A QUALITATIVE RESEARCH ON THE IMPACT OF THE ELECTRONIC HEALTH RECORDS INTEGRATED SYSTEMS ON PATIENT OUTCOMES

 

ABSTRACT

The passing of the HITECH ACT has led to the focus on the electronic health record systems, also called EHRs. Documentation of health records through digital means is not something new. However, there is scanty information about this innovation. Additionally, the impact of an integrated health care system is expected to promote improved patient outcomes. However, this has not been proved in some settings. The push for nationwide adoption of electronic health records depended on the premise that it will lead to improved patient outcomes in the health centers. This investigation aims to explore the impact of an EHR tool on the outcomes of patients. Therefore, the study follows a qualitative and retrospective approach using the most recent secondary data.

Chapter I

1.0 INTRODUCTION

1.1 Statement of the Problem

There is a high demand for the assessment of the influence of the electronic health records integrated system on the outcomes of patients. However, slight knowledge is available about the influence of the EHR on the patient outcomes because the issue seems very complicated. Therefore, the current study aims at investigating the impact that the Electronic health records integrated systems have on the perception of patients. It will take the dimension of a qualitative approach to identify the critical implications of the electronic health records integrated systems on patient outcomes.

1.2 Background to the problem

 

There has been a sound upsurge in demand for services in the health care sector, which has been faced by many challenges. Over the past years, the health care providers have not managed to meet the demands of the patients in the hospitals fully. Some of the problems affecting the healthcare systems include lack of enough funds, complex health situations, very high expectations by the public and complicated directives from the government to satisfy the needs of the society such as quality and accessible healthcare. Due to the complicated environment in the health care settings, many of the leaders in these settings are trying to find out many solutions to that will help to address the above issue. The idea of adoption of innovations in the provision of healthcare services has seen numerous steps in evolution from a simple level of novelty to enhance effectiveness in the health care organizations. The health care centers e to be the primary consumers of the numerous innovations. However, they are more concerned with the generation of change that they can be regarded as the adopters of the same technological advancement. Adopting current trends in the clinical setting can be perceived to be a multifaceted issue, and hence it is considered to be a process.

The application of advanced and computerized technology to retrieve and obtain information about has been documented since the year 1960. During the year 1978, there was a proposal that automated documentation process in the healthcare sector, and this would see the provision of medical orders and interventions in the healthcare sector. The use of computers to provide for documentation is not something new, but the adoption of this technology by the healthcare professionals is not known precisely.  Additionally, the impact of this invention on the environment for healthcare is not known just. There has been a tremendous and rapid increment in the usage of HIT in health record keeping. The medical institute aims to introduce a healthcare system that best suits the 21^st century, to offer safe, patient-centered and effective health care services. The anticipated benefits of adopting this system include the provision of real-time information delivery about patients’ progress. The new system is also expected to limit the redundant flow of work among the providers of medical care. There has been a rising trend in the use of this technology even in family health care settings. Rittenhouse et al. (2017) report this trend had been adopted by almost 25 percent of the dental practitioners based at the family level in the US.

In the process of adopting the electronic records integrated system, there is a need to make sure that the strategy that is cost effective is developed, and which entails the particular applications in the health care setting. Similarly, Rittenhouse (2017) noted that the high cost of the equipment had impacted EHR adoption since most of the practitioners find it costly to purchase.

However, currently, the use of the use of the electronic health records among the dentists is on the rise, as reported by Rittenhouse (2017). It is due to the significant investment in this program by the government since its adoption. Previously, the nation utilized about 5 billion dollars in implementing information technology projects as of the year 2009.  The allocation is going to increase by the year 2019. The ARRA recognizes the impact of this allocation at the state level.  The contemporary problem among the administrators of health care systems entails little consensus regarding the adoption of the electronic document which ensures that the general targets are secured, and eventually, the achievement of effective health.

The use of computers in health care environments has impacted the real and anticipated techniques for the offering of care for patients. Historically, the main aim of healthcare services provision has been founded on the responsibility for patients, while the secondary objective is to just adoption and proper use of current technology to to facilitate appropriate patient outcomes. The electronic systems have led to criticism of the practice of healthcare thereby prompting the health care providers and nurses to provide documents that are detailed, about the quality medical aid offered.

There have been cases of ideas by some individuals to produce competing products to this as reported in a study by Payne (2016). The people who are posing the critics claim that the devices have a poor user interface and hence, they will not impact the patients’ outcomes. Healthcare workers such as nurses are expected to document the variations in the condition of the patients and also the reaction or response of such patients towards the interventions for their health. Compared with the historical method, there is a significant difference. In the former, there was a summary of the patient records, in documents that were written by hand. The handwritten documents contained the health record of the patients. In the modern practice of nursing, the effect of information technology explosion on the registered nurses. In addition to that, it is important to consider developing innovative strategies through this form of technology so that is those new settings enhance the delivery of medical attention. Most medical care developments are initiated to promote the leader of an organization to have relevant knowledge about the environment for the practice of nursing. A technique that is clearly defined and quantified determines the healthcare providers’ workflow.

The computerized health records have been used in the US in many forms since the year 1960 (Shickel, Tighe, Bihorac & Rashidi, 2018). However, the notion by the public concerning the storage of patients’ records is only penetrating the public domain for a few years now. Therefore, the public recently developed consciousness about this issue of the electronic health care records integrated system.  The other industries adopted the computerized systems very long time ago, but the medical sector has been lagging in the adoption of this technology in the monitoring of patients’ progress. Therefore, most of the records of the patient have are on paper. The Institute of medicine has made many efforts in the enhancement of the adoption of the technology among the medical facilities. The main reason for the institute to urge the medical fraternity to acquire the electronic health records systems is that they had regarded that this form of technology will make the process of healthcare services delivery safer and easily accessible by the patients, thereby improving the outcome of the patients.

Additionally, efficiency is another benefit that will arise out the electronic systems in the medical community. An Agency of the State Director for Health Information Technology, in the section of Healthcare and Human Services to monitor the execution of the activities of electronic health records nationally, was established in the year 2004. The coordinator formulated the strategic plan very fast so that there would be consumer-oriented and data-oriented medical aid services delivery. The ensuing expectations founded the research:

• Enough study exhibit and proof postulating that care services relying on information technology helps to save the lives of the patients, and also it keeps on money spent on treating the patients.
• The merits of health care provider based on information technology exceed the costs of the same technique by a very significant margin, therefore the need for the state to go ahead and implement it by providing the resources needed.
• The demand for an information technology that is overwhelming, and therefore comes up with a web-based network for information exchange, that also ensures maintaining of the privacy of the information.

In the year 2005, there was the formation of a private, public partnership in the health sector. It led to the creation of the workgroup for electronic health record systems. From the recommendations of those workgroups, the award by the health and human services department ensued. The awards included the harmonization of the health standards, compliance with HIT certification, and the development of a prototype architecture.

The HIT gave pertinent evidence concerning the functioning descriptions so that the electronic health records would be deployed and developed through the webs. At its inauguration, the Obama government turned this reform in the health care delivery into a policy, which was aiming at affordable health care services among the people of America. In addition to that, the program would cover a wide area, and hence it was associated with universal coverage, to improve the efficacy and proficiency of the health sector. Moreover, the aim for this work plan was to reduce wastage, and that was to be realized through the use of EHRs that would enhance the exchange of information among healthcare providers.

The head of the United States of America signed the American recovery act into law. It made the implementation of EHR kits to be ongoing up to current times, and indeed, it is bringing a lot of change to the healthcare department. It was also called the economic stimulus act. In this act, there was HIT for the economic and clinical health, HITECH ACT. Therefore, this enhanced the formation of the federal committees, HIT policy committee, and the information technology standards committee, that was to complement the national group on important statistics which was still in existence. There was an allocation of 25 billion dollars that would facilitate investment in the health information technology, and also provision of the incentive funding to enhance the adoption of the technology by all the healthcare providers throughout the nation. Through the wide spreading of the electronic health record systems, it is essential to evaluate the impact of this on the management of health by the national authorities.

In the new regime in the United States of America, President Donald Trump is also reinforcing the implementation plans for health information technology. It was found in a study by Wan (2018). Under his administration, trump supports public health management, which focuses on the people who are at huge chance of attack by chronic conditions. Therefore, the American act on healthcare will derive meaning even in the years to come, since it aims at further improvements in the health information technology.

Currently, the new initiatives to offer precision medicine rely on electronic health records. For instance, in oncology, the long-term impression of the precision medicine is entailed. This will help to improve patient outcomes.

1.3 Hypotheses

 

The electronic health records integrated systems have many impacts on the patient outcomes.

The patient outcomes that have been impacted through the embracing of these systems in healthcare centers comprise the following:

• Patient perception and satisfaction
• Compliance
• Hospital readmissions
• Patient safety

Additionally, implementation of the EMR has improved the quality of healthcare provided in the United States of America.

Another hypothesis is that there are many hospitals in the United States of America that have implemented the electronic health records.

 

This paper will focus on those systems in the view of managing the healthcare system in the United States of America, since the time they were adopted for the first time to date. Perpetually, greater and specific emphasis will be laid on the patients. The objective is, therefore, to focus on the effectiveness of the program. In order to determine the effectiveness of the program, there will be a need to have an insight into what is working and what is not working in the healthcare settings about the management of the patients’ conditions. In addition to that, the healthcare system of the United States of America has been tremendously complicated, and therefore, there is no any form of doubt that that complicated system will be managed by new technology in the 21^st century. For instance, the electronic health record system will handle that. It is especially significant because it is evident that in the view of changing the lives of people for the better, the citizenry has been observed to be more mobile and digitally interconnected. A review of literature about this issue of Electronic Health Record system follows after this section, and a strive to make a summary of all the propositions and arguments that favor the adoption of this form of modern technology will follow. It would be based on the numerous benefits that accrue to the health system in the long run about the delivery of the healthcare services.

The government efforts to promote the adoption of this technology will also be discussed, and even the lack of the empirical data to supplement the approval of the technology in the medical facilities will be illustrated. The results of the study that pertains to the influence of the digital systems on the clinical outcomes will be navigated. Some of the issues that will be reflected on in this paper are patient perception, satisfaction, patient monitoring, and patient perception and also compliance will be highlighted qualitatively in this research. Moreover, patient safety ensues in the section that follows after literature review.

The conclusion and recommendations and suggestions for further research on this problem are imperative too.

 

Chapter II

2.0 LITERATURE REVIEW

2.1 Background

 

Electronic health records are also called electronic patient records, or computerized patient records. Additionally, when talking of electronic medical records, still it means the same thing. In this study, they will be called Electronic health records. It is a digitalized or computer-aided record for the history of a patient about their health or medical condition. This device is kept in the office of the doctor, or in any other health facility establishment that enables sharing of the information among the agencies that are involved in the provision of medical help to patients, and the agencies of the government, physicians, among others. The information is digital, and this means that the computer and storage generate it takes place in the same electronic device.

2.2 The Argument for Electronic Health Records

 

For quite some time gone, the Institute of medicine has urged the medical community in the United States of America to implement the electronic health or medical records, giving the argument that this would lead to the improvement in the quality of the healthcare in the nation. Therefore, the medical institute also issued a report that was entitled, “Crossing the quality chasm,” whereby there were details of the reasons why there were gaps in the state of healthcare at that time — afterward, the report directed on ways to expand the IT infrastructure for healthcare services delivery that was embracing high quality. From the report, the healthcare delivery system of the United States of America has no consistent and optimum quality for medical care for all its citizens. The Americans ought to count on obtaining healthcare that is capable of meeting their medical needs, and it should rely on scientific knowledge. However, there is valid evidence that this is no longer the case scenario in this nation.

The quality of health care is a critical concern since health care usually harms the patients most often and it sometimes fails, to offer the anticipated benefits. Between the already known healthcare and what could be the case, there is a considerable gap. The report further identified the factors that had led to the deterioration of the quality of healthcare, for instance, the emerging complexity of the medical care, that has characterized by what is to be known, what needs effective management, and what to watch. Additionally, the complexity in the healthcare settings is due to the growing number of attendees, who report daily to seek medical attention as compared to the previous sessions, which were characterized by few people who reported in the medical centers.

The authors of the report gave an argument that those challenges have rendered the state of health services delivery insecure. The other problems include the increment of the span of life of Americans, which is followed by the incidence of severe and chronic conditions like the heart diseases, diabetes, the complexity of the prevailing system, and asthma. It has made the healthcare organizations operate like siloes which do not rely on any information about the condition of the patients, history of medical attention, the types of services that have been offered by other health institutions in different localities, and also the medications that have been administered by other clinical attendants.

Since this is so cumbersome to monitor, the healthcare of the nation has failed to translate the knowledge into practice and also it has not succeeded in applying the new technological intervention safely and appropriately.

Consequently, a plan of action emerged and it aimed at the promotion of security in the healthcare systems. Additionally, the healthcare was anticipated to be effective, and also centered on the best outcomes of the patients. Equitability is another issue that was worthy considering. The previous was not equitable and therefore, adopting a fair system will promote the overall efficiency of service delivery in the healthcare sector.

The use of information technology got developed on the basis that the internet has a significant ability to transform the nation’s healthcare delivery system. Most importantly in a good extentss of information technology application is the automation of patient-specific clinical data. Such data is typically scattered in a collection of paper records which are frequently poorly organized, illegible and hard to retrieve. This makes it nearly impossible to deal with a range of sicknesses especially the permanent ones that need regular supervision. The desires of many patients will also be met in a short period at a cheaper cost if they talk to health experts using e-mail. Also, the use of automated systems for ordering medical assistance would reduce the mistakes in the prescription and dosing of drugs. Also, computerized reminders would assist the patients and doctors to recognize the required services.

Other researchers had made similar findings about this issue. For instance, Lehmann,  Gundlapalli, Williamson, et al. (2018) reported that the actions of the president Bush an Obama in their efforts to enhance improved health care system in the United States of America were a reality and therefore it would be achieved soon.

 

2.3 The Promise of Electronic Health Records

The significance of electronic health record system includes care continuum, the reduction of the costs associated with the provision of the medical help to the citizens, efficient management of the medications, a long-lived perspective and portability aspect realization, effective control of the emergency episodes and finally, it helps to empower the patients. On the contrary, almost all people are aware that promising a good outcome is one thing and fulfilling that promise is an entirely different thing. It is indeed the crux for this study, to establish whether the electronic health records are living up to the anticipated achievements or it is a just a fake promise to the patients in the United States of America. Primarily, this will be evaluated regarding the quality of the healthcare that is offered in the United States of America health care centers now that they have adopted this new tool to monitor the progress of patients.

2.4 Government incentives on the adoption of the Electronic Health Record

 

From the saying that change is a difficult task, it can also be implied in this scenario about the adoption of electronic healthcare records. It is unfortunate that the records for the health of the patients via electronic means are not excluded in the prior statement concerning change. The main reasons for this include the expenses that are associated with the adoption of this technology. Additionally, adoption of this technology faced the problem of the reluctance of the providers of this service to promote the transition from the old techniques of patient management to the new technology.

Moreover, there was a lack of enough training on the doctors, especially, on the use of the electronic health record kits. Even some of the nurses and other medical staff members are not conversant with the use of this technology. Hence there is a need for the intervention by the government to promote the effective utilization of that resource. There is also a considerable concern for the privacy of the information that is kept in the devices. The refusal by some of the people to work with this perceived trend of change in the organization poses a threat to the adoption of the electronic healthcare records integrated system. They do not visualize the benefits that the approval of the electronic health care records integrated systems will have for the patients in the medical care centers.

In recognition of the above needs, the federal government has put in place the incentive of Medicare and Medicaid incentive program so that the payments to the eligible people in this field are enhanced. It will encourage them to adapt to the new technology that is pertinent to improved patient outcomes. Therefore, the government is trying to implement, upgrade and also demonstrate the reasonable use of the certified electronic health record technology in hospitals and other healthcare centers.

ARRA also provided for the allocation of more than 20 billion for investment in the field of health information technology, and even the incentives offered to enhance the adoption of the technology by the providers of healthcare throughout the country. Through this motive, the professionals in this field seemed eligible to receive an amount up to 44,000 dollars, from incentive program already launched by the government. This was a donation from the Medicare incentive program. The Medicaid incentive program gave an incentive that amounts to 65,000 US dollars. The Medicare package has been in survival since the year 2011 and was to run up to date. The professionals in the healthcare field were given the opportunity to take part in the program for a period of up to 5 years. The maximum amount of the incentives by the relevant funding authorities for the adoption of the electronic health care records integrated systems would accrue to the professionals who made an initiative to join the program by the year 2012. Moreover, those professionals ought to portray a meaningful and reasonable use of the electronic health records systems in every year that they will participate in the program.

In case a professional who was eligible for the incentive of Medicare offers the services of healthcare in any one of the designated sections as the health professional shortage area, then the expert will receive an increment of 10 percent in every year on top of the rational allocation of the payments of the incentive program pertaining to electronic healthcare records systems. This will be an annual incentive, though. The incentive is also offered and administered by the states and those territories that chose to provide it. The payments by this important incentive program are expected to continue until the year 2021. The professionals who have the aim of being part of this program were given until the year 2016 to decide to join it. The maximum duration of their participation was extended up to 6 years. There were situations in which some professionals did not qualify for the tow incentives, the Medicare and Medicaid incentive programs, and they were prompted to choose one of the two or both of the incentives. However, the professionals who are eligible for Medicaid receive a payment variation with time, in case they also attend to patients who are entitled to the Medicare incentive in the United States of America.

In the course of reviewing the above literature, about the impact that the electronic health records integrated systems have on the patient outcomes and in general view, the first things that come into consideration is the abundance of anecdotal evidence and also the appalling dearth of empirical data. This has led to the remark that there has been limited evidence that show the effect of the electronic health care records on the patient outcomes.

In addition to that, the evidence, if available, has been inconsistent. The main reason for this scarcity in the proof is because no researcher has addressed the issue correctly. However, many comments have been made by other researchers, which have shown that there exist many facts that are interesting and which would shed light on the possible reasons for this circumstance. For example, Wan (2018) discovered that a digitalized physician order entry was not efficient because it led to an increase in the workload on the physician concerning the work time in each shift. Strangely enough, a similar study found out that the use of CPOEs helped to save the nurses about 25 percent of their overall time that they spend on documenting during their shifts. According to them, there were only three reasons that prompted this to occur. For instance, the nature of the terminal used, the characteristics for use training that was imparted on the users, and also technical specifications of the electronic health record integrated system used in such cases. The nurses used both the central station’s terminals and the bedside terminals while the doctors made use of the central stations.

The technical characteristics in this systems entail the automation of the electronic health record kits. In another study, by Lopez (2018), he reports that the extent of implementation of the electronic health records systems might have been a huge load when it comes to the assessment of the purported impact of this technology in the healthcare settings and specifically, on the patient outcomes. The report further complements that some of the physicians make a minimal use of the electronic health records in the course of their practice hence, he then argues that the full application of the electronic health records systems may not vary the way that some doctors carry out diagnosis and then administer treatment to the patients at the end.

Additionally, it seems that the challenge of defining important quality may have also led to a factor that deters the evidence for the impact of electronic health record systems on the patient outcomes. Therefore, the American heart association concluded that it is essential to measure and then monitor the extent of health care. However, the quantification of the quality of health care is very complicated and involving task. It also becomes challenging in some scenarios, and therefore, it needs a severe concern to devise a way of doing that measuring the quality of health care.

The forum by the American heart association, therefore, defined the outcome of the patients as follows: it refers to the consequences of treatment that can portray the markers of the progression of the disease. For example, the markers of progression include mortality and readmission in the health centers. Additionally, the health status of the patient forms part of the patient outcomes, and above all, the quality of life that the patients lead is a quantity that describes the outcomes of patients in the healthcare centers. Lopez and Fahey (2018) identified a need for broader studies through the support of the National agency for health care research and quality. Moreover, the study emphasized on the need for extra training for the providers of health care to foster their effectiveness and accuracy in the exercise of documentation of the events that take place in the health care centers.

They finally arrived at the conclusion that the electronic health care records integrated systems provide new and potentials avenues for the measurement of the performance of the healthcare services provided. However, the quality measurement derived from the electronic health care record systems has posed many limitations because of many factors, and most notably, the diversities and variations in the content of the electronic health care records integrated systems, their structure, and also the format of the data that is used in these systems. The local data and the procedures for extraction of the data should be considered since it has some limitations.

 

Chapter III

3.0 METHODOLOGY

A qualitative approach that is explorative is designed to evaluate the impact that the electronic health records have on the patient outcomes. However, some of the quantitative results are imminent, but these figures were not obtained through the primary methods of data collection. In addition to that, the first analytical techniques were not used to arrive at those figures. Therefore, a variety of secondary sources were used to obtain and determine the results that are presented. Several essential indicators were chosen, and a thorough review was performed to gauge and quantify the impact of the electronic health records integrated systems on the patient outcomes.

The key indicators include the following:

The promise of the electronic records, the government input/incentives for the adoption of the electronic health records integrated systems, the impact on the clinical outcomes, the impact on the perception and satisfaction by the patients, the implications for hospital readiness and preparedness, effect on the patient monitoring and compliance, and finally, the impact on the safety of the patients. The outcomes of the above review pertaining the relevant sources were applied to obtain the general impact of the electronic health record integrated system on the patient outcomes. A significant part of this study that was not addressed is the element of cybersecurity, and lack of that can be a contributor to the impact of the electronic health records integrated systems on the patients. However, this will be addressed in the part that deals with a recommendation for future research. Indeed, that is an important consideration that ought to be taken into serious account in the future for it impacts the patient outcomes as far as the use of electronic health records integrated systems is concerned.

Assessing the impact of the product that carries out a management role is to have a look at the effect of this element on the management process. Effects usually range from the flow of work and its efficiency, duration of the action, and the savings on the savings of the costs in the clinical outcomes. In this particular study project, the application of the electronic health records systems in the management of the health progress of patients was reviewed with the view of assessing the effect of the above technology on the clinical outcomes that pertain to the patients only. From the working group on cardiovascular disease and stroke, the term “outcomes” refers to the consequences of a form of treatment that is administered.  It may represent the essential markers of progression of the disease, such as the mortality, readmission of the patients into the hospitals, that is the frequency of re-entry, the health status. Additionally, it represents the cost of the management of the health conditions of the patients.

The health status of the patients entails the symptoms, the functioning of the body parts of the patients, the quality of the lives that the patients are expected to lead after the use of the electronic health records integrated systems technology, among others. The indicators of success, which include death, readmission of the patients, the endpoints for the psychological state of the patients, the health status of the patients, and the satisfaction of the patients are adopted in this study to reflect on answering the research question. Therefore, through this research, careful and critical attention was paid to avoid completely embracing the original use of the methods, terms, and analyses. However, at the time, it ensures that the specific results, charts, and conditions are adapted to provide that the particular context is fully satisfied. In addition to that, the framework of this study will also be sufficiently emphasized.

 

 

Chapter IV

4.0 RESULTS

 

Various resources were reviewed to provide information concerning the rate of HIT adoption among the hospitals in the United States of America. The following information was identified.

From the literature search in various journals indicate that the adoption rate of the EHRs is currently at 72.1 percent. It has been on the rising trend since its inception. Additionally, it was found that already, 83 percent of the health practitioners were currently planning the implementation of this technology, in its second stage. However, 9 percent were not having any plans over the same (Lim et al., 2018).

 

4.1 Adoption of clinical functionalities in the electronic format

There were significant variations in the implementation of important functionalities in many US health care centers. About 12 percent of the health care centers had adopted electronic records.

4.2 EHR Adoption

The research identified that about 59 percent of the healthcare centers had adopted a basic or comprehensive electronic health records system. This an improvement when compared with the value obtained in the other years as of 2014.

By the end of 2015, the adoption rate had increased, as shown below.

State	2008 Basic EHR adoption rate (%)	Number of hospitals surveyed	2011 Basic EHR adoption rate (%)	Number of hospitals surveyed	2017 Basic EHR adoption rate	Number of hospitals surveyed
Alabama	9	99	22	95	80	87
Alaska	0	21	nr	22	89	20
Arizona	14	60	17	62	78	60
Colorado	11	34.3	22	72	87	72
Kansas	0	122	19	123	73	125
Montana	64	54	15	54	83	53
Ohio	4	157	20	158	78	153

Adoption of the electronic records

The availability of the particular functionalities was considered in various research works, and the following information was obtained. Almost 1.5 percent of the hospitals in the United States of America had comprehensive electronic health records integrated systems.

 

Electronic functionality	Fully implemented in all units	Fully implemented in at least one unit	Began implementation or resources have been identified	No implementation with no specific plans
Clinical documentation
Medical lists	45	17	18	20
Healthcare assessment	36	21	18	24
Physician’s notes	12	15	29	44
Problem lists	27	17	23	34
Test and Imaging results
Diagnostic-test images	37	11	19	32
Diagnostic-test results	52	10	15	23
Laboratory reports	77	7	7	9
Radiologic images	69	10	10	10
Radiologic reports	78	7	7	8
Computerized provider order entry
Laboratory tests	20	12	25	42
Medications	17	11	27	45

source: Zuckerman, Sheingold, Ruhter & Epstein, 2016.

 

 

Chapter V

5.0 DISCUSSIONS

 

5.1 Overview of the impact of the electronic health records integrated systems on the patients’ outcomes

 

Despite the determination of the federal government to accelerate the countrywide adoption of the electronic health records integrated systems, less than half of the health care centers in the United States have transformed into this new technology in their clinical activities.

This is irrespective of the incentive funding and the massive expenditure that has been put in this sector.

By July 2012, forty-four percent of the health care centers in the United States of America had implemented the use of the electronic health records integrated systems in their scope of the patient management framework. Even though that was an increment to what was observed throughout the years, this a clear indication that goal of the government to achieve a countrywide adoption of the sophisticated technology is still a long way away from full implementation of the project as the states anticipate it. It is important to note that it was in the year 2009 that HITECH was signed into law. Therefore, there was a higher expectation on the outcome of the adoption of technology in the hospitals. Besides this, all the health care centers that were already using the technology were at the infant stages of the application of the electronic health records integrated systems. It further provides the lack of empirical evidence for the impact of the electronic health records integrated systems.

Therefore, an exhaustive and intensive solicitation for literature to have an insight into the evidence of the effect of electronic health care on the patient outcomes after the year 2009 is crucial. This was the year in which the HITECH Act changed into law, and this turns up mainly as an anecdotal proof that is more than the explanation of the benefits of the program. Thus, that little achievement was realized. There was a small talk about the benefits that accrued to patients at that time. Additionally, there is a limitation on the published findings of research concerning the impact of the electronic health records integrated systems, as far as management of the outcomes of the patients is concerned. Therefore, this brings out the essence for extra research on this issue.

5.1 Impact on Clinical Outcomes

 

The outcomes in clinical settings refer to the situation where there is a presence or absence of a disease, symptoms of the same illness or any other abnormal conditions that can be detected in a patient while the patient is in the clinical setting.

If the quality of health is to be promoted and improved in a significant margin, the clinical health managers should be able to aim at the improvement of the clinical patient outcomes, for example, prevention of the death threats of illnesses among patients, symptoms or signs of diseases must also be avoided.

From the published research, the electronic health records integrated systems are promoting the improvement of the outcomes of patients, and there is also a raised quality of the health care that is provided to manage various conditions of the patients’ health. Wan (2018) in panel research that entailed 12 counties discovered that the health care centers that were using the technology, electronic health records integrated system in their clinical settings experienced a decrease in the neonatal mortality rates. For example, the study identified a reduction of deaths by 16 deaths in every 100,000 births evident in the health care centers. From this research, they concluded that the decrease in the neonatal deaths, particularly, the deaths that arise from the health conditions of the patients, which demanded for careful and consistent monitoring and evaluation by the health care providers in those settings, was as a result of the intervention by the use of the electronic health records integrated systems.

On a similar note, the study by Ndifon et al. (2016) revealed that the risks-controlled death rates for the patients who had an acute myocardial infarction or those who experienced a congestive failure of the heart reduced notably by as high as 1 percent, for those health care environments that had fully seen the need for electronic health records integrated systems. Additionally, those hospitals had implemented the systems into their health records keeping a portfolio. Of importance about that outcome is the excellent use made of the electronic health records integrated systems kits, which had been adopted by the health centers.

The research revealed and pointed out that CPOE was the most critical and significant subsystem of Electronic Health Records that was responsible for the decrease of the risk-adjusted mortality rates resulting from cardiac arrests, even though the other subsets of this central system of keeping health records in an electronic technology were also significant. Their impact was also notable and hence, the electronic health records, in general, derives its importance about the impacting of the patient outcomes.

The same study revealed great extents of risk-adjusted mortality decline rates in the health care centers where the use of electronic medical records was implemented. This was a feature in those units that used the systems for health recording, and when compared with those that used the technology in few areas. The researcher, therefore, recommended, eventually, that the health care settings ought to adopt the electronic health records integrated systems across all their units of management of health services delivery to patients to optimize the quality of care that they offer to their customers.

An observation of a decline in the mortality rates was also observed in the research report by Rosen, Nakash & Alegría (2016), which was carried out on children, in which during a period of 18 months, they recorded a 20 percent reduction in the death rates. It now coincides with the application of the CPOE system that marketed as a subsystem of the Electronic Health Record integrated system.

5.3 The impact on patient perception and satisfaction

 

Satisfaction of patients is one of the critical indicators of the quality of health care that a patient has been subjected to. The perception of the service by a provider is just as a good as the extent of approval it receives from the patients who make use of it. Understanding of the health care is an ever-changing aspect, and the past or prior experiences may influence it, the opinion of the public, the level of education of the people involved, the goals and aims of an individual, and also the expectations of the individual people involved in that particular assessment scenario. Moreover, perception can also be determined by the fears that a person has towards a specific issue. The understanding of the patients has an influence capability on the satisfaction of the patients concerning the quality of medical care received.

On the other hand, the satisfaction of patients is crucial for those who provide health care services. Additionally, it is essential regarding the financial benefits and reputation that accrues to the provider of the health care service to the patients.

The most critical aspect of satisfaction in the medical care setting is patient satisfaction. This affects the extent of engagement of the patient and also the patient’s participation is influenced through this aspect, as far as the quality of health they are receiving is concerned. Patient satisfaction has been portrayed as a factor that affects their compliance, the treatment results and also the capacity to recall the prescriptions that they were given by the physicians (Zuckerman, Sheingold, Orav, Ruhter & Epstein, 2016). A health care system that is centered on patient outcomes is among the chief objectives of the current policy on the health of the nation. It involves a situation in which the patients get engaged, and they participate in an active manner towards the facilitation of the provision of health care services. Moreover, their participation is needed in the disease management plans by the health care providers. The empirical evidence contained in the literature promotes this viewpoint that the electronic health records integrated systems are favorable and this is a perception among most of the patients in the health care centers.

In a study that was designed to assess the effect of the electronic health records on the care among the diabetes patients, and also its outcomes, Payne, Corley, Cullen, Gandhi, Harrington, Kuperman & Tierney, (2015) identified that the patients who exposed to electronic health records integrated systems were 9 percent more likely to receive an optimum care bundle when compared to those who were not exposed to the technology at all.  The measures for optimal care included systolic pressure which was below 130 mm of mercury and a diastolic pressure below 80 mm of mercury. From Wise (2013), the satisfaction of the patients with the nurses and doctors’ services had an increment of 30 percent due to the implementation of the electronic health records integrated systems, and this was evident in the rise of the satisfaction rate from 30 percent to 80 percent in the respective cases.

In a similar impact research by the Sage Healthcare Segment, being part of the Sage North America, it was revealed that 81 % of the patients perceived the electronic health records integrated system as being favorable. 45% of this populace showed a high level of comfort and therefore, they were not about the clinician or physician using the electronic devices to provide documentation for their health statuses.  Seventy-eight percent of the patients had a belief that electronic health records had enhanced the betterment or improvement of their health conditions since they perceived that there was a high quality of health care provided. The patients were supportive of the opinion that an electronic health record integrated systems session was an appropriate encounter that is up to a point (Wolfe, Chisolm & Bohsali, 2018).

5.4 Impact on Hospital Readmissions

 

Among the factors which are deemed to be accountable for the cases of readmission include: inadequate conveyance of pertinent data to the patients, the providers of healthcare and also post-acute health care providers by those people who plan the same in the discharging hospital, failure to comply with the instructions concerning healthcare that are issued by the patients by the discharging healthcare providers, inadequate follow-up care by the long-term and post-acute caregivers (Zuckerman, Sheingold, Orav, Ruhter & Epstein, 2016). It indeed clear that there exists a tremendous and emergent concern and need for a tracking system for the patients, such as the electronic health records integrated the system, which will ensure that the effective discharge and after discharge support services are put in place.

The global institute for emerging healthcare practices takes into account that it can only be probable through the help of healthcare information technology (Ndifon, Edwards, & Halawi (2016). According to this researcher, there is a seamless transition that is evident to the next provider of healthcare services, which requires that the physician practice or center (for example rehab, hospitals, or any equipped healthcare facility be prepared to receive the patients and also that there will be availed a universal understanding of all the patients’ statuses, treatment plans, and their demands.

Standardization of the structure of information in the relay process is the best way of making sure that all the requisite knowledge is captured in that system — presumably, the mode of communication which will increasingly take place through the electronic devices that are implemented by the senders and recipients of the information conveyed. Therefore, it is essential for both the senders and recipients of such information to have more advanced features which include the health information conveyance. It is necessary to track the patients so that the planned schedules for support after discharge will take place in the appropriate time to address the gaps that were identified. It is through the help of that this is accomplished, and therefore, the loops will be closed.

Finally, the significant application of the HITECH will offer the fundamental basis of the much more complicated information of patients that will be available in the electronic health records integrated systems, and the foundational structure for such communication with the partners in the clinical setting by the exchange of the health information among them.

The healthcare centers that have the integrated electronic health records systems that bypass the clinic practice settings have a good start in providing HIT data that is needed to offer a continuity of the exchange of information that takes during the transition period right from the discharge point.

5.5 Impact on Patient Monitoring and Compliance

 

As clearly and simply stated, compliance refers to the extent to which patients perfectly follow the medical instruction. In addition to that, it involves adherence to the treatment of the doctor. It, therefore, entails the medication, the devices for medical administration, the prophylactic measures, the sessions for therapy, the physical exercise, among others. The patient and the providers of the health care are significant elements when it comes to ensuring compliance that can be deemed sufficient. Conversely, noncompliance can be a considerable hindrance in the process of attaining the anticipated quality of medical care among the hospital visits.

The achievement of prolonged curative outcome objectives requires a partnership with the patients. This is according to O’brien, Weaver Hook & Ivory, (2015). It is because of numerous reasons, some of which are intentional and other reasons are unintentional, that is about the issue of failing to comply with the treatment plans of the doctors. Intentional noncompliance takes place when the patients consider all the risks that are associated with the treatment, against the adverse effects of the treatment that are involved. Additionally, he or she weighs the benefits against the adverse outcomes and then makes a decision that leads him or her in discontinuing the course of medication or treatment. The other type of noncompliance, called unintentional noncompliance, is a result of the carelessness of the patients or forgetfulness of the patient to do what he or she is required to do. Regardless of the reason whatsoever, it is clear that there is a need for a compelling way to decrease the existing states of non-compliance so that the quality of care will be improved.

Wolfe, Chisolm & Bohsali (2018) stated that with the implementation of electronic health records integrated systems at a medical center at a local hospital, the center found out that there were numerous positive outcomes. To start with, there was an improved quality of care that was also consistent. Additionally, there was better communication among those people who were giving medical care. Another positive outcome was that the patients had easy access to the prescriptions that were given by the physicians.  Secondly, the hospital realized an increment of more than 90 percent for the vaccinations among the inpatients. Thirdly, the real-time surveillance reporting realized positive and instant positive impacts upon compliance.

Lastly, 96 percent of the summaries for discharge were availed in 30 days after the discharge of the patients. Guite et al. (2013), identified that the adoption of the current technology in health records management, the electronic health records integrated system, made the work of the nurses simpler and it led to the increase in the number of appropriate referrals to other departments, for instance, the ancillary department.

From that study, the use of an electronic health records integrated system means that there is sufficient information, more than 25 percent, which could be migrated from a prior encounter, and this discourages the duplication of the patient documentation. In addition to this finding, the admission data had its application in the monitoring and offering support for the measures that pertain to the quality of health care provided at the health facilities.  O’brien et al. (2015) provided a report that compliance with the vaccination schedule issued by the physicians at a university hospital, Robert Wood University Hospital, attained a significant improvement concerning the extent of care because of the implementation of the integrated schemes within its scope of administering healthcare to the patients. The electronic health records system was also supplemented by clinical decision support, which an advanced element that was aimed at promoting efficient information exchange within the health care center.

Consequently, the health center experienced a mean of 36 percent increase in the cases of compliance which were approaching 98 percent. Through the electronic health records CDS system being availed, the health care center was able to document almost 100 percent of all the medications that were achieved, and also a 96 percent compliance level was attained, concerning the home medications that were given in each discharge case. Eventually, the errors about the prevention of the patients’ conditions were evaded.

5.6 Impact on Patient Safety

 

Patient safety is an area of medical care in which there appears to be proof that is conflicting concerning the impact of EHR on patient outcomes. Therefore, there is no doubt that electronic health records will need extensive and consistent developments for them to function better and more effectively than the usual scenario without any technological advancement in place. The main thing to consider here is the training that the medical personnel is equipped with, concerning the efficient and effective use of the electronic health records systems.

When there is no training for the health care personnel, it implies that this medical team will not be competent. It, therefore, leads to many errors in the course of execution of their duties in the health centers. While the systems are expected to enhance improvement of the safety of the patients (Ndifon et al. 2016), from that report, 65 percent minimal errors and thus a 60 percent decline in the near-miss case of medication occurrences were witnessed among the hospitals that adopted the electronic health records system in their patient record management system. In other research works, there is a report of other severe challenges with the use of the electronic systems. For instance, Payne (2016) reported that the health information technology activities which are concerned with the harm that patients may be subjected to while in the healthcare centers. The report was submitted to the United States Food and Drug Administration database. The researchers identified that CPOE and the picture storage and communication systems were part of the causes of the 90 percent of the events that were reported.

Of the events with negative impacts, forty-one percent of them were linked with medical attention, thirty-three percent is associated with the processes within the clinical care settings, 15 percent were associated with the effects of radiation, and lastly, eleven percent were connected with surgical operations on patients.

There was the recommendation by the authors of that report that the strategies which will help to improve the safety of information on the health information technology need to be focused on the design of safer user interfaces, checks that are integrated into the key indicators and also the support for decision making. There is a demand for engineering the safer processes in the clinical settings. According to Shickel, Tighe, Bihorac & Rashidi (2018), most of the reports about the electronic health records integrated systems had many errors regarding entering human data, for example, the entering of wrong data, and even the inability of the devices to enter data. On the other hand, there were very few reports which portrayed technical faults on the part of the electronic health records integrated system.

 

Chapter VI

6.0 SUMMARY AND CONCLUSION

 

Application and use of electronic health records integrated systems in the United States has soared within few years gone, with many healthcare centers and physicians who are based in offices take an initiative to implement at least a basic form of this health information technology. However, the country is so far at a very long way from coming into full realization of its prior goal stated that every healthcare setting should have an electronic health record integrated the system. There exists a dearth of published data that is also empirical about the impact of electronic health records systems after the year for the current years, for instance, up to 2018. This is because the program was at its early phase of implementation.  However, from the little information that is known, it is clear that the electronic health records integrated systems have a positive impact on the patient outcomes.

6.1 Future Research

 

A significant aspect of this paper that was not considered is the issue of cybersecurity. There exists a model for cybersecurity whereby various continuous functions can help to standardize cybersecurity — for instance, identification, protection, response, and recovery. I recommend future research to entail a thorough study of this phenomenon because it may contribute to the improvement of the patient outcomes.

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