Introduction
According to Zlabek, Wickus and Mathiason (2011), electronic health record (EHR) systems enable hospitals to store and retrieve detailed patient information to be used by health care providers during a patient’s hospitalization and across the entire health care delivery process. Embedded clinical decision support and other tools have the potential to help physician to provide safer, more effective care than is possible by relying on memory and paper-based systems. In addition, EHRs can help hospitals monitor, improve, and report data and information on health care quality and safety. The Centres for Medicare and Medicaid Services (CMS) (2014) calls EHRs, “the next step in continued progress of health care.”
Ukpong (2010) stated that even with the several advantages of electronic health records (EHR) system, the Nigerian health care system is yet to embrace it. He attributed this to low level of technological development, lack of facilities, inadequate trained personnel in health informatics, apathy towards electronic health records and lack of political will of government in its implementation.
To accelerate the use of electronic health records in health care several efforts are being made by different stakeholders in health care delivery sector. For example, Jones, Koppel and Ridgely (2011) stated that for the widespread adoption and use of EHRs in the United States, the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009 (ARRA, or the stimulus package), established incentive payments from the Medicaid and Medicare programs for hospitals demonstrating that they are making “meaningful use” of an EHR system to improve patient care.
Concept of electronic health records (EHRs)
According to Wager, Lee and Glaser (2009), electronic health records (EHRs) is a longitudinal electronic record of patient health information generated by encounters in any care delivery setting such as patients’ demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR has the ability to generate a complete record of a clinical patient encounter – as well as supporting other care-related activities directly or indirectly via interface – including evidence-based decision support, quality management, and outcomes reporting.
Electronic health record (EHR) in the opinion of Gunter and Nicolas (2005) is the systematized collection of patient and population electronically-stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information. EHR systems are designed to store data accurately and to capture the state of a patient across time. It eliminates the need to track down a patient’s previous paper medical records and assists in ensuring data is accurate and legible.
Habib (2010) defined electronic health record (EHR) is an official health record for an individual that is shared among multiple facilities and agencies. Digitized health information systems are expected to improve efficiency and quality of care and, ultimately, reduce costs. Among other types of data, an EHR typically includes contact information, Information about visits to health care professionals, allergies, insurance information, family history, immunization status, information about any conditions or diseases, a list of medications, etc.
The utilization of electronic health records utilization are associated to several benefits. Some of these benefits as identified by Schumaker and Reganti (2014) include:
· Flexibility
· Improved efficiency and productivity
· Quality of care and patient safety
· Meeting public expectations
· Financial savings
· Data aggregation
· Data integration
· Data coordination
Jerome and Hartzband (2014) stated that electronic health records have several advantages when compared to paper documentation. Electronic health records are computable and hence shareable with other computers and systems. Other shortcomings of paper documentation such as expensive to copy, transport and store; easy to destroy and difficult to analyze can be easily overcome. Importantly, electronic health records are accessible to multiple healthcare workers at the same time, at multiple locations. While a billing clerk is looking at the electronic chart, the primary care physician and a specialist can be analyzing clinical information simultaneously.
In the opinion of Boumstein (2013), the goal EHR is to have patient information available to anyone who needs it, when they need it and where they need it. With an EHR, laboratory results can be retrieved much more rapidly, thus saving time and money. It should be pointed out however, that reducing duplicated tests benefits the payers and patients and not clinicians so there is a misalignment of incentives. EHRs are more efficient because they reduce redundant paperwork and have the capability of interfacing with a billing program that submits claims electronically. Consider what it takes to simply get the results of a laboratory test back to a patient using paper documentation system. This might involve a front office clerk, a nurse and a physician. With an EHR, laboratory results can be forwarded via secure messaging or available for viewing via a portal. Electronic health records can help with productivity if templates are used judiciously.
Evans, Nochol and Perlin (2006) highlighted EHR improves patient safety through many mechanisms which include improved legibility of clinical notes, improved access anytime and anywhere, reduced duplication, reminders that tests or preventive services are overdue, clinical decision support that reminds clinicians about patient allergies, correct dosage of drugs, etc. Electronic problem summary lists provide diagnoses, allergies and surgeries at a glance.
According to Milewski, Govindaraju and Bhardwaj (2009), EHR adoption results in better customer satisfaction through fewer lost charts, faster refills and improved delivery of patient health care services. Patient portals that are part of EHRs are likely to be a source of patient satisfaction as they allow patients access to their records with multiple other functionalities such as online appointing, medication renewals, etc.
Herwehe (2011) stated that EHRs help healthcare service providers to save a lot of money and eliminate unnecessary workload through duplications. There would also be fewer callbacks from pharmacists with electronic prescribing. It is likely that copying, faxing and mail expenses, chart pulls and labour costs are greatly reduced with EHRs, thus saving full time equivalents (FTEs). More rapid retrieval of laboratory and x-ray reports results in time/labour saving as does the use of templates. More efficient patient encounters mean more patients could be seen each day. EHRs reduce the cost of transcription if clinicians switch to speech recognition and/or template use
Boumstein (2013) stated that in order to make evidence based decisions, clinicians need high quality data that should derive from multiple sources: inpatient and outpatient care, acute and chronic care settings, urban and rural care and populations at risk. This can only be accomplished with electronic health records and discrete structured data. Moreover, healthcare data needs to be combined or aggregated to achieve statistical significance. Although most primary care is delivered by small practices, it is difficult to study because of relatively small patient populations, making aggregation necessary. For large healthcare organizations, there will be an avalanche of data generated from widespread EHR adoption resulting in “big data” requiring new data analytic tools.
According to Jerome and Hartzband (2009), paper health records are stand-alone, lacking the ability to integrate with other paper forms or information. The ability to integrate health records with a variety of other services and information and to share the information is critical to the future of healthcare reform. Digital unlike paper-based healthcare information can be integrated with multiple internal and external applications:
- Ability to integrate for sharing with health information organizations
- Ability to integrate with analytical software for data mining to examine optimal treatments, etc.
- Ability to integrate with genomic data as part of the electronic record. Many organizations have begun this journey.
- Ability to integrate with local, state and federal governments for quality reporting and public health issues
- Ability to integrate with algorithms and artificial intelligence.
Gunter and Nicolas (2005) stated that having more than one physician mandates good communication between the primary care physician, the specialist and the patient. This becomes even more of an issue when different healthcare systems are involved
Schumaker and Reganti (2014) stated that despite the enormous benefit derivable from the utilization of EHRs, its level of adoption by healthcare organisations is still very discouraging. Some of the barriers to the adoption and utilization of EHRs include:
- Costs of installation and maintenance
- Training costs
- Lack of semantic interoperability
Schumaker and Reganti (2014) highlight that even though the use of health IT could generate cost savings for the health system at large that might offset the HER’s cost, many physicians might not be able to reduce their office expenses or increase their revenue sufficiently to pay for it. Apart from the cost of installation, maintenance costs can be very high. For example most software systems require frequent updates, often at a significant ongoing cost. Some types of software and operating systems require full-scale re-implementation periodically, which disrupts not only the budget but also workflow. Physicians desire modular upgrades and ability to continually customize, without large-scale reimplementation.
Schumaker and Reganti (2014) stated that training of employees to use an EHR system is costly, just as for training in the use of any other hospital system. New employees, permanent or temporary, will also require training as they are hired. A key reason, aside from initial costs of EHR implementation, is lack of efficiency and usability. In terms of EHRs utilization, there are no standards for semantic interoperability of health care data; there are only syntactic standards. This means that while data packaged in a standard format (using the may lacks definition, or linkage to a common shared system.
Herwehe, (2011) recommended measures to overcome barriers facing the utilization of EHRs to include:
- Periodic assessment should be conducted to assess extent of utilization of different functionalities of the system and do improvements accordingly
- Orientation training should be done for the new physicians and continuous training for the current users. In addition, coordination should be done between the hospital and the EHR system vendor to conduct initial and follow up training
- There should be 24-hour availability of technical support in the hospitals
- The option should be given to physicians to customize the output according to users’ need
- Improvement of different communication tools with patients such as SMS and fax by the IT staff.
- A high attention should be drawn to the use of the emails between physicians themselves and with their patients. This could be done via providing internet access to the hospital.
