Electronic Health Records Implementation

Introduction

Due to the benefits involved, healthcare organizations are rapidly adopting EHR technology. However, the use of the system is limited since out of 44% of facilities using the system, only 5% employ all available features (DesRoches et al., 2013). This adoption rate and the limitations regarding use are associated with several barriers to EHR use, including costs, technology limitations, and insufficient training.

Background

It has been found that almost 60% of the negative events patients experience could be prevented (Ajami & Bagheri-Tadi, 2013). A primary objective for the use of EHRs is to reduce medical errors. One of the strategies to achieve this goal is to improve communication and collaboration among healthcare practitioners (Ajami & Arab-Chadegani, 2013). EHR can be defined as a computer-based system employed to store, collect, and share patient information throughout an individual’s lifetime. EHRs, which have been in use for over three decades, may include personal information, laboratory tests, treatments, observations, medical images, therapies, administered medications, legal permissions, and financial data.

System Functionality

Seckman (2016) describes nine major components of EHRs. Administrative processes involve conducting administrative and financial functions (such as admissions, schedules, patient claims, and administrative reports). Communication and connectivity are associated with the communication between healthcare professionals and patients (email, mobile means of communication, telemedicine). Decision support includes providing reminders, resource links, and alerts (clinical guidelines, medication dosage, links to helpful resources, risk prevention). Dentistry and optometry incorporate vision and dental records.

According to Seckman (2016), health information and data function involves entering and accessing data necessary for making clinical decisions (problem list, patient demographics, diagnoses, allergies, medications, reports). Order-entry management implies entering different orders through the computerized system (pharmacy, laboratory, radiology). Patient support offers patient self-monitoring tools and patient education instruments (instructions, learning, telemonitoring). Results management is concerned with diagnostic reports (radiology reports, laboratory tests). Population health management is the process of using data collection instruments aimed at supporting reporting requirements (public health system, bioterrorism surveillance, disease surveillance).

Common Issues and Errors (Practitioner Level)

Fucinari (2016) stresses that the use of EHRs is often associated with certain errors and issues that are common for many healthcare facilities. These mistakes can be found on the practitioner and organizational levels. The review of the system is a necessary but non-existent function that could prevent treatment contraindications. The function enabling automatic data entry may lead to various errors as healthcare professionals often forget to change information (Seckman, 2016). Medical personnel also tend to key in positive information, which can lead to distorted diagnoses and treatment plans. Patient assessment is a complex process enabling the staff to obtain valuable information. However, instead of entering all meaningful details, diagnoses are included. Physicians often refer to a list of the diagnoses they frequently encounter, which has a negative effect on patient outcomes.

Organizational Level

On the organizational level, some common issues also have an impact on the functioning of the system. Technical problems often occur, making it difficult or even impossible to access data and make decisions. Software providers upgrade the systems, but healthcare professionals are not prepared or trained to deal with the changes, causing inadequate use of EHRs (Fucinari, 2016). This problem is associated with another common issue: Healthcare practitioners do not receive necessary training, leading to various errors. Finally, it is essential to ensure that audits are regularly implemented. These reviews can be instrumental in identifying the most urgent gaps to address in the system.

Benefits of EHR

One of the primary benefits of adopting EHRs is cost reduction (Seckman, 2016). The use of the system is associated with a positive return on investment, billing efficiency, increase in productivity, improved reimbursement rates, lower medical records costs, and decreased length of stay. One of the factors contributing to financial benefits is better access. The staff has fast access to the necessary data and can make decisions rapidly and effectively. Increased quality is also a significant benefit. Healthcare practitioners report that the system alerts them to possible mistakes, enables them to access data in a timely manner, helps in making important decisions, and facilitates communication with patients (King, Patel, Jamoom, & Furukawa, 2013). All these features contribute to improving the quality of provided services, patient safety, and efficiency.

Barriers to Implementation

One of the most pronounced barriers to implementation for many facilities is the high cost of an EHR system (Jamoom, Patel, Furukawa, & King, 2014). The software can cost between $1 and $10 million, while maintenance costs may be up to 15–20% of the price. Data integrity is becoming a considerable barrier as the data now come from multiple sources as facilities have begun sharing certain information (Seckman, 2016). Confidentiality and privacy issues are regarded as significant obstacles to effective EHR adoption. Customers are still vulnerable to breaches, violations, and other problems that can lead to undesirable consequences. The lack and sometimes non-existence of standards hinders the effective use of the system as different facilities, institutions, and individuals tend to rely on different terminology, instruments, concepts, and strategies when addressing various issues.

The use of EHRs is an innovation that can be difficult to adopt within different contexts. Organizational cultures that do not embrace innovation, learning, and change are unlikely to effectively adopt EHRs. Although improvements in this area are substantial, user experience is still a barrier to EHR use (King et al., 2013). Using the system can often be a frustrating experience. Patient access is regarded as a necessary feature, but providing this access requires significant investment and development. The information is often fragmented, making it difficult to ensure patient access to the necessary relevant data. Safety is also an area of concern.

Overcoming Barriers

In order to address cost barriers, facilities should focus on their funds allocation policies. Participation in the development of a Health Information Exchange is also beneficial (Seckman, 2016). This system enables different facilities to use similar systems, reducing costs. Staff training is a key to overcoming barriers associated with data integrity. Furthermore, it is important to establish certain penalties for some types of errors and fraudulent activities. Clearly, software providers should continuously work on improvements. Staff training as well as software development and improvement are central in addressing issues related to confidentiality and privacy (Strong et al., 2014). To tackle the obstacles associated with the lack of standards, it is essential to take part in an ongoing effort aimed at establishing standards.

The effective adoption of EHRs is possible within the context of an appropriate organizational culture. In many cases, it can be necessary to implement change. In order to develop and establish the organizational culture under consideration, it is critical to focus on hiring, staff training, motivation, and the corresponding policy-making (Koppel & Lehmann, 2014). Innovation should be an integral part of facilities’ culture. User experience can be improved via software development and staff development. In many cases, healthcare professionals feel frustrated when using EHRs due to their lack of knowledge and skills.

Clearly, software providers should continue working on improvements that make the system easy-to-use and efficient (Rippen, Pan, Russell, Byrne, & Swift, 2013). Addressing the barriers related to patient access is one of the most challenging tasks. Some of the steps to be undertaken include staff training, software development, and extensive research. Apart from making sure that practitioners have the necessary skills to use the system, it is important to ensure that facilities’ standards are compatible with the available digital instruments. Finally, it is vital to conduct extensive research concerning patient needs, which may reduce the costs of new software development and use. Knowing exact patient needs can help make the process of adopting new technologies more cost-effective.

Conclusion

On balance, the adoption of EHRs can be regarded as the present and the future of health care. Technology enables healthcare providers to improve the quality of care to achieve the most positive patient health outcomes. The primary barriers to the effective use of EHRs include software cost, technology limitations, inadequate standards, and practitioners’ insufficient knowledge and skills. In order to address these barriers, facilities should consider close collaboration with other providers, developing an innovation-based organizational culture, and participating in the process of standards introduction. It is also essential to implement extensive research to identify the major gaps in the system and patients’ and practitioners’ needs, as well as ways to handle existing issues.

References

Ajami, S., & Arab-Chadegani, R. (2013). Barriers to implement electronic health records (EHRs). Materia Socio Medica, 25(3), 213-215.

Ajami, S., & Bagheri-Tadi, T. (2013). Barriers for adopting electronic health records (EHRs) by physicians. Acta Informatica Medica, 21(2), 129-134.

DesRoches, C. M., Charles, D., Furukawa, M. F., Joshi, M., Kralovec, P., Mostashari, F., … Jha, A. K. (2013). Adoption of electronic health records grows rapidly, but fewer than half of US hospitals had at least a basic system in 2012. Health Affairs, 32(8), 1478-1485.

Fucinari, M. P. (2016). The 10 most common EHR documentation errors. Web.

Jamoom, E. W., Patel, V., Furukawa, M. F., & King, J. (2014). EHR adopters vs. non-adopters: Impacts of, barriers to, and federal initiatives for EHR adoption. Healthcare, 2(1), 33-39.

King, J., Patel, V., Jamoom, E. W., & Furukawa, M. F. (2013). Clinical benefits of electronic health record use: National findings. Health Services Research, 49(1pt2), 392-404.

Koppel, R., & Lehmann, C. U. (2014). Implications of an emerging EHR monoculture for hospitals and healthcare systems. Journal of the American Medical Informatics Association, 22(2), 465-471.

Rippen, H. E., Pan, E. C., Russell, C., Byrne, C. M., & Swift, E. K. (2013). Organizational framework for health information technology. International Journal of Medical Informatics, 82(4), e1-e13.

Seckman, C. A. (2016). Electronic health records and applications for managing patient care. In R. Nelson & N. Staggers (Eds.), Health informatics – e-book: An interprofessional approach (2nd ed.) (pp. 90-110). St. Louis, MO: Elsevier Health Sciences.

Strong, D. M., Volkoff, O., Johnson, S. A., Pelletier, L. R., Tulu, B., Bar-On, I., … Garber, L. (2014). A theory of organization-EHR affordance actualization. Journal of the Association for Information Systems, 15(2), 53-85.

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