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The American Journal of Accountable Care September 2015
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Optimizing the Effect of Electronic Health Records for Healthcare Professionals and Consumers
Maryam Alvandi, RCT, MHS
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Optimizing the Effect of Electronic Health Records for Healthcare Professionals and Consumers

Maryam Alvandi, RCT, MHS
Electronic databases promote a safe environment for healthcare professionals by facilitating retrospective analysis of errors; however, providers should make significant changes to how they handle patient information.
The traditional paper medical record used in physicians’ offices, clinics, and hospitals no longer meets the needs of today’s healthcare industry, and is therefore becoming extinct. The way healthcare professionals store, access, and use medical information, as well as the requirements for the management of health-related information are transforming. Electronic health records (EHRs) have the potential to become the core tool in healthcare delivery, integrating all pertinent patient information into a single record, which can then be accessed by authorized interdisciplinary professionals at any time. The purpose of this article is to help leverage the potential of EHRs by increasing familiarization and acceptance among healthcare professionals and consumers toward its implementation. Several studies support the use of electronic databases and indicate that EHRs are one of the key elements to improving the healthcare system; they help to improve continuity of care when clients move between different healthcare facilities, and they have the potential to reduce medical errors. EHRs affect the entire healthcare community, including hospitals, healthcare providers, consumers, pharmacies, researchers, and public health agencies; automate and streamline the clinicians’ work flow; facilitate management of costs; and support all aspects of health industry. Nevertheless, healthcare providers need additional education to learn to skillfully use electronic databases and maintain their professionalism online. Having good system management to promote the growth and effective use of digital health, as well as to advance the design and evaluation of information technology needed, is all imperative in an increasingly complex environment.
Electronic health records (EHRs) are a distributed documentation system that enhances the efficiency and effectiveness of a work flow. The powerful framework of the computer-based patient record optimizes the collection, presentation, and communication of client data, resulting in time and cost savings for anyone who participates in the healthcare delivery process, such as clients, physicians, hospitals, and insurers. The EHR system has the ability to generate a complete record of a clinical patient encounter, as well as support other care-related activities directly or indirectly via interface, including based decision support, quality management, and outcomes reporting.1 The use of the EHR can also help one to analyze, document, and communicate basic care elements to improve uptake among healthcare providers.2 Patients have the ability to access their medical history and medications, manage relevant health information, promote health maintenance, and add new information to their profile. These benefits should ultimately help patients with their treatments,3 as the portability of information allows consumers to manage their own health—a very complicated process until now, with information inconveniently dispersed among multiple providers and related entities.4-6

For this paper, a literature review was conducted and several studies were critically analyzed to discuss some of the necessary guidelines to: successfully implement the new EHR system; assess its benefits and effectiveness; identify gaps, limitations, and solutions; formulate strategies to increase familiarization and acceptance among healthcare professionals and consumers; and discuss its current status and future directions.

Guidelines for Success
In order to be successful with the implementation of EHRs among healthcare professionals and consumers, 4 components must be established to promote health, enhance disease management, provide evidence-based treatment, and prevent illness. These include:

1. Patient medical record. The patient medical record is a lifelong data management tool that documents the medical history and includes all information typically found in a patient chart (eg, patient demographics, progress notes, medications, vital signs, immunizations, laboratory data, radiology reports). The system allows for order entry management, which enables clinicians to enter orders related to care and medications and to facilitate data collection.7 The value of its shared information will help to facilitate informed decision making.

2. Decision support system. The decision support system (DSS) provides a useful service to healthcare professionals to strengthen the selection of viable options by way of alerts, reminders, and best treatment recommendations based on current best practices. It can also extend to administration processes, such as scheduling, billing, and claim management that will directly impact care.8 This type of system provides clinicians with specific information that is intelligently filtered to facilitate making the most informed decisions, which will ultimately enhance healthcare.1 With this type of assistance, healthcare professionals are able to improve the diagnosis of a patient, including screening for correct drug selection and dosing; medication interactions; preventive health reminders in areas such as vaccinations, health risk screening and detection; and the creation of clinical guidelines for patient disease treatment that will prevent many errors and adverse events. Thus, DSS has the potential to directly and indirectly affect patient care and outcomes.9

3. Drug prescription component. The drug prescription component helps clinicians in calculating drug dosages; reducing the potential for mistakes; eliminating drug interactions; and enabling authorized healthcare professionals to access, manage, and safeguard the patient’s medication history. It also expedites and ensures quality medical care and monitors the patient’s compliance and progress.7,10

4. Interface with an Internet-accessed patient portal. A number of self-monitoring tools have been designed to give patients secured access to various health information, including their health records, services, such as appointment booking or requesting medication refills and interactive computer-based patient education. This will allow secure methods for bidirectional communication, information sharing, and enhancing quality of care.8,11,12

Benefits of the EHR
The driving forces for the development of the EHR are clinical quality, patient safety, productivity, and the need to revamp the healthcare delivery system. EHRs improve data integrity and quality of care, in addition to facilitating research. The benefits of this system can be best recognized when considering the needs of the diverse groups of users.1

Benefits of EHRs for Healthcare Professionals
The most common benefits of EHRs for healthcare professionals include increased delivery of guideline-based care, enhanced organization and accessibility, accuracy of patient documentation, capacity to perform surveillance and monitoring, and reduced medication errors.8,13 For healthcare professionals, EHR systems offer substantial medical assistance through an extensive database of information, acting as indispensable virtual assistants that provide reminders and alerts for diagnosis and care, thereby improving quality and outcomes in chronic disease management.10,13 Additionally, EHRs facilitate communication between healthcare providers and improved care coordination for interdisciplinary team work.13-15 Healthcare providers can not only access the charts faster, resulting in reduced liability due to better decision making and documentation, but also track patients better, which allows for improved analysis and evaluation of the care delivered.15,16 EHR use also improves the efficiency of billing and support for pay-for-performance bonuses.1

Benefits of EHRs for Consumers
The benefits of EHRs for consumers include a reduced wait time for treatment, enhanced access and control over health information, expanded use of best practices with inclusion of decision support to provide best medical treatment, greater responsibility for one’s own care, alerts and reminders for upcoming appointments, higher satisfaction, greater cost savings, and a decline in the number of redundant procedures.1

Legal, Professional, and Ethical Concerns, Barriers, and Solutions
Patient privacy and confidentiality are always paramount. Information security and confidentiality of personal information are major concerns in today’s society among medical records and how they are being preserved electronically.17 The right to privacy intersects with consent and confidentiality and raises questions like who would have access to an individual’s information? How will the information be used? Who owns and controls the information? Are they safeguarding the privacy and confidentiality even though electronic records are susceptible to compromise? Are there potential risks associated with the widespread use of information technology?8

It is important for organizations to provide their users with the proper training to avoid known threats, but more importantly to be able to discern a possible new threat. The EHR system must be configured to allow access only to those who have been identified as authorized users. The operating system should lock down after a specified period of inactivity and regular security training programs have proven to be extremely effective. The system must authenticate the user’s identity with user IDs and a strong password that includes a combinations of letters, numbers, and special characters.1 Data integrity can be compromised by incorrect entry, data tampering, and system failure that may include hardware and software impairments, so security mechanisms must use a combination of logical and physical restrictions to provide a greater level of protection to improve data integrity. These include measures such as audit trails, comprehensive procedures and policies, firewalls, the installation of antivirus and spyware detection software to eradicate viruses and other malicious programs—all of which should be reevaluated periodically to determine what modifications need to be made.1,8

In addition, initial and ongoing costs for developing and maintaining the electronic infrastructure have been found to be the greatest barrier to the creation of a fully functioning EHR; the development of the electronic links forming the infrastructure is costly and the allocation of fiscal responsibilities is challenging. Another obstacle to establishing an EHR system is resistance to implementation. Acceptance is frequently more difficult to obtain from healthcare providers, and barriers to adoption continue to exist as some healthcare professional are resistant to change unless they see obvious potential benefits.18 Clinicians generally will not use a system if it is not user-friendly and easy to access, so to promote adoption, a change management plan must be developed in conjunction with the EHR implementation design.8,18 People who will use the system and are involved early in the implementation process have been found to be a major determinant in a successful project that will result in high end-user satisfaction.18,19

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