Electronic Medical Records Essay Example

recognize their importance. Automated integrated systems like EMMER have provided relief for healthcare professionals facing challenges such as improving quality of care, adhering to clinical restrictions, reducing waste, and minimizing errors. These computerized systems have reduced paperwork, improved access to patient information, promoted consistency in processes, and even offered suggestions for appropriate diagnoses and treatments. The main concept behind an EMMER system is to bring organization to a chaotic paper-based environment by creating a centralized informational powerhouse.The system's value lies in its ability to promote Data Mining, store data in one place, and enable efficient extraction or filtering of necessary information. However, effective functioning requires centralization onto a database that allows easy data sharing among healthcare providers and hospitals. In today's economic climate, cost and return on investment are as crucial as the diagnostic process, making a transition to a more accessible and rapid electronic system advantageous. Comparatively few would argue against the superiority of an EMMER over printed charts for identifying practice patterns, assigning probabilities to diagnoses, identifying inefficiencies in patient care, delivering reports rapidly to patients and consulting services, and facilitating prompt billing. With digital forms gaining popularity in the medical industry, medical records can be automatically scanned for potential drug interactions and gaps in clinical data that may impact reimbursement. Furthermore, computer programs can generate reminders for physicians and patients. The following examples illustrate the potential benefits: individual physicians maintaining paper charts face limitations that become evident during office visits when comprehensive medical history (including family medical history), medication information, review of systems (ROR), and current conditions must all be provided by the patient upon arrival.Typically, healthcare providers collect patient information separately

and sometimes on multiple occasions. The amount of information needed varies based on age or medical condition and can be extensive. This repetitive data collection process frustrates patients and may lead to important details being accidentally left out. Implementing an Electronic Medical Records System (EMMER) would eliminate the need for redundant data collection. Healthcare providers could access and update medical records as necessary. This would be especially helpful in emergency situations when patients or their families cannot provide medical history, such as cases with unconscious patients or individuals with allergies.

Patient charts usually contain a significant amount of longitudinal data, including vital signs like heart rate, blood pressure, and temperature, as well as laboratory results like blood counts and blood sugar levels. Physicians often find that analyzing trended data over time gives a more accurate understanding of a patient's medical condition compared to discrete measures or norms. Physicians who use paper charts find it impractical to create graphical displays for each clinical measure. However, by adopting Electronic Medical Record Management (EMMER) systems, physicians can easily generate and review graphical representations of one or more measures over time.Such graphical displays would enable physicians to promptly identify emerging problems such as increasing blood pressure or blood sugar levels, allowing them to better address patient needs. When prescribing medications, physicians must consider both efficacy and cost. It is counter-productive to prescribe medications that patients cannot afford, whether due to exclusion from their insurance plan or the requirement of a generic for co-payment eligibility. With the expanding options and variations in medications, as well as the constant changes in health insurance benefits, comparing different options becomes difficult for physicians using

paper-based systems.Consequently, most patients remain unaware of medication costs and insurance coverage until they visit a pharmacy with their prescription.Patients often request alternative medications when they discover that lower-cost generics or other similar medications are available and covered by insurance.This can be time-consuming for the patient, provider, and pharmacy.

EMMER systems utilize databases containing insurance plan formularies and FDA-approved medications. These systems allow healthcare providers to assess medication coverage and discuss alternatives with patients during examinations. This consideration of insurance coverage enables physicians to have meaningful discussions about medication options with their patients.In addition to the advantages mentioned above, EMMER systems can also help reduce costs associated with paper charts, inadequate documentation, high malpractice premiums, support contracts, computer maintenance, and product updates. By utilizing EMMER systems, healthcare providers can decrease transcription expenses by offering a more efficient way of documenting patient information. These systems can also provide cost-effective alternatives to expensive medications. The use of computerized systems like EMMER can lead to lower malpractice premiums as a result of improved documentation and alerts for drug prescriptions. Nonetheless, the limited adoption rate of such systems is due to drawbacks such as high implementation costs, failure to meet objectives, concerns regarding security and confidentiality, and an increase in malpractice lawsuits.

The implementation of EMMER systems presents challenges because existing electronic data sources like laboratory records, pharmacy information, and physician dictation systems have varying structures, levels of detail, and code systems. This issue is particularly evident in cross-institutional clinical care and research where unique system designs and the absence of standards create difficulties.

Despite these challenges though national adoption of EMMER systems will soon be supported by legislative and executive bodies.In

a press release on January 5, 2005, President George W. Bush emphasized the importance of incorporating American medicine into the information age by digitizing medical records and applying 21st-century technology to healthcare. Three significant Federal mandates have been issued regarding the adoption of EMMER, indicating that a more computerized approach to medical practice will be seen in the coming years. However, security and privacy are major concerns in EMMER debates. According to a Harris Interactive online media poll, 68% of respondents believe that Emirs can improve patient care quality but also express worries about privacy issues.

As more provider groups, hospitals, and integrated health systems implement Emirs, concerns about patient privacy and ethical data usage have increased. The Health Insurance Portability and Accountability Act of 1996 (HAIFA) established guidelines for patient privacy and set a minimum threshold for sharing private health information (PHI), as well as standards for electronic healthcare transactions. Electronic records are expected to provide better controls than paper charts but healthcare organizations must take steps to reduce the risk of releasing private information. Each office member must have a password to log into the EMMER system which should never be shared and is considered an electronic signature. System access levels should be based on job roles.Users should log off when not actively using the system to prevent unauthorized access and maintain an audit trail linking system use to the user's surname. Secure connections are necessary for remote system access, and users need to ensure that others cannot view information displayed on their screens. Any printed information from the system must be appropriately filed or immediately shredded.

Emirs integrate various healthcare system areas under one

unified heading, as seen in Kaiser Permanent, which is an integrated health care delivery system. Kaiser acts as a pre-paid health insurance plan with its own hospital and ambulatory facilities, medical group (Permanent), pharmacy, and contracts with separate existing hospitals. Recently, Kaiser developed an EMMER system that automatically tracks utilization for their members across all services. This includes outpatient, inpatient, and pharmacy services. Clinicians have access to patients' medical history through this integrated model, enabling better care management.

However, privacy becomes a concern due to multiple parties having access to PHI under this model. Instead of individual offices being solely responsible for upholding privacy standards, the entire model must work together. It is unnecessary for everyone at the hospital to know about a physician's office visit from two years ago; only necessary information should be shared according to Hippo's requirementHowever, in 2002, the HAIFA Privacy Rule was amended by the Department of Health and Human Services, which some argue reversed the intent of ensuring privacy. This amendment limited control over who can access personal health information (PHI). The situation becomes even more complex due to the push for a national health care technology networking system that would integrate various sources, including Personal Health Records. This development raises concerns about privacy and ethics, particularly in segments such as self-insured employers.

Self-insurance allows employers to better manage costs and risks. The purpose of HAIFA was to integrate the EMMER system, making sensitive data more accessible to employers or through business relationships. Consequently, this could result in privacy violations and ethical issues like employee discrimination. Kaiser Permanent serves as an example where they act as the insurer, physician's group, and

hospital for employees. When medical information is entered by a physician's office, it becomes accessible to other entities like pharmacies, hospitals, finance areas - potentially even reaching the employer.

Therefore, it is crucial for employers not only to meet HAIFA's minimum requirements but also establish clear policies aimed at preventing any potential discrimination against employees.Concerns have been raised about the potential for a government-run electronic health system to allow government agencies immediate access to personal health information (PHI). The original purpose of HAIFA was to prevent the government from accessing specific healthcare data without consent, which meant that Americans had no way of preventing their medical records from being shared with the government. Similar worries exist regarding discrimination by the government based on healthcare matters, similar to employer discrimination.

The integrated EMMER system has the potential to enhance public health efforts by providing more accessible and analyzable data. However, this raises ethical dilemmas concerning how much information a government should possess about its citizens and how to balance overall public health with individual health rights. Healthcare professionals desire a comprehensive medical history system that can improve patient outcomes but must also consider how their findings may be used in the future and adhere to ethical standards outlined in the Hippocratic Oath.

Maintaining patient privacy means refraining from sharing medical issues with third parties lacking patient consent, including corporations, individuals, and non-healthcare related government entities.To ensure an efficient EMMER system that supports business processes and maintains streamlined functionality and performance, it is crucial to assess the pros and cons of integrating technology in the medical field. Implementing necessary checks and balances in the implementation process of the EMMER Best

Practices Framework, known as "Pacing Forward," will yield significant benefits and prevent potential setbacks. During the planning phase, setting goals and developing strategies around these objectives are vital. Common issues with data entry in EMMER systems include non-reportable format or inconsistent standardized entry by providers. It is highly recommended to implement the system gradually using discrete modules like lab order entry, messaging, preventive health maintenance, patient tracking, and e-prescribing. Creating a timeline while maintaining flexibility and regularly evaluating progress ensures commitment of resources aligned with the implementation process. It is also advisable to conduct a workflow analysis to identify opportunities for enhanced productivity and efficiency by analyzing existing work processes. Considerations should be made for staff involvement by appointing a motivating, enthusiastic, and knowledgeable Physician Champion who can oversee their participation. Additionally, an in-house Project Manager should be assigned to manage the entire project effectivelyIt is crucial to communicate the practice's desire for an EMMER system to staff members and involve them in choosing a vendor. However, it should be expected that support staff, specifically clerical clerks, may feel replaceable by the EMMER system. To address this concern, include end-user staff in system set-up by mapping out their current workflow and involving them in designing new workflow for the EMMER.

To ensure successful adoption of the EMMER system, establish access thresholds based on staff roles and responsibilities and allow sufficient time for learning curves. Often, the learning curve for adopting the EMMER is underestimated. During implementation, conduct volume testing and perform a dry run using a typical day's workload in a test database.

Request a list of known bugs from the vendor and create workarounds if needed

while identifying dates for patch fixes. Hardware testing involves preparing infrastructure and testimonial systems before implementing them. This includes piloting workflows, procedures, modules, templates, and documentation with a small group of staff prior to go-live.

Allocate enough time for training sessions separate from clinical work sessions. Set up a training room dedicated to staff practice where specific instructions on HAIFA (HTML Application Indexing File)and privacy requirements can be provided. Before go-live, evaluate the readiness of staff members and appoint super users who will serve as resources during implementation.During the go-live phase, it is crucial to have trained individuals, such as vendor trainers, super users, and an in-house project manager, available to support the staff. After the go-live phase, there should be an assessment conducted to gather feedback from staff about the process. Practice administrators should consistently provide ongoing training and support to reinforce and refresh staff knowledge. Moreover, regular audits of privacy procedures need to be carried out to ensure compliance with the stated requirements.