Health Information Technology: The Electronic Health Record

Electronic Health Record (EHR)
Longest and Darr
July 2009

EHR is an intranet system, which is utilized by one hospital or healthcare system to enhance medical records and data collection, storage, communication, retrieval and analysis via computerized information technology. EHRs, which have numerous advantages, were designed to improve medical safety, quality, clinical procedures, compliance with government regulations, and operational efficiency. Though initial cost is exorbitant, after implementation, EHR systems reduce costs due to need for less full time employees and other medical care savings as previously mentioned. The EHRs include information on inpatient and outpatient data, admissions, patient appointments, examinations, consultations, test results, diagnosis, surgeries and postoperative treatment.

Other valuable advantages of EHRs are that it eliminates creating, filing, moving, storing and retrieval of records, and make information immediately available. EHRs enhance the delivery of patient information at different sites, and reduce storage space of medical files. EHRs also reduce lost information, illegibility and time spent searching for information; provides immediate decision support and guidelines to healthcare professionals; and reduce variety in clinical procedures. EHRs commenced at the Mayo Clinic in Rochester, Minnesota in the mid-1990s, and by 2007 connected 16,000 users, 360 million nurse medical documents, 200 million laboratory results, 4 million radiology reports and 19.2 million clinical notations.

However, there are critics of EHRs that argue the disadvantages of the IT systems for medical facilities. One disadvantage is that EHRs reduces opportunities for physicians, laboratory, pharmacy, radiology and other hospital personnel to personally interact with patients. Additionally, EHRs is viewed by some as a diversion of physician attention from patients and personalized quality care. EHRs also present little need for hospital personnel to personally connect with admission, discharge, risk management and other medical personnel. Other problems include the duplication of storage information, lack of EHR system standards and improper physician coding.

Concerns with EHRs include confidentiality, privacy and information security issues relative to protecting patient information. Critics point out the easy accessibility of extensive medical histories of patients by making medical records readily available. Some patients may have psychological discomfort about knowing their medical information is on a computer and could be accessed by unauthorized individuals. Miller explains that legal disadvantages of EHRs and other computerized healthcare information systems is that unauthorized individuals might get access to information for unauthorized purposes. Importantly, some courts do not recognize computerized records as official court documents and prefer paper documentation.

According to Longest and Darr, all patients are not computer savvy, and some feel uncomfortable about physicians using the computer in their work considering it to be impersonal; but in the future it the physician use of computerized medical information systems will be expected by patients and perceived as the most professional method for healthcare. The high cost of EHRs is the main reason it is not widely used today, and presently most healthcare facilities and providers continue to use the paper system for medical records.

Managing Health Care Information Systems
Karen A. Wager, Frances Wickham Lee DBA, John P. Glaser
October 2008

It very well stated in the book of “Managing Health Care Information Systems” that “health care information is the reason we need health care information systems”. The most important key component of any study of Managing Information Systems (MIS) in Health Care is the investigation of relevant data and collective subject material for the research activity. The purpose and main concentration of this work is on the data and information that are specific and relevant to health sciences, for eg. Electronic Medical Record (EMR), Clinical data etc. generated during a patient entry. With the advancement of IT, its use in enhancing and providing the patients with more flexibility and security, hence offering them benefits like immediate treatments during emergency scenarios. The administrative and managers of any organization such as hospitals are getting aids from the information system techniques to reach their objectives of customer satisfaction, in this case the patients. The technology also helps them to make necessary planning and have a projected growth and sustainability of their organization. This study throws light into how FORTIS Hospitals implements MIS into their organization for optimizing their performance and thereby providing excellent healthcare.

Managing Information systems (MIS) can be referred as the subset of controls for the purpose of overall sustainability of the internal business which deals with the application of people, procedures, technologies, documents, by management accounts for the ultimate purpose of solving business issues. For example: costing of a particular product. MIS is an academic term often referred to a set methodologies of Information Management knotted together to serve the purpose of supporting the human decision making. For example, Expert systems, Executive information systems etc.
MIS can be find out where the technology meets or intersects the business. MIS provides people the information’s which helps them to know there job better, and as a result to do it faster and in a smarter way. According to Philip Kotler "A marketing information system consists of people, equipment, and procedures to gather, sort, analyze, evaluate, and distribute needed, timely, and accurate information to marketing decision makers.

Managing Information System is very much confused in the modern world. Information systems consists those systems that are not meant for the purpose of the decision making but for other purposes in the business world, but when it comes to the MIS, it is mainly used for the purpose of decision making or for making the human decision making much more easier .In other words it can be said as the MIS makes the workers work in a smarter way. There is a huge advancement in the ED (Emergency Department). Paper work, white boards are being replaced by automated computerized tracking software's and displays in most hospitals.

The Dutch Healthcare system
Barjis, J.,
March 2010

The Netherlands is a regionalized state. Policy making occurs at national, regional (12 provinces) and local (around 500 municipalities) level. Hospitals, GPs, paramedics, pharmacies, elderly care homes, and homecare are organized as private care providers. While most HealthCare (prevention, cure and long term) are financed by government, Homecare and Wellness are financed by Municipalities. As regards to public health, the Dutch health system is organized as a regional network of municipal health services, which take care of child health examination, vaccinations, environmental health, health protection and health promotion activities. Local public health covers all aspects of infectious disease control, general hygiene, school health and public health education. Finally the primary care system supports the public health task.

The idea of EHR project implementation dates back in 1972, where the Leiden academic hospital made an attempt to adopt an integrated Health Information system. However, early enough, implementers came face to face with the organizational, technical, legal, financial and political challengesAlmost 10 years after that date, most of GP used a kind of electronic clinical documentation. It is worth mentioning that till this time ICT adoption in Healthcare limited in administration functionalities leaving far behind the adoption of an EMR as we know it today. The practitioners still used paper documentation for patient’s medical records.

In the dawn of 1990 EMRs interested parties begun to realize the adoption of shared clinical data that can become accessible among different providers. The initiative for an EHR in the Netherlands came as an advice from the Council for Public Health and Health care (Raad voor Volksgezondheid en Zorg - RVZ) in October 1996. At the same time the RVZ conducted a research in order to explore the IT applications that were needed in order to improve quality, efficiency accessibility and transparency on health care domain. The results came to the point that an EHR was required. Though, standardization and normalization were basic prerequisites regarding the adoption of EHR. For this purpose in 1996, a special association was founded: Coordination point Standardization Information facility in Health care (Coördinatiepunt voor Standaardisatie Informatievoorziening in de Zorgsector – CSIZ).

Electronic Medical Record (EMR)
Taylor & Francis
February 2010

The use of Information and Communication Technology (ICT) in supporting the satisfaction of healthcare needs is not a new trend. When some computer vendors tried to solve hospital based medical problems, having as a goal to improve communications among hospitals facilities. Implementation costs, technology limitations, like limited mass memory, limited CPU speed, weak human-machine interface and other demonstration deficiencies are some of the reasons for which, those systems failed. However, in the dawn of the 21st century, the implementation of Information Technology in Healthcare remains slow, even though technological innovation has been extensively adopted in other industries. Among others, identify interoperability among different computerized systems, resistance from different parties (e.g. clinicians, nurses, and administrative staff), cost of implementation, privacy, lack of standards, as the most important obstacles to the adoption of Health Information Technology (HIT).

In this study we are concerned with two types of healthcare information technology: the Electronic Medical Record (EMR) -"An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization"- and the Electronic Health Record (EHR) - ‘’a digital record of patient health information produced and distributed in more than one health care sites’’ -, but from different perspectives. To avoid any misunderstanding is worth mentioning that these two systems are inextricably interwoven. That means that each of these systems cannot stand without the existence of the other and vice versa. Specifically, EMR comprises in tandem with Patient Summary Records the first two chapters of EHR.
First and foremost we plan to investigate the proportion of Dutch hospitals that have implemented an EMR in their clinical functionalities. In the second stage seek to examine what are the most cited barriers that impede in the adoption of EMR and in parallel we try to explore whether suggested policy solutions would affect the decision of the HER adoption. Last but not least we are going to identify how the organizational factors such as size and tax status of the hospital interrelated with the adoption or not of an EMR.

This Paper is organized in the following way. In the next sections of this chapter we state the research problem and motivation to conduct this study. In addition we determine both research objectives and the method used. In chapter 2 after a small overview of Dutch Healthcare system we explain the terms of clinical systems that we deal with in our research. Moreover we describe the components of EMR and also we outline the three most important factors (finance, policy & legislation and standards) that affect the adoption of EMR. In Chapter 3 we portray the literature review which includes prior research, in the purpose of describing both the barriers that impede the adoption of EMR and the facilitators that trigger the adoption of EHR. In the next chapter we analyze our data and in the final one we scrutinize our conclusions and in parallel we state our proposals for further research.
NVISH Hospital Management System
February 13, 2008
NVISH

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It improves the management and quality of hospital health care management and clinical care in the areas of action-based costing and clinical process analysis. NVISH-HMS helps you to develop your hospital and improve its efficiency and quality of work. For a hospital to be successful it is vital to manage the key processes efficiently which you can achieved by HMS as it helps you to manage, your various hospital related processes. HMS offers all process management tools including analysis, modeling, and simulation. Documentation all though a decisive part of a Hospital is an unproductive exercise for the intellect human being, whose capabilities lies in center areas of excellency. Hence a systematic way for documents to manage, can translate your Hospital resources to its advantage and Highest Utility.
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