Electronic Health Records – Benefits and Implementation
What is electronic health record (EHR)
An electronic health record (EHR) is a digital version of a patient’s paper chart, offering real-time, patient-centric information instantly and securely to authorized users. While an EHR encompasses medical and treatment histories, an EHR system surpasses standard clinical data from a provider’s office, providing a comprehensive view of patient care. EHRs are integral to health IT, can:
- Include medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory/test results.
- Grant access to evidence-based tools aiding providers in decision-making for patient care.
- Automate and streamline provider workflows.
A notable feature is the ability for authorized providers to create and manage health information digitally, facilitating sharing across diverse healthcare organizations. EHRs are designed to collaborate with other providers and entities, ensuring information exchange among laboratories, specialists, medical imaging facilities, pharmacies, emergency centers, and school or workplace clinics, consolidating data from all clinicians involved in a patient’s care.
Among other types of data, an EHR typically includes:
- Contact information
- Information about visits to healthcare professionals
- Allergies
- Insurance information
- Family history
- Immunization status
- Information about any conditions or diseases
- A list of medications
- Records of hospitalization
- Information about any surgeries or procedures performed
It is also becoming more common to see medical images attached to EHRs.
Differences between EHR and EMR
Electronic medical records (EMRs) are a digital version of the paper charts which contain patients’ medical and treatment history mostly used by clinicians. In contrast, EHRs covers more information than EMRs. Health could be defined as the general condition of the body, encompassing body, mind, or spirit and especially…freedom from physical disease or pain.
EMRs allow clinician improve their productivity with numerous advantages over paper records.
- Monitor data over a long period of time
- Effortlessly identify which patients are due for preventive screenings or checkups
- Track patients specific parameter progress such as blood pressure readings or vaccinations
- Monitor and enhance comprehensive quality of patient care
However, the data in EMRs faces challenges in seamless transmission beyond the practice. In some cases, patient records may need to be printed and sent via mail to specialists and other members of the care team, making EMRs not significantly more advanced than paper records.
On the other hand, Electronic Health Records (EHRs) surpass these limitations and offer additional capabilities. EHRs prioritize the overall health of the patient, extending beyond standard clinical data collected in the provider’s office to encompass a more comprehensive view of a patient’s care. Unlike EMRs, EHRs are designed to transcend the initial health organization that compiles the information, facilitating the sharing of information with various healthcare providers, including laboratories and specialists.
This capability transforms the nature of shared information, making it more robust and powerful. Given that healthcare is a collaborative effort, shared information significantly contributes to the effectiveness of the entire healthcare delivery system. The value derived from healthcare often hinges on the efficient communication of information between parties and the ability of multiple stakeholders to engage in interactive information exchange.
Benefits of Electronic Health Records
Although the prevalence of EHR systems in the healthcare system is well-established, it’s essential to highlight the assistance this health informatics tool offers to the industry. Here are the top seven benefits of harnessing EHR systems in healthcare.
Improves Quality of Care
EHR systems offer swift and convenient access to patient information, empowering healthcare providers to make well-informed decisions about patient care.
Here are a few ways EHRs enhance patient outcomes:
- Medication conflict checks: EHRs track patients’ medications and allergies, enabling them to identify potential issues or conflicts with newly prescribed medications.
- Improves emergency care: EHRs provide immediate access to critical information, such as life-threatening allergies, enabling emergency staff to deliver the right care to patients, even if they’re unconscious.
- Highlights safety risks: EHRs assist healthcare providers in averting potential safety issues by alerting them to potential risks, ultimately contributing to improved patient outcomes.
Increases Efficiency
EHR systems bring a notable advantage to healthcare organizations by significantly improving operational efficiency, supported by compelling evidence indicating a positive return on investment.
Key administrative processes streamlined by EHRs include:
- Appointment scheduling: EHRs automate scheduling, reducing common errors like double booking. Real-time updates enable providers to adjust schedules, send reminders, and enhance overall appointment management.
- Billing: EHRs minimize the risk of missed or delayed payments by automating bill generation and delivery to patients. They also identify discrepancies, such as duplicate charges or incorrect billing codes, ensuring accurate financial transactions.
- Patient communication: EHRs not only facilitate easier patient access to medical information but also provide secure messaging platforms for patients to communicate with their providers, fostering confidential and convenient interactions.
These improvements contribute to efficient workload management for healthcare providers, mitigating human errors such as illegible handwriting and misplaced paperwork.
Boosts Patient Engagement
EHRs foster a collaborative environment between patients and healthcare providers. By creating more transparency for patients, EHRs have allowed patients to have more of a say in their healthcare. This secure access to health information has encouraged more people to take control of their health and actively engage with their healthcare providers.
“One of the things that research has shown is that the more information you make available to the patients, the more engaged they become,” explains Spitulnik.
This is particularly true when considering chronic illnesses that require ongoing treatment, which impact approximately 60 percent of American adults. EHR systems improve providers’ ability to form long-term relationships with patients and collaborate with them to find solutions.
Reduces Medication Errors
Facilitating convenient retrieval of patients’ medical history, allergies, and current medications serves as a preventive measure for doctors, averting the prescription of medications that may pose harm or conflict with existing prescriptions. This not only enhances patient safety but also equips doctors with the necessary information to offer precise recommendations.
Furthermore, EHR systems contribute to averting medication errors through features like medication alerts, reminders for healthcare providers, and automated medication prescribing. Given that medical errors incur substantial costs, approximately $20 billion annually, EHRs play a pivotal role in mitigating these expenses, particularly by addressing communication errors—one of the primary causes of inaccuracies in the medical field.
Enhances Data Security
EHR systems offer better data security than paper-based systems, as data is stored in secure, encrypted formats that can only be accessed by authorized personnel. Additionally, EHRs facilitate secure sharing of patient data among authorized healthcare providers, allowing for seamless communication between teams and minimizing the risk of data breaches. These systems also conduct regular backups and data recovery measures, which ensures patient information is accessible and protected at all times.
Enhances Data Accessibility
The widespread adoption of EHR systems is largely attributed to their enhanced accessibility. They facilitate easy access to medical records for both healthcare providers and patients, enabling retrieval from any authorized device.
While both groups benefit from improved data accessibility, the extent of information available to them varies.
- For healthcare providers, EHR systems permit access to patient data from any location with an internet connection, facilitating the delivery of care to patients in diverse locations.
- In line with the HITECH act, patients now possess the right to access their healthcare information through a digital copy of their health data via a secure and confidential EHR system.
Saves Money
The cost-saving advantages of EHR systems are subject to debate, given their initial maintenance expenses. Nevertheless, there are several aspects of EHR systems that contribute to long-term financial savings.
Additional ways in which EHR systems can generate cost savings for healthcare providers include:
- Reducing the reliance on paper-based systems.
- Decreasing the time spent on administrative tasks.
- Minimizing instances of medical errors and inefficiencies.
Types of Electronic Health Record (EHR) Systems
On-Premise EHR Software
On-premise EHR software involves purchasing the software from a vendor and installing it on servers within your office. This method requires an initial investment in software, servers, and local network connectivity. However, on-premise EHR solutions typically don’t involve subscription fees, resulting in long-term cost savings compared to Software as a Service (SaaS) models.
Most enterprise on-premise EHR software is ready to use upon installation. Still, your practice may need to tailor clinical content, templates, reports, or other features to align with your specific needs and workflows.
SaaS EHRs
In contrast, Software as a Service (SaaS) or cloud-based EHR solutions eliminate the need for on-site servers and infrastructure. Your practice accesses a SaaS EHR system via the web, with lower initial costs but a requirement for a monthly or annual subscription. SaaS EHRs may offer less customization compared to on-premise solutions.
Custom EHR Builds
For highly specialized practices, a custom EHR system may be beneficial, tailored to specific needs. However, building a custom system from scratch involves a significant upfront investment. Given the array of Enterprise EHRs available, a more practical approach may be adopting a hybrid model. This involves integrating custom interfaces, templates, and reports into a flexible enterprise on-premise EHR.
How to Implement EHRs
Many healthcare professionals acknowledge that integrating an EHR is a continuous process without a defined endpoint, offering constant opportunities to refine workflows and enhance data utilization. This segment offers valuable resources to assist you at various stages of the journey toward EHR adoption, implementation, and enhancement. These stages encompass:
- Planning
- Selecting a vendor
- Contracting with a vendor
- Implementing and adopting an EHR
- Using your EHR
- Optimizing your EHR
Planning
Set a Clear Roadmap
Initiate the EHR adoption journey with a comprehensive evaluation of your facility’s readiness. Examine the existing infrastructure, clinical processes, education, and training capabilities to determine their suitability for EHR system implementation.
One common pitfall in EHR implementations is the lack of an initial needs assessment by management. To mitigate this, involve high-level executives in the planning phase to accurately gauge the current state of medical practices and capabilities.
This step focuses on key planning measures to guide you through the EHR acquisition process. A thorough understanding will enable effective communication of specific requirements to potential vendors. Key aspects include:
- Types of EHR products and service models
- Researching and comparing EHR products and vendors
- Identifying and prioritizing your EHR’s technical and operational requirements
- Due diligence — finding the best EHR for your needs
- Understanding certification and regulatory requirements
- Procurement strategy, planning, and resourcing
Select an EHR
The decision to transition to an electronic health record (EHR) system demands considerable time and effort. Prior to embarking on your implementation project, it is crucial to comprehend the advantages an EHR brings to your practice and establish realistic expectations. Potential obstacles to successful adoption include:
- Difficulty understanding your organization’s information needs
- Uncertain costs
- The intensive effort required to identify and implement a system
To overcome these roadblocks, ensure the presence of these success factors:
- Readiness
- Eager personnel
- A dedicated champion
- Stakeholders who perceive EHRs as useful
- Teamwork
Keep in mind that your planning should encompass both the initial and ongoing effects of EHR implementation on your clinical practice.
Adopt and implement your EHR
Achieving a successful EHR adoption involves two key steps: pre-implementation and implementation. Adhering to these guidelines will optimize the benefits of your system.
- In the pre-implementation phase, you should:
- Establish a governance process and a project plan.
- Communicate with and involve staff and patients.
- Redesign workflows.
- Provide education and training.
Establishing a governance process involves creating guidelines and a stewardship plan focused on data integrity. This ensures the effective and sustainable implementation of your EHR system, with proper data management practices.
In the implementation phase, you should:
- Tailor the system to meet practice requirements.
- Establish a change-management process.
- Determine how to backload patient medical histories.
- Account for the time your staff needs to learn and use the system.
- Provide ongoing support for the system.
- Encourage your staff throughout the process.
Migrate your data
Transitioning from paper-based documentation to an electronic health record (EHR) system demands meticulous planning, and the same applies when migrating from one electronic environment to another. There are various reasons why you might consider replacing your EHR, such as:
- Outgrowing the capabilities of your current EHR.
- Expanding your practice.
- Joining another practice.
Thoughtful planning for data migration ensures that your new EHR can seamlessly integrate and access historical data.
Optimize Electronic Health Records (EHRs)
Now is the moment to assess the implementation process and its impact on your practice. This evaluation allows you to discern successful strategies and areas for improvement, guiding you to either avoid repeating errors or replicate successful approaches.
Consider the following aspects:
- Was the implementation process executed smoothly?
- Did all members of your practice actively participate and feel engaged?
- Did events unfold according to the planned schedule?
- What were the strengths and weaknesses of the implementation?
- How did the implementation influence workflow — the procedural steps undertaken by you and your staff?
- Can you pinpoint areas offering opportunities for enhancement?
Reaching this noteworthy milestone in your electronic health record (EHR) journey signifies achievement. A comprehensive evaluation establishes a robust foundation, enabling you to enhance the value of your EHR system continuously.
Plan for ongoing improvements
“Usability” pertains to the ease, effectiveness, and efficiency of using a software application. The usability of your Electronic Health Record (EHR) is influenced not just by its design but also by the implementation process. After successfully launching your EHR, consider the following steps:
- Embrace a continuous optimization approach, acknowledging that the system can always be refined.
- Set up a structured process to collect feedback from clinicians, patients, and other EHR users.
- Implement improvements based on user feedback and industry best practices.
Challenges of EHR
Implementation and Usage Costs
The adoption of health information technology, such as Electronic Health Records (EHRs), can incur significant expenses related to personnel, training, infrastructure, and support. Securing funds for these investments can be particularly challenging for smaller healthcare practices.
Time-Intensive Training
The implementation of EHRs may demand substantial time, effort, and resources for training healthcare providers and the medical team. This training phase could pose a barrier to the smooth adoption of EHRs due to the additional workload.
Privacy Concerns
Some healthcare professionals and patients may harbor concerns about privacy when using EHRs, particularly in light of potential data breaches and the loss of medical records through cyber hacks.
Data Migration Challenges
Transitioning from paper-based to digital records can present logistical challenges for staff, especially in hospitals with extensive patient documentation. The migration process may be perceived as tedious, doubling the effort required for data entry.
Interoperability Issues
Despite the crucial role interoperability plays in understanding a patient’s complete medical history, achieving seamless data transfer remains a significant challenge. The lack of interoperability may impede care coordination, potentially leading to poor health outcomes and complicating the identification of the source of medical interventions.
Conclusion
For healthcare organizations, implementing an Electronic Health Record (EHR) is an ongoing process crucial for ensuring quality healthcare and compliance with meaningful use standards. In today’s healthcare landscape, a certified EHR system is not just a standard but a necessity for providers. Lobster Technologies provides tailored features to support the seamless operation of both financial and clinical aspects of your practice, allowing you to concentrate on providing optimal patient care. If you are interested in optimizing your business operations, please feel free to contact us at Lobster Technologies to explore how we can assist your organization in achieving its best performance.