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Electronic Health and Medical Records

Electronic health/medical records are patient records that have been converted to be stored electronically rather than in a paper format. They have their advantages and drawbacks, just like any other method. When a medical facility transfers to the electronic version, the practice, hospital, long-term care facility, or nursing home goes through a significant change.

In 1991, the Institute of Medicine stated that, by the year 2,000, each doctor’s office should have computers with which to improve patient care. They provided some recommendations that allowed medical practices to reach this goal. In 1996, the Health Insurance Portability and Accountability Act (HIPPA) was signed into law after hospitals and care providers ran into issues regarding security, privacy, and healthcare coverage. After this law came into being, care providers began to make the shift to electronic records. This was solidified by The Patient Protection and Affordable Care Act (ACA), which mandated that patient records be stored electronically. This took effect in 2014.

Electronic Health Records (EHRs) originated in the mid-1960s with an early data processing system. These records were specifically maintained for clinical data management. While EHRs/EMRs have their benefits, they may also present significant drawbacks. If you watch television programming created around medical practices or hospitals, you may hear characters in these programs refer to an electronic tablet rather than a paper chart. This is an EHR in practice. While television doctors scroll through the record with no effort, real-life equivalents come with their own issues.

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The Promises of Electronic Medical Records

The creators of electronic medical records (EMRs) or electronic health records (EHRs) promise to deliver conveniences for medical professionals and consumers. This technology promises to provide up-to-date, accurate, and complete information about patients, no matter where they go to receive medical care. This care is expected to be more efficient and better-coordinated. The information in each record should be secure, shared only with other clinicians as required and the patient for whom the information is pertinent. These records should also contain sufficient information to enable providers to reduce medical errors, provide accurate diagnoses, and safer care. Prescribing is also expected to be safer and more accurate.

Overall, EHR are supposed to make healthcare more convenient for patients and providers. They should protect and enhance the privacy and security of patients. Documentation will no longer be illegible or incomplete, with more accurate and streamlined coding and billing. Costly procedures can be reduced because each provider has access to the patients EHR. Information will be made available in real-time. When providers communicate with each other and have access to a mutual patient’s EHR, healthcare can be made safer and more in tune with the patient’s health issues. Once a patient portal has been implemented, it then becomes a function of the healthcare administration teams responsibility to update the patients records.

Overall Pros and Cons

Pros

Burnout is an insidious problem. We try to cover it up, but it is all but impossible to ignore. Healthcare professionals who suffer burnout tend to experience insomnia, an array of physical pains, loss of appetite, anxiety, and chronic fatigue, to only name symptoms related to physical and emotional fatigue. Burned-out healthcare workers also become cynical and detached from their environments. They might lose their sense of enjoyment, become pessimistic about the future, and feel both isolated and detached from others.

Here are some symptoms to look out for:

  • Improved Quality of Care:
    Because an EHR is accessible by multiple providers, healthcare is more targeted to patient needs and is potentially safer. An EHR should have fewer errors than a paper chart due to the use of dropdowns and typing rather than requiring hand writing of each item (EHRs enable medical practices to minimize spelling errors and help eradicate illegible handwriting.) Communication between doctors should improve when they use an EHR, as each doctor has full access to their mutual patient’s medical history. Consolidating records into one location allows medical practices to turn their efforts to actual patient care. Being able to share information with other providers after receiving patient authorization also makes it easier to coordinate medical care.
  • Convenience and Efficacy:
    An EHR makes it easier for doctors to find out what other providers have decided and prescribed. They can all follow up with their patient and track ongoing care. Using an EHR allows doctors to save precious time during a medical visit.
  • Financial Incentives:
    Having access to a patient’s EHR (particularly within the same medical group) means that each doctor’s practice will save money. Because they save money, the patient does as well. For instance, if one doctor wants to order an expensive diagnostic test, they could avoid it by seeing if another doctor has already ordered and/or received test results from such a test within a reasonable time frame.

Cons

  • Privacy and Security Issues:
    EHR’s come with the same expectation of security and privacy that paper records should have. However, because multiple medical providers have access to one patient’s chart, security and privacy can become a real issue. While paper records were highly limited, only available to one person or professional at a time, electronic records can be accessed by multiple individuals, including possible third-party access by those who have no legal or medical reason to access patient records.
  • Possible Inaccuracies

    Three areas are of concern:

    • Delayed documentation:
      With additional documentation required, providers may wait to post notes and close them out until the end of the day or even later. This means that a patient receiving ongoing care may not have important information added to their chart right away, like newly prescribed medication or other changes in treatment.
    • Empty data fields:
      Auto-population and rushing through filling in EHR’s may lead to empty fields and inaccurate new records.
    • Copy and paste:
      While convenient, this may endanger patient safety if not double-checked for accuracy.
  • Empty data fields:
    Auto-population and rushing through filling in EHR’s may lead to empty fields and inaccurate new records.
  • Copy and paste:
    While convenient, this may endanger patient safety if not double-checked for accuracy.

Patient Access

Pros

  • Shared information Between Caregivers:

    When patients have their medical information put into an EHR, they should benefit from the sharing of their information between each of their doctors. If, for instance, the patient’s primary provider refers their patient to an allergist, then these two professionals will be able to access their mutual patient’s record.

    When a hospital can share information on a patient with their doctor, this makes deciding on needed medical care much easier. Rather than waiting for paper records to be faxed, emailed, or mailed to the practice, they are there almost in real-time.

  • Improved Preventive Health:

    One intent of electronic health records is better preventive healthcare. The records show when a patient has received a flu vaccine or other early healthcare services. The Affordable Care Act (ACA) requires everyone with health coverage to receive preventive healthcare. The EHR indicates when a patient has received such a procedure, such as vaccinations.

    EHRs serve as a reminder to family doctors to track preventive healthcare services for specific medical conditions. If a patient suffers from high blood pressure and diabetes, they need to have regular blood pressure checks and undergo regular A1C tests. In turn, this helps patients to be more mindful of the steps they need to take to improve their health (diet, medication, exercise).

  • Shortened Clerical Time:

    Doctors, nurses, and clerical staff are required to put significant time into updating charts. With paper charts, this was a labor-intensive chore requiring nurses and doctors to write everything down manually. With EHRs, the hope is that medical professionals can make these entries on electronic tablets or computers, quickly updating each patient’s record without hassle.

    Practices also use electronic standing orders to reduce clerical time. Paper checklists are used to communicate between doctors and clerical staff. Clerks enter electronic orders into each patient’s EHR. This shortens the amount of time a doctor spends on the EHR, delegating this responsibility to clerical staff.

  • Quick Lab, Imaging, and Prescription Order Entry:

    Point-of-care settings make it easier for doctors and nurses to order prescriptions, lab tests, and imaging tests quickly. Also, if two separate practices are electronically linked, this allows for collaborative approaches to care. E-prescriptions arrive at the pharmacy, ready for filling and imaging and lab facilities quickly receive test orders.

    The patient can then go into a healthcare provider, give their authorization, and discuss with a provider the tests or imaging orders that have been entered. This requires that every EHR be securely linked via the internet and seamlessly integrated with medical information for the doctor and patient.

  • Charge Capture:

    Charge capture refers to tracking each charge to a patient for medical services given. An EHR makes it much easier for a medical practice to track a charge for each procedure performed. The average increase in per-patient charges is $11.09 and patient collections have increased by $11.48 on average. The increase in charges and collections may be due to more orders for additional services as well as improved documentation in each patient’s EHR. Forced completion of records and fewer errors in coding may also contribute to fewer mistakes in charging and collections.

  • Easy Sign-off on Nurse Notes/Activities:

    Providers are required to sign off on each patient’s chart. This used to mean taking each paper chart and signing each patient’s most recent orders, exams, and tests. Today, EHRs make it easier for this sign-off to be completed. This captures notes from the nurse, doctor, and the day’s medical activities for each patient.

    Charting in an EHR restricts nurses and doctors to choose from a list of options, using several lists. Rather than writing free form, which can take up a significant amount of time when spread across all patients seen in a day, the doctor or nurse learn to limit themselves to the options available. Even so, professionals are required to thoroughly and accurately document each patient encounter.

  • E-Messaging Between Caregivers:

    In each patient’s EHR, a function for e-messaging with other providers allows each doctor to send off quick notes about diagnoses, tests ordered, and treatment decisions reached. It is quick and keeps each provider up to date on shared patients. It’s also much more efficient than playing telephone tag with each other.

    If a primary care doctor is going to refer a patient to a specialist, e-messaging allows them to give the specialist a heads-up that a new patient is going to be requesting an appointment. The PCP also has the option to schedule the appointment via the e-message capability.

  • Greater Patient Participation:

    Today, an EHR can allow a patient to get more involved in their care. After their initial appointment, they should receive an email from their new doctor. This email allows them to create a login so they can review details of their care and, ideally, get information that they can use to communicate with their doctor in more detail.

Cons

  • Lack of Understanding:

    An EHR should be available for the patient to review. However, if it contains results that the patient doesn’t understand, this can lead to panic or fear. This is understandable, as test results are complicated and not created with patients in mind. While this is intended to promote patient empowerment, it may lead to a panicked call about the results of an exam or diagnostic test.

    Different medical practices have to decide how patient access to their EHR will affect the practice, the patient-doctor relationship, and the patient. This functionality is intended to improve the doctor-patient relationship by allowing the patient to ask questions. Depending on the patient’s experience, it can also improve patient satisfaction.

    When it comes to the effects on the medical practice, having patients call about tests or to ask questions may create too many demands on the staff’s time. If the patient doesn’t understand what they are reading, the doctor or one of the nurses will have to explain the entry.

  • Delay of Proper Care:

    EHRs are fairly new. The professionals who are charged with making entries in each patient’s record may not know how to complete specific tasks. If an update has changed how the EHR looks or responds to input, this makes it more difficult. This means delays in necessary medical care can happen, sometimes with tragic results.

    In one case, a patient with a strong family history of breast cancer came into the OB/GYN’s office for testing. Genetic testing revealed that she potentially had a harmful mutation. This information was entered in large, bold, and capitalized lettering at the top of the chart. Lower down, a box with smaller print detailed that no mutations were found in the BRCA1 and BRCA2 sequencing.

    The doctor scrolled down below the large warning box, missing the information there. A year-and-a-half later, the patient returned and was diagnosed with Stage III ovarian cancer. She filed a lawsuit against the doctor. If the doctor had seen the warning, they would have recommended a bilateral salpingo-oophorectomy, when her chance of primary peritoneal cancer was about 1%.

    In this case, the EHR could have been helpful, but the way it was set up, or the doctor’s lack of familiarity with the format, made it difficult for them to obtain all the needed information.

  • Time Wasted:
    While the EHR is supposed to make chart updates easier, in some cases it becomes more difficult. Some doctors are struggle with their tablets or computers when they should be communicating with patients. One study showed that doctors spend about 37% of their time looking at the computer. A second study showed that doctors spend almost 50% of their office time working on EHRs and other desk work. That’s compared to only 27% of direct clinical time with their patients. To be fair, that percentage grows when all medical practices and hospitals using EHRs are taken into account.
  • Lack of Integration:

    Different systems at hospitals or private practices don’t always mesh well with each other. Administrators and doctors are spending precious time trying to get separate systems to integrate. Thus, all functions may not work as intended, meaning EHRs in a hospital or private practice don’t always support financial, clinical, or administrative components and therefor aren’t as useful as they are touted to be.

    This extends to different EHR workflows for most hospitals and private practices. This has developed because the workflow in one EHR isn’t easily customizable with the EHR workflow for another provider. Technology limitations in EHR systems are to blame, even in those EHR systems that are among the best. This is due to a lack of technological standardization in the industry.

  • Cost:
    Start-up costs for an electronic health record system can be tremendous to each practice or hospital. Charts have to be converted to electronic format and training is required for all workers (nurses and doctors). All the requirements for the shift cost money that each provider has to pay out of its own business accounts. Expensive IT setups, trainers and training time for staff, and even time lost when looking for a paper record that has already been transitioned to EHR all cost care facilities more and more money.
  • E-Messaging Between Caregivers:
    E-messaging may be a positive because of the speed and apparent efficiency gained, but it takes face-to-face communication away from medical practitioners. This can lead to a loss of give-and-take in communication. Also, in an e-message it is difficult to ascertain emotion or tone. Practitioners worry that they may be missing something the other doctor needs. Miscommunications also lead to frustration or delays that can result in a patient’s worsening health or even death. Some doctors don’t read the e-messages sent from other doctors due to the apparent urgency of calls and a lack of time, which again can lead to dire consequences for their mutual patients.
  • Lack of Accountability for Updates:
    While medical facilities may be held accountable for the creation of an EHR system for their patients, who is responsible for making sure those systems receive continuous updates? It’s difficult to watch every hospital, care facility, and doctor’s practice to ensure that updates happen as needed. This means that safety and security may fall by the wayside as hospitals become lax in updating their systems. With the addition of millions of people’s personal information into the virtual realm, care facilities must be extra careful to improve their security as intrusive software becomes better and more prevalent.
  • Possible HIPPA Violations:

    With the use of EHRs going up, violations of the HIPPA patient privacy law are going up. The public isn’t aware that individual violations are as high as they are. When a HIPPA violation is reported, the responsible healthcare organization may be required to pay a fine that ranges from $100 to as high as $1.5 million.

    The 1996 Act aligned national standards for confidentiality and security, protecting patients and their health records. While a computer can be lost or hacked, a violation may be as simple as gossiping about a patient’s health status with others.

The EHR is a report of a patient’s medical history, physical exams, treatments, and investigations, in digital format. While they have the potential to increase patients’ access to healthcare, they also introduce new ethical issues. For instance, if a patient’s health record is linked or shared without that patient’s written authorization, their privacy has been violated. Knowing their information may be shared, they may hold information back. If the doctor doesn’t know something key to the patient’s condition, treatment can be impacted.

If thousands of patient EHRs are stolen or hacked, their private medical information can be spread. Security breaches can threaten the privacy a patient expects to have. When their information is widely available to others who have no business holding it, ramifications can be severe. Implementation of a new EHR system can cause major frustrations and challenges to a health organization. Some frustrations include wasted resources, such as funding or time. When a provider office is having difficulty in adjusting to a new patient record system, patients themselves can lose confidence in their doctors, nurses, and clerical staff. Patient safety may also be compromised. When a healthcare institution or hospital makes improvements to the electronic system without inviting the input of doctors and nurses, these clinicians become frustrated because they have to adjust to yet another new form of patient record-keeping. Learn more about the different administration careers in the healthcare field.

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