The paper will explore the motivation for healthcare systems to adopt electronic medical records over physical paper records. I shall focus on application of electronic medical records in the United States Health Care Systems. Electronic medical record refers to a digitized version of a paper chart that contains extensive patient’s medical history from one practice. Medical providers use electronic medical records for diagnosis and treatment. The advantages over paper records are that EMRs allow providers to track data over time, single out patients who are due for preventive visits and screenings, and monitor how patients perform to certain parameters such as blood pressure readings and vaccinations. In addition to the above benefits, EMRs enable providers to improve the overall quality of medical care in a practice. Remarkably, information stored in electronic medical records is not readily shared with providers outside of practice. In fact, the patient’s record might have to be mailed to specialists and other members of the care team (Fossel & Dorfman, 2013).
However, there are differences between electronic medical and electronic health records. An electronic medical record holds the standard clinical and medical data gathered in one provider’s office. Electronic health records do more than just handling data collected in the provider’s office as they include complete patient history. Electronic health records are designed to hold and share information from all medical providers involved in a patient’s care. Electronic health records data may be created, managed, and consulted by approved providers and staff from health care organizations (In Ullman & Zott, 2013).
Electronic healthcare records, unlike electronic medical records, allows a patient’s health history to move with her or him to the new health care providers, hospitals, nursing homes and sometimes across states. Provision of acceptable primary care requires that medical providers are armed with the requisite information when they render the medical care. Electronic medical records utilization will satiate providers’, patients’ and decision support information needs. In that view, I project the number of United States primary care providers’ utilizing EMR will exponentially grow from the current five percent. The providers will enjoy an enhanced quality, efficiency and quality coupled with an enhanced ability to carry out education and research (Fossel & Dorfman, 2013).
The Time for Electronic Medical Records in the United States is Ripe
In order to avail all United States citizens with good quality, affordable health care, each primary care provider must adopt electronic medical records system. The use of electronic medical records is necessary as primary care providers handle information from patients and other sources. The primary care providers have then to integrate that information with biomedical knowledge and decide with patients on direction of action. Usually, the above tasks are achieved through use of pen and paper despite the availability of electronic medical record systems (Klemensic, Quinn, Primis, & Lorman Education Services, 2013).
Although United States medical care is the world’s most costly, its outcomes are worrying compared with the rest of industrialized nations. World Health Organization report ranks United States system at number 37 on World’s health systems. “Cutting through the Quality Chasm,” an Institute of Medicine Report represents the United States system as fundamentally flawed and recommends significant federal investment in information technology as critical to attaining desired changes. Example of desired change is the elimination of handwritten clinical data towards the end of the decade. Efficient utilization of information technology is crucial to availing enhanced medical care at reduced cost (Hamilton, 2013).
Surprisingly, the healthcare industry invests a meager 2% of gross revenues in information technology despite the sector being information-intensive. The measly investment in information technology pales low with 10% for other information-intensive industries. Clearly, increased investment in health care information technology is urgently required. Naturally, the federal government, the largest purchaser of American healthcare, must be integral in bankrolling adoption of electronic records (Eichenwald, Petterson & Wapola, 2014).
Of 1.3 trillion dollars spent on health care in 2000 in the United States, public funds accounted for 589.4 billion dollars that are virtually 45%. The federal government in recent times has come up with unfunded mandates that constitute complex legislation such as the Health Insurance Portability and Accountability law of 1996. Other legal initiatives include the Clinical Laboratory Improvement changes. Embracing Electronic Medical Records will alleviate part of the financial load of the above initiatives. It is imperative that the federal government participates financially in implementing the above solution (Chute, 2014).
This research paper, therefore, implicitly calls for the federal government to play a pivotal role in bankrolling a support to speed up adoption of electronic records. Additionally, a public-private partnership must be created and mandated with creating a strategic framework to enable electronic medical records implantation. The above move will result in dividends to private health care and public, emergency readiness and the national community.
Primary Care Status
In the United States, the family physicians, pediatricians, general internists, nurse practitioners, and physician assistants constitute the principal personnel delivering primary care in the United States. Significant evidence suggests that first-rate primary care is critical to the health. The quality of primary care physician –partnerships interrelated with three significant results as one study find out. The three issues are adherence, satisfaction and improved health status. It is noted that patients treasure the first contact and coordinating role of primary care physicians (Hsiao, Hing & National Center for Health Statistics, 2014).
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It must be acknowledged that primary care providers deliver critical preventive services. For example, in one comprehensive review of women accessing primary care at their regular site strongly interrelated with getting preventive services. Remarkably, primary care providers are good at helping smokers to quit smoking. The providers are instrumental to the treatment of chronic ailments (Chute, 2014). Besides the above conditions being demanding and complex to treat, the conditions can be expensive. A group study describes that enhanced glycemic control in a population with diabetic is associated with reduced costs with one to two years. Additionally, the primary health care system serves essential national interests by availing an infrastructure for identifying unusual health events and a platform for quickly relaying information and care in the case of national emergency. However, unlike specialists, primary care providers are remunerated poorly for the care they provide. When viewed critically, primary care frequently loses money. The results are that health care organizations are cautious to invest money in primary care. In this vein, to create funding for adoption of information technology for primary care, incentives must be offered (Schanhals, 2013).
Take on Conventional Paper-Based Record-Keeping
The convenience of providers documenting and delivering care via paper records is mainly attributed to the simplicity, low implementation cost and general acceptance. Despite the above benefits, paper records have huge demerits such as being only available to one person at a time, not able to be accessed remotely, often illegible, search and storage challenges. The main demerit of paper records is that they hamper provision of clinical decision support. Impediment of clinical decision support is mainly due to data stored in formats that are inaccessible and, thus, cannot trigger decision support tools (Hsiao, Hing & National Center for Health Statistics, 2014).
Electronic Ambulatory Medical Record
Ambulatory electronic medical records frequently include a problem list, allergy list, medication list, health maintenance information, notes and results retrieval. Most electronic medical records constitute a digitized prescribing tool with some including an automated ordering. There exist tools for displaying and capturing data such as notes. Benefits of having legible complete and organized information can be increased by providing decision support using electronic applications (Fossel & Dorfman, 2013).
Campaign for Electronic Medical Records in Primary Care
Given the scope of primary care, the human mind simply will not process the huge volumes of clinical data needed for practice unaided. It is worth appreciating that as information gets obsolete and new knowledge is not integrated physicians will be tempted to pursue shortcuts. In this vein, shortcuts imply that physicians will tend to use clinical experience and heuristics instead of carrying out organized investigations. The propagation of genomics will heighten the problem further. Studies show that primary care providers have several critical information needs that are never satiated. It is argued that for every physician, they experience at least 8 questions out of every 10 ambulatory visits that are not answered. In this breath, if physicians adopt electronic medical records, they will help improve access to electronic information resources (Hamilton, 2013).
The integrating and coordinating function of electronic records are suited for critical care of individual groups. Communities that are naturally eligible for electronic medical records include children, women in the family way, rural residents, and the elderly and lactating mothers. The above groups depend heavily on primary care physicians. Undeserved and poor communities may need custom primary care services (Eichenwald, Petterson & Wapola, 2014).
The intention to shift from conventional paper to electronic charts started some time back. There are, however, three major developments that have spurred the motivation for electronic medical records. The widely spread nature of primary care services and the internet serves a significant role in this transmission. Therefore, high-speed connections from physician’s premises can avail web-based clinical tools via application service provider (In Ullman & Zott, 2013).
Furthermore, the power and speed of readily available computers are increasing with their costs reducing. Lastly, software and computers are evolving rapidly with mobile devices being linked to wireless medical networks. Handheld computers are helpful sources of drug and other information (Schanhals, 2013).
Even though the full benefits of electronic medical records will only be visible when implemented widely, nevertheless, electronic medical record systems will within shortest duration enhance quality and efficiency. Both dictation costs and costs of “chart pulls” will be substantially reduced and eliminated respectively. Additionally, providers can also get decision support regarding the selection and costs of drugs, radiographic studies and laboratory tests. By utilizing electronic medical records data, for example, identifying the least expensive drug within a category, providers reduced costs of drugs by 18 percent (Hamilton, 2013).
Electronic medical records are accessible at any time. Computerization of prevention guidelines and reminders benefits patients. A physician can quickly get a perception of patient’s problems by quickly going over those problems, recent notes in electronic medical record and medications. Computerization of medical records will yield quality in addition to efficiency. Furthermore, digitization of medication prescription enhances safety (In Ullman & Zott, 2013). Studies suggest that as large of 80 percent drop in error. Communication between providers and patients seems to represent a particular problem in outpatient care and computerization is part of solving that problem. More over monitoring and tracking unusual results will ensure that appropriate follow-ups happen. In cases of emergency, electronic records can be connected to public health surveillance (Klemensic, Quinn, Primis, & Lorman Education Services, 2013).
Electronic medical records automates aspects of chart reviews. Chart reviews make it easier to measure the quality of primary care as the public and payers demand. Electronic medical records enable sharing medical data between patients and providers (Chute, 2014). In the case of specialty care, electronic medical records holds enormous benefits. Computerization can solve the problem of poor communication that ails the current referral process (Hamilton, 2013).
The Financial Return on Electronic Medical Records Investment
At the moment, the general return on investment for adopting electronic medical records into primary care is yet to be determined. Even though studies have been carried by system vendors, the outcomes should be viewed with caution. Despite the above, the limited data point to excellent return. The level of benefit of electronic medical records to health care organization is subject on the reimbursement system. The return is marginally lower for a fee-for-service setting and huge with capitation. In the case of a fee-for-service setting, the middle player will enjoy many of the benefits (Hsiao, Hing & National Center for Health Statistics, 2014).
Models of Working Models of Electronic Medical Records in Primary Care
Both England and Australia have deployed highly successful national programs to create awareness on the use of electronic medical records in providing primary care. New Zealand and Netherlands are other countries that have gained remarkable success with electronic medical records. Australia outcome of deploying innovation is dramatic. For example, as of May 2000, at least 70 percent of standard practices indicated that the majority of physicians in their work were doing computerized consultations’ and prescriptions (Klemensic, Quinn, Primis, & Lorman Education Services, 2013).
Lessons learnt from Australia show that desirable transitions in electronic medical records in deployment can be attained by providing practitioners with financial aid to facilitate purchase computers, giving incentives for providers to turn in claims electronically and aiding system implementation for the subject users (Chute, 2014).
Another country with success in electronic medical records is England. In England, at least 98 percent general practitioners access it on their desktop. The medical practitioners utilize electronic medical records for prescription refills. In England, it is three vendors who supply these records. For example, Prodigy application interacts with the other applications and gives evidence-based decision support. The aim is to deploy the application in all primary care clinicians (Fossel & Dorfman, 2013).
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The success of the above countries is that they committed public investment in maintaining group to create a strategic outline and map out standards. Creation of the actual records has been implemented by private vendors, who have profited from having a general set of standards and goals. Each of the above countries came up with incentives for providers to embrace the transition from paper to electronic medical records (Hamilton, 2013).
Hurdles to Adoption of Electronic Medical Records
A number of hurdles exist in embracing of electronic medical records. A key hurdle is the initial cost of these record systems. Coming up with who will bankroll the electronic medical record system is not easy. For these records systems, the economic benefits are enjoyed by the third party payers and purchasers of health care instead of provider groups and investors. The Kaiser and Group Health is, however, an exception to the above largely because of committing a substantial investment in electronic medical records system (Schanals, 2013).
Secondly, transience of vendors is another visible barrier in embracing of electronic medical records systems. Early developers are in unstable economic positions. As a result, primary care providers perceive deploying these records from existing vendors as risky. The risks above can be reduced if vendors embraced common data standards. The above measure will smoothen transferring of data from legacy system to a new system. The workflow disruption will however remain (Fossel & Dorfman, 2013).
Thirdly, physicians’ apprehension to use of electronic medical records systems presents another challenge. The authors hold the view that the above uneasiness raises from perceptions by physicians that electronic medical records usage will negatively disrupt their workflows (Hamilton, 2013).
Lastly, security and confidentiality of using electronic information is a critical issue. Many works remain in developing and accessing of security strategies. Besides this challenge, there exists a technology to guarantee safety of data today (Hsiao, Hing & National Center for Health Statistics, 2014).
Dangers of Failure in Adopting Electronic Medical Records
Risks may rise by not seeking electronic medical records implementation. It is imperative to appreciate that the United States is lagging behind other countries because of lack or slow computerization of data related to managing problems in primary care environment. Many individuals will benefit from new devices and drugs that rely on computerized information. Lack of computerizing will result in missed opportunities in public health care delivery including preventative services. Additionally, efforts to deal with bioterrorism will suffer. Lastly, lack of a national plan will result in providers seeking their own electronic medical records system that may be incompatible with others creating chaos in electronic medical records implementation (Klemensic, Quinn, Primis, & Lorman Education Services, 2013).
There should be combined efforts by all players in primary care to manage issues relating to embracing electronic medical records. It is worth recognizing that lack of a central oversight body to coordinate efforts, the desired efforts of electronic medical records will not be realized. For example, increasing deployment of messaging and other standards is crucial to facilitating information exchange among providers, ancillary organizations and hospitals (Hamilton, 2013). The National Alliance for Primary Care Informatics should play a central role in handling adoption of these records systems.
Additionally, organizational endorsements, especially the federal government must offer funds to oversee the development of infrastructure for the deployment of electronic medical records system in primary care. A sizeable chunk of that investment should aid a primary group that would network with other groups, pursue specific projects and develop the necessary framework. The public-private liaison will be represented by the organizing group. The coordinating group should function within the federal department of health. Other agencies such as AHRQ that has a remarkable record of networking with other agencies must be utilized in efforts to enhance patient’s safety. The National Library of Medicine is a promising reservoir of useful informatics research outcomes over the years. NLM has availed biomedical data and bibliographic databases globally (Eichenwald, Petterson & Wapola, 2014).
I recommend that at least 20 million dollars initial funding should be set aside to facilitate utilization of EMRs in primary care through a coordinating infrastructure. The above group must be multidisciplinary and must constitute representation from payers, providers, government, vendors, consumers and employers. The subject group should carry out work to popularize selection of standards custom for content areas and work collaboratively with current standards-setting groups like the HL7. The group should root for extensive general initial studies of particular methods to promote electronic medical records adoption. Lastly, the group should propose subject policies and practices, for example zero-interest loans and more reimbursement for electronic medical records users. In addition, electronic prescribing and electronic decision support which needs more investment beyond the one stated above must be given more bankrolling.
Electronic medical records give many benefits more so to primary care. These records are the future standard of medical care. Interestingly, the investments and initiatives proposed in this paper can greatly reduce the costs and speed up electronic medical records deployment. Furthermore, the recommendations contained in this document will enable attainment of benefits like having a common national standard for clinical data. The government should, therefore, move in because of the effort of adopting electronic medical records systems will see the entire population benefit and positively affect the bigger health care chunk of the federal budget. The government must act as to facilitate the public-private partnership to motivate the embracing of electronic medical records in primary care.