Electronic health records (also known as ‘e-notes’) have commonly replaced the conventional paper records used in medical facilities. This discussion describes how electronic health records have provided a solution to a range of health care procedures, have offered cost savings and benefits, and still have greater potential for improvement through future efforts. Overall, this discussion documents the progress and demands for further convenience in regards to electronic health records, presenting concepts, statistics, and recent analyses published by authorities on the topic. Through this, it is evident that electronic health notes still have shortcomings that are commonly noted and targeted, but as they have solved many more problems inherent in previous systems, they are the ideal path for development and improvement in this area.
Electronic Health Records
Since the development of electronic health records, healthcare managers have been able to reach numerous solutions to previous problems in their systems; this has included improved capacities to record and store the clinical and demographic information patients, the capacity to observe or manage the results of laboratory tests, the capacity to give prescriptions, improved ease of managing billing data, and improved facilitation of analysis for clinical decisions. These improvements reveal the nature of challenges and demands relevant to operations using the previous form of records (paper), with electronic health records being substantially more organized, convenient, and manageable. According to Al-Ubaydli (70), the use of paper records “had several implications.
On the one hand, writing on paper fast and easy, so it fits well with clinical workflow. On the other hand, notes are only useful to the person who reads them, no to the one who writes them. When writing, speed and brevity are essential as there are always more patients to visit and care for. But for the reader, speed means illegible handwriting and brevity means incomplete notes. This leads clinicians to ask patients questions to which the answers already exist in the notes” (Al-Ubaydli 70). Moreover, as the author pointed out, paper is more difficult to transfer or copy, leading to it ultimately becoming easiest to keep the records confined to one central place. With this, they cannot move as easily as the patient, and the chore of copying tended to result in the patients being without a complete set of easily accessible records. Meanwhile, there are substantial space and cost requirements associated with storing paper records.
The development of computer hardware, software, and improved data storage techniques eventually led to the development of efficient and effective software capable of storing patient data in secure databases, further allowing all data to be stored in a size-efficient manner that could also be easily transmitted. With the development of the internet, patient files could even be stored and transmitted online, providing an ideal backup for databases while improving the capacity for patients to have complete record sets sent to a range of facilities.
The general motivation for creating these electronic health records was to address the problems inherent in the paper records, with the most convenient aspect being the cost-effective nature of storage and transmission; the nature of this being a virtually free cost and nearly instantaneous transmission made the desire and changes especially significant. Moreover, electronic health records would allow users to improve the capacity for users to index, sort, and search through records faster than the time demanded to sort through the paper files manually (Al-Ubaydli 70). An additional benefit is the reduced potential for illegible notes, as the nature of the systems means that all data is entered in using clear computerized text characters.
As mentioned, similar to the nature of demands and problems evident in the paper records, there are now demands for improving aspects of the electronic records. However, these problems can be addressed through improved organization, software, and other means that does not demand a drastic change in mediums, as was required to address the problems of the paper records. Al-Ubaydli (71) reported that electronic health records “must include checks and balances to audit and control access.
Second, the user interfaces for adding to the records must become easier to that they fit better into clinical workflow and allow clinicians to do more in less time. Speech recognition continues to improve, and the designers of templates continue to innovate.” The author further points out that similar to the improved search engines of the internet (first challenging and then drastically improved with developments like Google), electronic health records can be similarly improved without restructuring comparable to restructuring paper records.
Other researchers have analyzed the nature of electronic health records, further elaborating on the nature of solutions and remaining demands. DeVoe et al. (351) pointed out that the clear and detailed recording of all received and recommended services should be considered the most vital aspect of health records, which is most effectively addressed through electronic records rather than paper records. This further assists with insurance aspects, as the detailed and accurate aspects of recording services can improve coordination with claims and related demands. DeVoe et al. (352) further asserted that electronic health records have the potential to assist researchers and policy makers with overcoming prior restrictions in examining services provided in CHCs.
Meanwhile, Hoffman and Podgurski (425) reported on the growth of health care and pharmaceutical costs, frequency of unnecessary medical procedures, evoked healthcare reforms, and critical roles of records in all of these processes. With this, comparative effectiveness research (CER) has commonly been coupled with electronic health records to show that many expensive procedures have had less desirable outcomes for comparable conditions that less expensive ones, pointing out the nature of some health care facilities and physicians. Meanwhile, however, some have argued that CER is likely to lead to limited patient choices, improper rationing of health care, homogenized care, and potentially refusal of needed treatments (Hoffman and Podgurski 425).
Congress allocated $1.1 billion to CER through the American Reinvestment and Recovery Act, which included other aspects of improving and restructuring facilities. Soon it became evident that a unique application of CER could allow physicians to improve their decisions regarding treatment, as when coupled with electronic health records, physicians could conduct computer inquiries across a large database of patient records. Naturally, this would provide a valuable supplement to the patient’s history and literature. Hoffman and Podgurski (425) recommended that software be designed to summarize findings of queries by presenting the most relevant outcomes of patients with the most comparable conditions, while records be developed and stored in a manner which facilitates this. Thus, personalized comparison of treatment effectiveness or PCTE could become a phrase more common than CER in the future.
Electronic health care records have solved many of the problems that could not be effectively addressed through developments in the paper systems, with major improvements in the capacity to copy and transfer records, cost of storage, and clarity of information. Although this has led to implications for security and excessive copying, databases have been developed to improve the concerns in these areas. Moreover, researchers have proposed additional improvements in development as well as use, with records having the potential to serve as an informal accessible databank, thereby improving understanding and decision making.
Al-Ubaydli, Mohammad. Personal Health Records: A Guide for Clinicians. John Wiley & Sons: New York, NY, 2011.
DeVoe, Jennifer, Rachel Gold, Patti McIntire, Jon Puro, and Susan Chauvie. “Electronic Health Records vs Medicaid Claims: Completeness of Diabetes Preventive Care Data in Community Health Centers.” Annals of Family Medicine 9.4 (2011): 351-358.
Hoffman, Sharona and Andy Podgurski. “Improving Health Care Outcomes through Personalized Comparisons of Treatment Effectiveness Based on Electronic Health Records.” Journal of Law, Medicine & Ethics 39.3 (2011): 425-436.