is important in a healthcare environment to provide improved care and information quality based on accuracy, completeness, and legibility.

Challenges and Constraints in using EHRs

Although there are some benefits that come with the use of EHRs in providing quality care, there are many constraints and challenges that go with it. This includes security and privacy concerns, changes in workflow, financial issues, task dependency on data quality, healthcare practices and regulations, incompatibility of data standards and regional diversity in languages (Ratwani et al. 2015).

The cost of adoption and implementation of EHR, maintenance costs, decline in revenue presents a disincentive for healthcare organizations to implement EHRs. For EHRs to be implemented, it requires the purchase and installation of software and hardware, training end users and converting patient's data and information to electronic ones (Ratwani et al. 2015). The cost of EHRs maintenance is also expensive since software needs to be regularly updated and there must be the continuous training of nurses.

The use of EHRs leads to workflow disruption for medical practitioners and nurses leading to loss of productivity. The loss results from training end users to learn how to operate the system leading to revenue losses. It is estimated that end users spend about 123 hours to learn the EHRs and its activities (Ratwani et al. 2015). Such hours spend to do nonclinical responsibilities is expected to be around $10,000 per physician (Kohli & Tan, 2016).

The use of EHRs leads to the violation of patient's privacy system, which is a critical issue since most clinical data and information is usually exchanged electronically. As results, policy measures must be taken by healthcare organizations to ensure that the privacy and safety of patient information are achieved (Ratwani et al. 2015). Although it may be challenging to guarantee privacy concerns on patient's data, steps need to be taken to ensure EHRs stick by the strict regulations and rules aimed to provide the privacy of clinical information.

In the past years, EHRs has also increased overdependence in technology, medical errors, changes in the power structure and negative emotions. For example, past studies associate the use of CPOE with medical errors due to lack of end-user training and poorly designed interfaces. Besides, nurses may find it difficult to adapt to the new system leading to emotional responses and disruption of workflow (Ratwani et al. 2015). The power structure in a healthcare organization can also be altered due to the implementation of the EHRs. Besides the overdependence of technology is a significant challenge since most nurses have become more reliant on the EHR.

How Informatics Skills and Knowledge were Used

The competency of informatics skills and knowledge were developed through computer skills and informatics knowledge and skills. Computer skills include electronic searches, which assist in retrieving patients' demographic data and information, using telecommunication devices to attend to patients who may be outside the hospital facility, documentation of patient care and the use of EHRs to improve nursing care (Kohli & Tan, 2016). The informatics knowledge included the use of nursing data to improve care and nursing practice, bearing in mind that there are human factions during care that cannot be done through technology or computers. The involvement of EHRs design, selection, implementation and evaluation, the formulation of the ethical decisions, the determination of the limitations of EHRs is vital for the reliability and effectiveness of a computerized patient monitoring system (Kohli & Tan, 2016). Informatics skills were essential when interpreting information and developing analytic and innovative techniques for data organizing methods and scientific inquiry.

Conclusion

The Health information technology seeks to improve effectiveness, efficiency, and quality care. EHRs as a patient-oriented intelligent system helps to make clinical decisions and care process that offer quality care. EHRs as an electronic record contains data and patient's health information that presents many benefits ranging from financial savings to health benefits most of which result from efficiencies such as better collaboration and communication, legibility, accuracy, completeness, and consistency when using EHR systems. Therefore, EHR focuses on efficiency, effectiveness, and safety of patients. EHRs also present a number of challenges in providing quality care. This includes security and privacy concerns, changes in workflow, financial issues, task dependency on data quality, healthcare practices and regulations, incompatibility of data standards and regional diversity in languages. Although there are many challenges and concerns for EHRs implementation, it is recommended that the implementation of EHRs globally is important in transforming the health care system. EHRs should be seen as a way of diversifying the health care system by focusing on cost reduction and quality improvement. Thus, the major political and legislative support for EHRs implementation presents one of the best investments in the health care system.

References

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