Free «Electronic Health Records» Essay Paper

Electronic Health Records

Introduction

The issue of electronic health records is the subject of brisk debates within the healthcare area. Many experts, politicians, and journalists claim that adopting standardized electronic health records and protected traffic of health data would boost health care quality and safety, decreasing expenses in this field.

The Definition and the Essence of Electronic Health Records

Electronic health record can be defined as “an electronic version of a patient’s medical history that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider” (Centers for Medicare & Medicaid Services, 2012). Electronic health records usually comprise demographics, such as a patient’s height and weight, progress remarks, health problems, medical treatment, vital signs, medical history, data about immunizations, laboratory results, radiology reports, and billing information (Centers for Medicare & Medicaid Services, 2012). In fact, electronic health records are a digital version of patients’ paper charts. These advancements give licensed users an opportunity to receive the necessary information about individuals’ health immediately and securely.

Key Types of EHR Systems

Experts distinguish two types of EHR systems. They are the Application Service Provider (ASP) model and Client-Server or Standalone model (CS). The Application Service Provider model gives an opportunity to get patients’ data from a remote site by means of the Internet. . The interface of the above-mentioned service comprises enterprise resource planning items, such as human resources. Moreover, it may be used for e-commerce, management, and for other purposes. Monthly payment is taken for the traffic to the sites storing electronic health records and individuals’ health care information. Nevertheless, the great majority of clients is not satisfied with the Application Service Provider model.  Customers complain that its low protection against unauthorized intervention would cause leaking of confidential information. Poor reliability is the second drawback of the model. To protect interests of vendors and clients, the service level agreements are concluded. They discuss possible faults, their consequences, and the ways of indemnifying losses. Experts note that the Application Service Provider model is popular in the small business area. Clinics may decrease their expenses on hiring personnel to deal with the paper documents or training the staff and embedding additional IT devices. In fact, the payment for the above-mentioned service is rather small.

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The Client-Server or Standalone model is the type of EHR systems that suggest patients’ information keeping in a server in doctors’ offices. This option requires expenses on introducing advanced hardware, training the personnel of clinics and organizations, and supporting the EHR system. Nevertheless, many private clinics prefer the Client-Server because of its reliability.

Key Advantages of Implementing Electronic Health Records

The implementation of EHRs provides numerous benefits. First, it allows sharing and updating data among various clinics and organizations. Adopting electronic health records provides authorized health care contributors with an individual’s health data in any place a patient gets treatment. This service develops coordination and duration of the treatment suggesting informed decision-making. This innovation provides patients with more complete and accurate details to notify experts about their health care. Implementing electronic health records significantly decreases the number of preventable medical mistakes, escaping recurrence of medication and procedures.

Electronic health records are more effective in keeping and retrieval. Then, they can be organized and shared in the multimedia format, such as medical imaging results. Next, physicians can connect records to various sources of research. It boosts research by assisting in gathering of standardized information for the assessment of innovative medical techniques, devices, and medication. It shortens the deadline of introducing innocuous and successful products and services to the marketplace.

 
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Implementing electronic health records facilitates regulation of health services and patient care. Sixth, physicians have access to decision support systems. The use of electronic health records lowers the expenses on the medical system. It decreases administrative expenses and diminishes clerical mistakes.

An electronic health records system contributes to escaping of dramatic number of billing errors and wrong coding. Therefore, this fact would boost cash flow and increase revenue. The next advantages of electronic health records enhanced utilization of tests, diminished personnel resources directed to patient management, decreased spending on supplies for paper documents, low transcription expenses, and outgoings for chart pulls (Centers for Medicare & Medicaid Services, 2012).

Potential Drawbacks of Electronic Health Records

According to Scott, any “innovation is like travelling in negative. Instead of the familiar entering the foreign system, innovation is the foreign entering the familiar system” (Scott, 2007, p.6). The U.S. authorities gave about $27 billion to boost the effective implementation of electronic medical records systems (EMR) in 2009 (Landro, 2015). Nevertheless, only 17% of physicians and 10% of clinics have introduced basic EHRs. There are several reasons for their reluctance, including poor data security, medical records synchronization, great expenses, legal inconsistency, shortage of similar terminology, system architecture, and indexing. Initiating electronic medical records is expensive. Physicians and hospitals do not have financial return from putting their money into implementing electronic healthcare system. What is more, installing, maintaining, and updating the above-mentioned system pose many problems. Finally, security, confidentiality, and protection of individuals’ health data are not guaranteed. In fact, providers keep digital Protected Health Information in various electronic systems. However, the common threat for all the current data systems is their vulnerability to cyber-attacks (The Office of the National Coordinator for Health Information Technology, 2015).

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Having changed paper-based records, innovations cause significant worries among patients and experts regarding the security of patients’ health data. In fact, sharing data on some diseases such as mental disorders or fatal diseases may lead both to moral and material detrimental consequences for patients and individuals surrounding them. Therefore, the problem of data protection is the burning one.

At the present time, the information regarding an individual’s health can be stored in various forms, such as video and electronic files. The major way of protecting confidential data is allowing only the authorized individuals to have access to the information. The first step is authorizing the users. For example, the clerk identifies users, clarifies and confirms the type of required information, and appoints logins and passwords. Many clinics practice the innovative approach to protect their patients’ data that contains  biometrics identifier scan. It may include palm, finger, retina, and face control. According to the HIPAA Privacy and Security Rules, employers are responsible for the people who work for them. To illustrate, employees of UCLA health system were found guilty of criminal unauthorized access to notes about certain celebrities’ health (The Office of the National Coordinator for Health Information Technology, 2015).

Legislative Base for Implementing Electronic Health Records

During the last decades, experts, politicians, and ordinary citizens have been discussing the state of affairs in healthcare system. Specialists and policy-makers try to find the ways of improvement of American healthcare system, making certain steps in the legislative sphere, managing innovative processes. Adopting new laws, experts and politicians contribute to developing of the electronic health care records system.

The U.S. government provides the legislative base for initiating and using of electronic health records by clinics and health care organizations. These key legislations are the Health Information Technology for Economic and Health (HITECH) and and the Health Information Technology for Economic and Clinical Health Act (HIPAA) that came into force in 2009.

HIPAA Security Rule suggests the U.S. national requirements for the security of patients’ health information to be kept in digital systems. The HIPAA gives the U.S. citizens an opportunity to control their health facts, depict boundaries on the implementing and sharing their medical information, and suggests a set of privacy rules for health care vendors. Those guidelines impose punishment for the providers violating the requirements. To illustrate, any individual has a right to know the details about using and sharing his or her personal health data in the written form. What is more, individuals enjoy the right to inspect their medical records. In fact, healthcare providers are obliged to give the required data within 30 days of getting the application. Vendors are to notify their patients of the occasions of leaking and stealing their personal medical information (“HIPAA requirements, 2014).

HITECH was adopted in 2009. This act provides implementing programs on increasing health care standards, safety, and efficiency by means of adopting health information technologies, such as electronic health records and confidential and protected electronic health information interchange.

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The Office of the National Coordinator-Authorized Testing and Certification body (ONC-ATCB) is the current key certification authority dealing with electronic health record technology in the United States. It tackles vendors and consultants. Being founded as a major certification body according to the American Recovery and Reinvestment Act of 2009 under the Federal Stimulus Plan, the ONC-ATCB suggests necessary assistance for health care organizations in implementing and updating electronic health information technology. In fact, the ONC-ATCB it the element of the Department of Health and Human Services in the United States. The key goal of this institution’s activities is certifying EHR vendors and consultants (Janssen, 2015). The Medicare and Medicaid EHR Incentive Programs support authorized EHR technology.

Workflow Processes

Implementing electronic health records into practice by certain clinic or organization consists of several steps. The first step is evaluating practice readiness. This phase is extremely important. It suggests the assessment of the current state of affairs and preparedness to transformation from paper health records to electronic ones. Upgrading the accepted system to an innovative edition can be adopted at this stage. Top-managers and the staff of clinics and health care organizations are expected to appreciate key aims, needs, and financial and practical preparedness for advanced changes. There are several issues to be taken into account. First, the level of keeping documentation, organization, and efficiency of the administrative procedures are to be expected. Second, all the personnel have to understand the nature of basic workflow. Third, all the employees are to be familiar with computer technologies. Fourth, high-speed Internet is to be available. Certain calculations should be done to evaluate the possibilities of clinics and organizations to acquire new and additional hardware. Sixth, key priorities and needs are to be distinguished and the administrations of clinics and organization have to draw the ways these essentials are to be addressed.

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A workflow examination should be performed. The workflow study helps personnel to realize the task they are expected to do and to find the proper ways for boosting the productivity and efficiency of their work by means of adopting electronic health records.

The above-mentioned workflow analysis performs several functions. First, it describes the present office workflow in details, suggesting workflow maps of major office procedures. Second, a completed workflow investigation distinguishes present-day drawbacks, obstructions, and options for enhanced developments. Third, a workflow study will contribute to further rough ideas about workflow transformation by means of implementing electronic health records.

Initiating electronic health records consists of several phases. They include planning, vendor selecting, contracting, implementing, training the personnel of clinics and organizations, and further developing. The stage of planning can take different periods of time. Vendor selection usually lasts from one to three months. Making contracts proceeds approximately one month. The stage of implementation lasts from two to four months. Training the staff continues about two weeks. The stage of developments is the current process. The stage of implementing electronic health records follows signing contracts. This phase includes five steps.

Planning is the most long-term stage of implementing electronic health records. Several issues should be solved at this stage. They are distinguishing the types of documents to be converted from paper to digital form, the kind of information to be transformed, identifying the individuals having access to the data, drawing practice workflows, distinguishing problem fields and bottlenecks, and discussing security rights, authorized access, and system initiating.

The software is to be tested before initiating into practice by clinics and health care organizations. First, a test database should be created for personnel training. Second, the necessary time limits should be drawn for entering the information. Third, vendors are to explain potential difficulties and drawbacks of their models of EHR system. Fourth, the sites for workstations, printers, kiosks, servers, and wireless device access points are to be organized for a client-server environment in due time.

Administrations of clinics and hospitals should choose the type of EHR systems that would meet their needs. Being compared to the Application Service Provider model, the Client service model appears to be more expensive. It suggests buying, installing and supporting the EHR system in local offices. The Application Service Provider model requires authorizing EHR software and needs access to the high-speed Internet.

Nowadays, approximately one thousand certified EHR vendors suggest their services. Experts give several pieces of advice to choose the proper EHR vendor. The specialists distinguish key stages, such as identifying the key decision makers for the EHR selection team, developing a request for proposal, reviewing potential RFPs, and choosing the proper vendor. First, the high-qualified team is expected to be formed. It should consist of a project manager, a physician champion, and clinical and office personnel. The qualified staff makes decisions about the scale and level of the innovations, as well as about spending on the implementation of EHR system, comprising the budget and the assets. Then the goals of EHRs system are to be established. The second step is developing a request for proposal (RFP). This request for proposal explains potential vendor the key data about their clients’ practice. Moreover, requests for proposal suggest clinics and health care organization necessary details about the prospective vendors’ services. In fact, requests for proposal contribute to comparison between different providers and help to choose the proper supplier of necessary services between above one thousand vendors. The third step is reviewing the requests for proposal.

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Administrations of clinics and health care organizations should choose several prospective options. The representatives of the suppliers would show in practice how their systems work. At this stage, every member of the team has to take part in reviewing the requests for proposal and ranging the perspective suppliers. Then the list of potential vendors should be shortened to the key two or three options. The team leaders are to control all the references and hold vendors demonstrating their models of electronic health record systems. The fourth step is the choice of proper vendor. At this stage, team leaders organize a site visit at practices implementing the vendor’s software programmes. All the members of the team study the ways of exploiting the systems and choose the best vendor. Making contracts with the chosen vendors is an important issue. This step follows the stage of selecting the proper EHR vendor. Team leaders are to discuss the support suggested by the selected vendor. Experts focus on several matters of the above-mentioned negotiations. They are “user licences, type of interfaces, hardware specifications and installation, third party software, internet connectivity and redundancy, implementation project manager, training, service agreement, IT support, and additional terms and conditions” (The Maryland Healthcare Commission, 2012).

Experts give advice to involve an experienced lawyer and computer engineers to explore software vendor agreements. The contract has to be examined to escape arguable terms in its clauses. All the verbal agreements are to be put in the written form. Next, the contract is to comprise the stipulation about security and HIPAA compliance. All the cases of potential fees are to be documented. To illustrate, troubleshooting support, late payment fees, and system upgrades are important clauses of the contract to be negotiated for (The Maryland Healthcare Commission, 2012).

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Conclusion

The challenges of adopting and implementing electronic health records are often addressed in the healthcare area. Many authorities, experts, and journalists insist on to the fact that initiating standardized electronic health records and protected traffic of health data would boost health care quality and safety, as well as would diminish expenses in this field.

Electronic health record can be referred to as a digital variant of a patient’s health history that is supplied by the vendor. The major administrative clinical information relevant to individuals’ health care under the chosen vendor is the key element of electronic health records.

Experts distinguish two types of EHR systems. They are application service provider (ASP) and client-server or standalone (CS).

The implementation of electronic health records provides numerous advantages. It permits sharing and updating data among various clinics and organizations. The above-mentioned innovations are more effective in the storage and retrieval. They can be organized and shared in the multimedia format. Finally, the usage of electronic health records lowers the spending on the health care system. Electronic health records shorten the deadline of introducing innocuous and successful products and services to the marketplace.

The potential drawbacks of initiating electronic health records are poor data security, medical records synchronization, great expenses, legal inconsistency, shortage of similar terminology, system architecture, and indexing.

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The U.S. government provides legislative base for initiating and using of electronic health records by clinics and health care organizations. These key legislations are the Health Information Technology for Economic and Health (HITECH) Act and the Health Information Technology for Economic and Clinical Health Act (HIPAA). HIPAA Security Rule permits keeping  patients’ health information in digital systems. The law provides implementing programs of increasing health care standards, safety, and efficiency by adopting health information technologies.

The Office of the National Coordinator-Authorized Testing and Certification body (ONC-ATCB) is the current major certification body dealing with electronic health record technology in the United States. It tackles vendors and consultants. The Medicare and Medicaid EHR Incentive Programs support authorized EHR technology.

Providing electronic health records into practice by certain clinic or organization includes several steps. They are planning, selecting vendor, contracting, implementing, training the personnel of clinics and organizations, and further developing.

Taking into account all the above-mentioned facts, boosting the implementation of electronic health records is an extremely important matter on the national level.

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