Matthew Bowen. Northeastern University

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1 Running head: OVERCOMING BARRIERS TO ELECTRONIC RECORD KEEPING Overcoming Barriers to Electronic Record Keeping Matthew Bowen Northeastern University

2 Abstract In light of rapidly increasing costs through out the medical field, methods of making the industry more efficient are a major concern in the present day. Electronic medical and health records are one method that has the opportunity to make the industry more efficient, improve the quality of care, and reduce costs in the long run. Electronic record keeping systems have the ability to transform the medical industry and provide benefits at the clinical, organizational, and societal levels. Physicians are able to be more successful in their treatment of patients, communication across the field is greatly increased, and research can be more easily conducted by utilizing a bank of stored data. Though the initial cost of implementing a system is high, practices have the opportunity to experience significant returns in the future from reduced costs by using the systems properly. Other concerns such as decreased patient privacy are solved through strict regulations limiting access to information and imposing consequences on individuals who inappropriately access information. When implemented, these technologies provide many benefits to the medical field and as more institutions adopt these systems, the opportunities to experience the benefits associated continue to increase. 2

3 Introduction Over the past decade, many major industries have been revolutionized by technology, especially information technology. The health care industry has seen major changes as a result of the heavy use of technology in daily operations. Technology use in the health care industry is increasingly relevant to today s society as health care providers and other professionals in the field continually seek methods to make delivery of care more efficient. Electronic health and medical records are dramatically changing the way the health care industry is managed. The use of electronic medical or health records has grown rapidly in the past decade, from use in 48% of office- based practices in 2009 to 72% in 2012 (Hsiao, Hing, 2012). Electronic record keeping is allowing health care professionals across the country and around the world to better coordinate care and conduct their practices more efficiently; ensuring patients receive the best care. Electronic medical records were first conceptualized at the University of Vermont in 1969, centered on the idea that if patient information was recorded electronically instead of on paper, patient records would be more easily accessible, thus enhancing care (Satvat, 2011). As the idea spread to other institutions, a collaborative effort began that sought to develop a system that would allow efficient and reliable data storage. The use of electronic record keeping spread rapidly through out the 1970s and 1980s as more and more health care professionals saw virtue in its goals. Despite the early surge of interest however, the spread slowed to a crawl soon after because of various barriers to adopting the technology. Although benefits from using the technology are obvious, the cost of adopting such 3

4 technologies and controversial issues such as patient privacy concerns deter many professionals from implementing electronic systems. However, in recent years with health care costs growing exponentially, health care professionals have been forced to seek out ways to provide more efficient care. Electronic record keeping systems are giving physicians and medical professionals a way to provide quality care to patients in a more coordinated way, which allows the possibility of more efficient health care, causing the recent dramatic growth in the use of these technologies. Advantages to Electronic Systems Electronic record keeping systems are providing increasingly efficient means of communicating patient information across practices to bring about better quality care. According to Menachemi and Collum (2011), Potential benefits of electronic health records are often examined by considering three basic categories: clinical, organizational, and societal outcomes. Clinical advantages are those that bring about better patient care through means of less medical errors, for example. Organizational are those that increase financial or operational outcomes, allowing a practice to run more efficiently. Societal advantages are those that allow better research or health of the general public as a result of using these systems. These advantages as a whole contribute to a much more coordinated and successful health care system. Arguably the best way of measuring a health care system s success is by examining patient health. One of the most frequent medical errors today contributing to hospitalization is patient disability as a result of drug interactions or drug allergies not caught by providers. Since 2011, electronic health and medical 4

5 records have allowed practitioners to check over 40 million drug interactions that otherwise may have caused patient disability (Jamoom, Beatty, Bercovitz, Woodwell, Palso, Rechtsteiner, 2011). In the United States alone, medication errors are estimated to affect 1.5 million patients per year, with 400,000 adverse effects that are completely preventable (Agrawal, 2009). Using electronic systems, physicians are able to check drug interactions and patient allergies quickly and easily before prescribing medications, contributing to a significant decrease in medical errors. Electronic records give physicians the opportunity to share data and information quickly with other professionals who may be more knowledgeable about a disease or condition, allowing the delivery of better- specialized care. The clinical outcomes of using electronic record keeping in the health care field are incredibly advantageous to patients and contribute to much more successful patient results than would otherwise be possible. Although advantages as a result of clinical outcomes may be the most visible, organizational outcomes also vastly improve the health care industry when electronic records are utilized. Electronic records provide a platform for better communication between patient and physician and also between professionals across the industry. Electronic systems allow physicians to send patients their information electronically, much quicker and more efficient than sending information through the mail. Technologies also enable physicians to be constantly connected to their patients, as they are able to bring patient information home from the office with them on a laptop or similar device. Communication between physicians is also extremely important in ensuring quality health care outcomes. In 5

6 the past three years, physicians have been able to share 4.3 million care summaries with each other as a means to collaborate and better assist patients using electronic records (Hsiao, Hing, 2012). Collaboration such as this wouldn t be possible without electronic systems and thus these systems are contributing to much better care across the field. While clinical and operational outcomes dramatically improve the delivery of health care, societal benefits also come as a result of electronic record systems. As more and more providers continue to implement electronic systems in their practice, available clinical data grows. Public health researchers are able to utilize this data to solve medical problems, monitor disease outbreaks, and increase and improve the monitoring of biological threats. Having a large, common source of aggregate data allows researchers to conduct similar tests and verify results obtained by other researchers, contributing to advancements in the medical field that could take years longer if not for the data obtained through electronic systems. In this way, electronic records are helping to improve the health of entire populations by creating methods of more efficient research and collaboration. Barriers to Implementation Though clinical, operational, and societal advantages to implementing electronic systems are undeniable, it is easy to see potential disadvantages in becoming too dependent on these technologies. Many of these disadvantages stem from difficulties with implementing electronic systems. Often cited as the most difficult barrier to overcome is the financial burden of implementing an electronic system in an office. These technologies come at a significant cost and often practices 6

7 see a period of decreased productivity after implementation, further increasing costs. Another barrier that must be overcome is that of patient and public opinion on implementing these technologies. Many patients fear the lack of privacy and security surrounding their private information when these technologies are utilized. These disadvantages result in many practices choosing not to use electronic health systems, although once overcome and fully implemented, the advantageous outcomes are able to offset the disadvantages. The financial burden associated with switching to an electronic record keeping system is significant. Implementation costs alone are difficult to overcome which include purchasing the systems and hardware and converting paper information to electronic records. Associated costs are also a barrier, including ongoing required maintenance, employee training, and a period of decreased productivity following implementation as a result of needing to train employees. According to Menachemi and Collum (2011), In the outpatient setting, early researchers estimated an average initial cost of $50,000 $70,000 per physician for a three- physician office with a maintenance cost of $8,412 per year. Especially for a small private practice, these costs are difficult to overcome. However, as these technologies become more commonplace, costs are driven down, making it more affordable for physicians. In addition, once implemented, electronic systems have the opportunity to reduce costs for a practice while providing better quality care to patients. For example, handling prescriptions electronically as a result of installing electronic systems is known to reduce costs as well as improve care by ensuring that accurate prescriptions are sent to a pharmacy and allowing a physician to 7

8 better track their patients prescriptions (Gaylin, Moidudden, Mohamoud, Lundeen, Kelly, 2011). Electronic systems also have the ability to reduce excessive testing, better locate records, manage appointments, and allow physicians to better understand patient conditions, all allowing a practice to reduce costs. Though the initial costs of implementing such a system are high, the long run benefits are significant and can help to reduce costs while providing better quality care at the same time. Though costs are a significant barrier for physicians to the implementation of electronic health records, they also must work through concerns of their patients associated with privacy. As more information is exchanged electronically, patients become more wary of their private information being so readily accessible to so many people. Gostin (1997) states, advocates of the right to privacy view computerization as a substantial threat. As vastly greater amounts of information are collected and transmitted to an ever- increasing number of users in remote locations, the ability of consumers to control the dissemination of personal information is sharply reduced. As privacy becomes a larger issue however, policymakers continue to take steps to ensure patient safety. Legislation continues to attempt to make it both harder for individuals to inappropriately access data and also imposes strict consequences on those who try to access the information. New systems implemented have security measures designed to protect personal data including identifiers to restrict entry into a database, information organized by security level, and audits of everyone who 8

9 uses the databases (Gostin, 1997). Many hospitals and practices have implemented strict penalties for employees who abuse the systems and inappropriately access information. Though privacy is a significant issue, the measures being taken are helping to ensure patient data is secure so medical care can be conducted as efficiently as possible without risking the security and safety of patients. More Expensive or More Efficient? Though the direct and associated costs of electronic record systems are steep and the concerns surrounding them are valid, implementing a system allows medical professionals to provide their best care using the most efficient methods. Electronic medical and health records place all the information a physician needs to know at their fingertips, allowing a physician more time to focus on what truly matters: keeping their patients healthy. Many argue that implementing such systems only adds excessive costs to an already strained system. However, with the proven efficiencies resulting from making the transition to electronic record keeping, the system as a whole is able to benefit in ways not possible without them. As more private practices and hospitals transition to electronic health or medical records, more patients will be able to benefit from the collaboration possible. With greater implementation, physicians will be in better contact with each other and will be more able to share data to solve cases and treat their patients more successfully. As these systems become commonplace in the medical workplace, the costs will become more controlled and issues such as privacy concerns will be managed as policymakers are already working to do. Electronic systems may initially create significant costs and worries that are a significant barrier to overcome but in the 9

10 long run create opportunities for the medical field to function in a way not possible with the traditional paper filing system. Conclusion In the path to implementing electronic record systems in medical practices stand barriers that seem very difficult to overcome, resulting in many professionals choosing not to make the transition. On the other side of these barriers however, is much more efficient patient care that opens the door for professional collaboration, more successful treatment, less patient disability, reduced costs, and more. Concerns about patient security are already being taken care of with strict regulations and systems that have built in security measures. Universal implementation of electronic health and medical records will do a significant part in transforming the medical system to a more organized and better- operated industry. Adoption of these tools must be considered as a way to further focus on quality improvement and cost reduction. In the long run, adopting an electronic system will provide significant returns to a practice and to patients. 10

11 Reflective Note: At this point in time I believe I will include this paper in my final portfolio. It illustrates an attempt to bring together the research and findings of other individuals to craft an argument and persuade the reader that electronic medical and health records are beneficial to the health care industry. This paper also shows a method of creating an argument by discussing both sides of the issue, focusing on some points and downplaying others, which is a successful and useful method. This paper displays persuasive rhetoric and illustrates research abilities that I feel will fit well into my portfolio. 11

12 Sources Agrawal, A., (2009, June). Medication errors: prevention using information technology systems. Retrieved from Gaylin, D., Moiduddin, A., Mohamoud, S., Lundeen, K., Kelly, J. (2011, June). Public Attitudes about Health Information Technology, and Its Relationship to Health Care Quality, Costs, and Privacy. Retrieved from Gostin, L. (1997, October). Health care information and the protection of personal privacy: Ethical and legal considerations. Retrieved from b706- faf84bcb38fc%40sessionmgr111&vid=1&hid=101&bdata=jnnpdgu9zwhvc 3QtbGl2ZSZzY29wZT1zaXRl#db=aph&AN= Hsiao, C., Hing, E. (2012, December). Use and Characteristics of Electronic Health Record Systems Among Office- based Physician Practices: United States, Retrieved from Jamoom, E., Beatty, P., Bercovitz, A., Woodwell, D., Palso, K., Rechtsteiner, E. (2012, July). Physician Adoption of Electronic Health Record Systems: United States, Retrieved from Menachemi, N., Collum, T. (2011, May). Benefits and drawbacks of electronic health record systems. Retrieved from Satvat, A. (2011). Electronic Medical Records: An Inquiry into Promoting Their Adoption within the American Health System. Retrieved from content/uploads/2013/01/2010_2011 Satvat Amir Electronic_Medical_ recods_an_inquity_into_promoting_their_adoption_within_the_american_heal th_system Secured_PDF.pdf 12

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