In the recent yesteryear there has been a important accent for the demand to implement Electronic Medical Record systems. However, the benefits and defects of these systems need to be evaluated ( Amenwert et al. 2004 ) and a sufficient grounds base gathered utilizing a good structured scientific attack to warrant the alteration and step the organisational impact ( Wager et al. 2000 ) .
This essay will turn to the benefits and challenges of implementing Electronic Record Systems. It will look at applications of these systems in different attention scenes located in different environments so as to supply a broader position of some of the issues. The functions of the assorted stakeholders every bit good as the benefits and challenges they derive from electronic wellness records will be outlined and a elaborate rating of paper records and electronic records will be done. Decisions will so be made based on this analysis.
In context of wellness attention, electronic record systems can be defined as any structured record maintaining system, specifically designed to back up users by supplying context specific information which is electronically accessible, relevant, easy movable, accurate and complete. These records will normally keep information sing patients attention histories, non specific clinical informations, medical cognition or other wellness attention centered information. ( Coiera 2003 )
As the range is really wide and Electronic Health Records ( EHR ) has non been good defined ( Hayrinen et al. 2008a ) , the definition used was limited to EHR and allied systems such as Picture Archiving Systems ( PACS ) , Pharmacy Management Systems, Computer Physician Order Entry ( CPOE ) amongst other systems used twenty-four hours to twenty-four hours in a clinical scene. These countries are good documented and grounds easy gettable ( Clamp & A ; Keen 2005 )
Role of electronic records and patient Information in population based attention
A survey carried out by Qresearch utilised electronic records extensively with an purpose to describe on population tendencies and disease hazard factors. The analysis covered a 5 twelvemonth period and was able to set up that in the UK, London had the highest per centum of patients recorded as being tobacco users at 25 % and the lowest in the South East and South West at 20 % . It besides established that bulk of the tobacco users ranged from 25-34 old ages of age across all parts. ( Qresearch- NHS 2008 ) . The information obtained provided a platform for determination devising to find the intercessions to be undertaken, where resources should be focused and to whom it should aim. This sort of information excavation is merely possible when information is electronically stored ( Bocij and chaffey, 2005 ) as paper records suffer from monolithic atomization ( Dick et al. 1997 ) doing it hard to convey all the information for analysis. It has besides been established that manual methods would be uneffective to cover with such big informations sets and the multi dimensional analysis required ( Fayyad 1996 ) . The ability to execute such operations is a strong statement for electronic record acceptance in determination support and cognition find for population based intercessions ( Kraft et al. 2002 ) .
Furthermore, electronic records promote consistent recording of clinical information and this becomes a cardinal constituent when aggregating single records to organize datasets. Use of clinical codifications allows relevant informations to be derived from these unified datasets enabling dependable analysis across different sites. This in consequence is cardinal in supplying specific information for wellness research every bit good as in public wellness planning ( Ambinder 2005 )
Keeping in line with Pawsons theoretical account for context specific rating the literature was reviewed by looking at surveies done in assorted sites represented on table 1 and subsequently foregrounding advantages and disadvantages to assorted stakeholders identified.
General practicians are the initial point of contact between clinicians and patients, they play a polar function in guaranting that a patientA?A?A?s Electronic record is accurate, complete and current ( Dick et al. 1997 ) . As direct users of Electronic records, GPs benefit from the linkage of these record systems to other systems such as PACS or CPOE. Requests for accessory attention services can be done at a chink of a button and consequences for trials can be accessed instantly they become available. This in consequence enhances the completeness of patient records as they are updated in existent clip ( Ambinder 2005 ) cut downing the GPs administrative burden every bit good as accurately dwelling records for future brushs ( Wager et al. 2000 ) . Additionally, GPs are able to see different facets of a patients attention at a glimpse, forestalling duplicate in proving or medicine and cut downing costs ( Jones et al. 2008 ) . Attention can besides be drawn to countries that require GPs action through medical qui vives thereby steering the clinician in the expense of attention ( Coiera 2003 ) . In consequence, this increases the efficiency of the GP and a survey done in the Veterans Association has shown electronic records has allowed patients information to be available 100 % of the clip as opposed to 60 % of the clip cut downing the sum of Sessionss required to decide patient issues ( Wilson 2009 ) this, every bit good as enhance patient safety through, for case, reduced prescription mistakes ( Kaushal et al. 2001 )
Unfortunately, there is a significant acquisition curve and clinicians require preparation to utilize these systems ( Anderson 2007 ) . GPs may pass significant sums of clip inputting and recovering informations from these systems at the disbursal of interacting with their patients ( Poissant et al. 2005 ) . As information grows exponentially there is besides a fright of clinicians going overwhelmed due to the detonation of information ( Berner 2005 ) and the paradigm displacement in civilization besides presents chances for opposition to alter ( Hendy 2005 ) . System serviceability is besides a major concern when covering with electronic records. Young ( 2006 ) argues that this has been a major hindrance to widespread acceptance of these systems.
Patients and their carers
In the UK, The NHS attention record service is responsible for keeping Electronic records for all UK citizens centrally ( NHS 2008a ) . There is policy in topographic point that will see all patientsA?A?A? drumhead records being held nationally and elaborate records held locally within the assorted GP patterns ( NHS 2008a ) . This in consequence will buoy up the load to the patients and their carers of holding to retrieve the list of drugs, allergic reactions or inauspicious reactions they may hold encountered in the yesteryear ( Jones et al. 2008 ) .This will cut down the hazard from inauspicious events and close girls that can happen from incorrect disposal of medicine through prescription mistakes and increase the sum of assurance patients will hold on their clinicians ( Jones et al. 2008 ) . Furthermore, In the UK, Patients will besides be able to see their ain drumhead attention records via wellness infinite ( Greenhalgh et al. 2010 ) and guarantee their records are complete and accurate leading to better patient results ( Waegemann et al. 2002 ) . Additionally, in exigencies, where GPs may non be readily available, rapid entree to the patientA?A?A?s medical history can cut down the clip taken to supply critical attention ( Potts et al. 2004 ) Ultimately, the chief benefit to patients will be increased quality of attention and patient safety through increased pick in their attention options ( Eysenbach & A ; Jadad 2001 ) . This will mostly be due to portability of these records across different attention maps leting for entree by a assortment of clinicians.
Unlike paper records, electronic records are easy and readily accessible due to the interconnectedness of systems through webs doing them vulnerable to unauthorised entree ( Berner 2005 ) This brings a set of legal challenges as to who has entree to this information ( Delpierre 2004 ) . Under the UK information protection act of 1997 and the privateness act of 1974 in the USA, informations about patients is protected by jurisprudence ( Koeller 2002 ) . However, with records widely distributed and at times held by 3rd parties equal statute law demands to be put in topographic point and security steps such as firewalls and audit trails need to be implemented to protect this information. This raises complexnesss in execution every bit good as expands cost ( Koeller 2002 )
Health service squads and clinicians
Health service squads such as druggists alongside other wellness attention professional benefit vastly when records are easy shareable and rapidly available ( Wager et al. 2000 ) This is information can be used to accommodate medicine lists every bit good as provide cardinal information to multi disciplinary wellness professionals in a secondary attention puting where information is fragmented and spread across different attention tracts ( Miller & A ; Sim 2004 ) . This will cut down clinical hazard every bit good as save clip and associated costs ( Koeller 2002 ) . Furthermore, the job inherent in paper records of ineligible notes becomes nonexistent ( Schloefell et al. 2001 ) . Coding systems in electronic records besides avoids incidents of ambiguity that may be present in free text during attention episodes ( Dick et al. 1997 ) .
On the other manus, there is presently no cosmopolitan criterion for indexing and coding clinical information ( Schloefell et al. 2001 ) this in consequence is a challenge to wellness squads who may hold trouble in accessing patients informations across different system platforms ( Schloefell et al. 2001 ) The deficiency of unanimity in making unvarying criterions leads to interoperability across doctors systems, infirmaries and pharmaceuticss ( Wilson 2009 ) . This limits the sum of picks available to patients and adds unneeded trouble to wellness squads when such incidences occur.
Health suppliers, and allied organisations
In the UK wellness suppliers such as wellness trusts and Strategic Health Authorities derive their benefits as a consequence of benefits derived from patients and wellness attention squads ( Jones et al. 2008 ) . Other additions are made from quantifying resources non utilized as a consequence of implementing EHRs ( Byrne et al. 2010 ) these benefits accrue and are reflected as cost nest eggs to these governments. Fundss realized as a consequence of these nest eggs allow for better planning on both macro and micro degrees with resources expeditiously allocated to intercessions that have greater impact on the public ( Jones et al. 2008 ) . Furthermore, organisations concerned in medical research benefit vastly when records are electronically stored. The nature of the record allows for informations to be easy derived for specific research intents for acquisition and for usage by other allied establishments with minimum operating expense ( Mathers et Al. 2009 ) .
Alternatively, the cost, size and complexness of implementing these systems are prohibitory ( Hendy 2005 ) . Many wellness suppliers such as the NHS in the UK meet many of these costs. Harmonizing to the Donabedian position, the inputs required in puting up a working electronic record system are both clip and cost intensive ( Koeller 2002 ) . Infrastructure in footings of hardware and package, expertness, preparation and associated costs are high particularly when these are scaled to a national degree ( Cressman et al. 2006 ) . In the UK 105BN lbs has been allocated to the NHS for 2010/2011 financial twelvemonth ( DoH 2010 ) and $ 19BN has been allocated for the twelvemonth 2011 to advance the acceptance of EHR in the USA ( Wilson 2009 ) . This nevertheless is seen to be unequal and farther investings needs to be done.
Comparison of Electronic and paper records
physical and described as being material objects with concrete locations, fond regards and taging ( Bearman 1996 ) . Data is normally handwritten and takes the signifiers of Narrative text in most cases signifiers can besides be used to infix informations. Data entry lacks proof and prone to mistakes.
The literature reviewed provides grounds that supports acceptance of electronic wellness records. An analysis of the literature as represented on table 1 showed good grounds bespeaking betterment of patient safety and increase in efficiency of clinical staff as a consequence of implementing EHR. Evidence demoing an addition in information quality was chiefly qualitative and cost benefit analysis was scarce and difficult to happen. Future benefits and cost nest eggs were prognostic at best and were largely attached to decrease in hazard to patients and the false computation of costs nest eggs associated with this.
Hayrinen et Al. ( 2008b ) stated electronic wellness systems are as yet non decently defined and methods to measure these systems are still non good developed as a consequence. This in consequence raises major concerns, the first being the sustainability of these systems over the long term, the safety of the patients and the quality of information provided ( Coiera 2009 ) . As we move frontward, systems are going larger and more complex and the cost to benefits have major deductions to the national GDP of most states implementing a countrywide wellness scheme. It is in this regard that the top down attack adopted by the NHS has been favored to the underside up attack or sporadic attacks in other parts of the universe ( Cressman et al. 2006 ) . This attack aims to cut down mutual exclusiveness in informations rapprochement across systems which non merely hinders the continuity of patient attention but besides makes deducing informations in a co-ordinated and timely mode for usage in public wellness extremely complex. However, both systems are challenged and other statements have been made that favour a center out attack where local establishments drive the procedure but with inadvertence from regulating organic structures who set the criterions and policy to steer it ( Coiera 2009 ) .