Electronic Health Records: Technology is a two-edged sword

Doctor using electronic health record system (EHR) to search medical record of patient.

Electronic Health Records (EHR) is one of the most popular buzzwords in US healthcare circles. While it seems like an ideal situation that all healthcare units and doctors will use electronic health records, the path to digitization of health records is not as simple as it appears.

Earlier, doctors and healthcare institutions maintained all the patients’ details and relevant documentation in paper files. The information included data such as medical history, doctors’ notes, doctors’ diagnosis, medications and prescriptions, reports of lab tests, radiology and other reports, allergies and immunizations, and all other information related to a patient’s health. With the advent of computerized systems, personal computers and the internet, it was only a matter of time before electronic record keeping started becoming acceptable. The ease of storing and retrieving electronic data over the internet without limitation of geography, quickly progressed the idea of electronic health records or EHR in the medical fraternity.

There is a wave in favor of EHR and many doctors and healthcare institutions have implemented EHR for a majority of their administrative processes, considering the enhanced quality of healthcare which is possible when a doctor has entire health history and information of a patient available online at his/her fingertips.

This transition from paper to digital is being undertaken and many studies are taking place regarding the efficiency of this transition and post-transition process. The Journal of American Medical Informatics tells us that according to a new study, one of the primary challenges surfacing in implementation of EHR, is patient safety issues.

Internet networks are prone to downtime. Network outages may occur at an important juncture in the healthcare process. Also, there is always a possibility of hardware or software glitch due to which the doctor may not be able to access patient information immediately. This can lead to delay in clinical decision making; and while this may be manageable in non-critical cases, it may lead to serious complications in case of critical cases which require immediate medical attention and treatment. There is also the danger of the computer networks being hacked and information of a patient being stolen or its integrity compromised.

Another major challenge is training of medical personnel in using the Electronic Health Record EHR system. Reasonable time and cost gets invested in training. Also, the users also need extra time post-training, to familiarize themselves with the system and achieve desired speed of use without manual errors. If there are changes in the software or in the law, training is required yet again and time is needed to familiarize oneself with the new system as well. Patient data entry too involves time, cost and effort.

Data collected since 1999 from Informatics Patient Safety Office of the Veterans Health Administration (VA), offers an expansive insight into several other major challenges of EHR implementation. One of the often quoted challenge is display of patient information in the software, which may not show the desired information at the right time, may be cumbersome to understand or slow to access; leading to delay in availability of information. Another challenge arises when the software is being upgraded or modified. Bugs may appear within the software and sometimes data migration can pose difficulty. If new software is being installed by another vendor and the old one is being replaced, in this case also data migration can pose serious difficulties.

It is true that implementation & usage of EHR is inevitable; however it is also true that effectiveness of electronic health records is going to remain a major area of concern and challenge for the medical fraternity. There is a long winding road ahead before EHR becomes a headache-free solution for maintaining patient records.

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