Electronic Health Records (EHRs): The good, the bad and the inefficient?

EHRs have become increasingly more commonplace in healthcare in recent years. While they do greatly improve some aspects of healthcare, such as the ease at which doctors can access patient files; features like hard to navigate interfaces can be a source of hindrance in other aspects.

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Since the passage of the $30 billion Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, electronic health records (EHRs) have become more and more commonplace in American healthcare.1 An EHR is a digital version of a patient’s paper chart that can be easily accessed by the healthcare professionals treating them.

EHRs contain vital information such as medical history and test results.2 These systems were designed make it easier for doctors to diagnose and treat their patients. It is important not to get EHRs confused with electronic medical records (EMRs). Specific EMR software is generally only used within a single office/practice, while EHRs are shared between multiple sites and even institutions.3 In 2017, approximately 86% of all primary care physicians in the US were using some form of EHR.4 With EHRs increasingly becoming the norm, this article will explore both the usability and challenges of using EHRs in practice.

EHRs and usability 

In 2007, it was reported that over 60% of medication errors in hospitals were traced back to poor handwriting.5 Through the use of EHRs, prescription errors caused by illegible ‘doctor handwriting’ reportedly reduced by 66%.5 Storing information together in an organized and legible manner greatly reduces the chance of a record being misread or misunderstood by another healthcare professional.5

In addition, information stored as part of EHRs can be made easily and quickly available to the necessary people. For example, alerts in an EHR are able to tell care providers if a patient is allergic to any medicines, if the patient is unable to do so themself.6 This type of information is particularly important in emergency situations where care providers need to access crucial information about a patient as quickly as possible. In addition, the use of EHRs make obtaining information such as previous test results extremely easy, avoiding the need for unnecessary repeat tests.7

EHRs also have the potential to pick up on concerning symptoms or trends faster than standard methods.6 These trends are not solely referring to individual patients but may appear across wider patient groups. For example, through analyzing EHRs, a study found that individuals in the US with type 2 diabetes alone and patients with major depressive disorder (MDD) alone, with no history of cardiovascular disease, had around a 30% increased risk of a heart attack. Those patients with both type 2 diabetes and MDD were at an 82% increased risk, compared with patient without either condition.8

EHRs give patients the opportunity to be more independent and involved in their treatment. Systems such as My Medical Record allows patients to easily access their records, update their personal information, care preferences and generally be more informed about their healthcare and treatment.6 Patients may also be reminded about commonly forgotten medical considerations, such as keeping up to date with their vaccinations. In addition, EHRs can also assist healthcare professionals in providing treatment. In one study, computerized physician reminders triggered by EHRs were associated with increased rates of ordering vaccinations – pneumococcal increased from 0.8% to 35.8%; and influenza from 1.0% to 51.4%.9

New innovations within EHRs are constantly being developed and implemented; the ability for a patient to download their EHR onto a smartphone being just one example.10 In the future, it may also be possible to use dictaphones to help make data input quicker and more efficient for HCPs.11

In 2007, it was reported that over 60% of medical errors in hospitals were traced back to poor handwriting.5 Through the use of EHRs, prescription errors caused by fabled ‘doctor handwriting’ reportedly reduced by 66%.5 Storing information together in an organized and legible manner greatly reduces the chance of a record being misread or misunderstood by another healthcare professional.5

In addition, information stored as part of EHRs can be made easily and quickly available to the necessary people. For example, alerts in an EHR are able to tell care providers if a patient is allergic to any medicines, if the patient is unable to do so themself.6 This type of information is particularly important in emergency situations where care providers need to access crucial information about a patient as quickly as possible. In addition, the use of EHRs make obtaining information such as previous test results extremely easy, avoiding the need for unnecessary repeat tests.7

EHRs also have the potential to pick up on worrying symptoms or trends faster than standard methods.6 These trends are not solely referring to individual patients but may appear across wider patient groups. As an example, through analyzing EHRs, it was found that individuals in the US with major depressive disorder and no history of cardiovascular disease, had around a 30% increased risk of a heart attack.8

EHRs give patients the opportunity to be more independent and involved in their treatment. Systems such as My Medical Record allows patients to easily access their records, update their personal information, care preferences and generally be more informed about their healthcare and treatment.6 Patients may also be reminded about commonly forgotten medical considerations, such as keeping up to date with their vaccinations. In one study, computerized physician reminders triggered by EHRs were associated with increased rates of ordering vaccinations – pneumococcal increased from 0.8% to 35.8%; and influenza from 1.0% to 51.4%.9

New innovations within EHRs are constantly being developed and implemented; the ability for a patient to download their EHR onto a smartphone being just one example.10 In the future, it may also be possible to use dictaphones to help make data input quicker and more efficient for HCPs.11

Potential challenges with EHRs

Like any form of digital technology, EHRs can be vulnerable to security breaches. Indeed, reports of EHR security breaches are increasing year upon year. In 2019 over 41 million patient records were breached, with the largest single breach due to hacking.12 Cybersecurity, therefore remains an important challenge when handling sensitive data. The US is estimated to have spent over $18 billion in 2020 alone to support initiatives to tackle this.13

Despite the apparent benefits of an electronic-based system to monitor patient health, there are still challenges associated with their use.14 Even though these systems aim to provide more ease for doctors and better care for patients,14 doctors have reported that the ‘poorly-designed’ interfaces of EHRs in fact hinder their treatment of patients because they have to spend more time focusing on the EHR rather than the patient. In 2018, a survey into attitudes towards EHRs reported that more than 60% (of 521) of  primary care physician’s time spent with their patients is devoted to interacting with EHRs.14 In addition, a survey of 624 US physicians conducted in 2018 found that 58% felt that there is ‘a big opportunity for improvement in clinical documentation’, with a general consensus that there is room for a lot more efficiency.11 The survey also highlighted the necessity of interoperability in EHRs, with 62% saying that it needed improvement.11

Interoperability refers to the ease with which the various software used between different organizations can connect and exchange information. Unfortunately, due to the multiple EHR platforms available, this undertaking has proved difficult due to the volume of organizations supplying EHRs.11 Of course, for this system to be optimally effective, it would be required that all healthcare professionals use EHRs as part of their practice. If a healthcare professional is not using EHRs, they may not be able to prescribe certain medications as they must be done electronically.15 There therefore exists a challenge to further the use of EHRs, while not limiting effective patient management for all. Data input and record format standardization may be additional ways in which this challenge of interoperability can be overcome.

Should EHRs become the sole means by which doctors record patient data, any minor errors could have detrimental effects on a patient. Incorrect or incomplete data that is accessed by future healthcare professionals may put patients at risk. For example, order entry errors around the dose and administration of medications has the potential to be life-threatening.16 EHRs need to be accessible 100% of the time and, in an age where society is becoming more and more dependent on technology, is this dependence on technology in medicine going to be costly for patients?

Ultimately, the benefits and drawbacks of EHRs may not be as clear-cut as they originally seem. There is no question that there are plenty of advantages to a universal database where patient information is easily accessed by those who need it; however, the execution of these systems still needs refining for the healthcare world to truly benefit.

Discover more about digital health and EHRs in our articles on small data vs. big data, and connected data. Sign up for our monthly updates too here.

References

  1. Nursing 2020. Benefits of using an electronic health record. Available at: https://journals.lww.com/nursing/Fulltext/2016/07000/Benefits_of_using_an_electronic_health_record.6.aspx. [Accessed March 2020].
  2. Health IT. What is an electronic health record (EHR)? Available at: ww.healthit.gov/faq/what-electronic-health-record-her. [Accessed March 2020].
  3. Best Electronic Health Record software of 2020. Available at: https://www.techradar.com/uk/best/best-electronic-health-record-ehr-software. [Accessed March 2020].
  4. Health IT. Quick stats; office-based Physician Electronic Health Record Adoption. Available at: https://dashboard.healthit.gov/quickstats/quickstats.php. [Accessed March 2020].
  5. Science Daily. Computerized doctors’ orders reduce medication errors. Available at: https://www.sciencedaily.com/releases/2007/06/070627084702.htm. [Accessed March 2020].
  6. 5 ways electronic health records are boosting patient outcomes. Available at: https://pharmaphorum.com/views-analysis-digital/5-ways-electronic-health-records-are-boosting-patient-outcomes/. [Accessed March 2020].
  7. SE healthcare. The benefits and challenges of electronic health records. Available at: https://www.sehealthcarequalityconsulting.com/2018/09/18/the-benefits-and-challenges-of-electronic-health-records/. [Accessed March 2020].
  8. Scherrer et al. Diabetes care 2011; 34: 1729­–1734.
  9. Dexter et al. The New England Journal of Medicine 2001; 345 (13): 965–970.
  10. New federal rules allow patients to access medical records via smartphone. Available at: https://fortune.com/2020/03/09/medical-records-smartphones-ehrs-2020/. [Accessed March 2020].
  11. Electronic health records: Can the pain shift to value for physicians? Available at: https://www2.deloitte.com/us/en/insights/industry/health-care/ehr-physicians-and-electronic-health-records-survey.html. [Accessed March 2020].
  12. Breached Patient Records Tripled in 2019 as Malicious Actors Create New Problems for Patients. Available at: https://www.prnewswire.com/news-releases/breached-patient-records-tripled-in-2019-as-malicious-actors-create-new-problems-for-patients-301003328.html. [Accessed March 2020].
  13. Proposed budget of the U.S. government for cyber security in FY 2017 to 2021. Available at: https://www.statista.com/statistics/675399/us-government-spending-cyber-security/ [Accessed May 2020]
  14. Stanford Medicine. White paper: the future of electronic health records. Available at: http://med.stanford.edu/content/dam/sm/ehr/documents/EHR-White-Paper.pdf. [Accessed March 2020].
  15. EHR in Practice. Can a modern practice survive without an EHR? Available at: https://www.ehrinpractice.com/modern-practice-ehr.html. [Accessed March 2020]
  16. PSO Navigator. Wrong-Record, Wrong-Data Errors with Health IT Systems. Available at: https://www.ecri.org/Resources/In_the_News/PSONavigator_Data_Errors_in_Health_IT_Systems.pdf. [Accessed March 2020].

September 2020 RESP-42221

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