The emergence of the Electronic Health Record (EHR) systems rendered the traditional Paper Medical Records (PMRs) obsolete. In the twenty-first century, streamlined flow and sharing of patient information are vital for disease diagnosis, monitoring, control, and treatment. The use of traditional paper records impedes the attainment of the above objective due to various limitations. At the outset, PMRs hinder the availability and sharing of patient information amongst the health physicians since only one person can access it at a time. Therefore, a lot of time is wasted as the records move from one health facility to the other for the evaluation, particularly in the event of referrals. Manual documents are subject to displacement due to poor handling habits by either the patients or physicians. Also, delayed access to patient’s data affects coding, billing, and reimbursement processes. Secondly, the quality of PMR is not guaranteed since the paper is fragile and subject to staining, tearing, and fading. Consequently, patient information in PMRs can be distorted or lost.
This set of circumstances can lead to loss of vital patient data. Also, due to multiple circumstances that are posed to the healthcare providers, fragmentation of information increases because there is little or no sharing of patients’ historical records. Furthermore, handling of PMRs is tedious and costly. Such costs result from activities such as duplication, filing, retrieval, and supply of papers for copies, staffing for records management, distribution, and storage among others. The costs escalate in case of lost data. As a result, patients can be requested to undergo duplicate tests to obtain lost results. Additionally, PMRs limit productivity because a lot of time is lost during the search for paper charts and missing files. Delivering the paper records to different locations within the facilities also leads to time wastage.
Errors in the Contents of Paper Medical Records
PMRs often result in fatal errors that pose adverse effects on a patient’s’ healthcare provision. As aforementioned, paper records are subject to lose and mishandling among other factors that lead to errors. There have been reports of medical errors that result in clinical injuries or fatalities. Medical faults can be attributed to the non-reliability of PMRs. Many researchers have revealed that paper medical records are prone to numerous errors that include omission, delays, and misplacement among others (Farshi, Jebreili, and Abdinia 367)
Sometimes, PMRs fail to provide complete patient information. Healthcare providers can forget or ignore to include some details due to the tedious process of recording medical information manually. The omission can have substantial effects later when a different health care provider requires the data (Farshi, Jebreili, and Abdinia 367).
Delivery of paper records to different departments or facility locales can be delayed due to numerous factors such as distance, unavailability of papers for duplication, and/or busy photocopiers. However, electronic medical systems minimize delays since data can be shared instantly regardless of the distances involved.
According to Farshi, Jebreili, and Abdinia, PMRs can be misplaced or lost. Sometimes the patients are charged with the handling of the paper records (367). Sick people can misplace or lose them in case of unconsciousness or worsening conditions.
For instance, in a study that was conducted by the Institute of Medicine (IOM) on a sample of 1000 patient visits to five outpatient US Army facilities in 1997, the following data was obtained:
- 11.5% of the patients did not have any historical data available.
- Between 5% and 20% of the charts available had missing patients’ information. For instance, 75% did not indicate consistent laboratory results and 25% of the handwritten data was incomplete and incomprehensible due to illegibility.
- 14% – 78% of laboratory results were sketchily indicated in the PMR, and some missing elaboration was noted.
- 12% – 51% of the patient visits did not have clear referral documents. As a result, diagnosis information was difficult to retrieve.
- 24% – 35% of the patients’ records presented incomplete information despite the patients having gone through different facilities before visiting the army referral facility (Coffey et al. 54)
Lack of Awareness towards the Usefulness of EHR
According to the 2003 IOM report, many healthcare providers were reluctant to implement electronic records, despite the above-mentioned limitations associated with PMR (Wang et al. 397). This reluctance can be attributed to the non-supportive management who, for varying reasons, prevent the implementation of EHRs in most healthcare facilities. Some of the reasons that managers lean on for non-implementation include lack of funds to facilitate the acquisition of the facilities and training in the use of the technology. Numerous studies have revealed that the lack of awareness of the merits that come with EHR implementation prevents healthcare facilities from embracing the system. Empirical evidence shows that a great proportion of the healthcare providers do not see the benefits of EHRs since not all physicians are tech-savvy. Others are unwilling to undergo electronic training. However, the respondents failed to acknowledge that paper-based medical records hamper quality, accuracy, consistency, accessibility, interoperability, instant availability, and portability of patient information. For an effective campaign on the potential benefits that accrue due to the implementation of EHRs, there is a need to integrate the system into medical schools. New health physicians who will leave schools in the next few years should be competent in the use of the electronic system (Coffey et al. 55).
High Cost of Adopting EHR
Most of the facilities where EHRs implementation has been accomplished have revealed that the system is capital intensive. The approximate minimum implementation cost ranged from $255,000 per facility for the third-party hosted solution to $260,000 for vendor-hosted ‘Software as a Service’ (SaaS) in 2011. Given this high cost, most of the facilities management opts to maintain the PMRs since they are cheaper in the end. The initial cost of setting up the infrastructure, training, and maintenance is deemed the greatest obstacle to the adoption of EHR systems in many health institutions in the US. The stakeholders claim that they are unaware of the benefits that come with electronic systems, especially in the private sector. They also perceive that the overall driving force towards the implementation of the systems is the profitability of the healthcare facilities (Coffey et al. 56).
EHRs have other additional costs due to software licensing, support, hardware maintenance, and internet connectivity among others. The EHR connectivity costs vary depending on whether a facility acquires its server or subscribes to an Application Service Provider (ASP). Ownership attracts high up-front capital costs while the ASP approach costs are deemed minimal at both the installation stage and maintenance. Those who choose the contracted or (SaaS) pay a monthly fee for the services. EHR-related costs include transition costs, system upgrading, management configuration costs, reviews, audits, IT policies, privacy, and data integrity. Others encompass telecommunications costs for added bandwidth (wireless services), software, and additional computing devices (both stationary and mobile) that are necessary for other users who form part of the health care service provision, technical, and clinical-technical support staff (Coffey et al. 54).
Lack of Experience of the Use of Computers
Medical doctors have shown little interest in computerization. Many of the healthcare specialists who have been interviewed held that they were comfortable with PMR systems since they were simple to use. They affirmed that an individual required no training to use papers. However, most healthcare providers indeed have little or no computer skills that are paramount to the handling of electronic devices that are connected to the EHR systems. Some of the medical physicians are aged. For this reason, they do not intend to undergo any training in computer technology despite the fact they are competent professionals in medicine. In facilities where EHR systems were being implemented, issues such as the lack of knowledge to handle the advanced technology were common among the clinicians, even the middle-aged. Insufficient software knowledge together with minimal computer skills can lead to failure of the entire system. This set of circumstances can result in slow workflow and low productivity. Such occurrences can have adverse effects on the situations of the patient. The lasting solution to knowledge-related barriers is thorough training of entrant doctors to replace the aging and retiring traditional doctors. In this manner, the implementation will not discriminate against the physicians based on age (Ilie, Courtesy, and Van Slyke 9).
Resistance to New Technologies (EHR)
The greatest obstacle to EHRs implementation is resistance from health physicians. Most of them expressed a feeling of contentment with the use of PMRs. They affirmed that the use of the electronic system hurt the physicians’ workflow (Ilie, Courtesy, and Van Slyke 2). For instance, one hospital reported a 20% loss inefficiency. Others claimed that the system was 30% slower than the PMRs. As a result, healthcare providers had become dependent on traditional paper-based ordering. Any change was perceived as a source of inefficiency in the practice. Also, some organizations claimed that it was uneconomical to pay for the training of community-based physicians who worked based on part-time arrangements besides their unwillingness to undertake the training. In some cases, the resistance of physicians to change turned into rebellion, which derailed the entire implementation process. The negative publicity failed the management to adopt the EHRs. Some patients also expressed the fear of their confidential information falling into wrong hands. 22% of those interviewed were reluctant to accept uploading their confidential information regarding past medical history unless watertight security for their information was guaranteed (Ilie, Courtesy, and Van Slyke 7).
Web-Based Access to Electronic Health Records
In the wake of technological advancement, particularly in the IT sector, no one wishes to be left behind in the traditional way of doing things. The internet has sparked a revolution in the way humans share day-to-day experiences (Ilie, Courtesy, and Van Slyke 8). The medical sector stands to benefit significantly if the technology is embraced in every activity that touches on the management of illnesses. The EHR comes with a high level of interactivity amongst the patients and healthcare providers. They systems cheaply and easily avail vital medical information to all health stakeholders.
Health e-commerce is a component of modern health practice in the 21st Century. Online presence is becoming an important development in the sector. For instance, e-health portals such as OnHealth and MedScape are open to all health stakeholders. The portals facilitate free and unlimited medical information and innovations in health practice for a better future. Health e-commerce connectivity initiatives include internet-accessible EMR systems and assessment of provider quality based on clinical outcomes (Wang et al. 400). The modern e-commerce healthcare services do not target consumers only but are also accessible to patients among other parties. The IOM report indicated that more than 60 million people access the web in search of medical information yearly. For instance, Hi-Ethics is a set of 14 principles that were developed by a group of internet healthcare companies that direct websites to adhere to several guidelines such as providing credible and up-to-date information besides ensuring high privacy and security of health data.
The concept of Online Personal Medical Records (OPMR) is based on an online software application that allows individuals to manage their health information and/or other peoples’ health data under their authority. Patient information can be entered into the OPMR systems in two ways. At the outset, patients can enter the data individually. Secondly, data can be entered through a link to a third party’s computer system such as a laboratory system or physician’s EMR system (Wang et al. 401). Most of the OPMR systems can only handle one problem at a time. Others can take up multiple data on various health issues concurrently. OPMRs that link up with EHR systems deal with multiple problems. They can also be updated automatically through the EMR system to maintain constant relevance. However, sometimes compatibility of various OPMR with EMR systems fails, especially if patients change their data handlers such as switching between health physicians. To increase compatibility modes, some technologies solutions have been put forward (Wang et al. 402).
Online Personal Health Records
Numerous studies have revealed that some technologies such as the integration of speech recognition feature in an attempt to make the usefulness of the EHRs a reality failed. However, the system focuses on the enterprise regardless of whether it is a solo practice or multi-specialty clinic, provided it can use the internet to retrieve data from different providers and data repositories such as laboratory and radiology reports. Confidentiality is among the most important concerns that patients raise regarding the e-health sites (Shah et al. 112). Although the EHR systems aim at achieving interactivity and interoperability of healthcare practices for the benefit of patients, physicians, and service providers among others, the system can be intrusive in a way that a particular group of patients with peculiar diseases can feel targeted by some stakeholders as a way of promoting their products. Therefore, patients ought to be careful when uploading their confidential information on insecure websites. Security features should be flexible and configurable concerning the preferences of the end-users. There is a need for the health facilities to provide crucial information on the legal patient data handlers to avoid losses if the providers leave the business due factors such as insolvency, mergers, or change of business among others. The government should also play a part in the regulation of the operations of OPMRs to foster certainty and security of patient data (Shah et al. 114).
The continued use of traditional manual paper records impedes the many benefits that come with the implementation of EHR systems. Health stakeholders need to identify the existing obstacles to the full application of EHRs with a view of addressing them accordingly. The aforementioned limitations of PMRs are undesirable. The government needs to increase subsidies even for small healthcare facilities. It can also offer incentives to private stakeholders. If the electronic health record systems are introduced in the Schools of Medicine, they will increase awareness and development of competent health professionals to safeguard the future of the medical services.
Coffey, Carla et al. “A Comparison of Paper Documentation to Electronic Documentation for Trauma Resuscitations at a Level I Pediatric Trauma Center.” Journal of Emergency Nursing 41.1(2015): 52-56.
Farshi, Mahin, Mahnaz Jebreili and Babak Abdinia. “Comparison of Manual and Electronic Methods of Nursing Record: A Nurse’s Perspective.” International Journal of Pediatrics 3.1(2015): 367.
Ilie, Virginia, James Courtesy and Craig Van Slyke. Paper versus Electronic: Challenges Associated with Physicians’ Usage of Electronic Medical Records, 2007. Web.
Shah, Syed et al. “Accessing personal medical records online: A means to what ends.” International journal of medical informatics 84.2(2015): 111-118.
Wang, Samuel et al. “A cost-benefit analysis of electronic medical records in primary care.” The American journal of medicine 114.5(2003): 397-403.