Electronic Health Records the Development

Electronic Health Records

The development and growing adoption of Electronic Health Records (EHRs) presents a variety of issues, with parties on all sides of the debate (patients/consumers, physicians, regulators, health insurers/payors) having sometimes opposing viewpoints.

Some of the benefits of Electronic Health Records include: accessibility and sharing of a patient's medical information among care providers, legibility, reducing medical errors (e.g, through EHR mechanisms such as automated drug checking), improving consistency and quality of care (e.g., through EHR mechanisms such as automated preventive screening reminders), and workflow efficiency (Thakkar & Davis, 2006). However, some of the pitfalls and drawbacks of EMRs can include extensive costs for computer systems, a long time frame for any true "return on investment," as described by Lohr (2007) in the example of Dr. Baron's practice, and patient privacy and data security concerns.

Additionally, some organizations that have adopted an EHR system have noticed a temptation on the part of busy residents and physicians to "cut and paste" chart notes from one patient to another as described by Hartzband and Groopman (1998). This practice perpetuates erroneous information in the new patient chart, or can create "generic" documentation that fails to highlight new or unique information, and allows for shortcuts in taking a thorough patient history.

Another issue cited by organizations that have used EHR systems is the challenge of interpreting too much information and data. Charts that are populated with large chunks of generic text, as described above, certainly contribute to this problem. Additionally, it is convenient and efficient for laboratories to download test results directly into a patient's electronic chart. Results are then available quickly, but it can be difficult for providers to sort through large quantities of information to isolate the most relevant lab data. However, this concern has been alleviated by many of the better EHR system -- for example, those certified by CCHIT (CCHIT Find Products) -- which include automated checking mechanisms that highlight any test results that fall outside of pre-defined normal ranges, making it easy for providers to instantly hone in on critical data.

The key to reconciling many of the concerns expressed by providers and patients regarding Electronic Health Records seems to lie with providing adequate training and guidance for the human users of these systems. As with almost any significant new technology advancement, the strength of the new tool is only as great as the effectiveness with which it is applied and managed by the people who use it. Staff must be trained to use Electronic Health Records in a way that optimizes the potential benefits of the new technology, while avoiding sloppy habits that not only reduce effectiveness but are even potentially detrimental to the quality of health care (Hartzband & Groopman, 1998). There are literally hundreds of Electronic Health Records applications and products available on the market today. It is up to each organization to choose the product that suits their user environment, but they should also select a product that is well designed to promote good clinical and practices.