About Electronic Health Records

Introduction

Electronic health records (EHRs): the very mention can cause panic, but that need not be the case. This discussion is designed to make the topic of EHRs more easily understood. The keeping of medical records is a time and labor intensive activity with many repetitive components such as the chief complaint, history of present illness, past medical history, review of systems, physical examination, laboratory data, assessment, and plans. Much of the time and labor costs of medical records are attributed to the fact that the patient’s medical history is often widely distributed over space and time. Many health care providers in the US depend solely upon paper-based medical records and charts. Over time, the increasing need for cost savings across the health care industry will demand greater accuracy and interactivity, more broad functionality, and decreased cost of labor for medical records (Austin and Boxerman, 2008). This researcher asserts that these requirements can be met by the widespread adoption of electronic medical records (EHRs) as the preferred form for all medical records. By the year 2030 the widespread adoption of EHRs will be a reality, at least within the industrialized world.

 

Electronic Health Records (EHRs): Definition

 

According to Health Information Management Systems Society’s (HIMSS), the term “Electronic Health Record” (EHR) has the following definition:

“The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports. The EHR automates and streamlines the clinician’s workflow. The EHR has the ability to generate a complete record of a clinical patient encounter, as well as supporting other care-related activities directly or indirectly via interface—including evidence-based decision support, quality management, and outcomes reporting” (NIH, 2006).

According the the HIMSS’ definition, one of the major functions of EHRs is to automate and streamline workflow. EHRs are also expected to be interactive for purposes of evidence based decision support, quality management, and outcomes reporting. Interactive alerts to clinicians, interactive flow sheets, and tailored order sets are examples of some of the ways in which EHRs have functionality that paper records do not (NIH, 2006). [See Figures 1 and 2 below.]

 

Figure 1, (NIH, 2006)

 

Figure 2, (NIH, 2006).

 

According to HealthIT.gov and NIH (2006) Some additional qualitative benefits of EHRs are:

• Improved quality of patient care
• More efficient tracking of patients and costs
• Benefits to the business of healthcare (decreased overhead)
• Better documentation and improved audit capabilities
• Avoidance of repeating expensive tests and more time spent with patients
• Improved patient communications
• Better care coordination

Impediments to Health Care Information Access in 2030

 

The medical record is the point of origin and purpose for most health care information; therefore any process that impedes access to medical records will impede access to health care information. Two major impediments to health care information access in 2030 will be cost and interoperability, especially as they pertain to EHRs. Resources for funding health care are scarce now, and conditions of scarcity will certainly be present 15 years from now in 2030.

IT systems are highly specialized and it is the nature of specialized products to be costly. In addition to general costs, health care companies have to decide whether or not they will purchase a ready-made system or pay to have a system developed (Austin and Boxerman, 2008).  An additional impediment to health care information access occurs for those who lack insurance and therefore, cannot obtain medical help. Until universal insurance is a reality, people without health care access will not have information continuity within the system of EHRs.

Interoperability will be problematic because uniform standards for production are currently lacking, and vendor efforts for development, deployment and stocking practices are not coordinated (NIH, 2006). Development of uniform standards for interoperability now will help to eliminate the technical variances that will have to be over come in the future.

Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the American Recovery and Reinvestment Act of 2009, has committed federal dollars to support the widespread use of  EHRs. According to HealthcareIT.gov, 54 percent of Medicare/Medicaid participating health care professionals have registered for the Meaningful Use Incentive Program. Meaningful use incentives are specific, tangible benefits offered to Medicaid/ Medicare healthcare providers who use certified electronic health record (EHR) technology. Overall, there needs to be an even greater national, multidisciplinary, cooperative efforts between the Government and the private sector to educate physicians regarding the benefits and cost-efficacy of EHRs.

On the level of software development, Strategic IT concepts should be embedded within current medical education processes, so that the health care workforce of tomorrow will be able to make wise IT choices. Those who create health care IT need to create products based upon uniformly acceptable standards that will enhance interoperability and facilitate upgrades and repairs. Tax incentives can help to defer some of the costs for health care providers to change over to EHRs now which will positively impact widespread adoption of IT in health care businesses of the future.

All EHR platforms should be HIPAA compliant and accessible to all qualified personnel relevant to a patient’s care.

 

Heath Care Bake-In

 

According to Austin and Boxerman (2008), “baking-in” is the practice of “embedding knowledge into clinical and administrative workflows” such as reminders, evidence-based order sets, alerts and the ability to click through to relevant medical literature for further information. All baked-in information within the health care environment is selected for high impact and relevancy. The single most significant bake-in that this researcher would embed into an organization’s workflow would be an order alert that would prompt a clinician or nurse to order a specific test for evaluation of an abnormal lab value. Likewise, bake-in alerts can be used to tie in electronic health records with laboratory paper results and orders. Laboratories routinely put an asterisk next to a lab value that is outside of the norm, yet further action may be required in order to prevent catastrophic illness. Positive blood cultures could trigger a prompt to repeat the study or to write an order for antibiotics. Resistant bacteria could prompt to write an order for a change in antibiotics or to put the patient in isolation to prevent spread to other patients. These alerts can be followed up by quality assurance, and penalties can be applied to those physicians who routinely have delayed or absent responses to alerts.

 

Conclusion

 

The function of medical records has expanded considerably since the days of Hippocrates in the 5th Century B.C. when the purpose of medical records were to “accurately reflect the course of disease” and “indicate the probable cause of disease” (NIH, 2006). The growth of the medical industry to include numerous stakeholders and the advent of the information age have expanded the dimensionality of medical records to include interactivity and rapid availability. Electronic health records allow all the stakeholders in the health care equation to obtain data regardless of location, distance, and time in a way that is cost-effective. Likewise, baking-in or embedding knowledge into workflows is a cost effective way to increase efficiency and reduce medical errors. In many ways, IT is helping the mandates of ancient medicine to become a stepping stone into the future.

 

References

Austin, C. J., & Boxerman, S. B. (2008). Information systems for healthcare management (7th   ed.). Chicago: Health Administration Press.

Centers for Medicare and Medicaid Services. EHR Incentive Programs. Retrieved March 17, 2014 from: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/01_Overview.asp

HealthcareIT.gov. Benefits of Electronic Health Records (EHRs). Retrieved March 17, 2014 from: http://www.healthit.gov/providers-professionals/benefits-electronic-health-records-ehrs

HealthcareIT.gov. Meaningful Use Definition & Objectives. Retrieved March 17, 2014 from: http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives

National Institutes of Health. (April, 2006). Electronic health records overview. Retrieved March 16, 2014 from: http://www.himss.org/files/HIMSSorg/content/files/Code%20180%20MITRE%20Key%20Components%20of%20an%20EHR.pdf