Introduction
It goes without saying that during the last decades a great number of countries face a growing number of diseases, which noticeably affect our planet’s population. The main danger is posed by the previously unknown viruses or mutated forms of familiar diseases. Obviously, treating such serious illnesses require highly qualified staff, modern equipment and implementing of information technologies in healthcare projects. Fulfilling of all these conditions on a regular basis in health care organizations will surely make diagnostics and treatment of a great number of illnesses safer and faster, reducing medical errors.
Considering all these reasons, in the last decade there has been a great progress on the issue of ёthe adoption of electronic medical records (“EMR”), applying IT systems within health care organizations and replacing old equipment with the latest developments in this industry.
However, not all countries and organizations have such enthusiasm about these fundamental changes in the conventional systems. Thus, the reformation of health care industry all over the world goes not as quick as it was supposed to be, experiencing certain difficulties.
The issue of EMR
Electronic medical record is a medical record in a digital format, which can be shared across different health care settings [1]. EMRs are thought to be an important improvement in medical practice and are successfully adopted in many developed countries in recent years. However, some health care organizations have been reluctant to implement EMRs and some professionals are strongly against using such technologies in their practice.
According to Medical Economics Continuing survey, “Nearly 79% of primary care physicians (PCPs) are using electronic health record (EHR) systems, an 8% rise when compared to the previous year. At the same time, a growing minority of PCPs say they will never use EHR at their practice, despite losing out on incentive payments and facing future reimbursement penalties.” [2]
One of the main reasons for that lies in the existing number of older generations among doctors. Professionals of older generations claim that they are not able to master the full functionality of IT systems.
Those who are used to health care systems proven over the years are hardly able to adapt themselves to modern developments and think that such changes will reduce their productivity and make their work more complicated.
Other important factors are practice size and income. Surveys show that physicians with relatively small practice size and low income have no intentions of purchasing newest systems.
The list of the reasons for the existence of reluctant organization can be extended with difficulties, which face small organizations. For example, revenue losses from the paper-to-EMR transition or the necessity of regular technical expertise, which require hiring professional staff.
However, time passes and old traditions are always replaced with new ones. So, probably in a few decades electronic medical records will be the only used system of storing and sharing patients’ health data.
HIPAA and EMR
The Health Insurance Portability and Accountability Act of 1996 ("HIPAA") governs the access to the information of electronic health records and regulates the exchange of this information [3]. There is a list of factors which are considered when determining whether or not certain physician can be provided with an access to personal health data stored in EMRs. For instance, the physician’s relationship with health care facility, the purpose for accessing the information, the nature and extent of required information are taken into account. Additionally, all individuals who have access to a health care facility’s electronic health records system should be required to comply with the HIPAA privacy and security regulations. All of the above prove that HIPAA regulations implement administrative, physical and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic health records that it creates, receives, maintains, or transmits [3].
The HITECH Act
Any reformation has always met some difficulties and health care reform connected with the adoption of The HITECH Act has also its advantages and disadvantages. Implementation of the electronic health records without doubt has significant benefits for the medical workers, but what about patients? From the patient’s perspective the benefits of EMR include faster made decisions about treatment and faster care, reducing errors found within personal health records and the improved diagnostics and treatment.
On the other hand, many potential patients are worried about the protection of their personal health data.
In 2008 the U.S. Joint Commission states that "As health information technology (HIT) and 'converging technologies'—the interrelationship between medical devices and HIT—are increasingly adopted by health care organizations, users must be mindful of the safety risks and preventable adverse events that these implementations can create or perpetuate. Technology-related adverse events can be associated with all components of a comprehensive technology system and may involve errors of either commission or omission. These unintended adverse events typically stem from human-machine interfaces or organization/system design." [4]
The medical staff should understand that risk always exists but their job is to provide a professional help and be trustworthy for their patients. The only right strategy is to be engaged by honest labor, to spend enough time with each of the patients during visits and concentrate on providing good care with strong preventative medicine services. They should show patients that EMR system is not getting in the way of an effective physician-patient relationship, but helps to provide more reliable and qualified results.
A way to improvement
Optimal workflow requires having the right information at the right time so that the individual performing a step or task can advance the process toward completion. To achieve optimal workflow, organizations must take a step back and analyze the flow of work.
Workflow analysis, also known as process analysis, involves identifying, prioritizing, and ordering the tasks and information needed to achieve the intended result of a clinical or business process [5].
In health care industry, workflow is more than moving staff around performing their duties. It covers every step in the process of care delivery. The workflow processes differ depending on the specificity of a certain organization (whether it is an outpatient clinic, inpatient care, sanatorium etc). But some features are the same everywhere: doctors visit their patients (or vice versa), examine their health records, suggest treatment, consult and share the data with specialists from other departments and carry out procedures. Every wrong detail in the organizational process can have a negative impact on the overall workflow. Thus, the major rule for stable and productive work within health care organizations is the right organization of departments’ connection, space, and, what is the most important, time. Sometimes time is a matter of life and death, so time is an extremely precious thing in medical industry. With the help of EMRs which help to access to and transfer health data among departments much quicker doctors can noticeably increase the efficiency of their work. For example, using electronic medical record a physician can examine patient’s health history in details before the planned visit and this can significantly reduce time allotted for one visit. Additionally, there is almost no need to contact directly specialists, who take part in a process of treatment for consultation because the process of sharing the data from one department to another is much easier. All these examples show only profits from the reformation of .organizational processes for both medical staff and patients.
Standards of health care information
The usage of IT developments in health care industry has to be thoroughly controlled and secured because of the enormous amount of the millions of patients’ operated private data. For this purpose special organizations exist in many countries. In North America one of the main organizations that develop standards is The American Society for Testing Materials (“ASTM”). ASTM is an ANSI-accredited (American National Standards Institute) organization.
ASTM’s current standards in this area are:
Standard Guide for Confidentiality Privacy Access and Data Security Principles for Healthcare Information Including Computer-Based Patient Records
Standard Guide for Electronic Authentication of Healthcare Information
Standard Guide for Training of Persons who have Access to Health Information
Standard Guide for User Authentication and Authorization
Standard Guide for Individual Rights Regarding Health Information
ASTM has also published the following provisional standards:
Provisional Standard Specification for Authentication of Healthcare Information Using Digital Signatures
Provisional Standard Guide on Security Framework for Healthcare Information
Provisional Standard Guide for Intranet Healthcare Security [6].
Fundamental advantages and the future progress
The major effect of health information technology on quality of care was its role in increasing adherence to guideline- or protocol-based care. There were many adherence studies examined the effects of health information technologies on different entities of health care organizations. These studies examined the effects on enhancing preventive health care delivery, the effect of health information technology on secondary preventive care for complications related to hospitalization etc. They also showed the capacity of health information technology to improve quality of care through clinical monitoring based on large-scale screening and aggregation of data and examined the role of health information technology surveillance systems in identifying infectious disease outbreaks. These studies demonstrated how health information technology can support new ways of delivering care that are not feasible with paper-based information management. There were also studies examined 2 primary types of technology-related effects on efficiency: utilization of care and provider time [7].
The general results of these examinations have shown the significant improvement in efficiency and an overall workflow process. There are substantial benefits for the medical staff and potential patients, as an example: the better organization and accessibility of patients’ data, the ability to quickly transfer it among departments, reduced operational costs and overtime labor expenses, increased productivity by increasing the number of patients served per day. And for the patients it is an opportunity to be provided with an improved diagnostics and treatment, which take less time and withal reduce the risk of medical errors.
Of course, there are some imperfections of the systems, but this may soon change for better with the development of existing technologies, taking into account experience gained.
Furthermore, the newest technologies are being developed to provide the industry with new reliable IT developments and safer treatment techniques. If to predict some revolutionary inventions we will meet in the near future, we can’t miss a word about nanotechnology and its fundamental role in future medicine.
Nanotechnology is a multidisciplinary field that covers a vast and diverse array of devices derived from engineering, physics, chemistry, and biology. The burgeoning new field of nanotechnology, opened up by rapid advances in science and technology, creates myriad new opportunities for advancing medical science and disease treatment in human health care. Applications of nanotechnology to medicine and physiology imply materials and devices designed to interact with the body at molecular scales with a high degree of specificity. This can be potentially translated into targeted cellular and tissue-specific clinical applications designed to achieve maximal therapeutic efficacy with minimal side effects.
Scientists are currently working on numerous projects which are aimed on the extension of the scope of nanotechnology in health care industry and there is no need to doubt the fact of the coming medical revolution [8].
Work cited
Advantages of Electronic Medical Records. (n.d.). Retrieved January 24, 2016, from http://www.micromd.com/emr/advantages.html
EHR holdouts: Why some physicians refuse to plug in. (n.d.). Retrieved January 26, 2016, from http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/2013-salary-survey/ehr-holdouts-why-some-physicians-refuse-plug?page=full
Legal Alert. (n.d.). Retrieved January 26, 2016, from https://www.mcguirewoods.com/Client-Resources/Alerts/2008/8/HIPAA-Impact-on-Electronic-Health-Records.aspx
Joint Commission On Accreditation Of Healthcare Organizations, USA (2008). "Safely implementing health information and converging technologies". Sentinel event alert / Joint Commission on Accreditation of Healthcare Organizations (42): 1–4.
Washington, Lydia. "Analyzing Workflow for a Health IT Implementation." Journal of AHIMA79, no.1 (January 2008): 64-65.
Allaërt, F., Blobel, B., Louwerse, K., & Barber, B. (Eds.). (2002). Security Standards for Healthcare Information Systems: A Perspective from the EU ISIC MEDSEC Project. IOS Press.
Chaudhry, B. (2006). Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care [Abstract]. Annals of Internal Medicine Ann Intern Med, 144(10), 742. Retrieved from http://annals.org/article.aspx?articleid=723406&issueno=10&atab=10
Sahoo, S., Parveen, S., & Panda, J. (2007). The present and future of nanotechnology in human health care. Nanomedicine: Nanotechnology, Biology and Medicine, 3(1), 20-31. Retrieved from http://www.nanomedjournal.com/article/S1549-9634(06)00342-X/fulltext
