The Electronic Health Record (EHR) is a system of managing patient information in an interoperable, easily accessible, and highly effective manner. It enables easy retrieval of important health information for patients regardless of their point of treatment. With EHRs, health physicians can access and evaluate the patients’ history. This situation underpins accurate diagnosis and execution of proper actions to prevent instances of fatal medical errors. EHR technology comes with several advantages that include monitoring and recording of diagnostic information, medical account, and disease symptoms among others. The EHR system makes the clinician’s workflow highly streamlined through automation and increased efficiency since one avoids the hassle of fumbling through paper medical records that do not provide consistent information on the patients’ medical history. The healthcare system monitors, records, and generates precise information about the progress of patients whilst suggesting feasible solutions to recurring or sustained symptoms. Despite the aforementioned benefits that come with EHR systems, numerous studies reveal that its implementation in Saudi Arabia is still in its infancy stages. Empirical research shows that even in the wake of rapid technological changes and globalization, the country faces major barriers in the implementation of EHRs that either hamper or slow down the process. This paper examines the factors that have leveraged the implementation of electronic health records in Saudi Arabia as compared to the United States.
The contemporary world is characterized by globalization that has been significantly heightened by enormous shifts and proliferation of technology, especially in information dissemination through highly interactive communication avenues. Nevertheless, various health industry players such as hospitals and healthcare centers in Saudi Arabia have continued to use outmoded paper medical records whilst its counterparts notably Sweden, the United Kingdom, Netherlands, and Australia have successfully integrated the EHR systems in over half of its healthcare systems. However, the countries have not reached the interoperability objective of the EHRs that seeks to allow sharing of the patient’s information amongst the various stakeholders in healthcare systems. Instead, the systems serve local practices. The United States remains at the forefront of the implementation of EHRs. However, it was not until President Obama’s government brought in the Affordable Care Act (2010) that the country started embracing the system and replacing the traditional paper medical records. Numerous studies show that there was a need for the US to reduce and prevent medical errors that accounted for significant patient deaths annually.
Many countries now follow suit to improve efficiency and accuracy in their healthcare systems. Many countries including Saudi Arabia still face challenges in the implementation of the healthcare electronic system. Substantial evidence suggests that paper medical records do not provide reliable and updated information on patients. Health physicians provide medical services based on patient history. In cases where this information is inaccurate and/or inaccessible, chances of medical errors due to improper prescriptions remain high. This situation can result in adverse patient effects and/or fatalities. The EHRs provide real-time access to medical accounts concerning the patients; hence, they provide accurate guidance to health physicians in administering proper medication. Credible evidence from healthcare facilities where the EHR was successfully implemented revealed that the system allowed multiple users to access patient records with ease as data was properly organized, legible, and complete. Also, enhanced information access correlated with the improved quality of patient care services. The players also reported reduced medical injuries resulting from medical errors.
Differences between the Health Systems of Saudi Arabia and the United States
In the Kingdom of Saudi Arabia, public healthcare facilities provide free medication to its legitimate citizens. However, the private sector offers care services for a fee. In contrast, health insurance companies in the United States play a critical role in the issuance of medical cover to individuals. Hospitals in Saudi Arabia provide free services to patients based on the sectors within which they belong. As a result, only members of a particular sector benefit from the free healthcare services that are offered in the hospitals. For instance, military hospitals provide free services strictly to militants and their beneficiaries. Others who do not comprise the military can access services from the private facilities across the country for a fee unless they have been referred to the military hospitals by other health facilities. Hospital specialization in the Kingdom of Saudi Arabia is a common practice as the high-level facilities treat specific medical conditions. Consequently, patient referrals to specialized hospitals are common in the country. One of the most prominent referral health facilities in KSA is the King Faisal Specialist Hospital and Research Center (KFSH&RC). The facility only handles illnesses that are related to tumors. The hospital deals with tumor-related conditions only. Patients who are diagnosed with such conditions are referred to as the particular facility for specialized treatment.
In the United States, all citizens are encouraged to enroll in health insurance to meet expensive health services. Open enrollment is done annually. For instance, programs such as Medicaid and Medicare facilitate the provision of reasonably priced medical services for the US population. The programs are aimed at making healthcare accessible to underprivileged groups in the country. These programs have been operational since 1967. On the other hand, the Saudi Arabian government mandates the Ministry of Health to control care delivery in both public and private health facilities. The ministry works in conjunction with several other government agencies the National Guards hospitals, hospitals of the Ministry of the Interior, Ministry of Defense and Aviation, and the Royal Commission for Jubail and Yanbu to provide healthcare services to employees and other citizens under special procedures. Recently, KSA began adopting the concept of health insurance coverage for the working class. The Saudi Arabian government passed a regulation directing all employed persons in the private sector to obtain health insurance from the employer companies.
It was not until 2002 that the New Saudi Health System (NSHS) was implemented. The system sought health insurance for all expatriates and Saudi citizens who worked in the private sector. The uncovered citizen has a choice of seeking free health services in public facilities or visiting the private sector for paid care. They can also purchase an insurance plan for private healthcare services. The aforementioned differences between the healthcare systems of KSA and the US underpin the feasibility of implementing EHRs in the country.
Hospitals in Saudi Arabia
The Kingdom of Saudi Arabia has an estimated population of more than 26 million people with an annual growth rate of approximately 2.2% million. The country has over 400 hospitals (249 are MOH, 39 government, and 127 private sector hospitals) that provide healthcare to the population. These hospitals provide jobs to over 500,000 people who come from more than 80 countries. The hospitals fall under different managements under the Ministry of Health, Ministry of Defense, National Guard, universities, and/or private sectors.
A great percentage of KSA hospitals under the Ministry of Health has not implemented the EHR systems in their facilities. As a result, they depend on either manual paper records or basic software tools to keep patient information such as disease diagnosis and medical history. For instance, a primary government hospital such as the 5 Riyadh Medical Complex uses paper medical records since it does not have EHRs in place. However, the King Faisal Specialist Hospital and Research Center (KFSH&RC) in Riyadh has realized an almost full implementation of the EHRs system. The hospital began its EHRs implementation in1978. The financial and administrative departments were the first areas within which the system was implemented in the first years. A decade later, the implementation was taking place in the Laboratory and Pharmacy modules, which form the primary areas of focus on the electronic health systems. Presently, the hospital is implementing a partial Patient Record System (PRS) as part of a larger process of computerizing the operations of the facility. Various studies have revealed that the hospital has opted to retain the manual record system despite the enormous steps towards a complete EHRs system.
Also, many hospitals under the Ministry of Defense have realized partial implementation of the EHR system in core units such as patient admission, laboratories, and pharmacies. The Ministry of Defense manages several hospitals notably the Riyadh Armed Forces Hospital among others. The King Fahad National Guard Hospital is the largest military hospital under the administration of the National Guard in the Kingdom of Saudi Arabia. The hospital specializes in advanced medical conditions. The country has advanced health facilities that deal with trauma and cardiac cases. However, despite having a basic EHR system, the hospital replaced it with advanced CPR technology known as the Misys Healthcare System (MHS). This method has significantly improved the delivery of healthcare in KFNGH because it has facilitated the monitoring and recording of patient information. University Hospitals in the country research various subjects while also providing healthcare services. However, they lack functional EHR systems in their facilities. As a result, they depend on manual records for their research and patient care.
Description and History of Electronic Health Record
Description of EHRs
Electronic health records focus on patient data management from capture, storage, and retrieval whenever such information is needed. The system is designed to enhance interoperability and interaction between current and past medical history of patients. The EHR systems can gather information from a broad range of divergent patient data sources including visit notes, reports from different physicians, lab and X-ray results, and information from health facilities. All EHR systems have similar characteristics that are listed below.
- Their primary purpose is to manage patient data
- They utilize various methods of data entry including voice recognition, pen, and optical character recognition
- EHRs can network through LAN, internet, and/or wireless systems
- They are secured through encryption, passwords, and biometrics
- They support instant messaging
- EHRs allow flexible storage of clinical information in a way that permits movement from one system to another
EHR systems allow multi-functional capabilities whereby physicians can perform numerous tasks simultaneously. For instance, they enable physicians to have real-time access to patient problem lists, prescriptions, and related adverse reactions and test results among other information. The system also enables physicians to prepare documents and reports regarding the services they offer to patients during their visits and justification for clinical decisions. They also identify clinical issues using red flags that alert and remind physicians. Alerts play a key role in clinical practice as they can remind physicians of drug allergies. Furthermore, clinicians can make guided decisions on clinical issues upon access to comprehensive and steadfast databases and references that are provided by the EHRs system. The system provides a basis for the standardization of disease management goals for patients with chronic conditions.
The History of EHRs: 1960s to 1980s
With the emergence of computers in the 1960s, many industries welcomed and began integrating technology into their business activities. However, a substantial amount of literature reveals that the health care industry has been slow in the adoption of computer technology despite the innovation capabilities enhanced by information technology (IT). Service industries such as banking finance and telecommunications are some of the sectors that welcomed and embraced computer technology. Larry Weed, who introduced the conception of Problem-Oriented Medical Record into healthcare, first speculated the idea of recording patient information. The idea sought to replace paperwork based recording of patient data as he envisioned a recording system that was to allow third-party individuals to verify patient information independently. Nevertheless, despite the many benefits of EMR, its take-off was significantly slow. The idea of EMR aimed at enhancing the reliability of information and protection from data loss. The EMR technology increases the storage space virtually while relieving physicians from paper charts. Due to the proficient organization of patient data, the system has resulted in improved care delivery that has been characterized by reduced mortality rates in healthcare facilities that have realized its implementation. Efficient is also realized since medical errors are pointedly reduced due to proper management of health information. Today, the idea of EMR has been promoted through the proposal of healthcare systems to adopt EHRs. Healthcare leaders are encouraged to envision apt strategies that endorse note documentation, information coding, and interactive decision-making.
Notable forms of EHRs systems in different health facilities include the HELP system at the LDS Hospital in Utah, the COSTAR system at Massachusetts General Hospital, and the TMR system at Duke. Most of the systems date back to the 1970s and utilized techniques in the workflow, exhibition, and user interface that formed the standardized basis of modern technology of the 21st Century. Despite these systems being a landmark discovery that can revolutionize healthcare systems, administrators failed to support them as some considered them as unbeneficial. Other managers were reluctant to spend enormous amounts of capital and labor in systems whose feasibility was skeptical. These arguments have been the active barriers to the successful implementation of EHRs up-to-date. In the 1970s, two approaches to health information system (HIS) applications emerged. The first approach was a concept of immense design whereby a single, large time-shared computer was used to support a collection of applications. The other one used a multi-machine model. However, these approaches were deemed impractical. Many systems at the time lacked interoperability as they functioned from a stand-alone perspective. EHRs were meant for interactivity within healthcare settings. Physicians often preferred relying on their acquaintance and experience rather than the systems. The systems were incapable of providing fine-grained and comprehensive data on patients. In the1980s, there were notable technological advancements that supported the EHR systems. This set of circumstances led to the development of affordable networking systems that underpinned the implementation of EHRs. Data interchange was amplified as the first version of the HL7 standard was developed.
Massive research also intensified as attempts were made to apply the expert system methodologies in developing more suitable decision support systems for clinical needs. Research on various systems such as QMR, DXPLAIN, and ILIAD among others proved that integrating reminders and alerts into the EHR systems lowered healthcare costs. Technology improved significantly from the 1980s onwards. There was continued the development of standards in the HL7 that focused on recording electronic data, which was easily shared and accessible. By the late 1980s, most healthcare institutions had realized the enormous achievements in the implementation of the HER systems. Interconnectivity was ensured by the installation of single terminal PCs that were located either in the office or hospital ward where health care workers retrieved essential patient test results including blood chemistry, microbiology, radiology, and biopsy reports. It included three major facets that included uses and users, technology, and policy and implementation. There was an increased need to revolutionize the EHR systems with a view of promoting healthcare delivery.
Conclusion and Recommendations
The health care system of KSA stands to improve substantially upon the successful implementation of the electronic health records system. EHRs help in data management, interoperability, information sharing, and decision making by health physicians. The system also cuts data storage costs, minimizes information loss, and prevents medical errors that result in fatal injuries and deaths. The rapidly burgeoning population of the KSA requires a modern health care system to ensure efficient and effective disease control and monitoring.
Various recommendations can be considered to support the implementation of EHRs in the Kingdom of Saudi Arabia. Firstly, Electronic Health Records are vital for hospital administration to improve patient outcomes by eradicating medical errors. Therefore, the KSA government needs to increase budgetary allocations for public hospitals to support EHR implementation. Also, the government should support and create an ample environment to allow private hospitals to thrive in the implementation of the system. Secondly, the government needs to promote training and avail support forums through the provision of appropriate literature on EHRs. The Ministry of Health can offer suck kind of literature by using the government health portal, as in the case of the US, where the public can access it easily. Additionally, the EHR system should allow multilevel confidentiality such that health providers from the diverse health institutions gain access to patient information that is relevant to their responsibilities whilst preventing access to confidential data that other stakeholders are not supposed to view. Lastly, there should be a well-documented contingency plan that prevents frustrating scenarios in cases where the systems fail. Therefore, the government should invest in thorough training for both IT professionals and physicians to allow successful integration of the systems and healthcare. This situation will ensure the credibility, reliability, and accuracy of the EHR systems. Consequently, regular system checks, servicing, upgrading, and testing are recommended. Finally, yet importantly, governments around the world should support the implementation of electronic health records to improve care delivery and patient safety in health institutions