In treatment histories of patients, an EHR

In the modern days we are in, technology is taking the older methods of documentation and rejuvenating it to make the information more accessible to the masses. A way that technology helps us document is by the use of electronic health records. An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system was built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care. EHRs are defined as “a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports.” It can also allow access to evidence-based tools that providers can use to decide on a patient’s care, and it automates and streamlines provider workflow. Electronic health record systems have the potential to transform the healthcare system from a mostly paper-based industry into one that utilizes clinical and other pieces of information to assist providers in delivering higher quality care to their patients. Some of the basic benefits associated with EHRs include being able to easily access computerized records and the elimination of poor penmanship, which has historically plagued the medical chart. EHR systems can include many potential capabilities, but three particular functionalities hold great promise in improving the quality of care and reducing costs at the health care system level. Those functionalities are clinical decision support (CDS) tools, computerized physician order entry (CPOE) systems and health information exchange (HIE). A CDS system is one that assists the provider in making decisions with regard to patient care. Some functionalities of a CDS system include providing the latest information about a drug, cross-referencing a patient allergy to a medication, and alerts for drug interactions and other potential patient issues that are flagged by the computer. CPOE systems allow providers to enter orders into a computer rather than doing so on paper. Computerization of this process eliminates potentially dangerous medical errors caused by poor penmanship of physicians. It also makes the ordering process more efficient because nursing and pharmacy staffs do not need to seek clarification or to solicit missing information from illegible or incomplete orders. HIE is the process of sharing patient- level electronic health information between different organizations and can create many efficiencies in the delivery of healthcare. Historically, providers rely on faxing or mailing each other pertinent information, which makes it difficult to access in the “real time” when and where it is needed. HIE facilitates the exchange of this information via EHRs, which can result in much more cost-effective and higher-quality care. The benefits of EHRs by considering clinical, organizational, and societal outcomes. Clinical outcomes include improvements in the quality of care, a reduction in medical errors, and other improvements in patient- level measures that describe the appropriateness of care. Organizational outcomes have included such items as financial and operational performance, as well as satisfaction among patients and clinicians who use EHRs. Lastly, societal outcomes include being better able to conduct research and achieving improved population health. Although researchers have found CDS tools to be beneficial in most situations, many medical conditions do not have scientifically based guidelines for providers to follow, thus reducing the usefulness and effectiveness of these tools in many clinical situations. Some researchers have also found an association between EHRs and efficiency in healthcare delivery. Efficiency refers to the avoidance of wasting resources, including supplies, equipment, ideas, and energy. One such form of waste involves redundant diagnostic testing. Performing redundant tests is costly and may lead to more false-positive results, which will then lead to even more costs. Evidence indicates that there is a significant negative (eg, desirable) association between redundant diagnostic testing and the use of an EHR and/or its components. The organizational outcomes are focused on EHR use in both the inpatient and outpatient settings. Such outcomes have frequently included increased revenue, averted costs, and other benefits that are less tangible, such as improved legal and regulatory compliance, improved ability to conduct research, and increased job/career satisfaction among physicians. Increased revenue comes from multiple sources, including improved charge capture/decrease in billing errors, improved cash flow, and enhanced revenue. While, with an EHR system, many billing errors or inaccurate coding may be eliminated, which will potentially increase a provider’s cash flow and enhance revenue. Studies have also shown that having an EHR as opposed to a paper file can result in reduced transcription costs through point-of-care documentation and other structured documentation procedures. It was pointed out that EHRs can facilitate improved legal and regulatory compliance in terms of increased security of data and enhanced patient confidentiality through controlled and auditable provider access. Some societal benefits are having patient data stored electronically increases the availability of data, which may lead to more quantitative analyses to identify evidence-based best practices more easily. The availability of clinical data are limited, but as providers continue to implement EHRs, this pool of data will grow. By combining aggregated clinical data with other sources, such as over-the-counter medication purchases and school absenteeism rates, public health organizations and researchers will be able to better monitor disease outbreaks and improve surveillance of potential biological threats. A physician satisfaction should be a priority in healthcare organizations, because it is associated with better quality of care, better prescribing behaviors, and increased retention in medical practices, particularly those in underserved areas.There are potential disadvantages associated with this technology. These include financial issues, changes in the workflow, temporary loss of productivity associated with EHR adoption, privacy and security concerns, and several unintended consequences. Financial issues, including adoption and implementation costs, ongoing maintenance costs, loss of revenue associated with temporary loss of productivity, and declines in revenue, present a disincentive for hospitals and physicians to adopt and implement an EHR. EHR adoption and implementation costs include purchasing and installing hardware and software, converting paper charts to electronic ones, and training end-users. The maintenance cost of an EHR can also be costly. Hardware must be replaced and software must be upgraded on a regular basis. In addition, providers must have ongoing training and support for the end-users of an EHR. The costs of EHR adoption, implementation, and ongoing maintenance are compounded by the fact that many financial benefits of an EHR generally do not accrue to the provider (who is required to make the upfront investment) but rather to the third-party payers in the form of errors averted and improved efficiencies, which translate into reduced claims payments. This misalignment of incentives for healthcare organizations, along with the high upfront costs, creates a barrier to adoption and implementation of an EHR, especially for smaller practices. In fact, physicians frequently cite upfront costs and ongoing maintenance costs as the largest barriers to adoption and implementation of an EHR. A disadvantage of an EHR is disruption of work-flows for the medical staff and providers, which result in temporary losses in productivity. This loss of productivity stems from end-users learning the new system and may potentially lead to losses in revenue. With EHRs becoming a needed documentation for the medical field, there comes many advantages and disadvantages. Many of the benefits accumulate to patients and society overall. While providers are expected to face, technological and logistical obstacles on their quest to achieve meaningful use of EHRs. A nationwide implementation of EHRs is a necessary, although not sufficient, part in transforming the US healthcare system for the better. EHR adoption must be considered one of many approaches that diversify out focus on quality improvement and cost reduction. Over time, providers, and researchers will be eager to quantify the returns that are expected from these investments.