Electronic Medical Records: Advantages and Disadvantages.

Electronic Medical Records are basically electronic versions of paper-based medical records. An Electronic Medical Record (EMR) is essentially an electronic record of health related information on an individual that can be created, gathered, managed and consulted by authorized clinicians and staff in one healthcare organization. Electronic medical record systems lie at the centre of any computerized health information system. There are many functions associated with patient health records. Not only is the record used to document patient care, but the record is also used for financial and legal information, and research and quality improvement purposes. Because all this information must be shared among many professionals who constitute the healthcare team, and there continue to be problems with the paper health record, it is becoming more apparent that developing an automated health record is very important. However, just as there are advantages and disadvantages with the paper medical record, there are also advantages and disadvantages associated with the EMR.

Advantages of EMR: The EMR provides the opportunity for healthcare organizations to improve quality of care and patient safety. The greatest challenge in the new world of integrated healthcare delivery is to provide comprehensive, reliable, relevant, accessible, and timely patient information to each member of the healthcare team. It provides information that is more accessible. All clinical laboratory and patient demographic information is a part of the electronic medical record and can be viewed at any computer terminal in the hospital as long as the employee has security clearance. Data retrieval is more accurate and efficient due to automated clinical documentation and protocol information being electronically linked to clinical data reports. An EMR can decrease charting time and transcription errors, therefore increasing the productivity of healthcare workers and decreasing medical errors due to illegible notes. Since handwriting is instinctive, and therefore difficult to change automated systems can help eliminate this problem. The EMR will not only deliver the correct information, it will actively assist in the treatment of patients through the use of that information. It will act as an assistant to the healthcare provider in addition to its role as a storage device for patient information. However, it should not take the place of physicians critical judgments. This heightened efficiency of this type of medical records storage fosters a more effective medical practice. Having instant access to electronic health records allows providers to chart during their patient encounters as opposed to several hours later. In theory, this enhances accuracy of the patients health record.

EMR system provides a centralized patient information which can be accessed anywhere via the internet, increasing efficiency and reducing redundancy. This has proved to be a real boom for practices with multiple office sites. Another benefit to an EMR is that it allows for customized views of information relevant to the needs of various specialties. It is far more flexible, allowing its users to design and utilize reporting formats tailored to their own special needs and to organize and display data in various ways. EMRs are used for result management to quickly access new and past test results, increasing patient safety and the effectiveness of care. It is also used to enter and store orders for prescriptions, tests, and other services in a computer-based system to enhance legibility, reduce duplication, and improve the speed with which orders are executed. The EMR can also provide reminders, prompts, and alerts. Computerized decision-support systems help improve compliance with best clinical practices, ensure regular screenings and other preventive practices, identify possible drug interactions, and facilitate diagnoses and treatments. There are tools that give patients access to their health records, provide interactive patient education, and help them carry out home-monitoring and self-testing can improve control of chronic conditions, such as diabetes. The EMR also employs uniform data standards which enable health care organizations to respond more quickly to federal, state, and private reporting requirements, including those that support patient safety and disease surveillance. One definite advantage of the EMR system over paper based medical record system is the fact that it provides long time preservation and storage of records. Currently the paper record represents massive fragmentation of clinical health information. This not only causes the cost of information management to increase but also fragmentation leads to even greater costs due to its adverse effects on current and future patient care. Medical records storage through digital means eliminates any threats of losing the patient health information in an emergency. Many electronic medical record systems are backed up everyday automatically and are accessible almost anywhere in the world. An EMR also represents a huge potential for cost savings and decreasing workplace inefficiencies. Unnecessary staff expenses and storage costs are eliminated with ele ctronic medical records storage. Additionally, the cost of medical record chart materials are replaced by inexpensive maintenance costs, which helps pay for the investment over time. Financially, the EMR provides more accurate billing information and allows the providers of healthcare to submit their claims electronically, therefore receiving payment quicker.

Another advantage of using EMR system is that during a medical audit, all information is readily available making workflow and procedures faster and smoother.

Disadvantages of EMR: The adoption of an EMR is a major investment for a medical practice. There are two categories of costs associated with electronic medical record implementation: System Costs and Induced Costs. System costs include the cost of the software and hardware, training, implementation, and ongoing maintenance and support. The start-up cost for adoption of EMR is colossal. Computer access is required to use an electronic health record system. A sufficient number of workstations, laptops, or other mobile computers must be available to accommodate the number of healthcare providers at any one facility. EMR software ought to be backwards compatible with older technology so that existing technology infrastructure can be used. Furthermore, most healthcare facilities have at least some degree of existing computerization, whether in the lab or in billing services. EMR systems need to interface with existing systems, again mandating a modular approach. Software technology advances at a rapid pace. Most software systems require frequent updates, often at a significant ongoing cost. Some types of software and operating systems require full-scale re-implementation periodically, which disrupts not only the budget but also workflow. Induced costs are those involved in the transition from a paper to electronic system, such as increased staffing hours for training on the new system, additional technical support, and network administration. A temporary loss of production is seen as the staff learns to incorporate the new system into their daily routine. This loss of productivity is highest in the first month of implementation with productivity returning to baseline levels on average within the first quarter of use. This is a result of EMRs that have been over-engineered and are not intuitive, forcing physicians to spend more time clicking through screens and menus to get their work done. Another disadvantage to an EMR is that there is a substantial learning curve and it is helpful if the users have some type of technical knowledge. These systems must be user friendly, otherwise these systems will not be easily accepted, nor will they be used to their fullest capacity. Security is potentially a major problem. There may be no system in the world that is entirely uncrackable. Hackers may ultimately be able to penetrate EHRs despite security precautions, and they may then release confidential information to others. However, there are several security technologies available that will help prevent unauthorized access to protected health information. Some of these technologies include firewalls, passwords and properly designed and monitored audit trails that can enhance user accountability by detecting and recording unauthorized access to confidential information.

A more significant problem with EMR systems is the lack of standards to interchange information. While a number of standards exist to transmit pure data, such as diagnosis codes, test results, and billing information, there is still no consensus in areas such as patient signs and symptoms, radiology and other test interpretation, and procedure codes. Although some associate the National Library of Medicines Unified Medical Language System (UMLS) with a comprehensive clinical vocabulary, its goal is much more modest, to serve just as a meta-thesaurus linking terms across different terminology systems.

Conclusion: Using an EMR system has risks and benefits, just as medications do. The EMR provides the essential infrastructure required to enable the adoption and effective use of new healthcare modalities and information management tools such as integrated care, evidenced-based medicine, computer-based decision support, care planning and pathways, and outcomes analysis. However, the start-up cost, the maintenance, lack of standardization and the security concerns act as barriers in its implementation.