THE BENEFIT OF ELECTRONIC HEALTH RECORDS SYSTEM IN HEALTH CARE DELIVERY
TABLE OF CONTENTS
CHAPTER
ONE
1.0 Introduction
1.1 Background of the study
1.2 Statement of Research problem 1.3 Aims and objectives of the study
1.4 Significance of the study
1.5 Research question
1.6 Scope of the study
1.7 Definition of terms
CHAPTER
TWO
2.0 Literature Review
CHAPTER
THREE
3.0 Research methodology
.3.1 Research design
3.2 Study population
3.3 Sample selection
3.4 Research instrument
3.5 Data analysis
CHAPTER
FOUR
4.0 Data presentation and analysis
CHAPTER
FIVE
5.0 Summary, Conclusion and
Recommendation
5.1 Summary
5.2 Conclusion
5.3 Recommendation
5.4 Limitation of the study
5.5 Reference
5.6 Questionnaire
CHAPTER ONE
CHAPTER ONE
1.0 INTRODUCTION
From
the out set, professional organizations of global positioning system (Gps) have
played an active role in setting guidelines for information systems in general
practice and in assessing the systems available in the market. This active role
was started in early 1980s when they identified the basic needs of global
positioning system for using system in their practices and set the first broad
guidelines for systems tailored specifically for primary car few patient today
deal with only one healthcare provide. This is particularly true for those who
have complex health problems for those who move frequently for work purposes
and for drivellers generally. In the absence of continuity of care, continuity
of information is essential to optimize heath care. There is a great deal of interest
with both the public and private sectors in encouraging all health care
providers to migrate from paper – based health records to a system that stores
health information electronically and employs computer added decision support
systems. In part this interest is due to a growing recognition that stronger information
technology (IT) infrastructure is integral to addressing such national concerns
as the need to improve the safety and quality of health care, rising health
care costs, and matters of homeland security related to the sector.
Network technology and communication
(telematics) are now prominent developments in information technology and have
a large impact on health care. By using standard communication networks and
standard software, data interchange between the four levels of health care
delivery (i.e, the region the institution: the clinical department or
outpatient clinic, and the individual physician, nurse, or patient) is more
efficient.
An dectronic health record (EHR) is a
systemic collection of electronic health information about an individual
patient. It is a record in digital format that is theoretically capable of
being shared across different health care settings. In some cases this sharing
can occur by way of network – connected, enterprise – wide information systems
and other information networks or exchanges. EHRs may include a range of data,
including demographics, medical history, medication and allergies, immunization
status. Laboratory test result, radiology images, vital signs, personal
statistics like age and weight and billing information.
The system is designed to represent
data that accurately capture the state of the patient at all times. It allows
for an entire patient history to be viewed without the need to track down the
patients previous medical record volume and assists in ensuring data is
accurate, appropriate and legible. It reduces the chances of data replication
as there only one modifiable file, which means the file is constantly up to
date when viewed at a later date and eliminates the issue of lost forms or
paper work. Due to all information being in a single file it makes it much more
effective when extracting medical data for the examination of possible trends
and long term changes in the patients.
1.1 BACKGROUND OF THE STUDY
The
idea for EHRs was thought to have started in the 1960s by a physician named
Lawrence L. weed who was later on assisted by research done at the University of Vermont
An early version of Electronic health
records was introduced in the late 1960s and early 1970s in a hospital setting
and their migrated to ambulatory care and inpatient care settings.
Numerous systems developed in the
advancement of technology and understanding of how such a process might work in
creating new types of electronic system and solutions.
During the 1970s and 1980s, several
electronic medical record system were developed and further refined by various
academic and research institutions. The technician systems was hospital – based
and harvoid’s COSTAR system had records for ambulatory care. The help system
and duk’s the medical record are examples of early in-patient care system, Indiana
New with the advent of strigent HIPAA
rules and regulations to protect patient privacy as well as rapid advancement
in technology to maximize efficiencies and security, there are dozens of
electronic health records systems, processes, and software packages available,
with many deployed through healthcare document management outsource providers
and service companies that offer highly specialized electronic health record
solutions.
1.1.0 HISTORICAL BACKGROUND OF THE STUDY
The Federal Medical Centre was established
in July 1998 as an offshoot of the then Ido General hospital. The Ido General Hospital Ekiti
State Specialist Hospitals , General
Hospital , Comprehensive Health Centre
e.t.c.) in Ekiti State General Hospital General Hospital
In the 70’s and 80’s there used to be
one or two Doctors on ground, Nurses and Pharmacists have always been on
ground. This situation continued until the 90’s.
Prior to the take over of the hospital
in 1999, few departments were on ground administration, Nursing, Pharmacy,
Laboratory, X – ray and Dental. Before the take over of the hospital in 1999,
75 staff were on ground, out of these, 10 were absorbed into the new FMC. On 1st November, 1999,
the General Hospital
The melodiministration of the centre
which participated serious crises completed the them Honourable Minister of
Health post the formal Medical director to the centre in person of Dr. (Mrs.)
Ololade Olusola Ojo. The hospital has 28 fully function department comprising
of 18 clinical department moment by specialist and support the department. In
the late May 2012 Dr. Ayodele Lawrence Majekodunmi became the Acting Medical
Director of FMC Ido-Ekiti in line with the public services rules following the
retirement of former CMD, Dr (Mrs.) Ololade Olusola Ojo, presently. FMC
Ido-Ekiti offers services in primary, secondary and tertiary health care
services. The community health departments conduct the primary health care
services such as immunization, antenatal care: the hospital as a tertiary
health care centre receives patients from all health institutions, the
consultants engage in clinical works, teaching and training serices. The bed
compliment of FMC Ido-Ekiti was increased from 77 to 380.
1.2 STATEMENT OF THE RESEARCH PROBLEM
The essence of this study is to
undertake regorious examinations of he benefits of electronic health records
system in health are delivery. There are numbers of problems involved in this
study, the problem ranges from:
-
Start – up cost-> The step price of
EHRs and provider uncertainly regarding the value they will derive from
adoption the form of return on investment have a significant influence on
electronic health records adoption, in which hospital administrators and
physicians who had adopted HER noted that any gain in efficiency were offset by
reduced productivity as the technology was implemented, as well as the need to
increase information technology staff to maintain the system.
-
Maintenance cost-> Maintenance cost
can be high since software technology advances at a repaid price, which
requires frequent updates.
-
Training cost-> Training of
employees to use an HER system is costly just as for training in the use of any
other hospital system. New employees, permanent or temporary, will also require
training as they are hire. Others challenges to implementation of electronics
health records system include technical problems, Organizational barrier, and
using of different policies in the health care delivery.
1.3 AIMS AND OBJECTIVE OF THE STUDY
The
major objective of this study is to investigate the benefits of electronic
health record system in health care delivery. The study will also find out the
factors that may affect the effectiveness of the implementation of the study,
possible solution and the success so far since its introduction.
1.
In order to improve health care
quality and convenience for the providers and the patients.
2.
To support effective and
efficient health care delivery
3.
To improve car co-ordination
4.
To improve population and public
health
5.
To ensure adequate privacy and
security protections
6.
To improve communication between
health professionals
1.4 SIGNIFICANCE OF THE STUDY
The
benefits of electronic health records system in health care delivery can not be
over emphasized. The important of this study are to lay more advance in better
health care by improving all aspect of patient care, including safety,
effectiveness, efficiency and equity.
-
This research work also helps to
improved efficiencies and lower health care cost by promoting preventative
medicine and as well reducing waste and redundant tastes
-
The study also help the health care
delivery to speed up access to appointment booked, diagnostic procedures
ordered.
1.5 RESEARCH QUESTIONS
The following question will be answered
in the study.
1.
Is the process of using
electronic health records use in F.M.C IDO – EKTI appropriate?
2.
Can problem of electronic health
records system in F.M.C IDO – EKITI be solve?
3.
Can electronic health records
system be improved in F.M.C IDO – EKITI?
4.
Is there any functional
relationship between the physician and the patient using electronic health
record system?
1.6 SCOPE OF THE STUDY
This
study examines the benefits of electronic health records system with reference
to federal medical center IDO – EKITI.
1.7 DEFINITION OF TERMS
For
effective communication, it is pertinent to operationally define some of the
salient concept in this study.
1.
ELECTRONIC
SYSTEM This is the use of computer order to gather
information and also to disseminate information. Computers abound in today’s
hospital largely because we are living in an area where most hospital works
depend on the collection, use, creation and dissemination of information,
hospital performance largely depend on information and the use of it, because
computer systems can process facts at a very high speeds.
2.
HEALTH:
This
is the state of complete physical, mental and social well being of an
individual and not merely the absence of disease or infirmities: if any of the
major components is missing then the state of healthiness is not met.
3.
HEALTH
RECORD: These are gathered facts and information on health
issues which are basically aids to effective planning, monitoring and
evaluation. This information or facts can be gathered from different sources
which could be primary. Secondary and tertiary source.
4.
HOSPITAL:
This is an institution for the treatment and care of sick or injured people.
5.
FILING
SYSTEM: This is the arrangement of set of documents in a
prescribed order for convenience of reference or presentation
6.
TRACER
SYSTEM: This is the tracing of where about any documents
taken out of the storage area at any point in time.
7.
MASTER
INDEX: This is a catalogue of cases filed in
alphabetical order, ehich relates the patrient to his/her medical records.
8.
RECORD:
This is a written account of facts, or an event written down at the time they
occur.
CHAPTER TWO
2.0 LITERARURE REVIEW
Krtty S. chan reviewed empirical
studies of Electronic Health Record data quality published in January 2004,
with an emphasis on data attributes relevant to quality measurement, to review
examined multiple aspect of data accuracy. 57% data completeness, and 23% data
comparability. The diversity in data clement, also future research should be
focus on the quality of data from specific HER, component and importation data
attributes for quality measurement such as, granularity, timelines and
comparability.
The health information Technology for
Economic and clinical health (HITECH) act of 2009 state that signed into law as
part of the “stimulus package” represents the largest us initiative to date
that is designed to encourage widespread use of electronic health records
(EHRs) in light of the changes anticipated from this policy initiative HITECH
Act requires that providers adopt EHRs and utilize them in a “meaningful” way,
which includes using certain HER functionalities associated with error
reduction and cost containment.
In a 2008 survey by Desroches et al. of
4484 physician (62% response rate), 83% of all physicians, 80% of primary care
physicians, and 86% of non – primary care physicians had no EHRs. The CDC
(Centers for Disease Control) reported that the EHRs Adoption rate had steadily
reason to 48.3% at the end of 2009, this is an increase over 2008 in the United State
2.1 INTRODUCTION
Our world has been radically
transformed by digital technology, our daily lives and the way we communicate.
Medicine is an information – rich
enterprise. A greater and more seamless flow of information within a digital
health care infrastructure, created by electronic health records (EHRs),
encompasses and leverages digital progress and can transform the way care is
delivered and compensated with EHRs. Information is available whenever it is
needed.
When fully functional and exchangeable;
the benefits of electronic health records system offer far more than a paper
record.
TERMINOLOGY
The terms electronic health records
system (EHRs) EPR (Electronic Patient Record) and EMR (Electronic Medical
Record) are often used interchangeably, although differences between them can
be defined. The EMR can, for example, be defined as the patient record created
in hospitals and ambulatory environments and which can serve as a data source
for the HER (Electronic Health Record) it is important to not that an HER is
generated delivery network, clinic, or physician office to give patients,
physicians and other health care providers employers and payers or insurers
access to a patient’s medical record across facilities.
-
A personal health record (PHR) is, in
modern parlance, generally defined as an HER that the individual patient
controls.
Comparison
with paper – based records.
Paper
– based records require a significant among of storage space compared to
digital records. Most institution require physical records be held for a
minimum of seven years. The cost of storage media, such as paper and film, per
unit of information differ dramatically form that of electronic storage media.
When paper records are stored in different locations collating their to a
single location for review by a health care provider is time consuming and
complicated. Ulereas the process can be simplified with electronic records.
This is particularly true in the case of person – centered records, which are
impractical to maintain, if not electronic (thus difficult to centralize or
federate) when paper-based records are required in multiple locations, copying,
faxing and transfer of digital records, because of these many “after-entry”
benefits, federal and state governments, insurance companies and other large
medical institutions are heavily promoting the adoption of electronic medical
records.
The benefits of EHRs offer far more
than paper record are:
-
Improve quality and convenience of
patient care
-
Increase patient participation in
their care
-
Improve accuracy of diagnoses and
health outcomes
-
Improve care coordinator
-
Increase practice efficiencies and
cost savings.
In
contrast, EHRs can be continuously updated (within certain legal limitations).
The ability to exchange records between difference HER systems
(interoperability) would facilitate the co-ordination of health car delivery in
non-affiliated health care facilities.
Technical
features of Electronic health records
-
Digital formatting enables information
to be used and shared over secure networks
-
Track care (e.g prescriptions) and
outcomes (e.g blood pressure).
-
Trigger warnings and reminders.
-
End and receive orders, reports, and
results
-
Health information Exchange – Which
are technical and social frame work that enables information to move
electronically between organizations.
-
Reporting to public health
-
Electronic prescribing
-
Sharing laboratory results with providers
-
Some Electronic health records system
automatically monitor clinical events by analyzing patient data from an
electronic health record to predict detect and potentially prevent adverse
events. This can include discharge/ transfer orders, pharmacy orders, radiology
results, laboratory results and nay other data from ancillary services or
provider notes. This type of event monitoring has been implemented using the Louisiana
Philosophical
views of the EHRs.
Within
a meta-narrative systematic review in the field, Prof. Trish Greenhalghand
colleagues defined a number of different philosophical approaches to the EHRs.
The health information systems literature has seen the EHRs as a container
holding information about the patient, and a tool for agree gating clinical
data for secondary uses (billing, audit e.t.c) however, other research
traditions see the HER as an actant in a network, while research in computer
supported cooperative work (CSCW) sees the HER as a tool supporting particular
work.
Implementation,
end user and patient considerations
-
Quality
Several
studies call into question whether EHRs improve the quality of care. However, a
recent multi provider study in diabetes care, published in the new England
journal of medicine found evidence that practices with HER provided better
quality care.
HER
do help improve care co-ordination, since anyone with that HER can view the
patients chart, it cuts down on guessing histories, seeing multiple
specialists, smoothing transitions between care settings, and better care in
emergency situations EHRs may also improve prevention by providing doctors and
patients better access to test results, identifying missing patient
information, and offering evidence-based recommendations for preventive
services.
-
Software
quality and usability deficiencies.
The
healthcare information and management system society (HIMSS) a very large u.s. healthcare
it industry trade group, observed that HER adoption rates “have been slower than
expected in the united state especially in comparison to other industry sectors
and other developed countries. A key reason, aside from initial costs and lost
productivity during HER implementation is lack of efficiency and usability of
EHRs currently available. However, physicians are embracing mobile technologies
such as smart phones and tablets at a rapid pace. According to a 2012 survey by
physicians practice 62.6% of respondents (1,369 physicians, practice managers,
and other healthcare providers) say they use mobile devices in the performance
of their job. Mobile devices are increasingly able to synch up with electronic
health record system, thus allowing physicians to access patient records from
remote locations most devices are extensions of desk-top HER system, using a
variety of software to communicate and access files remotely. The advantages of
instant access to patient records at any time and any place are ear, but bring
a host of security concerns. As mobile system become more prevalent, practices
will need comprehensive policies that govern security measures and patient
privacy regulative.
-
Unit
ended Consequences
Per
empirical research in social informatics, information and communications
technology (ICT) use can lead to both into ended and unitended consequences.
A 2008 sentinel event Alert from the
U.S Joint commission, the organization that accredits American hospitals to
provide health care services, state that “As health information technology
(HIT) and converging technologies: the interrelationship between medical
devices and HIT are increasingly adopted by health care organizations, users
must be mindful of the safety risks 2nd revertible adverse events
that these implementations can create or perpetuate. Technology- related adverse
events can be associated with all components of a comprehensive technology
system and may involve errors of either commission or omission. These unitended
adverse events typically stem from human-machine interfaces or organization
system design.
In
a Feb. 2010 U.S food and drug Administration (FDA) memorandum, FDA notes HER
unitended consequences include HER related medical errors due to:
i.
Error of Commission (EOC)
ii.
Error of Omission or transmission
(EOT)
iii. Error
in data analysis (EDA)
iv.
Incompatibility between
multi-vender software applications or system (ISMA) and cites examples. In the
memir FDA also notes the “absence of mandatory reporting enforcement of H.I.T
safety issues limits the members of medical device reports (MDRs) and impeds a
more comprehensive understanding of the actual problems and implications.
A
2010 Board position paper by the American medical informatics Association (AMA)
contains recommendations on HER-related patient safety, transparency, ethics education
for purchasers and users, adoption of best practices, and re-examination of
regulation of dectronic health applications. Beyond concrete issues such as
conflicts of interest and privacy concersis, questions have been raise about
the ways in which the physician patient relationship would be affected by and
dectronic intermediary.
-
Privacy
and Confidentiality.
In
the united state in 2011 there were 380 major data breaches involving 500 or
more patients records listed on the website kept by the U.S department of
health and human services (HHS) office for civil right. So far from the firs
wall pstign in September 2009 through the latest on December 8, 2012, there
have been 18,059,831 “individual affected” and even that massive number is an
undercount of the breach problem. The civil right office had not released the records
of tens of thousands of breaches it has receive under a federal reporting
mandate on breaches affecting fewer than 500 patients per incident
-
Medical
Data Breach
The
security rule according to health and human services (HHS), establishes a
security framework for small practices as well as large institutions. All
covered entities must have a written security plan. The HHS identities there
components as necessary for the security plan administrative safeguard,
physical safeguards and technical safe guards.
The
majority of the counties in Europe have made a
strategy for the development and implantation of the EHRs. This would mean
greater access to health records by numerous stakeholders, even from countries
with lower levels of privacy protection.
There is also the risk for privacy
beaches that could allow sensitive health care information to fall into the
wrong hands. Some countries have enacted laws requiring safeguards to be put in
place to protect the security and confidentiality of medical information as it
is shared electronically and to give patients some important rights to monitor
their medical information and receive notification for loss and unauthorized
acquisition of health information’s. The united state and the Europe
have imposed mandatory medical data breach notification.
-
Breach
notification
The
purpose of a personal data breach notification is to protect intervals so that
they can take all the necessary actions to limit the undesirable effect of the
breach and to motivate the organization to improve the security of the infrastructure
to protect the confidentiality of the data.
-
Long – term preservation and strange
of record an important consideration in the process of developing electronic
health records is to plan for the long – term preservation and strange of these
records. The field will need to consensus on the length of time of store EHRs.
Method to ensure the future accessibility and compatibility of achieved data
with yet-to be developed retrieval system and how to ensure the physical and virtual
security of the achieves.
PATIENT BENEFITS ON EHRs
Electronic
health records are already having a positive impact of patient care across the
province. Patient will notice a difference in their health care experience theory:
1.
Improved care thorough safer move
accurate and complete information shared among all health care providers
2.
Reduce want times for
appointments, procedures and access to community care facilities.
3.
Improved security of confidential
health information through modern encrypted data protection systems.
DOCTORS AND CLINICIANS BENEFITS
OF EHRs.
For doctors and clinicians, the impact
of electronic health records is far reaching, allowing care givers to improve
the services they provide through:
1.
Immediate, accurate, secure
access to pertinent patient medical information fro all relevant sources,
including hospital and community care reports and discharge records, as well as
EMR files.
2.
Rapid access to a wide array and
data ranging from annual patient physicals, laboratory reports and test results
medication records, and digital diagnostic images.
3.
Ability to co-ordinate and share
data among different electronic record keeping systems.
4.
Reduced potential for adverse
drug interactions due to electronic prescribing and record-keeping
5.
More time to focus on patients.
IMPACT OF EHRs ON THE HEALTH CARE
SYSTEM
Electronic health records improve
access to the health care system and the quality of care patients receive while
reducing costs.
Benefits
to the system are achieved though:
1.
Lower costs through fewer
duplicate tests, fewer physician and specialist visits, and fewer emergency
room and hospital visits.
2.
More efficient transfer of patients
to the appropriate level of care (from hospital emergency rooms to long-term
care facilities)
3.
Improved management of chronic
disease
4.
Reduced demands on health care
resources.
GOVERNMENT,
PRIVACY AND LEGAL ISSUES.
Privacy concerns
In the United
States , Great Britain ,
and Germany
Privacy concerns in healthcare apply to
both paper and electronic records, According to the Los Angels Times roughly
150 people (from doctors and nurses to technicians and billing clerks) have
access to at least part of a patient’s records during hospitalization, and
600,000 payers, provides and other entities that handle providers’ billing data
have some access also recent revelations, in banking and other financial institutions,
in the retail industry, and from government databases, have caused concern
about storing electronic health records n a central location records that are
exchanged over the internet are subject to the same security concerns as any
other type of data transaction over the internet.
The Health Insurance portability and
Accountability Act/HIPAA was passed in the U.S in 1996 to establish rules for
access, authentications, storage and auditing, and transmitted of electronic
medical records. The standard made restrictions for electronic records more
stringent than those for paper records, however, there are concerns as to the
adequacy of these standards.
In the United State
Personal
information protection and electronic Document Act (PIPEDA) was given royal
assent in Canada on April 13, 2000 to establish rules on he use disclosure and
collection of personal information in 2002 (PIPEDA) extended to he health
sector in state 2 of the laws implementation.
According to wall street journal, he
DHHS, state that if protection and security are not part of the systems
developed people will not trust technology nor will the participate in it
CHAPTER THREE
3.0 RESEARCH METHODOLOGY
This chapter serves the purpose of
presenting the design of the research study as well as the methodology employed
for the collection of data, also the nature and type of data collected is
explained in details, the method of data collection, instrumentation,
reliability and validity and method of analysis are represented in this
chapter.
3.1 RESEARCH DESIGN
The main focus of this research is to
investigate on the Benefit of Electronic Health Record in Health Care Delivery,
also the chapter describes the method used to collect data, research instrument
and the statistical procedure adopted for the study.
3.2 STUDY POPULATION
The project work is carried out in
Federal Medical Centre Ido – Ekiti, Ekiti
State
3.3 SAMPLE SELECTION
Every number of the total population
has a chance of been selected. In order to have a high response rate the
sampling size will be made up of 80 people who are randomly chosen among the
target population
3.4 RESEARCH INSTRUMENT
The
research instrument adopted by the researcher are primary and secondary instrument.
These include physical observation, oral interview and the use of
questionnaire.
3.5 DATA NANLYSIS
In analyzing the data collected, the
descriptive statistics of percentage of both positive and negative respondents
to the questionnaire were calculated and pres
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