For years the health care industry has explored methods to improve the way patient information is managed. Electronic medical records were developed to solve many, if not all, issues surrounding paper medical records and the management of patient information. Storage, legibility, accessibility and security of medical records are a few of the areas where electronic medical records excel over paper medical records. Instantaneous access and improved accuracy resulting from electronic medical records can greatly improve a patient’s quality of care, prevent serious harm to patients, and ultimately save lives.
Financial aspects play a large role in the implementation of electronic medical records. While there are many cost-saving advantages to electronic medical records, the initial cost of implementation burdens many if not most health care facilities. This burden may prohibit health care facilities from the ability to implement electronic medical records. Overall, physicians and patients agree that electronic medical records will help improve patient care and efficiency.
Health Information Technology: Electronic Medical Records
For years the health care industry has explored methods to improve the way patient information is managed. Paper medical records are cumbersome and require a lot of storage space and personnel to maintain them. Transferring paper records between health care facilities and professionals is very tedious and time-consuming. To solve many, if not all, issues surrounding paper medical records, electronic medical records were developed. Electronic medical records relieve the issue of large warehouses of storage and tedious transferring of information, as well as many of the other concerns affiliated with paper records. While there are many advantages to electronic medical records, there are also some downfalls, such as the initial cost of implementation and the financial burden this places on healthcare facilities.
According to journalist John Csiszar, hospitals and medical facilities have warehouses filled with decades-worth of paper medical records (2012, Storage section, para. 1). Paper medical records not only take up quite a bit of space, they are also not eco-friendly (Csiszar, 2012, Storage section, para. 1). Another drawback of paper medical records is that they deteriorate over time due to paper being degradable and the more a paper record is handled, the faster it deteriorates. This poses major consequences, especially for patients who have chronic medical issues that require multiple reviews of their records. Electronic medical records are far easier to store than paper records.
Csiszar states, “Electronic [medical] records can be stored on computer drives that require much less space and fewer resources to produce” (2012, Storage section, para. 1). Electronic medical records can also be stored and accessed forever, without concern of deterioration, as is associated with paper medical records (Csiszar, 2012, Storage section, para. 1). This is extremely beneficial for health care providers as they are able to review patients’ medical histories repeatedly without risk of deteriorating or damaging records.
It is generally acknowledged that the readability of a hand-written document is dependent upon the penmanship of the writer. Legibility of handwriting varies with the individual. Medical terminology, especially for those unfamiliar with medicine, can be challenging to decipher in paper medical records (Csiszar, 2012, Legibility section, para. 1). This legibility problem can lead to miscommunication among health care providers and grievous errors, which in turn can lead to poor care, harm, and even death of patients. Csiszar notes, “One of the clear benefits of electronic [medical] records is that typeface is more or less standardized and clear across all records” (2012, Legibility section, para. 1). The clarity provided by electronic medical records saves time for the reader, and time is critical during medical treatment (Csiszar, 2012, Legibility section, para. 1). Improved accuracy resulting from the clarity of communication can prevent serious harm to patients and ultimately save lives.
When it comes to accessing a patient’s medical record, paper records are by far the most vexing to retrieve. In order for health care facilities or providers to share patient records with other facilities and providers, paper medical records must be copied and mailed, faxed, or scanned into the computer and emailed (Csiszar, 2012, Access section, para. 1). These processes can be very time-consuming and ultimately affect the outcome of a patient’s condition. Electronic medical records are designed to be easily shared among health care providers, especially providers employed by the same health care company. Electronic medical records can be shared almost instantaneously via electronic transmission or direct access to a computer storage system (Csiszar, 2012, Access section, para. 1). This instantaneous access can greatly benefit a patient’s quality of care, particularly when time is of the essence.
Both paper and electronic medical records can be problematic when protecting patient privacy. According to the Health Resources and Services Administration (HRSA), part of the U.S. Department of Health and Human Services, three of the most common security risks include: “(1) the risk of inappropriate access, (2) the risk of record tampering, and (3) the risk of record loss due to natural catastrophes” (2012, para. 2).
Risk of Inappropriate Access
Regardless of the format of a patient’s medical record, it is always vulnerable to a risk of inappropriate access (Health Resources and Services Administration, 2012, para. 3). For paper medical records, the risk of inappropriate access occurs when individuals gain access to record storage areas, find records left in patient or exam rooms, receive misdirected faxes, or other similar scenarios (Health Resources and Services Administration, 2012, para. 4). The HRSA states, Since access to paper [medical] records implies physical access, securing against inappropriate access is accomplished by segregating records into separate locked storage areas; restricting physical access to storage areas; recording sign in and sign out procedures; and maintaining records handling training and other similar procedures (2012, para. 4).
With electronic medical records, inappropriate access takes place in one of two ways: (1) an unauthorized user accesses a patient’s record; or (2) an authorized user violates conditions of the appropriate use policy (Health Resources and Services Administration, 2012, para. 5). According to the HRSA, “Electronic [medical] records can also be subject to breaches of network security that may allow a hacker to gain access to user credentials and thereby bypass the access control protections” (2012, para. 5). It is important for health care facilities to have strict network access guidelines and security as well as an appropriate use policy that is reviewed by newly hired staff and routinely reviewed by all staff.
Risk of Record Tampering
Medical records can be manipulated or tampered with in many ways, including changing dates of records, entering fraudulent data, or changing entries. Any individual who has access to a patient’s paper medical record has the ability to remove pages, add or erase entries, or other fraudulent acts (Health Resources and Services Administration, 2012, para. 7). Tracing the origin of altered paper medical records is very difficult and sometimes impossible. Electronic medical records are much more difficult to fraudulently manipulate because the ability to make changes to an electronic record depends on the rights assigned to a specific user.
Individuals with privileges to modify data have the ability to add, delete, or change data or entire records (Health Resources and Services Administration, 2012, para. 8). An electronic medical record can also be tampered with by directly accessing information stored on the server using a server account rather than a user account (Health Resources and Services Administration, 2012, para. 8). Fortunately, any access or manipulation to electronic medical records can be tracked and thus is traceable. Identifying the person who may have fraudulently accessed or modified a record is much easier through electronic medical records than through paper medical records.
Risk of Loss Due to Natural Catastrophes
According to the HRSA, “Fires, floods or other environmental disasters attack physical locations and can result in the complete loss of both paper and electronic medical records” (2012, para. 9). An advantage to electronic medical records is that they can be continuously backed up to off-site storage. Therefore, the records can always be recovered, even if the physical medical facility is damaged.
In recent years, hospitals nationwide have been faced with immense pressure to implement health information technology systems, such as electronic medical records. According to Jay J. Shen, PhD and Gregory O. Ginn, PhD, CPA, The initiative to implement health information technology has persisted through two administrations. First, during the G.W. Bush Administration, the position of the National Coordinator for Health Information Technology was created by executive order in the Department of Health and Human Services.
Later, in the B.H. Obama Administration, Congress passed The American Recovery and Reinvestment Act of 2009 (2012, p. 61). The expectation of implementing health information technology is the improvement of hospital performance with regard to cost and quality of care to the consumer and the health care system. The downside of these initiatives is the crushing financial repercussions endured by non-profit hospital systems.
Positive Financial Aspects
By implementing health information technology, especially electronic medical records, hospitals can reduce the costs associated with quality patient care. Shen and Ginn state, Hospitals should be able to reduce the costs associated with medical errors by identifying harmful drug reactions or possible allergic reactions using the information provided by … [electronic medical records]. Hospitals should also be able to lower costs by facilitating preventative medicine and helping physicians manage patients with complex chronic conditions by utilizing the information provided by … [electronic medical records] (2012, p. 62).
Electronic medical records help to increase efficiency and reduce cost by: (1) decreasing the need for medical transcription and physically pulling charts; (2) prompting providers to prescribe generic drugs instead of brand-name drugs; and (3) reducing duplicate diagnostic tests and studies (Shen & Ginn, 2012, p. 62). Electronic medical records contribute to lowered costs while improving the efficiency and quality of care for hospitals, patients, and the entire health care system.
Negative Financial Aspects
In recent years, only a small percentage of health care facilities have implemented electronic medical records, even though these facilities have the ability to experience substantial cost savings and improvements in quality of care (Shen & Ginn, 2012, p. 62). “This low rate of adoption is attributed in large part to financial barriers,” states Shen and Ginn (2012, p. 62). Some of the financial barriers contributing to the low adoption rate of electronic medical records include: (1) significant capital requirements; (2) absence of clear evidence showing a positive effect on investment return; (3) high maintenance expenses; and (4) high human resources costs associated with the need for an increased number of information technology staff (Shen & Ginn, 2012, p. 62). Another financial barrier for health care facilities is that although they endure the cost of implementing electronic medical records, the providers and payers experience the financial benefits from the cost savings (Shen & Ginn, 2012, p. 62).
Physician and Patient Perception of Electronic Medical Records Overall, research shows that electronic medical records have been well-received by the base of physicians and patients affected by their implementation. Sage Healthcare Division, a unit of Sage North America, conducted a study that examined the effect of electronic medical record implementation on physicians and their patients (Healthcare IT News Staff, 2011, para. 1-2). The study indicated that the majority of patients and physicians have a positive perception of electronic medical records (Healthcare IT News Staff, 2011, para. 1). Healthcare IT News Staff specify, “According to the study, patients felt more comfortable with physicians that used … [electronic medical records], and more importantly, felt that the information contained in the medical record was more accurate when they physically saw information being entered electronically” (2011, para. 3).
Betty Otter-Nickerson, President of Sage Healthcare Division, noted, “… [W]e learned … [that] … patients like to see their verbatim information entered into the record as they said it, not as the doctor interpreted it” (Healthcare IT News Staff, 2011, para. 4). She also noted that patients who participated in the survey said they had greater confidence in providers who used electronic medical records and encouraged their physicians to adopt more connected technologies such as electronic medical records (Healthcare IT News Staff, 2011, para. 6-7). “… [D]irect feedback from patients gives providers an opportunity to learn how to improve their practices and their patient relationships,” stated Otter-Nickerson (Healthcare IT News Staff, 2011, para. 7).
* Physicians and patients have a positive overall perception of patient care that was documented electronically (62 percent of physicians and 81 percent of patients) (Healthcare IT News Staff, 2011, para. 5). * Nearly half of patients positively perceived their physician when they were noted to be documenting electronically (45 percent) (Healthcare IT News Staff, 2011, para. 5). * Over half of physicians find real-time access to patient records to be the biggest benefit of using electronic medical records (60 percent) (Healthcare IT News Staff, 2011, para. 5). * One of the most important benefits noted by physicians is the ability to easily share information with other physicians, facilities, and payers (Healthcare IT News Staff, 2011, para. 5). *
The majority of patients and physicians agreed that electronic medical records will improve the quality of care in the healthcare industry (78 percent of patients and 62 percent of physicians) (Healthcare IT News Staff, 2011, para. 5). * Both patients and physicians have concerns about patient privacy and the security of electronic medical records (81 percent of patients and 62 percent of physicians) (Healthcare IT News Staff, 2011, para. 5). * The most important benefits noted of electronic medical records were: (1) they give physicians real-time access to patient records; (2) they help physicians securely share patient information with other providers; and (3) they help the physician improve the quality of patient care (Healthcare IT News Staff, 2011, para. 5).
Electronic medical records are a useful tool in improving patient satisfaction, quality of care, and the efficiency of the health care industry. Electronic storage options relieve the burden of large warehouses and the risk of deteriorating repeatedly viewed medical records. Instantaneous access and improved accuracy resulting from electronic medical records can greatly improve a patient’s quality of care, prevent serious harm to patients and ultimately save lives. The ability to easily identify individuals who may have fraudulently accessed or modified a record helps to protect accuracy of records and patient privacy. Although the initial implementation costs of electronic medical records can be quite arduous, the cost-saving benefits will continue to grow. Patients and physicians agree that electronic medical records will improve patient quality and efficiency of care.
Csiszar, J. (n.d.). Paper vs. electronic medical records. Retrieved November 12, 2012, from Chron: http://smallbusiness.chron.com/paper-vs-electronic-medical-records-40354.html Health Resources and Services Administration. (n.d.). What are the privacy and security risks of electronic vs. paper health records? Retrieved November 12, 2012, from U.S. Department of Health and Human Services: http://www.hrsa.gov/healthit/toolbox/HealthITAdoptiontoolbox/PrivacyandSecurity/securityrisks.html Healthcare IT News Staff. (2011). Study: Patients believe EMRs bring accuracy to their records. Retrieved November 15, 2012, from Healthcare IT News: http://www.healthcareitnews.com/news/study-patients-believe-emrs-bring-accuracy-their-records Shen, J. J., & Ginn, G. O. (2012). Financial position and adoption of electronic health records: A retrospective longitudinal study. J Health Care Finance, 61-77.