Electronic medical records and healthcare quality improvement

¶ … Movement toward Electronic Medical Records

In the recent years, the United States of America's healthcare system has been riddled with criticisms. According to Fung (2012), the healthcare system is complex, expensive, and riddled with inefficiencies in quality of care. Poor quality of healthcare is closely associated with professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use." Improved quality of care can reduce mortality rate in the healthcare sector. According to Gabriel (2008), EMRs are instrumental in enhancing quality of heathcare. Gill (2009), explains that the United States has well received the EMR in outpatient settings. The government has slated over $20 billion of the federal economic stimulus to help practitioners, healthcare organizations, in adopting health information technology.

Defining Electronic Medical Records

Electronic Medical Records is a clinical information system that collects, stores, manipulates patient's records. The system also makes the collected information available in dispensing patient care. It is the data of a patient's medical records comprising complete interoperability within the healthcare organization. The system is based on a software ran on computers connected in a networked setting between various departments within a healthcare organization. The main purpose for the system is clinical data and may be limited in their scope of information for example, dedication to laboratory information or comprehensively cover a wide range of information.

Re-structuring the Healthcare System

Quality of Healthcare

Electronic Medical Records is a revolution in the healthcare sector. It improves the quality of healthcare in numerous ways. EMR as opposed to paper-based records are safely secured in the computer. These records stored in the computer are damage proof and have minimal chances of getting lost. EMR in this regard have advantages over the paper medical records as keeping more than one copy of a paper medical record is impractical. There are issues with storage space and the need to ensure that all records remain completely up-to-date. The single-record concept also prevents simultaneous access by more than one provider and by those who are not in proximity to the paper chart. In addition, when patient charts are delinquent, they are typically sequestered in the medical records department awaiting completion, which then necessitates that providers access these records in that location. Access to charts requires borrowing the medical record, and when lost, this patient data can rarely be completely replaced.

Paper-based records are subjected to filling, their management is a challenge, sorting them is time consuming and they are bulky. EMR makes searching for records easy with a single click of the mouse thereby reducing search time. EMR makes it possible to email reports to patients thereby showcasing advanced patient care. In addition, this makes delivery of reports to patients from other states less tedious and timely as opposed to mailing (Dray, 2002). This technology reduces chaos associated with paper clusters and information mismanagement. Instead of a health care center filled with papers it avails an organized environment with proper document management.

In addition, medical practitioners are able to easily share records and discuss rare clinical situation as opposed to the traditional paper-based records that require physical presence. With EMR medical records is easily and cost effectively distributed. In the same line, handwritten prescription is a practice of the past (DoBias, 2003). Medicine spelt similarly or misspelt is bound to be miss- understood at the dispensing pharmacy and can have dire consequences. Therefore a computer-based prescription neutralizes the dangers of prescribing wrong drugs to patients. EMR makes faster emergency service possible. Patients medical history is instantly generated leading to shortened treatment time as opposed to paper-based method. In addition, patient safety and care is guaranteed as information on Adverse Drug Reactions is readily available to the doctors. The technology helps patients make informed decision in treatment choices. They are made aware of the treatment methods available to them thereby reducing issues with Patient Consent as patient are informed of the risks and benefits associated with the treatment. This technology defiantly lessens the burden on the medical practitioners as well as patients.

Health Care Costs

Healthcare sector is experiencing decay of core processors. The old IT infrastructure is becoming ineffective. The healthcare sector can upgrade the old equipment to facilitate EMR thereby saving money. Due to the bulkiness of the paper-based medical records, many organizations have recruited additional staff in order to manage such operations and these additional staff require additional budget. Nonetheless, with paper-based medical records, the staff needs to realize that they must appropriately record patients' medical status in a bid to thrive in their medical practices and this requires large space. Therefore with the wisdom that business operations always grow with increase in revenue outlay or increased number of clients, as the medical practice grows, the organization will need to increase the storage space for keeping the medical records. This will require an additional cost in the healthcare organization (Reynolds, 2009).

According to Daily Koss (2009), there are healthcare centers that have cut operation costs by up to 40% after a successful EMR rollout. The medical practitioners don't have to get up to retrieve records, instead, patients records can be called without searching huge files, thereby limiting labor intensive healthcare system. In addition, this reduces time spent in mining and entering data, which translates to less hospital staff. It is no doubt that a records department will have limited paper work in turn translating to secondary cost saving measures.

EMR is beneficial not only to the healthcare organizations, but also to patients. Patients no longer have to carry copies of records to the doctor thereby saving paper. The patient no longer spends time calling their insurance company seeking to clarify information from their doctors. The patients are not subjected to expensive complications in case they get into a life-threatening situation because the emergency room is aware of medical history.

As part of comprehensive healthcare reform, use of EMR will have hospital share their records thereby reducing costs for patients, medical practitioners as well as the insurance companies. This will introduce a single payer system managed by a central body as opposed to individual health organizations.

EMR Interoperability

As a revolution and a healthcare reform tool, EMR is beneficial in an advance healthcare system. EMR technology should be able to share information seamlessly in an interoperable environment. This enables better work flow and limits repetitions thereby allowing data sharing among EMR systems and stakeholders in the healthcare system. This ultimately enhances delivery of health care by enabling appropriate information available at the right time to the right people.

Barrier and Challenges in Developing Electronic Medical Record System

Financial Barriers

Many physicians are face with monetary issues in the implementation of the EMRs. EMR implementation takes form of startup and ongoing costs. High start-up costs involve the budget of what is needed to install the system such as hardware and the software selecting and contracting costs (Randeree, 2007). In addition to startup costs, the other financial impediment is high ongoing costs involving system administration, control and maintenance that support the operations as well as efficiency. Many health organizations are concern with the financial risks of the EMR which is mainly Uncertainty over Return on Investment (ROI). It could take a long time before the return on investment is realized (Miller & Sim, 2004). The high cost of startup and maintenance can result in funding such projects. Therefore lack of financial resources is one aspect limiting the implementation of EMRs.

Technical Barriers

This is an advanced technology that requires complex hardware, software as well as advanced installation knowledge. It appears that medical practitioners are not adequately equipped with such computer skills therefore resulting in resistance of the technology. Many experienced practitioners got into the profession just about the time computers were introduced in the market for other purposes other than for medical record storage. It will require additional training for them to get the necessary skills. In addition, Lack of technical training and support is another aspect impeding the implementation of the EMRs. Medical practitioners struggle to get appropriate technical training and support in operation the system (Valdes, Kibbe, Tolleson, Kunik, & Petersen, 2004). It takes the medical practitioners' time to learn the system due to the complexity and usability problems associated with it. They have to learn the system effectively and efficiently. Organizations in the health sector speculate that the system will reach the limit hence becoming obsolete. Moreover, others claim that the system does not meet special needs and they cannot use it to their requirements (Randeree, 2007). There are also concerns of temporary loss of critical patients' information due to hacking, phishing as well as viral attack of the system. Reliability and dependability are key issue in the implementation of the EMRs as there are dire repercussions in event important patients' data are lost. In addition, interconnectivity and standardization with other devices raise issues making physicians reluctant to adopt the technology. It also appears that medical practitioners are reluctant to abandon the existing system for an integrated one.

Legal Barriers

Electronic Medical Records contain information that is private and confidential. The possibility of these records creating legal issues is high. This is one of the high barriers in the implementation of the EMRs. EMR gives flexibility of sharing information and this can lead to leaking of such information thereby raising privacy or security concerns. Medical practitioners are not sure whether this technology is a secure medium of storage of vital information. They fear that the system can be accessed by unauthorized personnel thereby creating grounds for litigations. Simon, et al. (2007), explain that to physicians, this issue is of utmost importance than the patients theselves, they believe that the system is prone to security and confidentiality issues.

Organizational Barriers

Organizational characteristics of individual practices determine the implementation of EMR.

According to Simon, et al. (2007) Organizational size is a determinant of the adoption of this technique. It seems that medical practitioners in large organizations are more likely to adopt the EMR than those in smaller ones. Larger health organizations are more likely to have extensive support in the application of the system. Conversely, these organizations need time to select and acquire this system and in addition, convert and enter information.

These organizations can however easily solve problems with interconnectivity as opposed to smaller ones because they possess stronger resources including expertise in management, support staff as well as the most important, financial resources. On the other hand Reardon and Davidson (2007), state that most smaller practices are IT enabled and do not have barriers associated with the implementation. On the same line, the affiliation of a practice to a hospital determines the implementation of EMR. It appears that employed medical practitioners are more likely to use EMR than those who own the their establishments (Burt & Sisk, 2005).

Change Process Barriers

EMR can bring change in the process of performing work that has taken a long time to establish. This can make medical practitioners unwilling to make the change. This makes the process a hindrance to the implementation efforts. Some of the issues that arise during the change process include lack of support from the organizational culture. There is need for cultural change in order for the implementation of EMR to occur and this change is slow (Randeree, 2007). There is need for change in aspects of the organization that can forester an electronic information system. The culture has to be friendly in order for there to be meaningful transformation from paper-based to an electronic record system. In addition, lack of incentives is a critical factor in the implementation of EMR. Unless the medical practitioners identify ways in which they will personally benefit from the system, they might not be motivated to adopt it. On the same note, lack of participation is also an important factor in the implementation of the EMR. The implementation of the EMR is most likely to be successful only when the entire organization participates in it. Nonetheless, lack of leadership is a major impediment in the adoption of the EMR system. Team leads or project managers have a critical role to play in either the success or the failure of adopting the EMR system. The leaders need to motivate the member of the organization of the importance and the benefits of the system. Failure to do this will be detrimental to the implementation plan (Miller & Sim, 2004).

Vendors of Electronic Medical Record

According to Hamilton, (2009) the following are the leading top ten healthcare Information Technology vendors in the United States of America. (Appendix 1)

Cost of Electronic Medical Record System

The cost of Electronic Medical Record system is not straight forward. It is not practical to stop by an electronic shop for an EMR system and choosing from a variety including prices. According to Valancy (2002 ), the vendors of EMR do not conform to a set price making it a challenge to compare various vendor proposals. Some prices are low with higer support cost while other are high cost. In most cases the ongoing costs are not included in the pricing (Appendix 2)

How Medical Record System Are Implemented

There need to be a proper implementation plan to avoid implementation gap after the installation of the stystem. Implementation that is not well managed is most likely to fall short of Expectations. First, the organization appoints someone to take charge of the implementation and act as a logistic manager. This person keeps the operations as well as the vendor on track.

Second, the organization through the logistics manager needs to monitor the cost of the project and check if they are within the original estimates. Making changes in the original budget can be detrimental to the implementation process.