No one is going to miss the days when patients were asked to come to their appointment 15 minutes earlier to fill out a barrage of paper forms or when multiple calls and fax transmittals had to be made to get referrals or test results.

Electronic Health Records (EHR) systems are becoming the norm, thanks to the wide-spread application of telecommunication technologies. Medical professionals everywhere are not only able to exchange data in real-time, but EHRs are a flexible tool in the virtual care toolkit, helping practitioners treat their patients remotely in numerous ways. For a start, ideally by reducing the amount of time wasted on gathering physical evidence of their medical history.

Below you will find some basic facts about electronic health record-keeping; what they include, who owns them, and what is required from you as a practitioner to effectively protect your patients’ information.

What Is an Electronic Health Record?

Put simply, an electronic health record (EHR) is a record of a patient’s medical history in digital format. EHR has the advantage of providing doctors with real-time, accurate data that they can access and edit securely through electronic interfaces.

More specifically; an EHR can operationally be defined as:[1]

“A digitally stored healthcare information throughout an individual’s lifetime with the purpose of supporting continuity of care, education, and research.

Features and Functions

Besides being a digital version of a patient’s records, rather like an Electronic Medical Record (EMR) EHR helps doctors find the best treatment plans and also to follow the statistics and trends in their sector. Such tools are crucial for the improvement of the medical act altogether, allowing doctors to use and apply complex analysis and research tools.

Before EHR became a standard form of recording medical data, blended care professionals would have quick access to their own records but would need time to gather information from other specialists, from laboratories or auxiliary units like school and workplace cabinets or pharmacies.

With the help of EHR, a doctor is able to see all the data gathered by various professionals in the patient’s medical history and compare the results for a more effective treatment plan.

The type of information contained in an electronic health record include: [2][3]

  • Billing data and administrative information (contact information, insurance information);
  • Demographic data – such as age, diet, and any pre-existing conditions;
  • Information about the patient’s progress;
  • Vital signs and measurements – often, these can be supplemented with valuable data from synchronizable mobile health apps;
  • Medical history (surgeries, admission into the hospital, ER visits, chronic conditions, etc.)
  • Single or multiple diagnoses;
  • The medication or prescriptions the patient has received so far;
  • Data about immunizations;
  • Information about the patient’s allergies;
  • Imagery (radiology); and
  • Laboratory test results.

EHR data is designed to be comprehensive, clear and organized in a way that allows a doctor to quickly find relevant indicators and add his own observations and findings to the system. Perhaps unsurprisingly, research shows that the more organized and easy-to-use an EHR, the more likely it is that healthcare practitioners will use it to streamline their practice management.[4]

Who Uses Electronic Health Records?

Electronic Health Records are used by both doctors and patients and are stored in a digital network; this way, every medical specialist who is using the system can efficiently access one virtual record.

The main purpose of EHR and the reason they were created is to store the individual data of patients and easily exchange data between specialists. For example, if you have a chronic condition and you’re admitted into the ER because of a car accident, the ER unit doctors will check your EHR and they will know what precautions to take when administering the emergency treatment.

In 2014, more than 80% of doctors in the US used an EHR system, according to healthcare industry reports.[5][6] Primary care physicians seem to be the most likely to adopt an EHR system, mainly to input demographic information about their patients. These numbers have most likely risen since then, as telehealth and telepsychology become increasingly more the norm.

Solo practitioners were the least likely to use an EHR system were solo practitioners. For these doctors who run their own cabinets, buying an EHR system might be an unjustified expense.

Patients themselves also use EHR, as there are platforms that allow collaboration to keep EHRs updated and detailed – in this respect, encouraging patient activation and thus potentially improving patient health engagement.[7] Of course, a patient’s access to his own EHR is restricted, as to protect its accuracy, and they will only edit non-medical information or the subjective component of the medical notes (how the patient feels, how they describe the symptoms, etc.).

Since the main goal of EHR technology is to interconnect all the actors in the healthcare system through a digital data collection tool, the answer to “Who uses EHR?” is simple: everyone in this system.

Why Are EHR Systems Important?

In the context of an ever-changing world, with numerous technological breakthroughs that can be applied in our daily activities, EHR has an important role in how health care collects and stores the data it works with.

Medical services are, first of all, based on the ability of the medical professional to identify relevant information, collect it and, based on it, create a treatment plan for a patient. Of course, the doctor’s skills and the efficiency of the system they work in are key factors in how good the medical act will be, but not the only ones that we can improve.

What EHR does is provide a more simplified, safer and faster way of collecting and exchanging medical data – although the research points to mixed findings on its efficiency benefits.[8][9] For units who are already working with an EHR system on a regular basis, the possibility of checking a patient’s medical history, billing information and treatment plan in an instant has smoothed out the workflow and made it easier to consult specialists from outside the unit, for a more comprehensive medical approach.

EHR has an important role in how health care collects and stores the data it works with.

So far, this is clear. But interconnectivity and organizing medical data in a neat way are not the only advantages of making EHR an important part of health information technology (HIT). Collecting data from such a large number of patients (more than 80% of doctors use EHR), means that you can start researching trends and filter a certain population of interest using the statistics from EHR systems.[5]

Having the medical data of patients in a digital form, together with their demographics and other types of information, enables professionals to discover certain phenomena, or to outreach discrete populations, like ethnic minorities.

Interconnectivity has brought another perspective on the importance of EHR: allowing better communication between medical units and affiliated institutions or organizations, such as schools and social services.

Related: Medical Software: Changing Medicine for the Better

Why Do EHR Projects Fail?

Discussing all these huge advantages EHR has and seeing how it’s already embedded in today’s healthcare environment makes one wonder why is it not adopted by everyone. The prevalence of EHR use shows a majority of doctors and medical units that use an EHR system, so what happened to the rest of them who didn’t?

Costly to Implement

The truth is, EHR systems are not so affordable.[1] They do come at a steep price and small units or individual practitioners are not willing to invest such an amount into a system that cannot guarantee them an increased efficiency or a reasonable return of investment.

Maybe EHR will become the norm one day, and every single cabinet will be connected through EHR use, but we could say that we are still in the transition period from an analog medical bureaucracy to this digitized universe of mobile applications and systems. It’s only natural that some members of the medical community will reject this practice, as they are not willing or able to adapt to it or don’t see its purpose, or they can’t afford staff who are trained to use it.[10]

Implementation Barriers

Another main reason why EHR was not adopted at the expected rate in the US is that its implementation comes at the cost of lost productivity.[11] Switching from one documenting system to another does take an amount of time when staff need to be trained, adjust to the new system, and so on. For certain medical units or doctors, losing productivity at a certain moment or rate is simply not acceptable.

To better understand how EHR systems help healthcare, we need to be aware of their possible negative consequences. Safety risks have always been a concern surrounding health information technology (HIT) and virtual care, because of the possible faults in the human-machine interaction, or in the system design itself.[12]

Some difficulties observed through the implementation of EHR systems are the following[12]:

  • Increased workload for professionals who have just adopted an EHR system (having to learn how to use it while still doing their job can add quite a bit to their time and efforts)[13];
  • Privacy concerns when medical data is entered in a digital system without proper safety mechanisms;
  • Decreased productivity for physicians who have to use an EHR system – due to misuse or insufficient training.[10]

Who Owns EHR Data?

A very important question in the context of security and privacy concerns is who owns the data contained in a patient’s EHR.[14]

Populating an EHR

Now that we know what kind of data is contained by an electronic health record, we can list out all the data sources of this information:

  • The patient himself;
  • The healthcare professionals who have examined and interviewed the patient;
  • Laboratories and imagistic test results;
  • Insurance companies; and
  • Public health services.

Does this mean that all this data is owned by the patients themselves since it’s about them? Or by the teams that collected the data? It’s an interesting issue, and it does raise some concerns when it comes to the implementation of digital data storage for such a delicate and valuable field of information[15].

The ownership of medical data is established by the law of each state, and it can vary depending on where the data is collected. The only state that gives patients clear ownership over their medical records in New Hampshire, while most other states don’t even have specific laws to declare who owns medical data.

So, the medical data is governed by a set of other rules and regulations that have to do with the right of possessing data, the intellectual property of data generated by you, and so on[16].

A Note on HIPAA

HIPAA (The Health Insurance Portability and Accountability Act in 1996) is an Act meant to regulate and modernize the way health information circulates.[17] It consists of five titles, and the title that concerns us most in the context of EHR is the second one: preventing health care fraud and abuse. Under HIPAA’s Privacy act, your medical provider is obliged to protect your medical data, even though they legally own your record. To put it simply, your medical provider may own your medical record, but you own the data in it.

It’s important to know, though, that medical providers like pharmaceutical companies or even government organizations have the means of using data collected from you and other patients for other purposes, and they do a trade for data by using methods of de-personalizing data, for instance.

One place to check is the OECD’s Guidelines on the Protection of Privacy and Transborder Flows of Personal Data, which is due for an update in 2020.

Data Ownership and Privacy

One of the ethical issues that EHR implementation is facing is the fact that few physicians address the data ownership question when contracting an EHR system provider. Since there are many EHR and EMR platforms and providers on the market, each provider has a certain expectation regarding the data collected through their system.

Physicians should address this issue from the very beginning, and ask for very clear conditions on who owns the medical data and what happens to it in case they want to change provider.

As telemedical solutions like EHRs and client management software become more popular with practitioners, patient data ownership has a lot of grey areas and still remains a controversial issue. The fact that medical data is suddenly “stewarded” by multiple entities makes it hard to establish who ultimately owns it.

Conclusions

To conclude, EHR represents the core of future medicine and enables efficient data collecting and processing. Patients are also increasingly involved in the EHR completion, making them more in control over their medical data and more involved in the medical process. This means a healthier, more educated population!

As with all major technological applications, EHR can have unwanted consequences and a series of unpredicted events, but its potential benefits are so great, that more often than not it proves to be an improvement, as long as it’s used correctly. With paper records rapidly becoming obsolete, regulating and managing EHR systems to serve the interest of the patient should be a priority for any health care organization.

References

  1. ^ Ajami, S., & Arab-Chadegani, R. (2013). Barriers to implement electronic health records (EHRs). Materia Socio-medica, 25(3), 213.
  2. ^ Quintana, Y., & Safran, C. (2017). Global health informatics—an overview. In Marin, H., Massad, E., Gutierrez, M.A., Rodrigues, J. R., & Sigulem, D. (Eds). Global Health Informatics (pp. 1-13). NY: Elsevier.
  3. ^ Institute of Medicine. (2003). Key capabilities of an electronic health record system. Retrieved from http://iom.nationalacademies.org/Reports/2003/Key-Capabilities-of-anElectronic-Health-Record-System.aspx
  4. ^ Øvretveit, J., Scott, T., Rundall, T. G., Shortell, S. M., & Brommels, M. (2007). Improving quality through effective implementation of information technology in healthcare. International Journal for Quality in Health Care, 19(5), 259.
  5. ^ Heisey-Grove, D. & Patel, V. (2015). Any, Certified, or Basic: Quantifying Physician EHR Adoption. ONC Data Brief, no. 28. Office of the National Coordinator for Health Information Technology: Washington DC. Retrieved from https://www.healthit.gov/sites/default/files/briefs/oncdatabrief28_certified_vs_basic.pdf
  6. ^ ONC. (2015). Office-based Physician Electronic Health Record Adoption: 2004-2014. Office of the National Coordinator for Health Information Technology Health IT Quick-Stat. Retrieved from http://dashboard.healthit.gov/quickstats/pages/physician-ehr-adoption-trends.php
  7. ^ Barello, S., Graffigna, G., Savarese, M., and Bosio, A. C. (2014). Engaging patients in health management: towards a preliminary theoretical conceptualization. Psicologia Della Salute, 3, 11.
  8. ^ Adler‐Milstein, J., Everson, J., & Lee, S. Y. D. (2015). EHR adoption and hospital performance: time‐related effects. Health Services Research, 50(6), 1751.
  9. ^ Poissant, L., Pereira, J., Tamblyn, R., & Kawasumi, Y. (2005). The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. Journal of the American Medical Informatics Association, 12(5), 505.
  10. ^ Boonstra, A., Versluis, A., & Vos, J. F. (2014). Implementing electronic health records in hospitals: a systematic literature review. BMC Health Services Research, 14(1), 370.
  11. ^ Barsley, R. E., Sharp, H. M., & Smith, C. (2017). Ethical and legal considerations when treatment planning. In Stefanac, S.J., & Nesbit, S.P. (Eds.). Diagnosis and Treatment Planning in Dentistry (pp. 139-154). NY: Elsevier.
  12. ^ Spetz, J., & Keane, D. (2009). Information technology implementation in a rural hospital: a cautionary tale. Journal of Healthcare Management, 54(5), 337.
  13. ^ Gans, D., Kralewski, J., Hammons, T., & Dowd, B. (2005). Medical groups’ adoption of electronic health records and information systems. Health Affairs, 24(5), 1323.
  14. ^ Fernández-Alemán, J. L., Señor, I. C., Lozoya, P. Á. O., & Toval, A. (2013). Security and privacy in electronic health records: A systematic literature review. Journal of Biomedical Informatics, 46(3), 541.
  15. ^ Reis, F. F., Costa-Pereira, A., & Correia, M. E. (2008). Access and privacy rights using web security standards to increase patient empowerment. Studies in Health Technology and Informatics, 137, 275.
  16. ^ Benaloh, J., Chase, M., Horvitz, E., & Lauter, K. (2009). Patient controlled encryption: ensuring privacy of electronic medical records. In ACM, Proceedings of the 2009 ACM Workshop on Cloud Computing Security (pp. 103-114). NY: Association for Computing Machinery.
  17. ^ United States. (2004). The Health Insurance Portability and Accountability Act (HIPAA). Washington, D.C.: U.S. Dept. of Labor, Employee Benefits Security Administration.

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