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The Advantages and Disadvantages of Electronic Health Records

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    Running head: ELECTRONIC HEALTH RECORDS The Advantages and Disadvantages of Electronic Health Records Michelle H Gay Cabarrus College of Health Sciences Abstract There are many advantages to electronic health records but there are as many disadvantages to implementation of this technology. This paper will discuss the advantages and disadvantages that take place during the implementation process of electronic health records. This material was gathered from published materials.

    The health care industry is an organization that can prosper from electronic health records if the barriers can be overcome. The Advantages and Disadvantages of Electronic Health Records Society today is ever changing as is technology. Technology is omnipresent especially throughout the medical profession. Historically the only means available to record health information were paper and pen, today the industry has multiple options. This type of information has been known to be transmitted between practitioners and facilities via personal messenger, phone, or interdepartmental mail.

    There are numerous options of transmittal but most of the above mentioned methods were fraught with errors and time consuming. Medical information recorded in paper format makes tasks difficult, provides opportunities for mistakes, and lacks transferability. Many physicians’ offices and integrated health facilities are implementing an electronic health record in hopes that it will increase efficiency, reduce medical errors, and improve communication between the many providers in the system.

    An electronic medical record (EMR) is a medical record in digital format that allows for a variety of functions. Electronic medical record can facilitate access of patient data by clinical staff at any given location, build automated checks for drug and allergy interactions, incorporate accurate and complete claims to insurance companies, expedite the scheduling process of appointments, send and view certain types of labs, and send prescriptions to pharmacies electronically.

    Many facilities have accepted the benefit and importance of EMR but others are still reluctant for many reasons. The advantages and possible disadvantages are looked at from a broad spectrum by different people and different facilities. The low adoption rates according to the benefits and barriers that are presented need to be examined to fully understand why the US is observed as being behind the technology criteria (Hillestad, 2005). According to the National Ambulatory Medical Care Survey, on average of 17. % of physicians report using EMRs in their office based practices, 29 % use them in hospital outpatient departments, and 31% use them while in hospital emergency departments. As of 2005, adoption of the EMR has been the low with limited physician practices. Practices with more physicians and those owned by health maintenance organizations were significantly more likely to use this technology (Burt & Sisk, 2005). Researchers and analysts have pushed for EMR technology and have stated that information technology systems would improve quality of care and the efficiency of health services.

    It has been noted that the US tends to adopt other clinical technology but presently the adoption for EMR are straggling behind the other parts of the world. Burt and Sisk (2005) reported that the federal government has developed a framework to accelerate the adoption of Health Information Technology, with the goal of having EMRs for most practices within the next decade. This framework calls for bringing EMRs into clinical practice through financial and nonfinancial incentives and support.

    It also calls for interconnecting clinicians through regional and national frameworks, improving consumers’ access to information, and improving population health through public health surveillance. Quality-of-care monitoring, research, and dissemination of knowledge will aid in the framework for implementation (Burt & Sisk). There have been many surveys and discussions evaluating the benefits of EMRs and there continues to be significant challenges with acceptance.

    Less than a quarter of physicians use EMRs, further investigation into the low rate of adoption needs to occur. Most medical journals indicate that the primary reason for the low adoption rate is the high initial cost and the uncertainty of the financial benefits (Miller, 2004). In recent findings, upfront cost for an EMR system could range anywhere from $15,000 to $38,000 per physician with no guarantee of financial payoff (Crosson, 2005). The price is dependent on the unique structure of the practice, its needs, and its requirements.

    In a recent cost-benefit analysis presented in the American Journal of Medicine, the estimated net benefit from using EMR for a five year period was $86,400 per provider. These benefits accrued from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors. Additional findings included, that EMR in a primary care can result in a positive return on investment for the health care organization (Wang, 2003). This leads to the question as to “Why have all physicians not incorporated EMR in the clinical settings? ”

    There are several barriers that have left physicians skeptical to implement EMRs, some include the increased time that would be involved into the average workday for implementation (disruption), the challenge of the usability of the technology, inadequate support after implementation, lack of data exchange between other clinics (interoperability), lack of personal incentives after implementation for the high initial cost, patient privacy, older record incorporation, and in general a physician resistance to change (Miller, 2004). Several solutions for each barrier can be argued that has been presented.

    One solution to the concern of interoperability is the fact that most hospitals, laboratories, and pharmacies are incorporating several electronic data exchange systems to ease the difficulty in connectivity among physicians. Support for a product that is purchased is only good if the purchaser decides to use it. In research of the EMR systems that are on the market today, almost all of them offer continued support throughout implementation and beyond. The only barrier that could exist would be the user not taking full advantage of the support given.

    A technology barrier would be the physician that was not totally on board with the new program. To be able to use all the options that the EMR offers, the physician must dedicate extra time to understand the usability of the program and believe that it will improve quality of care. This would not be a quick process and this could only add to frustration of the implementation (Miller, 2004). Several articles and medical journals report the increasing concern of patient privacy. According researchers, roughly 150 people (from doctors nd nurses to technicians and billing clerks) have access to at least part of a patient’s record, and 600,000 payers and providers and other entities that handle providers’ billing data have some type of access. (Electronic Medical Record, 2008) This is a very discerning statement for organizations and physicians that are required to ensure protection of patient confidentiality and legal documents. Since the growth of EHR, there have been measures to improve software and for computer network security. All EMR software vendors are required to ensure adequate protection and only authorize parties access the information (Simon, 2007).

    Parallel to the many barriers to EMR implementation are the benefits. The benefits outweigh the barriers if they can be overcome without great difficulty. Several of these benefits include storage capabilities, security, support, speed, accessibility, infrastructure, versatility, administrative efficiency, clinical efficiency, quality of patient care and services, manageability, cost reduction, and revenue enhancement (Hillestad, 2005). The business world of the 21st century has become a very fast-paced and technologically advanced environment.

    When managing information, the clinics need to be precise and fast-paced. Electronic medical recording can speed up documentation by leaps and bounds with the data exchange time and less time spent troubleshooting documents for accuracy. Less time spent in documentation means the more time spent on the patient and the quality of care that is being given. Speed and quality care are huge players but the affects of documentation quality and efficiency of the clinic by acting in a fast-paced environment effectively is the better outcome.

    Another benefit to EMRs is the storage capabilities. Imagine trying to find the room to store 10 years worth of paper documentation on 1000s of patients. With EMR, the storage capabilities are endless in comparison. The database can manage records from multiple facilities as well as multiple types of records, and can be backed up for long term storage (Wang, 2003). Accessibility is an enormous benefit to physicians with EMR software. With the way technology has grown in the past decade, it is second nature for a hysician to access records from a PDA, palm device or online from another location. When a patient is coming in to the hospital emergently with chest pain, the Emergency Room can start assessing the patient and send the results to the physician on his PDA while he/she is in route. This could have a remarkable impact as to how soon a patient can receive treatment. For the patient, this could be the life saving act that technology and EMR has implemented. The time it takes for treatment of a patient like this one has been cut in half due to accessibility.

    This relates to the quality of care and the efficiency of the organization which is noticed by the community and the strides that the organizations are taking to meet the needs of each community (Miller, 2005). A powerful benefit that is never overlooked is the enhancement in revenue and the reduction in cost. As it was mentioned earlier, one of the main barriers is cost. The initial cost to implement this system is high, but once implemented it can enhance revenues. This can be achieved with coding accuracy, increasing the number of services that can be offered in the clinic, and increasing the number of visits per day (Miller, 2005).

    There is no guarantee as to how long it takes to see the increased revenues, but many analyses have studied the effects and are certain that the increase will be seen if managed properly. The reduction in costs pairs with productivity and efficiency. With these qualities working together, physicians begin to see a reduction in labor costs, transcription costs, malpractice costs, and it also pharmacy costs (Wang, 2003). Electronic medical records have been shown to decrease overall healthcare cost. The decreases are seen in areas such as administration, patient, organization, and insurance companies.

    Practice Partners incorporated this strategy by stating “Successful EMR sites are more efficient than traditional offices. As a result, the number of FTE’s required to support physicians is lower than at paper based offices. Practice Partners reports 2. 0 to 2. 5 FTE’s per doctor, compared to the MGMA average of 4. 0. ”(Practice Partners, EMR 101 pg2) The benefits from EMR implementation are great. Less clerical staff pulling charts and filing, searching for lost charts in the file room, and extensive rambling through ineligible documents could be an improvement associated to these findings.

    Improved communication between staff, physicians, and outside departments can also be attributed to EMR use (Wang, 2003). Most businesses look to the bottom line. A medical practice is no exception to this rule. It is still a business that must make a profit to survive in its industry. There have been several incentives put into place to foster the adoption of EMRs so that the physician and the patient can be rewarded (Crosson, 2005). With the benefits of EMRs, there are hopes that the EMRs is an option in more clinical settings to encourage cost efficiency, accuracy, improved communication, storage capabilities, and efficiency.

    Paper charts or records bring about questions regarding completeness, availability, and legibility. This could lead to a failure in the communication process. Failures place patients at risk. The high cost of implementation could pay off as a result. In today’s market, the ease of usage has improved throughout most software programs along with the needed support to accompany the overall package. There are many EMRs in the market and the physician must choose the one that is right for the organization and structure of care given. References Burt, C. & Sisk, J. (2005).

    Which Physicians and Practices Are Using Electronic Medical Records? Health Affairs, 24, No. 5. 1334-1343. Retrieved 10/28/2008 on the World Wide Web: www. healthaffairs. org Crosson, PhD,J. (2005). Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict. Annuals of Family Medicine, 3, No. 4. 307-311, Retrieved 10/28/2008 on the World Wide Web: www. annfammed. org Electronic medical record. (2008, September 12). In Wikipedia, The Free Encyclopedia. Retrieved 10/12/2008 from http://en. ikipedia. org/w/index. php? title=Electronic_medical_record&oldid= Hillestad, R. (2005). Can Electronic Medical Record Systems Transform Heath Care? Potential Health Benefits, Savings, and Cost. Health Affairs, 24, No. 5. 1103-1117. Retrieved 10/28/2008 on the World Wide Web: www. healthaffairs. org Miller, J. (2005). 10 Benefits of an Electronic Medical Record, Retrieved 11/12/2008 on the World Wide Web: www. advancedmd. com Miller,R. & Sim, I. (2004). Physicians’ Use of Electronic Medical Records: Barriers and Solutions.

    Health Affairs, 23, No. 2. 116-126. Retrieved 11/02/2008 on the World Wide Web: www. healthaffairs. org Simon, MD, MPH, S. (2007). Physicians and Electronic Health Records. The Archives of Internal Medicine, V167, No. 5, 507-512, Retrieved 10/28/2008 on the World Wide Web: www. ama-assn. org Wang, MD S. (2003). A Cost Benefit Analysis of Electronic Medical Records in Primary Care. The American Journal of Medicine, V114, Issue5, 397-403, Retrieved 11/15/2008 on the World Wide Web: www. elsevierhealthsciences. com

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