Current Problems in Electronic Healthcare Records Implementation - Research Paper Example

Electronic Healthcare Records (EHR) Lecturer: Introduction An Electronic Healthcare Record (EHR) is a streamlined digital record (system) that stores patient information. Patient information includes variables such as: administrative and billing information; patient demographics; progress notes; family history; vital signs; previous illnesses; previous medical treatments; radiology images; immunization dates and laboratory data. The EHR system has the capability to generate specific reports about the patient data so as to enhance efficiency while disbursing care to the patient (HIMSS, 2014). Functions of EHR systems EHR systems have a number of functions (HFMA, 2006). These include: Administrative functions: These include operations such as billing, patient scheduling and resource management. Order entry and management functions: These include operations such as consultation, medical ordering and clinical tests ordering. Results management: Practitioners can be in a position to access patient information when needed. From there, they can be able to disburse care to the patient. Electronic communication: EHR allow for swift and effective communication of patient information among practitioners. Health reports generation: EHR systems can generate immediate health reports about the patient’s information and use it for analysis and/ or evaluation. Patient communication and access: EHR systems allow the patient to gain access to their medical records. Clinical decision support: EHR systems have the capability to compute diagnosis and treatment results so as to verify their accuracy and correctness before care is disbursed to the patient. Electronic data capturing: EHR systems capture the patient’s information on an online and centralized database that can be accessed from anywhere when needed. EHR standards EHR systems need standards that will enable interoperability between systems as well as offer meaningful use of the EHR. As such, the current standards that exist are focussed on ensuring that the EHR are interoperable and they allow the practice to showcase meaningful use. The Office of the National Coordinator for Health Information Technology’s (ONC) is on the forefront to seek ways that will propagate interoperability in vendor’s EHR systems. As such, they have backed up the Clinical Document Architecture (CLA) Continuity of Care Document (CCD) of Health Level 7 International (HL7) (EHR Intelligence, 2013). Other standard’s initiatives include: the standardization of healthcare vocabularies; transport through email protocols that are secure; services through transparent and accessible application programming interfaces (API’s); privacy and security through the implementation of standards set out by the National Institute of Standards and Technology (NIST). Steps in the implementation of EHR It is recommended that EHR systems should be implemented by hospitals and clinics so as to improve on the quality of care. As such, below is the step by step guide while implementing EHR systems (USDHHS, 2013). Step 1: Assess your clinical practice readiness This step involves: conducting an assessment of the EHR system need; outlining the goals and objectives to be achieved when the EHR system has been implemented and determining the financial capability to implement the EHR system. Step 2: Plan your approach The second step involves planning how the EHR will be implemented successfully. Moreover, the goals and objectives mentioned in step one should be reviewed so as to ensure that the plan is efficient and effective. Other factors that need to be reviewed include: the information security policy template; EHR workflow process mapping and implementation and the workflow redesign templates. Step 3: Select or upgrade to a certified EHR system The third step involves selecting the best EHR that suits the practice processes and operations. It is important for the practice to implement an EHR system that has been certified so as to avoid financial loss. In the event that the EHR does not optimally fit into the goals and objectives mentioned steps could be taken to ensure that it is aligned to the goals and objectives of the practice. Step 4: Conduct training and implement an EHR system After the EHR system has been selected, the next phase is implementing the system and later conducting training. While implementing the EHR, the plan and schedule has to be adhered to strictly so as to eliminate the chances of making errors which could impact the overall functioning of the system in the long run. Therefore, the following aspects should be considered while performing the implementation plan: chart migrations and scanning checklist; EHR go-live checklist and the EHR system testing plan. Step 5: Achieve meaningful use This step ensures that the EHR works as per the plan outlined in steps 1 and 2. Moreover, it ensures that the EHR system has achieved its “meaningful” use as mandated by the Medicare and Medicaid EHR Incentive Programs. Meaningful use entails: improvement in quality, safety and efficiency of care; patient engagement; co-ordination of care; privacy and confidentiality of patient information and improvement of public health. Step 6: Continue quality improvement This is the final step while implementing the EHR system. It involves the continuous evaluation of the EHR system during its use so as to ensure that it fulfils the outlined goals and objectives. In the event that EHR is known to not fulfil the mandated objectives and goals, strategies should be laid out so as to correct the issues identified. Benefits of Electronic Healthcare Records (EHR) EHR systems have a number of benefits to the hospital that implements it. These include: Improved care co-ordination: EHR systems have the capability to integrate and organize patient information. Moreover, they can aid in disbursing the patient’s information to authorized hospitals that the patient visits. The benefit of this attribute to the patient is that: they can be in a position to visit a number of specialists without limitations; they can receive emergency treatments from any health care institution; the patient does not have to perform unnecessary tests while visiting different care experts and they offer better transitional care between health care settings. Availability of patient information: EHR systems assist in disbursing patient information to authorized care experts since they have an integrated and centralized data repository. As such, the patient does not need to worry about explaining their condition (s) to different specialists. In a survey that was conducted on the effectiveness and availability of patient information, 94% of the providers confirmed that EHR systems enabled information to be readily available at the point of care. In addition, 75% of the providers mentioned that EHR systems enabled them to receive lab results faster (Jamoom et al., 2012). Patient participation: EHR systems involve the patient in matters regarding to their health. As such, the patient and the doctor can be in a position to make decisions on the care that the patient shall receive. Moreover, medical aid providers can manage patient appointments electronically and also communicate to them when the next appointment shall be. Hence, EHR systems provide easy communication between the patient and the provider hence optimizing on patient participation. In a survey that was conducted to determine the effects that EHR had on patient, providers mentioned that there was a 27% increase in the number of office visits (Jamoom et al., 2012). Improved accuracy in diagnosis and health outcomes: EHR systems ensure accuracy of the data and/ or information contained in a patient’s report through their in-built computing and analysis functionalities. This helps medical providers to make better diagnosis and treatment decisions as quickly as possible. Hence, this increases patient’s health outcomes. In a survey that was conducted to determine the accuracy of EHR systems in diagnosis, 75% of the physicians mentioned that it helped them to deliver optimal patient care (Jamoom et al., 2012). Better medical practice: EHR systems help to schedule patient appointments by directly linking the appointment to the patient’s notes. Secondly, they have interlinked modules which enhance effective communication of the patient’s information. In a survey that was conducted to determine if EHR produced any clinical benefits, 88% of the practitioners supported this fact. In addition, 79% mentioned that the overall clinical practice was efficient with EHR use (Jamoom et al., 2012). Electronic prescribing (e-prescribing): EHR systems are also used in e-prescribing. This is due to the reason that the patient’s data is contained in the system. As such, the physician can communicate with authorized pharmacies before they issue medication to the patient. This helps to reduce medical errors, lower costs and improve the quality of care. Privacy and security of patient data and/ or information: EHR systems have the capability to offer maximum confidentiality and security of the patient’s data and/ or information. This is due to the reason that the system is only accessed by authorized personnel. In a survey to determine the confidentiality index of EHR systems, 70% of the physicians mentioned that EHR offered better security as compared to paper based systems (Jamoom et al., 2012). Financial gains: EHR systems have electronic billing functionalities that help to cut on costs needed to employ accounting personnel. Secondly, they have chart management features that eliminate the use of paper charts in practice. Hence this saves space and money. Thirdly, they allow for the tracking of pay-for-performance and lastly, they eliminate transcription costs. Barriers to EHR implementation Despite the benefits that EHR brings, there are some barriers that have an effect on its implementation. The table below summarizes the major barriers as noted by Jamoom et al. (2012). Table 1: Barriers to EHR adoption Source: Jamoom et al. (2012) Costs of purchasing a system: 58% of physicians mentioned that the cost associated with adopting the system was high. As such, only 55% of physicians had adopted the system into their practice operations. Loss of productivity: 46% of physicians mentioned that the adoption of the EHR system would lead to productivity loss in their practice. EHR that meets practice needs: 34% of physicians mentioned that EHR do not meet their needs effectively. Hence, it could be a hindrance to their practice. Maintenance costs: 33% of physicians mentioned that the annual maintenance costs associated with EHR was high. Training adequacy: 33% mentioned that the training provided was not adequate to their practice. Effort needed to select and effective and efficient system: 31% mentioned that selecting an EHR system that fully suits their needs was a cumbersome task. Technical support: 30% mentioned fear in the lack of technical support after they implemented the EHR. Resistance to change by practice work force: 30% were not ready to change from their existing practice methods and operations to using the EHR. System reliability: 25% mentioned that the EHR system was not reliable enough to be used in their practice. Ability to secure financing of the EHR system: 20% of the physicians mentioned that their finances were little and they could not adopt the EHR system immediately. Internet access: 8% mentioned that the stability of internet access would hinder their full optimization of the EHR system. Other barriers set out by (HFMA, 2006) include: Lack of standards and code sets: 62% of the practices stated that there were no clearly defined standards that would be followed to ensure interoperability and meaningful use (MU) of EHR. Concerns about physician use: 51% of practices were not sure about how to optimally implement, use and benefit from EHR. Lack of interoperability: 50% of physicians mentioned that the lack of interoperability between EHR systems caused them to have a redundancy in adopting EHR into their operations. Lack of available funding: 59% of practices claimed that there weren’t enough funds and/ or government funds that would help practices incorporate EHR into their operations. The solutions to the barriers of the adoption of EHR Some of the solutions to the EHR barriers include: Setting of standards for interoperability and meaningful use (MU): 62% of practices in the HFMA (2006) survey mentioned that the lack of national standards which ensured MU would be a barrier in the implementation of EHR. As such, if the federal government was to set out the standard EHR guidelines, them the numbers of practice adopting EHR would increase progressively. Funding and incentives: It is without doubt that EHR adoption costs are extremely high. In a 2005 RAND analysis, it was revealed that implementing EHR in the US for the next 15 years would cost approximately $100B. Moreover, $6.5B would be spent by hospitals annually and $1.1B would be spent annually by physicians (HFMA, 2006). Based on those figures, a majority of clinical practices as well as physicians mentioned that the federal government should step in and aid in funding. Other practices and physicians mentioned that, if the federal government was not capable of offering funding, then they should reduce the regulatory barriers such as Medicare payment systems. This would in turn reduce administrative costs; hence, allowing the practice to have money saved up for ICT investments such as EHR (HFMA, 2006). Practice and physician acceptance: Resistance to change is an issue in a number of practices. In a report by Jamoom et al. (2012), 30% of practices were not willing to adopt EHR into their operations. As such, if the benefits of using EHR were outlined and put into test, then change would not be a big deal in practice. The impacts of the adoption of EHR systems on healthcare EHR have a number of impacts both positive and negative to the hospital’s operations, the patient and the physician (Jamoom et al., 2012). These include: Efficient practice operations: 79% of adopters who are MU ready supported the fact that EHR helped them to offer better and efficient care to patients. On the other hand, 76% of adopters who are not MU (meaningful use) ready supported the same. Efficient lab reporting: 75% of MU ready adopters and 61% of adopters who are not MU ready accepted the fact that EHR offered better lab reporting for their practice. Financial gains for the practice: 67% of MU ready adopters and 56% of adopters who are not MU ready accepted the fact that EHR brought financial gains to their practice since operations were electronic and not paper based. Saves time while sending prescriptions: 82% of EHR adopters who are MU ready and 67% of EHR adopters who are not MU ready confirmed its efficiency in sending Rx. Saves on paper costs: 75% of adopters who are MU ready and 72% of adopters who are not MU ready mentioned that it helped to save on paper costs. EHR aided in recruiting physicians: 68% of adopters who are MU ready and 58% of adopters who are not MU ready mentioned that the EHR system helped them in recruiting professional and experienced physicians to join their task force. Data privacy and confidentiality: 70% of MU ready adopters and 60% of adopters who are not MU ready stated that EHR helped to improve privacy and confidentiality of patient information as compared to the use of paper based systems. Improved doctor visitations: 27% of MU ready adopters and 22% of adopters who are not MU ready stated that EHR helped to increase the number of doctor visitations at the practice. Information availability: 94% of MU ready adopters and 91% of adopters who are not MU ready stated that EHR enabled the availability of information at the point of care when needed. Clinical benefits for practice: 88% of MU ready adopters and 79% of adopters who are not MU ready stated that EHR produced clinical benefits for their practice. Improved patient care deliver by the physician: 75% of MU ready adopters and 70% of adopters who are not MU ready stated that EHR optimized on care delivery by the practitioner. Increased time in reviewing orders and documenting care: 77% of MU ready adopters and 78% of adopters who are not MU ready stated that EHR had a negative impact with regard to the time needed to document care and review orders. Increase in the time needed to respond to pharmacy calls: 28% of MU ready adopters and 34% of adopters who are not MU ready stated that EHR increased the time needed to respond to pharmacy calls from the patients. Incomplete billing for services billing: 22% of MU ready adopters and 18% of adopters who are not MU ready stated that EHR caused incomplete billings for services. Effect of EHR on costs The costs of implementing EHR systems are quite expensive to a country’s national economy. Nations such as USA, UK and Australia have been having trouble with determining what the best strategy is so as to implement EHR systems nationwide without stepping out of the budget allocated. In the UK, the costs of implementing the EHR system rose from £2.6B in 2002 to approximately £15B in 2006. The same case stands for Australia where the costs rose from AU$500M in 2000 to AU$2B in 2006. For the US, the working estimate in implementation of EHR was determined to be approximately $100B and $150B and an annual operating figure of $50B in 2006 (Charette, 2006). In a 2005 study that was sponsored by both the Commonwealth Fund and the Harvard Interfaculty Program for Health Systems Improvement, it was revealed that approximately $156B was to be used as capital investment of EHR for the next five years (up to 2010). Moreover, $48B was to be used as annual operating expenditure. In addition to that, computer hardware and software funds had to be catered for separately and providers had to seek self funding while performing system maintenance. Based on the stated facts and figures, 58% of physicians mentioned that the cost associated with adopting the EHR system was high (Jamoom et al., 2012). Where we are and where we are going – the future for EHR It is without doubt that progress has been made with regard to the adoption of EHR. Despite the fact that a number of hospitals have not yet adopted the use of EHR, there is still room for them to adopt the use of health ICT into their operations. The federal government has played a huge role in trying to promote the adoption of EHR. For example, they offer funding and incentives to Medicare and Medicaid if they choose to adopt EHR. Apparently, Medicare pays their doctors $44,000 for over five years while Medicaid pays their doctors $63,750 for over six years. These payments not only encompass on EHR use, but they also focus on the ability of the practice to use more features in the EHR system such as communication with other EHR systems. The approach that has so far yielded progress in the implementation of EHR is the carrot and stick approach. This is where the practice is rewarded for using EHR and penalized for not using it. The result of this approach as noted by the US Department of Health and Human Services is that the numbers of adopters increased from 17% in 2008 to approximately 50% in 2013. Lastly, the future of EHR is promising due to the reason that by 2015, Medicare shall start to penalize physicians who do not achieve MU while using EHR. As such, each system adopted by any hospital shall be MU ready (Theo, 2013). Conclusion The US federal government has been having challenges with implementing health information technology in US hospitals since the administration of G.W Bush to the current administration of Obama. Still, there are no optimal strategies which can be implemented so as to promote the adoption of EHR despite the barriers that currently exist (Steinbrook, 2009). In different studies, the top EHR implementation barriers that were noted by a lot of practices and physicians were: the start-up and running costs associated with implementing EHR; the annual maintenance costs of EHR; the lack of standards that strive for interoperability and meaningful use (MU); financial penalties for practices that do not have certified EHR that strive to achieve MU (Ford et al., 2010; Jamoom et al., 2012); the lack of funding and/ or federal aid; an EHR that fully meets practice needs; physician and practice acceptance (resistance to change); reliability of the EHR system and technical assistance. There have been a number of solutions that have been strategized to decrease on the number of barriers in the adoption of EHR. However, these solutions may take some time to be fully incorporated into the practice and reap the benefits that EHR comes with since the future of EHR is promising. Bibliography Charette, R. N. (2006). EHRs: electronic health records or exceptional hidden risks?. Commun. ACM, 49(6), p. 120 EHR Intelligence. (March 2013).What is the future of standards for EHR, interoperability?. Web. Retrieved from: http://ehrintelligence.com/2013/03/12/what-is-the-future-of-standards-for-ehr-interoperability/ Ford, E. W., Menachemi, N., Huerta, T. R., & Yu, F. (2010). Hospital IT adoption strategies associated with implementation success: implications for achieving meaningful use. Journal of Healthcare Management, 55(3), pp. 175–189 Healthcare Financial Management Association (HFMA). (February 2006). Overcoming Barriers to Electronic Health Record Adoption. Web. Retrieved from: http://www.vermontmanagedcare.org/Contribution/Providers/EHR/EHR_PDFs/2006%2002%2006%20HFMA%20Over.pdf Healthcare Information and Management Systems Society (HIMSS). (2014). Electronic Health Records. Web. Retrieved from: http://www.himss.org/library/ehr/?navItemNumber=13261 HealthIT. (N.d). Health Information Exchange (HIE): Benefits of Electronic Health Records (EHRs). Web. Retrieved from: http://www.healthit.gov/providers-professionals/benefits-electronic-health-records-ehrs HealthIT. (N.d). Health Information Exchange (HIE): Standards & Interoperability. Web. Retrieved from: http://www.healthit.gov/providers-professionals/standards-interoperability Jamoom, E., Patel, V., King, J., & Furukawa, M. (August 2012). National perceptions of EHR adoption: Barriers, impacts, and federal policies. National conference on health statistics. Web. Retrieved from: http://www.cdc.gov/nchs/ppt/nchs2012/SS-03_JAMOOM.pdf Steinbrook, R. (2009). Health care and the American recovery and reinvestment act. New England Journal of Medicine, 360(11), 1057-1060. Theo, Francis. (2013). Electronic Health Records: Where we are and where were going. Web. Retrieved from: http://www.pej-acpe.org/pej-acpe/july_august_2013?pg=84 US Department of Health and Human Services (USDHHS). (August 2013). How To Implement Electronic Health Records. Web. Retrieved from: http://www.innovations.ahrq.gov/content.aspx?id=3872 Read More