Electronic Patient Records - Essay Example

Electronic patient records (EPR) Introduction Medical information science is one of the rapidly expanding areas of information and communication technology (ICT). This has a complex use involving with electronic patient records, performance indicators, paramedical support, emergency service, computer aided diagnosis, medical control, research support, and hospital administration. Its use should perfectly support and must definitely not be in disagreement with the basic medical moral principles. The Electronic Patient Record (EPR) is suggestive of the progress in medical informatics and agrees to suppliers, patients and payers to interrelate more capably and in life-enhancing behaviours. It presents novel techniques of storing, controlling and conversing medical information of all kinds; those are more influential and flexible than paper base recording methods. It is the strategy of governments that seems to support a national healthcare infrastructure with a longitudinal patient record comprising a patients whole medical history from the birth to the death. At the same time, these advances increase a number of moral concerns. EPR may easily build a doctor-patient rapport through use of computerised notes, which the doctor and patient share. On the other hand, EPRs can damage the relationship and weaken faith. For instance, in the some developed countries there are medical data clearinghouses that trade medical patient information to insurance companies, police departments, employers, drug companies, and so on. As a result, patients are becoming unwilling to tell their doctors all about their medical conditions and the origin of them. Because of this doctor-patient rapport gets damaged and most crucially threatens to damage quality of care. Obviously, there is an anxiety and trade-off amid the need-to-know and the right to confidentiality that must be dealt with. Breach of medical confidentiality may seem to be easy for the reason that the competence of computerised systems. The harm to the patient whose confidentiality is dishonoured may be proportionately bigger as the quantity of information held within the EPR. But the merits comparing to the demerits are greater. The intention of this article is to trace the history of the efforts made by a Western industrialised nation to implement EPR, (b) to identify the benefits and issues arising, and (c) to reflect on the extent to which such an initiative is transferable to a developing country (Rogerson, 2000). Realization of EHR/EPR in England The development in medical science is in step with the growth in various other fields, mainly the progresses in the field of computer science. In this age of information, medical care needs computer technology and in future will only further flourish if healthcare personnel are at ease and at same speed with the advancement in computer sciences. This article looks in to the concept of electronic patient record in England that is being implemented at present. It is essential to understand terms, Electronic Health Record (EHR) and Electronic Patient Record (EPR). “EPR refers to a documentation of periodic care, held by a single provider concerning a single person and is patient centred” (InterSystems.com, 2007), (Martin, et al., 2008), while EHR refers to the fully incorporated documentations of the patient’s whole medical past. NHS explains it as the concept of electronic longitudinal compilation of patient’s health and health care – from birth to death. EHR merge information from diverse care settings held in different systems and in some cases aggregates the information and display them as a single record. The British Computer Society was founded in 1957 (British Computer Society, 2008). The Department of Health (DoH), in September 1998, policy document ‘Information for Health’ dedicated the NHS to lifelong electronic health records for all, throughout day and night, on-line access to patient records and information (insider.com , 2008). Another important step in this direction was the setting up of National Information Authority (NHSIA) in 1999 by an Act of Parliament, it combined all the IT and information bodies. In June 2002, National Programme for IT (NPfIT) was pronounced by Department of Health (DoH) and NHS Connecting for Health (NHS CFH) in 2005, with the obligation to deliver the programme, substituted NHSIA. The goal set for NPfIT is to have a sole, centrally managed electronic documentation by 2010 (insider.com, 2008). Strategically, NPfIT is divided into sub programmes; NHS Care Record Service (NHS CRS), Choose and Book, Electronic Transmission of Prescriptions (ETP), National broadband IT network for NHS (N3), Picture Archiving and Communications Systems (PACS), IT supporting GPs together with Quality Management and Analysis System (QMAS) and systems for GP to GP transfer of records (GP 2 GP) and lastly a message system NHS mail (connectingforhealth, N.D.). The backbone is the NHS CRS and is divided further; the Personal Demographics Service (PDS), the Personal Spine Information Service (PSIS) and the Secondary Uses Service (SUS) (connectingforhealth.nhs, N.D.). All these are interconnected by; the Transaction Messaging Service to permit medical messages from NHS CRS users to be safe and to handle the response to their needs. The internet based Clinical Spine Application offer healthcare experts with access to the NHS CRS to get patient information offered by the PDS and the PSIS. The Spine User Directory and Spine Accredited Systems are the security methods to make sure that messages are only processed from authorized users and systems - a key element of the security of the Spine and an Access Control Framework (ACF) to substantiate all users. ACF will provide a single login and a record of all healthcare experts accessing a patient’s NHS Care Record. PDS is the central and only source for patient demographic information, such as NHS number, name, address and date of birth. PSIS is central database containing clinical records for all NHS patient and supply the latest summary of information and important events in a patient’s life and care such as drug allergies, operations, conditions, medication history in addition to particulars of contacts with care givers. SUS will take care of the public health trends, examining the efficiency of treatments and scheduling the number of beds and staff the NHS needs. And also SUS will promote a number of national programmes, the first being Payment by Results, a key government plan that is shifting the way money flows through the NHS. The recent electronic booking facility, Choose and Book allows GPs and other main care staff to make hospital outpatient appointments at a suitable time and date for the patient. ETP will ease prescriptions of GPs to be transferred electronically from their surgeries to pharmacies; GPs send prescriptions to the Spine to make them accessible for dispensing. Simultaneously, prescribed medicine information is stored in patient’s electronic files held by the NHS CRS. The pharmacist can get the electronic prescription from pharmacy’s computer system and after dispensing the medicine, a communication is sent back to the Spine, recording what has been dispensed to the patient. The recent national network for the NHS in England is N3 and is a broadband service, provided by BT plc (n3.nhs, N.D.). Administration of EPR at hospital trusts is at six different levels. First level is Patient Administration System (PAS) and Departmental Systems, second level is incorporated patient administration and departmental systems, third level is clinical activity support and permitting doctors to order a clinical examination and get lab results, X-rays and other investigations, CIS and PACS are part of it (Stewart, 2001). Fourth level is clinical knowledge, result support and incorporated care pathways, computer system have an intelligent input into the patient care, like stopping/ prescribing a medicine to a patient who is allergic to it, fifth level is sophisticated medical documentation and incorporation and sixth level is complete multi-media EPR on line. These levels are being slowly launched to the hospitals, and the majority of hospitals in England are at level three of EPR. At present a study is being carried out by University College London called Early Adopter Programme (connectingforhealth.nhs. N.D.). The team comprises representatives of organisations, together with clinicians, hospital administrators, patients and ambulance services. The plan is to make one logical record of all data’s concerning a particular patient. The documentation will be recognized as the Summary Care Record (SCR). Five, Early Adopter Site in England are participating in this exercise. Benefits and challenges National Audit Commission reported in 2000, NHS disburses £3.6 billion for medical negligence claims annually. Further the Audit Commission report that 1,000 deaths yearly are caused due to medical mistakes, lack of correct patient information at the time of treatment (connectingforhealth.nhs N.D.). The audit study stated that the use of contemporary information technology could save 75% of these lives and could save time spend on documentation and communicating information on paper. Saving 10% of clinical time spent on patient paperwork could save around £6 billion yearly, which could be re-invested in patient care wisely. Modern technology can bring down this inefficient paper work and offer the electronic case sheets at the time of patient care efficiently. It is necessary to look in to the problems and difficulties England faced to complete this project. On its commencement, the programme cost was supposed to be £ 2 billion but it is now going to be up by 440% to 770% of its original estimated expenditure. Yet another problem is that as the information technology is continuously getting up-to-dated the expenditure of this change in technology going to be high and not easy to maintain. Constant technological attention and training is needed as time and technology changes. One of most important issue is the ownership, control and consent for data. It is vital to obviously describe the consent procedure for this data and its commercial and political use, new legislations required to avoid misuse of data by people in power or with business interests. Further to that the question is will people have the faith in the system to disclose each aspect concerning their life or are they going to hold back the information and have the right to do so? Because all this information may affect their future insurances, mortgage, jobs and many other things in their life. Since the data itself is multifaceted with inherent problems it is a huge task to keep it updated, maintain and working all the time. The problem of unlawful settlers, visitors and provisional worker in the nation need a concern as how to get their information and what to do with it once the individual is out of country? (Saleem, 2009) Institute of Medicine (IOM, USA) had affirmed that future patient record systems must support patient’s healthcare, assist to advance its value, have an impact to get better efficiency of healthcare personnel and reduce expenditure. Simultaneously they should be configured as acting in accordance with the future changes taking place in the fields of health technologies, policies, management and finance and resolute criteria that computer based patient records must have. An Electronic Patient Record System (EPRS) must be developed accordingly, should keep all information electronically concerning health condition and healthcare of a person’s life period and should have the capability to replace paper based health records as the basic evidence in a way that satisfies all medical, lawful and organizational requirements. At present, because of study and improvement in the fields of information technologies and medical informatics, profit-making EPRS products are more commonly used. Use of EPRS is a lawful requirement in USA and a number of European countries. Even though there are several international wide-ranging studies particularly in USA and Western Europe, use of EPRS could be realized in few developed countries so far, since its extremely multifaceted structure and procedures particularly in application field. Still, progress in present information technologies and cost reductions made feasible to plan EPRS on an appropriate form and a number of global companies have ongoing studies in this field. A paediatrician in Massachusetts, Dr. Peter Masucci, understood that changing to computerized processing patient’s details made possible to advance his patient care. A report, published online on ‘The New England Journal of Medicine’, shown that doctors who use electronic health records have improved the excellence and appropriateness of care. To improve patient care it is essential bringing patient records into the computer age, reducing mistakes and controlling expenses in the American health care system. The majority doctors in private practice, particularly those in small practices, not have the financial incentive to spend in electronic records. The countrywide study established that electronic records were used in less than nine percent of small offices, where almost half of the nation’s doctors practice medicine. Dr. Paul Feldan, one of doctors in a primary care practice in Mount Laurel, N.J., said that definitely, the idea of electronic records is wonderful, but the initial cost of upgrading the office’s personal computers is too high, and in addition the effort and technical support needed. Because of these reasons he decided not to go for it. Dr. Blackford Middleton, a health technology expert at Partners Healthcare, a non-profit medical group that comprises Massachusetts General Hospital in Boston suggested that the government should take responsibility in providing incentives or financial support to speed up the use of electronic patient records in the United States, whose acceptance rate trail the majority of developed countries. A fresh study based on a big sampling, about 2,600 doctors across the nation, and a thorough review, making it more perfect than precedent research; show a strong support to electronic health records. For instance, 82 percent of those using such electronic records said they enhanced the excellence of clinical decisions, 86 percent said they helped to stop medicine errors and 85 percent said they bettered the deliverance of preventative care. Dr. David J. Brailer, the former health information technology coordinator in the Bush administration said that those numbers are remarkable and encouraging. Large technology corporations, like Microsoft and Google, lately have started services that tender consumer-controlled personal health records over the Web, which are stored in the companies’ data centres. These consumer-controlled health records are planned to connect up and exchange data with electronic patient records in doctors’ offices and hospitals (Spencer, N.D.). Implementing electronic patient record systems in developing countries In spite of the complexities in organizing information systems in developing countries, some have effectively incorporated into medical fields. Though none stand for a total or perfect solution, their unbeaten use over many years, with collective patient records, presents important insights into victorious potential deployments. Indiana University School of Medicine and University School of Medicine (Eldoret, Kenya) teamwork led to the Mosoriot Medical Record System (MMRS), in February 2001. The MMRS was established in a primary care healthcare centre in rural Kenya. An evaluation of the clinic before and after acceptance of the MMRS illustrated patient visits were 22% shorter, provider time per patient was abridged by 58%, and patients spent 38% less time waiting in the hospital; hospital staff spent 50% less time interacting with patients (Fraser, et al., 2004). The MMRS has as well greatly simplified the creation of obligatory reports to the Ministry of Health and total change in clinical system. In Uganda, US Department of Health and Human Services has developed a medical record system to support HIV treatment using the Careware system. This offers complete tools for following HIV patients and their treatment, as well as clinical assessment, medications and billing data. It is extensively used in health centres and hospitals in the US, and has lately been deployed in Uganda in October 2003. Careware is a model of a US-based stand-alone EMR that is being tailored for developing country settings. “The Brazilian public health system uses the Computerized System for the Control of Drug Logistics (SICLOM) to provide ARV treatment to over 100 000 patients” (aids.gov.br, 2001). Separate EMR databases on every doctor’s computer system periodically connect to the central server by dial-up to update records. This system used to advise and track medicine supplies. It is well thought-out as a key factor helping to conquer logistical problems of delivery of antiretroviral treatment in Brazil (Galvao, 2002). England and other developed nations have steadily developed the technology and system over a period of time and as well improved the culture and social values for information technology and systems to prosper. The developing nations need not devise anything new, but must unite to share and contribute their attainment to the new global village - closely attached as one by information technology. As one can appreciate the several advantage of the healthcare informatics, there are lots of complexity came across by the English system which can be kept away by the developing nations. The developing countries need to have a ‘Lego’ like makeup in its place of one massive grand plan for the IT system. The costs may be manageable and private sector can also be able to contribute. They require introducing healthcare informatics in all the health linked institutions as an important subject. Trust and confidentiality has to succeed along with necessary legislation. Community understanding need to be elevated and simplicity with freedom of information need to be initiated. These steps are essential for the healthcare informatics to blossom (Saleem, 2009) Conclusion and suggestions It is vital to keep in mind that all good things come at a price, at times concession have to be made, and past methods and events have to give way to latest thoughts and innovative processes. Mind-set must be transformed with up-to-date information. The focus really required at this time is to put effort on public understanding and education, as the system is being set up. The healthcare employees being qualified for this alteration in the system and related schools/colleges need to incorporate this feature in the curriculum to organize the next generation of healthcare workforce who is capable to use this technology efficiently. The mission is one of the major of its kind and the success exists in its simplicity. And also there is a need to delegate the programme to a local level, observing the capability and interconnectivity as an important element of the programme. The advantages of EHR/EPR are well recognized. That means the patients have more option and less waiting time, the physician save time and can instantly access data on past record, hence making sure safe, competent, reliable and incessant healthcare for the patients. Health organization save time and funds by stream lining the system, avoiding duplicate instruction and stopping of pilferage of medicine. References aids.gov.br (2001) AIDS Drugs Logistic System.2001. [On line] Available from: [18 February 2009] British Computer Society (2008) British Computer Society Fortran Specialist Group Available from: [18 February 2009] connectingforhealth (ND) NHS Connecting for Health. [On line] Available from: [18 February 2009] connectingforhealth.nhs (ND) Spine factsheet. [On line] Available from: [18 February 2009] connectingforhealth.nhs (ND) NHS Summary Care Record. Concept training for Healthcare Staff ( non-GP) user guide V1.0 (Authorised). [On line] Available from: [11 June 2008]. connectingforhealth.nhs (ND) NPfIT vision to support the NHS modernisation programme. [On line] Available from: [18 February 2009] Fraser H, Jazayeri D, Nevil P (2004) An information system and medical record to support HIV treatment in rural Haiti. British Medical Journal 2004;329:1142–6 Galvao J. (2002) Access to antiretroviral drugs in Brazil. The Lancet 2002;360:1862–5. InterSystems.com, (2007). The Fast Path to Connected Healthcare Creating Regional and National Electronic Health RecordsWith InterSystems HealthShare [On line] Available from: < http://www.intersystems.com/healthshare/whitepapers/HealthShareWP.pdf> [18 February 2009] insider.com (2005/2006)Business plan. [On line] Available from: [18 February 2009] Martin D, Mariani J, Rouncefield M.(2008) Implementing an EPR Project: Everyday Features and Practicalities of NHS Project Work [on line]. Available from: [18 February 2009] n3.nhs (ND) What is N3? 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