Effectiveness and Efficiency of Electronic Record Keeping In Healthcare Facilities

Introduction

An electronic health record (EHR) is a patient’s medical history electronic version sustained by a health care provider over a given time and includes all the key administrative clinical data that are significant to that client’s care under a specific provider including vital signs, medications, problems, progress notes, demographics, radiology reports, past medical history and laboratory data (Carroll, Edward, & Rodin, 2012). The EHR automates information accessibility and it has the potential of streamlining the clinician’s workflow. EHR also directly and indirectly supports all the other care-related activities through various interfaces including outcomes reporting, quality management and evidence-based decision support. The next step in the continued health progress is EHR which strengthens the association between a clinician and patients.

Electronic health record (EHR) systems allow hospitals to stock and retrieve comprehensive information of a patient to be used by a health care giver or physician during their hospitalization across the health care setting. In every country, health information is one of the key factors contributing to the strengthening of health care delivery. Reliable health information leads to timely health planning and policies that leads to improved general health status in a region, and it serves as a vital element in a specific health facility in improving and managing healthcare delivery (NSW, 2012).

According to Carroll, Edward and Rodin (2012) the data, availability and its timeliness enables health care providers to provide better care and make better decisions. The EHR system improves the care of the patient by reducing medical errors by improving clarity and accuracy of medical records. It also avails health information, reduces duplication of test, reduces treatment delays, and it informs patients to make better decisions. Embedded clinical decision support together with other tools may assist clinicians to provide more effective, safer care than while relying on paper based and memory systems. EHR system also assists hospitals to improve, monitor and report health care quality and safety data.

Statement of Problem

The use of Information and Communication Technology (ICT) has rapidly grown in the delivery and provision of health care services. In many countries, the paper-based records have increasingly given away to electronic health records (EHR). The design of EHR is in such a way that it alleviates paper record system limitations and it improves the quality of care delivered. In a study conducted in Cameroon on EHR trail, organizational issues, lack of funding, insufficient training of personnel, insufficient leadership, among other were identified as the cause of failure to the system. This has called for studies in the system to increase efficient and effectiveness of EHR. The implementation of EHR is ascending in the country’s healthcare systems as majority of the major hospitals have resulted to EHR implementation to help in improving their record keeping system together with their healthcare delivery systems. However, as noted below, the challenges in implementation of EHR are likely to occur if appropriate measures are not adapted.

Purpose of the Study

The purpose of the study is to determine the effectiveness and efficiency of Electronic record keeping in healthcare facilities. The study will also be conducted in partial fulfillment of the researcher learning program.

Study Objectives

• Examination of the factors that promote or impede the usability of EHR system by health care providers
• Examination of the impact that is derived from EHR system installation and its influences to healthcare delivery
• Evaluation of the effectiveness and efficiency of EHR system

Research Question

1. What is the impact of the EHR on healthcare delivery?
2. What are the factors that promote or impede the usability of the system?

Literature Review

According to the Centers for Medicare and Medicaid Services (CMS), EHR is referred as the “the next step in continued progress of health care.” Despite electronic health records utility, health care facilities were originally slow in adapting them. According to American Hospital Association (AHA) 2009 survey, it was found that only 1.5 percent of healthcare facilities used a comprehensive EHR system. This means that the system was performing 24 specific functions and was used in all clinical units. 7.6 percent of the study group used at least an EHR in one clinical unit.

In accelerating widespread usage and adoption of EHR, part of the American Recovery and Reinvestment Act of 2009 (ARRA, or the stimulus package), the Health Information Technology for Economic and Clinical Health (HITECH) Act, established payment incentives from the Medicare and Medicaid hospital programs, they demonstrate that they are making use of EHR system to improve the care of a patient. The National Coordinator for Health Information Technology (ONC) office disseminated the criteria of EHR’s “meaningful use” which includes various specific applications in the tool for improved quality and safety. All hospitals who are meeting the criteria apply for payments (NSW, 2012).    

According to NSW (2012), adoption of EHR is being promoted by meaningful-use incentive payment, possibly while combined with the availability of better and new EHR products and increasing emphasize on integrating care accountability care organizations. There was a 2011 update to the 2009 survey of American Hospital Association (AHA) hospital revealed that the number of hospital using EHR doubled in two years. Just over half of all federal and community hospitals, which is nearly 2700 earned the meaningful-use payments for purchasing or having a contract to purchase HER (Carroll, Edward, & Rodin, 2012).

According to Giaedi (2008), there is increased deployment of electronic health record (EHR) within health care organizations to improve quality and safety of care. However, for this goal to be achieved, clinicians and other healthcare providers should use EHR, and this remains a challenge. Several factors are associated with EHR use. Maximization of the technical characteristics that supports the EHR system such as speed and value-added functionalities like automated reportsorder entry systems are documented with high EHR use. Training and user-related characteristics are also important.

In the early phases of planning, the integration of EHR in to the clinical workflow must be considered in order to integrate the system into a clinical use routine. Definitely, the need for a good fit between EHR and clinical practice routine is time efficiency and essential which are used to access the quality if this integration (Health IT Gov., 2014). NSW (2012) explains that health care providers spend a lot of their time providing direct care to patients with the hope that the EHR will increase their patient interaction time together with the quality of care they are delivering. Additionally, the provision of care requires clinical information as a routine clinical activity intrinsic aspect and it is essential from both the legal and professional standpoints.

According to Hoyt (2016), health care providers consider a system to be efficient if it reduces their documentation time, even though the aspect of time saving does not translate into better patient care. Due to the above reasons, on evaluation of EHR impact on healthcare activities, some studies uses direct patient care time as a secondary outcome and documentation time as a primary outcome. The significance of evaluating time efficiency in documentation is directly related to observation which increases documentation time. This acts as a barrier to successful EHR implementation.

Hoyt (2016) explains that the implementation of electronic health record requires considerable investment with majority of projects which averages to several million US dollars. In order to have a successful EHR, it is important that managers identifies and manages the elements of EHR implementation that are critical in enhancing documentation and time efficiency by nurses and physicians. User populations and clinical information systems vary in their characteristics making it hard for individual studies to identify common trends that predict EHR implementation success.

Methods

An extensive literature search was performed using HEALTHSTAR, CINAHL, MEDLINE and Current Health databases. The search included use of key words like computerized patient records, efficiency, organizational, hospital information systems, workload, medical records systems, electronic records, and task performance and analysis. Only English peer reviewed proceedings and journals were selected. This study excluded letters, editorials and conceptual papers. All papers addressing the research question were retrieved regardless of the study design they were using.

Discussion

According to the study, time efficiency is one possible outcome for which EHR integration success can be assessed and studies review also reported on user satisfaction, direct patient care time, overall impact on workflow, completeness of data entered and accuracy of the information. However, time efficiency is accepted as an important barrier or facilitator of EHR implementation. The following are the most important reasons why healthcare system benefits from widespread transition from paper to health electronics.

Paper Records Are Severely Limited

Health IT Gov. (2014) explains that paper records and documents have several shortcomings. Some documents may be illegible and may not be electronically stored or shared. The data may not be structured or computable hence not shareable with other computer systems. Other shortcomings include; easy to destroy, expensive to transport, copy and store; the negative impact on the environment, and difficult to analyze and determine who has seen it. Electronic patient encounters characterize a quantum leap forward in the ability and the legibility to rapidly retrieve information. Almost all industries are now digitized and computerized for trend analysis and rapid data retrieval.

According to Carroll, Edward and Rodin (2012), due to the relatively recent healthcare models of accountable care, patient centered medical home model and pay-for-performance organizations creating new reasons to embrace technology to assist in aggregating and reporting results in order to receive reimbursement. It is much easier to track and retrieve patient data and patient registries using EHR than using labor intensive paper chart reviews. EHR are better organized than paper charts and they allow faster retrieval of X-rays and lab results. An EHR is also likely to have electronic problem summary list which outlines the major illness of a client, medications, injuries surgeries and allergies (Giaedi, 2008).

EHR allows easy navigation through the entire patient’s medical history. It also makes the information of a patient to be available to health care providers on call so they can review patient’s records that are not in their panel. EHR is also known to improve the coding level. A study on impact of electronic health record on the clinical histories completeness in a delivery and labor unit which demonstrated it improves documentation as compared to paper-based histories. An EHR provides clinical decision support like reminders and alerts (Carroll, Edward, & Rodin, 2012).

 Need For Improved Efficiency and Productivity

According to Giaedi (2008), the goal of EHR is to avail patient information to anyone who needs it, where they need it and when they need it. An EHR retrieves results much more rapidly thus saving money and time. One of the newest features of comprehensive EHR is embedded clinical decision support. Clinical practice guidelines, linked patients handout and educational content can be part of the EHR. This permits discovering the answer of a medical question while the patient is still alive.

Quality of Care and Patient Safety

Through many mechanisms, an EHR improves the safety of the patients. It improves the legibility of clinical notes, together with its access time anywhere. At a glance, electronic problem summary lists provide surgeries, allergies and diagnosis. EHR reduces duplication of information (Giaedi, 2008). As compared to paper chart that requires a chart review, EHR easily generates quality reports. A health information or data warehouse organization generates quality reports which receive data from an EHR and other sources.

Governmental Expectations

Hoyt (2016) explains that the Federal government considers EHR as an integral and transformation to healthcare reform. This results to reimbursement in the major HITECH Act focal points. It is the US Government goal to have an interoperable electronic health record by 2014. Additionally, to federal government support, payers and states have the initiative of encouraging the adoption of EHR. According to many organizations, the state of healthcare should move from cow path to the information highway.

Financial Savings

According to the Center for Information Technology Leadership (CITL), $44 billion yearly are saved by ambulatory EHRs, and in rejected claims per patient per outpatient visit, it eliminates more than $10. The CITL concludes that not only does it save money in eliminated chart rooms and record clerks; but it also reduces the transcription requirement. The EHR reduces the chart pulls and labor costs, mail expenses faxing and hence saving full time equivalents (FTEs) (Hoyt, 2016).

 Technological Advances

Hoyt (2016) explains that the internet and World Wide Web make the electronic health record’s application service provider (ASP) concept possible. The ASP preference means that the software of EHR and patient data is residing on a remote web server that accessible by the user via the internet from hospital, home, or office. The access to the electronic health record, hospital information system and the internet using a variety of mobile technologies, are permitted by mobile and wireless networks.  

EHR is a Transformational Tool

According to Hoyt (2016) large organizations such as the Kaiser Permanente and Veterans Health Administration use EHR robust like (VistA and Epic) which generates enough data that changes medicine practice. As a result of their visionary leadership and comprehensive EHR (KP HealthConnect) they have seen improvement in population health, care coordination and standardization of care. These organizations have also been able to experience advanced EHR data analytics by use of computerized simulation models (Archimedes), use of artificial intelligence and their Virtual Data Warehouse.

Studies have it that majority of EHR critical outcomes relates to patient’s safety and quality of care (Gordon, 2012). Patient safety involves avoidance of injuries to the patient from care that is intended to help them while the quality of care involves ‘‘doing the right thing at the right time in the right way to the right person and having the best possible results’’. The quality of care is measured in six dimensions: patient’s safety, effectiveness, efficiency, patient-centeredness, equitable access and timeliness. Saver (2010) explains that empirically, EHR has linked with increased adherence to adequate care and evidence-based clinical guidelines. From the perspective of societal public health, adhering to guidelines keeps individuals health while lowering their risk of disease outbreaks.

Conclusion

Nationally, EHR implementation is a necessity; although it is not satisfactory to transform the health care system in US for better, its adoption is one of the many approaches that focus on cost reduction and quality improvement. The existing major political and legislative HER support represents the greatest health information technologies investment in the US. The increased accessibility and portability of electronic medical records increases accessibility by unscrupulous users or unauthorized personnel, which calls for Health Information, and Accessibility Act. EHR is effective and efficient while compared to paper records as its advantages far outweigh the disadvantages. 

References

Carroll, S., Edward, J., & Rodin, D. (2012). Using Electronic Health Records to Improve Quality and Efficiency: The Experiences of Leading Hospitals (1st ed.). THE COMMON WEALTH FUND. Retrieved from http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Jul/1608_SilowCarroll_using_EHRs_improve_quality.pdf

Giaedi, T. (2008). The Impact of Electronic Medical records on improvement of health care delivery. The Libyan Journal Of Medicine. http://dx.doi.org/10.4176/071118

Gordon, L. (2012). Electronic Health Records And Improved Care. Health Affairs, 31(6), 1366-1366. http://dx.doi.org/10.1377/hlthaff.2012.0474

Health IT Gov,. (2014). Medical Practice Efficiencies & Cost Savings. The Benefits Of EHR. Retrieved from https://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings

Hoyt, R. (2016). Benefits of switching to an electronic health record. Health Informatics: A Practical Guide, 6. Retrieved from http://www.practicefusion.com/health-informatics-practical-guide-page-1/

NSW,. (2012). Health Care Records – Documentation and Management. Ministry Of Health NSW. Retrieved from http://www0.health.nsw.gov.au/policies/pd/2012/pdf/PD2012_069.pdf

Saver, B. (2010). One System For Electronic Health Records. Health Affairs, 29(6), 1273-1273. http://dx.doi.org/10.1377/hlthaff.2010.0514