Electronic health records – benefits and pitfalls

2 Dec 2014  |  Print

Electronic health records – benefits and pitfalls

Digital technologies are radically altering the way we live our lives. For each of us as individuals, email, social media, smart phones and tablets have transformed our ability to communicate. Meanwhile, at an institutional level, technologies that facilitate online data storage, filtering and retrieval are becoming increasingly important.

Medicine is both information-heavy and multidisciplinary. Hence, any digital technology that allows patient information to be collated and shared in a cost effective and secure manner offers enormous potential benefits.

An excellent example of this is the use of electronic health records (EHRs).

What are EHRs?

At a simple level, EHRs may just be digital versions of patients’ paper charts – making it possible for authorized users to access the information faster, easier and more securely.[1] However, EHR systems can potentially go beyond this to provide a broad, holistic view of patients’ care.

For example, they can[1]:

  • Store patients’ medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results;
  • Provide access to evidence-based tools that healthcare providers (HCPs) can use to help make decisions about care; and
  • Automate and streamline practice workflow.

Benefits of EHR systems

These systems offer at least two key benefits. First – and most importantly – they can improve patient care.[2]

How? Because they provide easy access to accurate and up-to-date patient information for HCPs, whether in the office or at a remote location; and because they facilitate clearer and faster communication between HCPs and patients.[2]

Furthermore, EHRs can often be shared with other HCPs across multiple organizations – including specialists, laboratories, imaging centers, pharmacies and emergency facilities. This means that relevant information is available whenever and wherever it is needed.[1] Hence, fully integrated, multidisciplinary care is made possible.

Second, EHR systems can improve the internal efficiency of a healthcare practice.[2] In particular, they reduce the administrative time that would otherwise be spent searching for paper records, entering information manually, etc. If this eliminates half an hour of paperwork per day, it might not seem like much – but it equates to perhaps two more patient appointments, or 30 minutes extra that an HCP can spend on leisure activities instead.[2] Indeed, the use of EHRs has already been associated with improved quality of life among HCPs.[2]

These benefits can be accrued not just in the developed world, but are also perfectly feasible in the developing world, despite financial and logistical challenges.[4]

Barriers

On the flipside, there are some important barriers to the use of EHR systems that may sometimes limit uptake.

Perhaps the most significant is the financial barrier. Purchasing and implementing an EHR system is inevitably associated with start-up costs for the equipment, contracts and human resources.[5] In this regard, it is important to view an EHR system as an ‘investment’ and not only as an ‘expense’. As already described, these systems can improve the efficiency of a practice, with associated long-term cost benefits.

In addition to cost, there is a group of barriers that relate to the transition from paper to electronic records. Each of these can create resistance to uptake. For example, even industry-leading EHRs will inevitably be challenging to use initially, while users become accustomed to the interface and the options available.[3] A lack of computer literacy and/or inadequate training among users can sometimes exacerbate this issue.[6] In addition, all existing patient data will need to be transferred into the new system, and this will of course be time consuming.[6]

As a result, it has been reported that providers work longer hours for an average of 4 months during the initial EHR implementation period, before time savings become evident.[2]

The transition can be made simpler by having an in-house technology ‘champion’ or problem solver to support colleagues.[6] Indeed, even when an EHR system is well established, the presence of a product champion who can answer questions, trouble shoot, and encourage others to advance their own skills is very valuable.[7]

Selecting an EHR for your practice

For an HCP in normal clinical practice, choosing an EHR system can be daunting. However, there is advice out there on how to do so successfully. The following six-point plan provides a simple guide[8]:

  1. Assess your practice readiness. Conduct an assessment of your current practice and its goals, needs and financial / technical readiness. With an accurate view of your level of preparedness, you can create an implementation plan that meets the specific needs of your practice.
  2. Plan your approach. Draw on the information gathered during the assessment phase to develop the practice’s EHR implementation plan.
  3. Select a certified EHR system. For example, certification by the Certification Commission for Health Information Technology (CCHIT) ensures that baseline functionality requirements are met.[9]
  4. Implement the system. This involves installation of the EHR system, as well as associated activities like training, mock ‘go-live’, and pilot testing.
  5. Achieve meaningful use. A key phase of EHR implementation involves successfully demonstrating meaningful use, and re-assessing what you have learned from training and everyday use of the system.
  6. Continue quality improvement. Continuous evaluation of your practice’s needs after implementation of an EHR system is essential to improve workflows and fully leverage the functionality of EHRs.

By following these steps, a valuable and cost-effective EHR system can be put in place, which will serve HCPs and patients for many years to come.

References:

1. HealthIT.gov. What is an electronic health record (EHR)? March 2013. Available at: www.healthit.gov/providers-professionals/faqs/what-electronic-health-record-ehr. Accessed November 2014.

2. Lorenzi NM, Kouroubali A, Detmer DE, Bloomrosen M. How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings. BMC Med Inform Decis Mak 2009;9:15.

3. Miller RH, Sim I. Physicians’ use of electronic medical records: barriers and solutions. Health Aff (Millwood) 2004;23:116-126.

4. Williams F, Boren SA. The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review. Inform Prim Care 2008;16:139-145.

5. Gagnon MP, Desmartis M, Labrecque M, et al. Implementation of an electronic medical record in family practice: a case study. Inform Prim Care 2010;18:31-40.

6. Terry AL, Giles G, Brown JB, Thind A, Stewart M. Adoption of electronic medical records in family practice: the providers’ perspective. Fam Med 2009;41:508-512.

7. Denomme LB, Terry AL, Brown JB, Thind A, Stewart M. Primary health care teams’ experience of electronic medical record use after adoption. Fam Med 2011;43:638-642.

8. HealthIT.gov. How to Implement EHRs. April 2013. Available at: www.healthit.gov/providers-professionals/ehr-implementation-steps. Accessed November 2014.

9. duPont NC, Koeninger D, Guyer JD, Travers D. Selecting an electronic medical record system for small physician practices. N C Med J 2009;70:399-403.

RM-1518-V1-1016