Abstract
Despite the fact that scientists invented computers more than fifty years ago, the healthcare industry has remained somewhat limited in its use of electronic information systems. Most hospitals still use paper-based records to manage patient information. However, the twenty-first century has ushered in the development and increased usage of healthcare information systems such as Electronic Medical Records (EMR), and Electronic Health Records (EHR), among others. This paper focusses on the EHR, its components, contributing factors, and applications in the medical field. Eight essential components identified include administrative processes; communication and connectivity; decision support; health information and data; order management; patient support; results management; and, reporting. Examples of the measures of efficiency of these components are also given to illustrate their usage. The major contributing factors to the successful implementation of EHR include right leadership; supportive organizational culture; engagement of stakeholders; adequate resources; and, implementation planning. The EHR has numerous applications such as diagnosis of medical problems, disease surveillance, and registration of admissions among others.
The healthcare Information and Management Systems Society (HIMSS) defines EHR as “a longitudinal electronic record of patient health information produced by encounters in one or more care settings” (2012). The definition implies that the EHR enables sharing of medical data across multiple health organizations. In addition, the systems facilitates collection and storage of comprehensive medical histories of patients such as birth, allergies, medical conditions, health defects, diseases suffered, and death among others.
Communication and connectivity component provides a secure medium of communication between health providers and patients through avenues such as email and web messaging. Continued dialogue fosters quick diagnosis and treatment of ailments. In addition, health providers can monitor the recovery of their patients online. An example of a measure of efficiency of this part is a reduction in the number of follow-up visits by patients. The decision support component has tools such as alerts, prompts and reminders that assist patients with some level of decision-making. It has a knowledge base consisting of best health practices, medication, allergic reactions, and other preventive practices that aid patients in making conscious choices regarding their health. An example of its measures of efficiency is a reduction in recurring incidences of chronic epidemics such as typhoid, as a result of patients improving their personal hygiene.
Health and information data segment deals with collection and storage of all pertinent medical data regarding patients, so that practitioners can access them and consequently make reliable clinical decisions. An example of its measure of efficiency is a reduction in time taken by physicians to obtain medical histories of patients and make informed clinical diagnosis.
Order management component deals with collection and storage of orders such as prescriptions and laboratory tests. The system schedules orders as they arrive thus accelerating their execution, and improving legibility of prescription and laboratory sheets. Statistics such as number of orders executed electronically per hour compared to those completed manually can be obtained to measure its efficiency. The patient support component promotes patient education by offering self-monitoring tools, access to clinical records, and self-screening. Patients can compare their body symptoms to medical data regarding various diseases in the online disease database, and consequently undertake actions aimed at mitigating these symptoms before going to a hospital. Statistics such as a percentage reduction in the number of patients sent to the laboratory for preliminary tests will attest to the effectiveness of online self-screening tests.
Results management component enables physicians to access past and current results regarding particular patients, thus facilitating accurate disease diagnosis and treatment. Medical practitioners depend significantly on past medical results in making current decisions Statistics such as a percentage reduction in the number of cases of wrong diagnosis or treatment can be determined to evaluate its efficiency. Finally, the reporting component facilitates processing of reports customized to meet the requirements of different stakeholders such as top management and the federal government. Examples of statistics that can measure its efficiency include the number of people suffering from a particular nationwide ailment such as HIV/AIDS that have access to government-funded anti-retroviral drugs, or how fast the top-level management responds to emerging medical issues contained in the reports generated by the system.
Merrill (2010) describes five key contributing factors to the successful implementation of EHR. These include right leadership, supportive organizational culture, engagement of stakeholders, sufficient resources, and, implementation planning. Right leadership is essential in providing vision and motivation to subordinates. If the top-level management makes EHR a priority, the whole institution is likely to embrace the change. In addition, the leadership team can motivate other stakeholders by offering incentives to those who surpass the expected goals set for each phase of EHR implementation. Secondly, a supportive organizational culture that embraces change is necessary. Merrill (2010) asserts that a culture consisting mainly of ‘young, progressive practice’ is likely to be more receptive of technology as opposed to ‘older, more traditional practice.’ Therefore, top-level management should analyze the prevailing culture of the organization and tune motivation efforts to match these needs.
Thirdly, the engagement of stakeholders such as nurses, doctors and patients, is crucial in identifying the system requirements of the final EHR system. In addition, change agents can be identified and assigned the task of championing the new system throughout the organization. These can be reputable doctors or nurses with an excellent grasp of the organization culture, can sway the opinions of peers, and can work well with top management. Fourthly, adequate financial and technical resources should be provided. Financial resources include setup costs, upgrade of existing technology, installation costs, among others. Technical resources include expert outsourcing and technological requirements of the new system. Finally, implementation planning should consist of an overall plan, broken down into smaller phases with realistic timeframes. In addition, allowances must be made for training of staff on the new system, evaluation measures, and future improvements when need arises.
In conclusion, the importance of EHR cannot be ignored since more health practitioners are embracing its usage across the country. Each of its components plays a vital role in collecting, analyzing, storing and producing relevant medical information that fosters timely clinical diagnosis, treatment and prevention of further recurrence. EHR, in itself, will not achieve desired results unless all stakeholders support its adoption. Thus, the importance of good leadership and culture of change cannot be overlooked. Some have argued that a shared interface of medical records will compromise confidentiality and security of medical data. Such threats are a major concern, particularly in the light of the recent increase in data piracy and cyber-attacks. However, with stringent data security and access protocols, these crimes can be mitigated. The future of EHR remains bright and may see the emergence of advanced technology such as customized medication or virtual health centers.
References
Healthcare Information and Management Systems Society (HIMSS). (2012). Electronic Health Records. HIMSS. Retrieved from: http://www.himss.org/library/ehr/.
Merrill, M. (2010). Top 10 Factors for Successful HER Implementation. Healthcare IT News. Retrieved from: http://www.healthcareitnews.com/news/top-10-factors-successful-ehr-implementation.
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