Monday, December 15, 2008

Health Care and Electronic Records

Many people in the US healthcare industry, our government, and the press use the terms electronic medical record (EMR) and electronic health record (EHR) interchangeably, according to HIMSS Analytics. However, these terms describe completely different concepts, both of which are crucial to the success of local, regional, and national goals to improve patient safety, improve the quality and efficiency of patient care, and reduce healthcare delivery costs. EHRs are reliant on EMRs being in place, and EMRs will never reach their full potential without interoperable EHRs in place. It is important to understand the differences, and to reduce confusion in the market. The EMR is the legal record created in hospitals and ambulatory environments that is the sourceof data for the EHR. The EHR represents the ability to easily share medical information among stakeholders and to have a patient s information follow him or her through the various modalities of care engaged by that individual. Stakeholders are composed of patients/consumers, healthcare providers, employers, and/or payers/insurers, including the government.But before we can move to effective EHR environments, provider organizations must implement complete EMR solutions. At this point, few hospitals have EMR solutions that can effectively reduce medical errors or improve the quality and efficiency of patient care.

According to sources on Wikipedia, A major concern is adequate confidentiality of the individual records being managed electronically. The LA Times reports roughly 150 people (from doctors and nurses to technicians and billing clerks) have access to at least part of a patient's records during a hospitalization, and 600,000 payers, providers and other entities that handle providers' billing data have some access. Multiple access points over an open network like the Internet increases possible patient data interception. In the United States, this class of information is referred to as Protected Health Information (PHI) and its management is addressed under the Health Insurance Portability and Accountability Act (HIPAA) as well as many local laws.
Additionally, as reported by Wikipedia, to attain the wide accessibility, efficiency, patient safety and cost savings promised by EMR, older paper medical records ideally should be incorporated into the patient's record. The digital scanning process involved in conversion of these physical records to EMR is an expensive, time-consuming process, which must be done to exacting standards to ensure exact capture of the content. Because many of these records involve extensive handwritten content, some of which may have been generated by different healthcare professionals over the life span of the patient, some of the content is illegible following conversion. The material may exist in any number of formats, sizes, media types and qualities, which further complicates accurate conversion. In addition, the destruction of original healthcare records must be done in a way that ensures that they are completely and confidentially destroyed. Results of scanned records are not always usable; medical surveys found that 22-25% of physicians are much less satisfied with the use of scanned document images than that of regular electronic data.
According to the New York Times, a report by The New England Journal of Medicine found that doctors who use electronic health records say overwhelmingly that such records have helped improve the quality and timeliness of care. Yet fewer than one in five of the nation’s doctors has started using such records. Bringing patient records into the computer age, experts say, is crucial to improving care, reducing errors and containing costs in the American health care system. The slow adoption of the technology is mainly economic. Most doctors in private practice, especially those in small practices, lack the financial incentive to invest in computerized records. The national survey found that electronic records were used in less than 9% of small offices with one to three doctors, where nearly half of the country’s doctors practice medicine. Private and government insurers and hospitals can save money as a result of less paper handling, lower administration expenses and fewer unnecessary lab tests when they are connected to electronic health records in doctors’ offices. Still, it is mainly doctors who bear the burden making the initial investment.
The NY Times reports electronic health records were used by 51% of larger practices, with 50 or more doctors. Indeed, electronic health records are pervasive in the largest integrated medical groups like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic, University of Pittsburgh Medical Center and others. These integrated groups not only have deep pockets. By combining doctors, clinics, hospitals and often some insurance they can also capture the financial savings from electronic health records. Large medical groups have long been the early adopters, and small practices have struggled. With physicians who use electronic records, the results, also show a strong endorsement of electronic health records by doctors who have them, especially for what the report termed “fully functional” records, which include reminders of care guidelines, based on a patient’s age, gender or medical history. For example, 82% of those using such electronic records said they improved the quality of clinical decisions, 86% said they helped in avoiding medication errors and 85% said they improved the delivery of preventative care. One wave of innovation is coming from big technology companies, like Microsoft and Google, which recently have begun services that offer consumer-controlled personal health records over the Web, which are stored in the companies’ data centers. These consumer-controlled health records are intended to link up and exchange information with electronic patient records in doctors’ offices and hospitals.
According to, electronic medical records offer numerous advantages over paper records which are sometimes illegible and very often not where the patient is when he or she needs treatment. An electronic medical record allows the doctor to instantly see the patient's prior treatment, medication history, and other details critical to care, and errors decrease.
Electronic records also promote preventive care, improving health and lowering costs. For example, the medical staff can be electronically prompted to offer an older individual a pneumonia shot or to remind the patient of the need for colonoscopy. And by preventing pneumonia or by diagnosing cancer at an earlier stage, electronic medical records can substantially reduce health-care costs.
A variety of companies — from private health-care providers and insurance companies to big technology firms such as Microsoft and Google — are developing and launching sites, most of them free, that allow patients to keep personal health records according to USA Today. They can include everything from medical histories to test results, doctors' notes and prescriptions. Patients can input their records themselves or have them added by the few doctors' offices and other medical facilities that keep compatible electronic records online. Because the field is so new, standards and legislation still are under development. And privacy advocates worry about sensitive records falling into the wrong hands. But nearly everyone applauds the idea behind the records: They aim to bring the notoriously slow-to-computerize health records out of the era of manila folders and scribbled notes and into the future of electronic information that can be transported with the click of a button. Most of the sites also are trying to become health leaders by running online health-care malls, where people can do everything from storing their own records to doing medical research online.
According to USA Today, advocates of personal health records say they will result in better-informed patients, the elimination of redundant tests and better-prepared doctors who can get a more complete picture by having their patients' entire medical history in front of them. Errors will be reduced by quickly giving physicians access to crucial information, such as allergies, advocates say. Ultimately, systems could allow emergency room physicians, for instance, to have instant access to incoming patients' records. But others warn there's a big downside to personal health records, especially the chance that private and personal records could be bought and sold by, for instance, pharmaceutical companies. All companies with private personal health records say privacy is of paramount importance and outline strict privacy measures in their terms of service agreements. Privacy advocates worry that companies could legally sell medical records, valuable to drug and insurance companies.
Regardless of the evidence in favor of electronic medical records, fears of privacy breaches or corruption of records are real needs that must be addressed by government, private medical providers, and the medical community. The cost of health care and medical treatment has skyrocketed over the past few years, and some of those cost increases may be alleviated or softened by the use of electronic medical records. However, the cost of implementation and the concerns over who has access must also be addressed before there would be a complete transformation of record keeping in the health care industry.
Until next time. Let me know what you think.

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